Key reads

DEA data shows overdoses soared even as prescription opioid shipments declined

Data from the Drug Enforcement Administration released as part of the opioid litigation shows that the number of prescription opioid pills shipped in the U.S. in the second half of the 2010s decreased even as the overdose crisis deepened. In 2019, 8.8 billion dosage units (e.g., pills, patches, lollipops) were shipped for 12 common opioids. That is just half as many doses as the peak in 2010, when nearly 16 billion doses were shipped. The strongest doses of pills are also no longer on the market. However, as prescription shipments decreased, illicit opioids increased, and the number of overdose deaths continued to rise. Many of the counties with the highest fentanyl death rates started out with alarmingly high doses of prescription pills per capita. Counties with the highest average doses of legal pain pills per person between 2006 and 2013 suffered the highest death rates in the nation over the subsequent six years. Every prescription opioid saw declines in the final five years of the data except for buprenorphine. Shipments of buprenorphine to pharmacies and practitioners rose significantly from 42 million doses in 2006 to 577 million in 2019.

Source: Prescription opioid shipments declined sharply even as fatal overdoses increased, new data shows (Associated Press); Overdoses soared even as prescription pain pills plunged (The Washington Post)

Fentanyl crisis increasingly politicized despite historically bipartisan nature of opioid crisis

The fentanyl crisis has become a political weapon, despite the opioid crisis once being a topic that brought Republicans and Democrats together. The discourse around fentanyl has become more politicized and less aligned with reality, especially when Republicans talk about its connection to the border. The White House issued a memo outlining the stakes of the government funding debate, noting “life and death priorities like fighting the fentanyl crisis.” House Republicans’ border oversight hearings have regularly invoked fentanyl smuggling alongside migration issues. Fentanyl repeatedly came up during the first GOP presidential debate, with at least one candidate calling for military involvement against Mexican cartels. The focus on reducing supply has meant highly charged conversations about the border, international relations and law enforcement. Republicans have conflated the flow of illicit fentanyl from Mexico across the U.S. border with the migration crisis, which is inaccurate. Although the majority of the U.S. fentanyl supply comes from Mexico, most enters through legal ports of entry.

Source: The politicization of the fentanyl crisis (Axios)

Federal news

988 adds American Sign Language services

The Department of Health and Human Services announced the addition to 988 of nationwide American Sign Language (ASL) services for people who are Deaf and Hard of Hearing. To connect directly to a trained 988 counselor in ASL, callers who are Deaf, DeafBlind, DeafDisabled, Hard of Hearing and Late-Deafened can click the “ASL Now” button on and follow the prompts. Direct dialing to 988 from a videophone will be available in the coming weeks. In the meantime, ASL callers can call 1-800-273-TALK (8255) from their videophone to reach ASL services.

Source: 988 Suicide & Crisis Lifeline Adds American Sign Language Services for Deaf and Hard of Hearing Callers (Department of Health and Human Services)

With naloxone available over the counter, HHS urges expanded availability

Last week, the nation’s top substance use officials called for greater availability and training for naloxone and received training to administer it during a public demonstration at the Department of Health and Human Services (HHS) headquarters. They received the training ahead of the September 30 expiration of several critical public health programs, including the SUPPORT Act. Naloxone became available without prescriptions last week as well. HHS headquarters has been outfitted with naloxone nasal sprays should they be needed, along with written and audio instructions, and HHS called on other workplaces to follow with a similar setup. Considering the price of naloxone, it may be more reasonable to expect that employers, rather than individuals, would be willing to pick up the cost. Capitol Hill is hosting a second naloxone training this week with lawmakers and staff.

Source: Biden admin wants employers to make opioid overdose reversal drug available (Axios); With naloxone now more available, HHS officials tout its use (Roll Call)

CMS approves Medicaid mobile crisis services in West Virginia

The Centers for Medicare and Medicaid Services approved West Virginia’s mobile crisis state plan amendment, the eighth mobile crisis state plan amendment to support community-based mobile crisis response services for individuals with Medicaid. Biden signed this new option into law through the American Rescue Plan to provide essential tools to rapidly provide critical services to people experiencing mental health/substance use crises by connecting them to a behavioral health specialist 24/7. This option helps states integrate these services into their Medicaid programs, a critical component in establishing a sustainable and public health-focused support network.

