Key reads

Administration plans to allow Medicaid to cover addiction and other care for people who are incarcerated

Office of National Drug Control Policy Director Rahul Gupta announced that states would be encouraged to submit proposals to use Medicaid funds to provide addiction treatment and other medical services for incarcerated people. The Centers for Medicare and Medicaid Services will release guidance this spring. California was the first state to be given approval to use Medicaid for some services for incarcerated people last month. Gupta also announced that all federal prisons will be offering medications for addiction treatment by summer. Medicaid has historically had a ban on using the funds to cover incarcerated people. People released from incarceration have high risk of death in the weeks following release, particularly due to overdose. Allowing Medicaid to fund treatment during incarceration could help keep people alive and reduce recidivism.

Source: US plans to allow Medicaid for drug treatment in prisons (Associated Press)

America needs to pursue a public health approach to addiction

A public health approach is needed to address the addiction crisis. The Biden administration has taken positive steps, but more is needed. Federal officials should make clear that people operating supervised consumption programs will not face prosecution; eliminate the federal sentencing disparity between crack and powder cocaine; and change the law so that family members or other people who use substances are not criminalized for calling 911 in response to an overdose. Parity laws should be expanded to Medicare, and training in addiction treatment should be made a requirement for medical schools receiving state/federal funding. Communities should create more housing options and pathways for people with addiction to achieve food security and access to medical care, including through policies that make it easier for people convicted of drug felonies to get social safety net program benefits, as well as the Medicaid Reentry Act. The Office of National Drug Control Policy should create a national network of treatment programs, bound to standards and guided by the same policies/procedures. Lawmakers should lift the ban on federal funding for syringes used in syringe exchange programs. The Centers for Disease Control and Prevention should study what is working and not as funding is deployed.

Source: America Has Lost the War on Drugs. Here’s What Needs to Happen Next. (The New York Times)

Federal news

EQUAL Act reintroduced in Congress

Reps. Armstrong (R-ND) and Jeffries (D-NY) and Sens. Booker (D-NJ) and Durbin (D-NJ) reintroduced the Eliminating a Quantifiably Unjust Application of the Law (EQUAL) Act, which would eliminate the federal crack and powder cocaine sentencing disparity and apply it retroactively to those already convicted or sentenced. The bill passed the House last session.

Source: Armstrong, Jeffries, Booker, Durbin Announce Re-Introduction of Bipartisan Legislation to Eliminate Federal Crack and Powder Cocaine Sentencing Disparity (Kelly Armstrong)

FDA releases independent report on opioid-related activities

The Food and Drug Administration (FDA) shared a report from an independent external opioid-related activities review. It provides lessons learned and recognizes the work already being done by the FDA. The report makes three recommendations. The first is to continue efforts to comprehensively implement the recommendations in the 2017 National Academies of Sciences, Engineering and Medicine report, including evaluating scientifically sound, inclusive study designs to inform a systems approach for regulatory decision-making that incorporates public health considerations. The second recommendation is to consider seeking from Congress certain additional authorities regarding opioid analgesic approvals and review of the advertising and promotion for such products, as well as additional resources to implement such authorities to strengthen oversight of prescription opioid analgesics. The third is to be transparent regarding decision-making for opioid analgesics, as increased transparency can encourage appropriate uses of prescription opioid analgesics, promote innovation in pain management and prevention of opioid use disorder and enhance public trust.

Source: FDA Advances Additional Activities to Prevent Drug Overdoses and Reduce Death (Food and Drug Administration)

State and local news

OnPoint uniquely provides harm reduction services in New York City

OnPoint provides harm reduction services in New York City neighborhoods hit hard by the addiction crisis. Community outreach teams build trust with residents, collect used syringes and hand out supplies including clean needles and pipes, toothbrushes, food and wound care kits. OnPoint offers free laundry and showers, an acupuncture and massage center and the nation’s first publicly sanctioned supervised consumption room. Since its opening on November 30, 2021, OnPoint has met both praise and protest. The community outreach teams have to convince skeptics that programs like these can be a net positive for the community and persuade those with addiction to accept the lifeline. There are still policies that stand in the way of harm reduction and perpetuate barriers to services, and the country needs to move more fully toward a public health approach. While the data is imperfect, most experts and public health officials believe there is enough evidence to justify giving programs like OnPoint a chance, but culture and politics often stand in the way.

Source: One Year Inside a Radical New Approach to America’s Overdose Crisis (The New York Times)

NYC medical examiner's office responds to surge in deaths from overdoses

Daily deaths in New York City are higher than they were a few years ago and have not fallen as the pandemic wanes. The largest factor is the sustained jump in accidental overdoses, mostly from fentanyl. There were nearly 2,700 overdose deaths in New York City in 2021, the highest total in at least two decades, and 2022’s toll is expected to be even higher. On average, the city has a fatal overdose death every three hours. While overdoses used to account for around 60% of accidental deaths in the city, they now account for 80-85%. Fentanyl is mixed in to the city’s heroin and cocaine supplies and is involved in 80% of accidental overdoses. There have been rises in the powerful veterinary tranquilizer xylazine, designer benzos and illicit opioids known as nitazenes. The medical examiner’s office is hiring a team of social workers, funded in part by opioid settlement funds, to reach family members of each fatal overdose victim to offer condolences and connections to help.

