At the end of the year, Congress passed and President Biden signed into law the Consolidated Appropriations Act, 2023, a $1.7 trillion spending bill that includes billions of dollars and several policy provisions to address mental health and addiction. It includes provisions to expand access to medications for addiction treatment, support education and training to bolster the behavioral health care workforce, strengthen parity enforcement and expand crisis response services. The bill also includes provisions to promote quality recovery housing, support maternal mental health and addiction care, ensure access to mental health and addiction services during public health emergencies, increase access to non-opioid treatments for pain management, support youth mental health and reauthorize key programs and grants that support prevention, treatment and recovery services.
For more complete summaries of this law, including the policy and appropriations provisions, see Summary of the Consolidated Appropriations Act, 2023 and Consolidated Appropriations Act, 2023 One-Pager.
See also, Partnership to End Addiction Statement in Support of the Consolidated Appropriations Act, 2023.
In 2021, there were 106,699 overdose deaths, a 14% increase from 2020. The rates of overdose deaths were highest among those aged 35-44 and lowest for those 65+ in 2020 and 2021. However, adults 65+ had the largest percentage increase. Rates increased for each race and Hispanic-origin group except non-Hispanic Asian people. Rates were highest for non-Hispanic American Indian/Alaska Native (AIAN) people and lowest for non-Hispanic Asian people, but Non-Hispanic Native Hawaiian or Other Pacific Islander and non-Hispanic AIAN people experienced the largest percentage increases. Rates involving synthetic opioids, cocaine and methamphetamine increased, while rates involving heroin declined. Life expectancy in 2021 decreased. Heart disease, cancer and COVID remained the leading causes of death, followed by unintentional injuries (including overdoses), which was the leading cause with the greatest increase other than COVID. Chronic liver disease and cirrhosis became the 9th leading cause. Life expectancy decreased largely because of increases in mortality due to COVID, unintentional injuries, chronic liver disease and cirrhosis, suicide and homicide.
Source: Drug Overdose Deaths in the United States, 2001–2021; Mortality in the United States, 2021 (Centers for Disease Control and Prevention)
The Department of Justice (DOJ) filed a civil complaint against AmerisourceBergen, alleging that the company violated federal law in connection with the distribution of controlled substances to pharmacies and other customers across the country, contributing to the opioid crisis. The complaint alleges that from 2014 through the present, AmerisourceBergen violated the Controlled Substances Act by failing to report at least hundreds of thousands of suspicious orders of controlled substances to the Drug Enforcement Administration as required by law. The alleged unlawful conduct includes filling and failing to report numerous orders from pharmacies that AmerisourceBergen knew were likely facilitating diversion of opioids. The complaint alleges that AmerisourceBergen not only ignored red flags of diversion, but also relied on internal systems to monitor and identify suspicious orders that were deeply inadequate in design and implementation. The complaint also alleges the company flagged only a tiny fraction of suspicious orders, and intentionally altered its systems to reduce the number of controlled substances reported as suspicious.
Source: Justice Department Files Nationwide Lawsuit Against AmerisourceBergen Corp. and Subsidiaries for Controlled Substances Act Violations (Department of Justice)
Attorney General Merrick Garland instructed federal prosecutors to end sentencing disparities in cases involving the distribution of crack and powder cocaine. Garland’s memo to U.S. attorneys directs prosecutors to charge “pertinent statutory quantities that apply to powder cocaine” when pursuing crack cases and to “advocate for a sentence consistent with powder cocaine rather than crack cocaine.” The move comes as the EQUAL Act, a bill to eliminate the disparity, stalled in the Senate amid objections from some Republicans. The memo cited Justice Department testimony to the Senate Judiciary Committee that the disparity is not supported by science. The Department continues to support passage of the EQUAL Act, as unlike a legislative change, the memo would not retroactively apply to previous convictions.
Source: U.S. attorney general moves to end sentencing disparities on crack, powder cocaine (The Washington Post)
The National Institutes of Health (NIH) established a research network that will test harm reduction strategies in different community settings to inform efforts to help save lives. The efforts represent the largest pool of funding from NIH to date to study harm reduction strategies. Funded through the Helping to End Addiction Long-term (HEAL) Initiative, the awards are expected to total approximately $36 million over five years. Studies will investigate a range of harm reduction approaches, such as distributing naloxone and fentanyl test strips, as well as examine the efficacy of moving harm reduction services and tools into communities via mobile vans, peer support specialists, internet- and smartphone-based tools and other types of outreach.
Source: NIH launches harm reduction research network to prevent overdose fatalities (National Institute on Drug Abuse)
Office of National Drug Control Policy Director Rahul Gupta hosted a listening session with public health and public safety leaders from several states and territories about trends they are seeing related to xylazine and efforts to address these trends. Xylazine is used in veterinary medicine as a non-opioid sedative and analgesic. Participants described increases of xylazine in the illicit drug supply, both on its own and as an adulterant to fentanyl. In some jurisdictions, xylazine has been reported in a large percentage of street opioid samples, and other locales are working to expand testing for xylazine to improve estimates of prevalence. Several officials noted that they are working to increase awareness about xylazine among people who use substances, substance use disorder treatment and harm reduction providers, law enforcement and the medical community. They also described efforts to rapidly track xylazine in the drug supply.
