Partnership to End Addiction’s Linda Richter and University of North Carolina’s Diana Fishbein explain the need to use opioid settlement funds for a comprehensive, proactive and sustained approach to substance use and addiction. The blueprints for doing this right are available, but many state and local governments are planning to allocate funds to law enforcement and other measures that attempt to address the end-stage consequences of addiction rather than to prevention efforts. Research shows that addressing adverse social determinants of health and promoting protective and supportive environments significantly reduce substance use and prevent escalation to addiction and other health and social problems, and investments in this approach are cost-effective. Undervaluing the importance of such efforts will prevent the addiction crisis from being solved. Policymakers on the local, state and federal levels must take seriously the recommendations that have been made for most productively allocating opioid settlement funds, including substantial allocations to prevention.
Source: Allocate opioid settlement dollars to real addiction-ending solutions (STAT)
See also, associated podcast: Listen: Will opioid settlement money actually go to opioid prevention? Here’s hoping (STAT)
As fentanyl gains attention, mistaken beliefs persist about it, how it is trafficked and why so many people are dying. Experts believe deaths surged because fentanyl is so powerful and because it is laced into so many other illicit substances, not because of changes in how many people are using substances. Advocates warn that some of the alarms being sounded by politicians and officials are wrong and potentially dangerous. These include the ideas that tightening border control would stop the flow of illicit substances, that fentanyl might turn up in kids’ Halloween candy and that merely touching fentanyl briefly can be fatal.
Source: As Fentanyl Drives Overdose Deaths, Mistaken Beliefs Persist (Associated Press)
The Government Accountability Office (GAO) released a report on the behavioral health workforce. GAO found that the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) estimate and develop projections of the number of various types of providers in the behavioral health workforce. SAMHSA estimated there were about 1.2 million behavioral health providers in 2020, and HRSA estimated shortages of psychiatrists in 2017 and has projected shortages of psychiatrists and addiction counselors for 2030. HRSA estimates that there will be a sufficient supply of other behavioral health occupations such as marriage and family therapists and school counselors by 2030. GAO identified three key categories of barriers to recruiting and retaining providers – financial, educational and workplace. Incentives such as loan repayment and scholarships help address these barriers. Agencies have taken actions to support recruiting and retaining providers, including administering workforce development programs to recruit and retain providers in underserved and mental health shortage areas.
Source: Behavioral Health: Available Workforce Information and Federal Actions to Help Recruit and Retain Providers (Government Accountability Office)
The Centers for Medicare and Medicaid Services (CMS) released the 2023 Physician Fee Schedule and Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rules. They allow behavioral health clinicians like licensed professional counselors and marriage and family therapists to offer services under general (rather than direct) supervision of the Medicare practitioner. Medicare will pay opioid treatment programs (OTPs) that use telecommunications to initiate buprenorphine. OTPs can bill for treatment services provided through mobile units. The rules include policies to pay for clinical psychologists and licensed clinical social workers to furnish integrated behavioral health care as part of a primary care team. Medicare will provide a new monthly payment for comprehensive treatment and management services for patients with chronic pain. To increase access for rural/underserved communities, Medicare will pay hospital outpatient departments to provide remote behavioral health services to people at home, making permanent a policy first implemented through emergency rulemaking in response to COVID-19. It will separately pay for five non-opioid pain management drugs when administered in ambulatory surgical centers to ensure that Medicare beneficiaries have access to non-opioid pain management medications.
Source: HHS Finalizes Physician Payment Rule Strengthening Access to Behavioral Health Services and Whole-Person Care; HHS Continues Biden-Harris Administration Progress in Promoting Health Equity in Rural Care Access Through Outpatient Hospital and Surgical Center Payment System Final Rule (Department of Health and Human Services)
See also: Strengthening Behavioral Health Care for People with Medicare (Centers for Medicare and Medicaid Services)
The Centers for Medicare and Medicaid Services approved an amendment of Arkansas’ Medicaid 1115 demonstration, Arkansas Health and Opportunity for Me (ARHOME). It will test interventions to address health-related social needs among targeted populations through coverage of intensive care coordination and other person-centered supports provided by Life360 HOMEs, which are designed to connect people to health services and community supports while engaging them in promoting their health. The state will work with local hospitals and community partners to advance Rural Life360 HOMEs to support individuals with serious mental illness and/or substance use disorder in rural areas; Maternal Life360 HOMEs to support individuals with high-risk pregnancies up to two years postpartum; and Success Life360 HOMEs to support young adults at high risk for long-term poverty and poor health outcomes due to prior incarceration, involvement with the foster care system or involvement with the juvenile justice system and young adult veterans at high risk of homelessness.