Source: Inside the Medical Examiner’s Office, Where Opioids Fuel Surge in Deaths (The New York Times)

States across the political spectrum are moving toward legalization of psychedelics for medical use

Amid growing acceptance of psychedelics, advocates in blue states like Colorado and Oregon began their pushes with ballot measures proposing to decriminalize psychedelics like psilocybin. Advocates in red states like Utah and Missouri are starting in a different way, proposing studying them or first making them legal for medical use. Legislation to allow research on the therapeutic benefits of psilocybin is under consideration in states across the political spectrum this year, including in Arizona, Hawaii and Oklahoma. Legislation to legalize therapeutic use or create pilot programs is under consideration in states including California, Connecticut, New York, Utah and Washington. In most states, legalization efforts face opponents who argue potentially opening a door to widespread and debilitating substance use outweighs the benefits therapy could have for the few who can afford to pursue it.

Source: Red states join push to legalize magic mushrooms for therapy (Associated Press)

Other news in addiction policy

Concerns grow over the rise of soda companies' alcoholic drinks

For the last century, the alcohol industry mainly produced drinks categorized as beer, wine or spirits. In recent years, a fourth category of ready-to-drink beverages has emerged – hard seltzers and other flavored malt beverages, wine coolers and canned cocktails. Although the products differ in primary ingredients and how the alcohol is processed, all typically are flavored and packaged for casual consumption. As alcohol-related deaths in the U.S. reach record highs, regulators and public health experts are voicing concern that the new class of drinks and the expanding industry could alter how people buy and drink alcohol. Some expressed worry that the convenience of the new products could reverse the long-term decline in alcohol consumption by young people.

Source: Big Soda’s Alcohol Drinks Worry Health Experts (The New York Times)

Adults with co-occurring conditions have higher arrest rates

Adults reporting co-occurring mental illness and substance use disorder (SUD) in the past year were more likely to be arrested compared with both those with mental illness alone and those who did not experience any mental illness or SUD. Adults with co-occurring disorders made up 2% of the population but 15% of all people arrested between 2017 and 2019. Almost half of these individuals had a substance-related arrest, such as drug possession, as the most serious charge. More than 1 in 9 adults with co-occurring disorders were arrested annually, 12 times more often than adults with neither SUD nor a mental illness, and 6 times more likely than those with a mental illness alone. Women with co-occurring disorders were arrested 19 times more often than women with neither SUD nor mental illness and accounted for more than 1 in 5 of all women arrested. Black adults with co-occurring disorders were arrested 1.5 times more often than their White counterparts. People with co-occurring disorders were also unlikely to receive treatment for more than one disorder.

Source: More Than 1 in 9 Adults With Co-Occurring Mental Illness and Substance Use Disorders Are Arrested Annually (Pew)

Opioid prescriptions for pain declined, while those for OUD treatment and overdose increased in Medicaid

An analysis of Medicaid claims data from 2016 to 2019 found that opioid prescriptions declined during that period, driven by a 44% decline in the number of prescriptions for opioids to treat pain. Prescriptions for medications to treat opioid use disorder (OUD) or reverse opioid overdose doubled, driven by an increase in buprenorphine prescriptions. The share of enrollees receiving at least one opioid prescription for pain declined from 11.3% to 7.2%, which drove the overall decline in utilization of opioids to treat pain. The magnitude of declines varied by state, eligibility group and race/ethnicity. The share of enrollees receiving at least one medication used to treat OUD or reverse overdose doubled. Compared with Black and Hispanic enrollees, White enrollees were more likely to receive at least one treatment prescription and saw the largest increase in their share, suggesting racial disparities in access to medication to treat OUD or reverse overdose.

Source: A Look at Changes in Opioid Prescribing Patterns in Medicaid from 2016 to 2019 (Kaiser Family Foundation)

Analysis explores SUD among Medicaid enrollees

In 2019, 7.3% of Medicaid enrollees ages 12 to 64 had at least one clinically defined substance use disorder (SUD) in Medicaid claims data. Opioid use disorder was identified in 3.3% of Medicaid enrollees, alcohol use disorder in 2.5%, cannabis use disorder in 1.9%, stimulant use disorder in 1.7% and another type in 1.7%. People with SUD were more likely to be male, White, over 25 and qualify for Medicaid based on disability or Medicaid expansion. Rates vary by state, with Vermont having the highest share of any clinically identified SUD (13.3% of enrollees) and Arkansas having the lowest (3%). Rates vary not only because of prevalence, but also because of factors such as provider screening behavior and variation in coverage of SUD services. SUD rates are likely undercounts, as there may be low identification due to gaps between screening and referral, patient privacy concerns or few health care visits. There is broad variation in Medicaid policy and coverage of SUD services across states.

Source: A Look at Substance Use Disorders (SUD) Among Medicaid Enrollees (Kaiser Family Foundation)