Source: Readout from Dr. Gupta’s Listening Session with Public Health and Safety Leaders on Xylazine and Efforts to Address Trends (Office of National Drug Control Policy)
A Centers for Disease Control and Prevention report found that from July-December 2019 to July-December 2021, median monthly overdose deaths among persons aged 10-19 years increased 109%, and deaths involving illicitly manufactured fentanyls (IMFs) in the age group increased 182%. Approximately 90% of the overdose deaths involved opioids, and 83.9% involved IMFs. Only 35% of decedents had documented opioid use history. Counterfeit pill evidence was present in 24.5% of overdose deaths, and 40.9% of decedents had evidence of mental health conditions or treatment. Two-thirds of decedents had a potential bystander present, but most provided no overdose response. Naloxone administration was documented in 30% of deaths. To prevent overdose deaths among adolescents, urgent efforts are needed to prevent substance use initiation, reduce the availability of illicit substances, strengthen resilience and connectedness of adolescents, increase education regarding IMFs and counterfeit pills, expand naloxone training and access and ensure access to treatment.
Source: Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021 (Centers for Disease Control and Prevention)
The Washington state attorney general filed a lawsuit against pharmacies Albertsons, Kroger and Rite Aid for their role in the opioid crisis. The lawsuit alleges the pharmacies collectively ignored federal regulations, put profits over safety and knowingly oversupplied prescription opioids in Washington. It asserts that the pharmacies’ conduct was an unfair business practice that violated the state Consumer Protection Act and the state’s public nuisance law. The attorney general also announced resolutions (not yet final) with five other companies that produced or sold opioids, bringing the state’s total recoveries to more than $1.1 billion for funding opioid abatement and treatment programs.
Source: AG Ferguson files lawsuits against three national pharmacy chains for their role in fueling the opioid crisis and announces five resolutions with drug companies totaling more than $400 million for Washington state (Washington State Office of the Attorney General)
New York Governor Kathy Hochul signed a legislative package to help prevent and treat substance use disorder. Bills prohibit copays from being added to opioid treatment programs to make care less prohibitively expensive; require the health department to publish reports on its website detailing sales of opioids sold in the state and the Opioid Stewardship Fund; require the Office of Addiction Services and Supports (OASAS) to develop training materials for screening for alcoholism and chemical dependency, requiring OASAS to use Screening, Brief Intervention and Referral to Treatment (SBIRT) to identify behavioral patterns with at-risk people who use substances and allowing SBIRT to be used beyond the emergency room; require doctors to consider and discuss non-opioid alternative treatments for patients experiencing pain before prescribing an opioid; and create a program that allows nightlife establishments to carry opioid antagonists and receive training.
Source: Governor Hochul Signs Legislative Package to Help New Yorkers Prevent and Treat Substance Use Disorder (Governor Kathy Hochul)
Ohio Governor Mike DeWine signed into law a criminal justice reform bill. The law will allow prosecutors or city law directors to expunge thousands of low-level marijuana possession offenses, as well as ensure that arrests or convictions for possessing marijuana paraphernalia will not appear on criminal records; allow inmates to shave more time off their sentences for participating in educational, job training or substance use disorder treatment programs; and expand the Good Samaritan law that provides immunity from arrest or prosecution for people who seek medical assistance for an overdose, as long as the person receiving that legal protection is referred to addiction treatment within 30 days. The law will also reduce the maximum punishment for people under 21 years old caught drinking beer or liquor from six months in jail and a $1,000 fine to 60 days and a $500 fine; decriminalize fentanyl test strips; and broaden Ohio’s impaired driving law to prohibit driving under the influence of “harmful intoxicants.”
Source: Sweeping criminal justice reforms to become law with Ohio Gov. Mike DeWine’s signature (Cleveland.com)
Testing drug samples in labs is delivering insight to researchers and people who use substances. People who use substances can learn what is in a substance before they use it, alert others to dangers or find out why a substance led to an overdose or other reaction. Labs are also examining samples of substances that caused fatal overdoses and relaying results to harm reduction groups. As the drug supply is increasingly contaminated by other substances, there are calls to invest in more sophisticated drug checking. While fentanyl test strips cost $1, drug checking machines cost tens or hundreds of thousands of dollars. Drug checking has typically been conducted by crime labs or the Drug Enforcement Administration, which hesitate to share results quickly or publicly to help people who use substances know about the supply. Some harm reduction groups have cheaper, toaster-size machines that conduct less comprehensive checks but are portable, allowing health workers in cities to test samples out of vans, with quick results.
Source: A High-Tech Strategy for Keeping Drug Users Safe: Analyzing Their Fentanyl (The New York Times)