Source: HHS Approves Arkansas’ Medicaid Waiver to Provide Medically Necessary Housing and Nutrition Support Services (Department of Health and Human Services)
CVS and Walgreens announced agreements in principle to pay about $5 billion each to settle opioid lawsuits nationwide. Walmart is also in discussions for a deal ($3 billion). The deals, if completed, would end thousands of lawsuits in which governments claimed pharmacies filled prescriptions they should have flagged as inappropriate. The settlements would bring the total value of all settlements to more than $50 billion, with most of it required to be used by state and local governments to combat opioids. Before the settlements move ahead, state and local governments need to sign on. Under the tentative plans, CVS would pay $4.9 billion to local governments and about $130 million to Native American tribes over a decade. Walgreens would pay $4.8 billion to governments and $155 million to tribes over 15 years. If the settlements are completed, they would leave mostly smaller drug industry players as defendants in lawsuits.
Source: CVS, Walgreens announce opioid settlements totaling $10B (Associated Press)
Consulting firm McKinsey has agreed to settle claims by hundreds of local governments and school districts around the country that it fueled the opioid crisis through its work for Purdue and other drug companies. McKinsey previously agreed to pay more than $600 million to settle claims brought by all U.S. states and territories and had argued that those settlements should shield it from local governments’ and school districts’ lawsuits. It has not admitted wrongdoing. The firm still faces claims by health insurance plans, Native American tribes and families of children exposed to opioids in the womb. A judge denied McKinsey’s bid to dismiss the pending cases on the grounds that courts in the states where the New York-based company did not directly do business had no jurisdiction over it.
Source: McKinsey reaches deal with U.S. local governments over opioids (Reuters)
The New York Opioid Settlement Fund Advisory Board issued its annual report containing recommendations for allocations. The Board requests the state use three themes as the lens for consideration and implementation – service integration to best treat co-occurring disorders, service equity and meaningful evaluation that demonstrates reduced suffering and positive impacts on the social determinants of health. The Board identified 10 topic areas as top priorities for funding – harm reduction (22%), treatment (12%), investments across service continuum (16%), priority populations (15%), housing (10%), recovery (10%), prevention (7%), transport (5%), public awareness (2%) and research (1%). It also outlined specific initiatives for consideration.
Source: Opioid Settlement Fund Advisory Board Annual Report (New York Office of Addiction Services and Supports)
The debate over drug policy has shifted, with increasingly partisan attack ads focusing on fentanyl. Most Republicans are talking about opioids not as a public health problem, but as part of what they describe as a crime and border crisis. Until recently, response to the opioid crisis has been remarkably bipartisan, de-emphasizing drug war-era strategies and focusing more on treatment. In recent months, however, Republicans in close campaigns began hitting Democrats hard on the issue, linking fentanyl deaths with rising crime and fears about border security. Democrats are worried about looking soft on the issue, and some have embraced a Republican proposal to designate fentanyl as a weapon of mass destruction. Polls seem to have shifted toward Republican candidates after the GOP began focusing on drugs, crime and the border. Some state legislatures are moving back toward a drug war-era approach, toughening fentanyl laws with more focus on police, arrests and prison sentences.
While youth mental health challenges are urgent and require serious action, framing it as a “crisis” can backfire. The youth mental health crisis narrative paralyzes us by focusing our attention on the problem’s immensity without helping us see what we can do to solve it and advances damaging stereotypes of young people as troubled teens and adolescence as an inevitably dangerous time. It focuses almost solely on suicide rates and violent behavior issues, ignoring the way supporting positive youth development is essential to build mental health. The narrative may raise awareness of the issue, but research demonstrates that awareness is not enough and can backfire, and explanation is needed. The crisis story directs attention to dealing with problems already happening, and youth mental health needs to be proactively built rather than retroactively repaired. We need to move the narrative to one that provides an accurate and motivating sense of what is possible.