Source: CMS Roundup (Sep. 8, 2023) (Centers for Medicare and Medicaid Services)

State and local news

Kroger reaches $1.2 billion opioid settlement with states, localities and tribes

Kroger reached a potential $1.2 billion agreement in principle to settle a majority of claims made by states, local governments and Native American tribes that accused the company of helping fuel the opioid crisis. Kroger has agreed to pay up to $1.2 billion to states and local governments and $36 million to Native American tribes to fund opioid abatement efforts. Both amounts would be paid over the course of 11 years in equal installments, beginning in December. The company said all parties – 33 eligible states and D.C., along with tribes and municipalities – will have an opportunity to opt-in to participate in the settlement. The potential settlement is not an admission of wrongdoing or liability.

Source: Kroger agrees to pay up to $1.2 billion to settle national opioid lawsuits (The Hill)

NY announces funding for addiction workforce development program

New York Governor Kathy Hochul announced more than $7.7 million through the Office of Addiction Services and Supports to support a new workforce development and fellowship program at four medical schools across New York. The addiction workforce training initiative will support 83 New York fellows with professional health care experience to gain educational training and development to best meet the needs of New Yorkers impacted by addiction. The program will allow medical students, current medical professionals and certain state workers to enter the fellowship program by supporting their stipends (or salaries) and benefits, and will also support curriculum development, instruction and supervision of the fellows. Enrolled professionals will gain experience across multiple prevention, treatment, harm reduction and recovery settings.

Source: Governor Hochul Announces $7.7 Million to Support Addiction Workforce Development Through New Fellowship Program (Governor Kathy Hochul)

California legislature passes bill to decriminalize psychedelics

The California legislature passed a bill that would allow adults 21 and older to possess and use small amounts of plant and mushroom psychedelics, which would make California the third state to decriminalize psychedelics. The bill would make several naturally occurring psychedelic substances, including psilocybin and psilocin, DMT and mescaline (excluding peyote), legal within the state. In addition to decriminalizing personal possession and cultivation, the bill would establish “community-based healing” practices that promote group therapeutic use of psychedelics. The bill will return to the Senate for approval before it goes to Governor Gavin Newsom. If Newsom signs it, the bill would go into effect January 1, 2025.

Source: California lawmakers approve psychedelics decriminalization bill (The Hill)

Other news in addiction policy

NAM papers highlight role of social determinants of health in substance use and overdose risk and prevention

The National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic released a paper on the interplay among individual, interpersonal, societal and structural factors that contribute to the development of substance use disorder (SUD) and overdose risk, using a socioecological approach. It proposes evidence-based strategies and interventions across primary, secondary and tertiary levels of prevention. By doing so, the authors hope to encourage policymakers, funders, service providers and community leaders to broaden their approaches to SUD prevention and consider how they can create and advocate for a health-promoting environment by addressing the social and structural factors that drive rising SUD and overdose trends. Two associated papers provide recommendations, strategies and examples of efforts in the field to address social determinants of health in overdose prevention.

Source: Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies (National Academy of Medicine)

Never Use Alone safe-use hotline helps prevent fatal overdoses

Never Use Alone is a safe-use hotline for people who use substances. The call line serves people who worry using alone makes them vulnerable to dying by overdose. Never Use Alone increases a caller’s chance of survival by allowing the operator to stay on the line while the caller uses substances so they can send help if the caller becomes unresponsive. Operators instruct callers to make sure their door is unlocked, to set out Narcan if they have any, and to make sure pets are locked away some place safe to ensure that if emergency medical services are called, they can get to the caller as quickly as possible. Never Use Alone is an entirely volunteer operation, with only about 20 people answering between 250 and 300 calls a week. The article highlights the story of one of the line’s operators.

Source: The Woman on the Line (Slate)