National Institute on Drug Abuse Director Nora Volkow explains the need to address co-occurring mental health and substance use disorders (MH/SUD), which are common but often overlooked. Substance use often begins as self-medication to cope with stress or manage symptoms of chronic mental health problems they may not even know they have. Fragmented and hard-to-access care lead MH/SUD to go untreated. Substance use to manage mental illness can lead to addiction and can worsen the original mental illness. Discrimination, isolation, childhood trauma, poverty and lack of access to education and health care can increase risk of developing MH/SUD. Stigma exacerbates these factors. Expanded screening and care for mental illnesses is needed to successfully address the addiction/overdose crisis. Investment in prevention is needed, including for interventions early in life that address the common risk and protective factors of mental health and SUD.
In August, the first full month of the mental health crisis line 988, there was a 45% increase in overall volume of calls, texts and chats to the Lifeline compared to August 2021. The number of calls answered increased by more than 50%, the number of tests increased by 1,000% and the number of chats increased 195%. The average response time for calls, chats and texts decreased from 2.5 minutes to 42 seconds, a significant improvement. The Biden administration invested historic amounts in 988 infrastructure, with much of the funding going toward new backup call centers and hiring more people to answer calls at existing centers. The data does not have a state-by-state breakdown, so it is not yet clear how 988 is faring in individual states. With the release of this data, the Department of Health and Human Services also announced a $35 million grant to support 988 services in tribal communities.
Federal Judge Reed O’Connor ruled that parts of the Affordable Care Act (ACA) mandating insurers cover many preventive services for free are unconstitutional. Under the ACA, health insurers are required to cover an array of preventive services at no cost, including any service/medication that gets an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF). Plaintiffs argued they should not be compelled to buy/offer coverage that includes “PrEP drugs, contraception, the HPV vaccine, and the screenings and behavioral counseling for [sexually transmitted disease] and drug use.” O’Connor agreed that services recommended by USPSTF are invalid because members “are unconstitutionally appointed” by the Department of Health and Human Services, rather than the president and Senate. O’Connor ruled that the requirement to cover PrEP violates religious freedom, agreeing that coverage would “facilitate and encourage homosexual behavior, intravenous substance use, and sexual activity outside of marriage between one man and one woman.” An appeal of the decision is likely.
The Centers for Medicare and Medicaid Services approved Oregon’s proposal to cover community-based mobile crisis intervention services in Medicaid. Made possible by the American Rescue Plan, the new first-in-the-nation Medicaid state plan amendment will allow Oregon to provide community-based stabilization services to individuals experiencing mental health and substance use crises by connecting them to a behavioral health specialist 24/7.
Source: HHS Approves Nation’s First Medicaid Mobile Crisis Intervention Services Program, To Be Launched in Oregon (Department of Health and Human Services)
Labor Secretary Marty Walsh met with leading mental health advocacy groups, health care professional associations and other stakeholders to discuss workers’ access to mental health services, treatment and supportive workplaces. The gathering allowed Walsh and officials from the Employee Benefits Security Administration to highlight the department’s work to enforce and interpret the Mental Health Parity and Addiction Equity Act and other departmental initiatives focused on mental health and substance use disorders. Topics discussed included suicide prevention in the workplace, exclusion of medical treatment for eating disorders, the economic toll of mental health conditions and barriers to job development training for mental health workers.
Senator Tammy Baldwin (D-WI) introduced the Naloxone Education and Access Act, which would provide grants to states and Tribal entities to promote education, dispensing and distribution of opioid overdose reversal drugs and devices. It would reauthorize a grant program and provide $10 million annually to implement strategies for pharmacists to dispense overdose reversal drugs or devices, encourage pharmacies to dispense opioid overdose reversal medication and encourage health care providers to co-prescribe overdose reversal drugs or devices. The bill would also support innovative community-based distribution programs; develop/provide training material that overdose reversal drug or device prescribers/dispensers may use to educate the public concerning when and how to safely administer it and steps to be taken after administration; and educate the public concerning the availability of overdose reversal drugs or devices.
Senators Jeanne Shaheen (D-NH) and Tammy Baldwin (D-WI) introduced the State Opioid Response Grant Authorization Act, which would improve the State Opioid Response grants by providing additional investments and flexibility for states and local communities. It would allow funds to address stimulant use and use disorders; allocate 5% of funding for Tribal communities; support states and Tribes with additional guidance on how funding can better be used to increase access to recovery support services; and increase the minimum grant award to $12 million and institute a “transition period” in the event that a state or Tribe’s allocation will be reduced by more than 10%. The measure would also provide technical assistance to states and Tribes to enhance grant applications, as well as outreach and direct support to rural and underserved communities and providers, and authorize $2.7 billion per year for fiscal years 2023-2027.
Senator Dick Durbin (D-IL) sent a letter to the Food and Drug Administration (FDA) and the Department of Health and Human Services (HHS) condemning the FDA for its failure to meet e-cigarette and synthetic nicotine deadlines, unwillingness to take action against companies that defy the agency’s orders and general lack of urgency when it comes to protecting children from the harms of tobacco and nicotine use. The court-ordered deadline for the FDA to finish reviewing e-cigarette applications was one year ago, but the FDA has only completed reviews of about half of e-cigarettes with submitted applications that represent a large share of the market. Durbin called on HHS to step in and take a more robust role in protecting children from vaping products.
In 19 states, fentanyl test strips are still classified as drug paraphernalia, making possession or distribution a crime. While some states have broadened access, others have maintained a hardline stance, arguing that drug-checking tools facilitate substance use. Research shows that people using substances often alter their behavior if they detect fentanyl using a test strip, often opting not to use the batch, use smaller doses, use in the company of others or acquire naloxone. The laws lead organizations to refrain from distributing test strips for fear of losing grant funding or putting community members in legal jeopardy. Even where they are legal, the cost can add up quickly for people using substances daily and for organizations. They also may not be useful for people who regularly use heroin, which nearly always contains fentanyl, as they just measure the presence of fentanyl, not the amount. However, there is still immense value for people who use substances more occasionally or who use substances other than heroin.
Just under 1 in 10 overdose deaths in D.C. involved heroin in the first 5 months of 2022, compared to more than half in 2017, signaling the near-total replacement of heroin by fentanyl. In D.C. and other cities, people who had been injecting heroin for decades, frequently older Black men, initially sought to avoid fentanyl. Many have now grown accustomed to fentanyl, however. Public health strategies should be tailored to opioid markets now occupied almost exclusively by fentanyl. Some previous approaches, such as fentanyl test kit distribution for people who use heroin, may no longer be as effective. Other approaches, such as syringe service programs, need to be redoubled, since fentanyl has shorter-lasting effects and usually spurs more frequent use. Even as some seek treatment, barriers persist, including insurance rules that do not consistently permit higher doses of buprenorphine needed to effectively treat people who use fentanyl.
Source: Heroin overdoses are vanishing from D.C. The reason? Fentanyl. (Washington Post)
Since January 1, 2021, eight states have introduced bills that would decriminalize personal possession of all or most controlled substances (Kansas, Maine, Maryland, Massachusetts, New York, Rhode Island, Vermont, Washington). Of those, two (Massachusetts, New York) have pending decriminalization bills in place, while bills in the other six failed without having reached a chamber vote. Decriminalization efforts have gained momentum since the passage of Oregon’s Measure 110 in 2020, but they have been largely unsuccessful. Oregon is the only state to enact a law that decriminalizes personal possession of all controlled substances.
Source: Stalled Momentum In State Efforts To Broadly Decriminalize Possession Of Most Or All Controlled Substances (Center for Public Health Law Research)