Key reads

DOJ formally moves to reschedule marijuana

The Department of Justice (DOJ) formally moved to reclassify marijuana to Schedule III, a historic shift in U.S. drug policy. A proposed rule sent to the federal register recognizes the medical uses of cannabis and acknowledges it has less potential for intentional misuse than some of the most dangerous substances. The notice kicks off a 60-day comment period followed by a possible review from an administrative judge, which could be a drawn-out process. The process is normally steered by the Drug Enforcement Administration (DEA) but was taken over by DOJ, with Attorney General Garland signing the order. The order notes that “DEA has not yet made a determination as to its views of the appropriate schedule for marijuana.” While the Controlled Substances Act grants the Attorney General responsibility for regulating the sale of dangerous substances, federal law delegates authority to classify them to the DEA administrator. DOJ said the proposal was consistent with the determinations of HHS and that it was legally required to follow HHS’s scientific and medical findings, at least until the start of the rulemaking process.

Source: Justice Department formally moves to reclassify marijuana as a less dangerous drug in historic shift; Top US drug agency a notable holdout in Biden’s push to loosen federal marijuana restrictions (Associated Press)

The small decline in overdose deaths in 2023 could mean that fentanyl has peaked

There are a few possible reasons for the decline in overdose deaths in 2023 shown in preliminary data. First, drug epidemics tend to follow a natural course in which substances enter the market, spread and then fade away. Fentanyl first spread across the East Coast and the Midwest in the mid-2010s, consistently causing spikes in overdoses. As fentanyl’s spread briefly stalled at the Mississippi River, overdose deaths declined in 2018. But then fentanyl spread westward and COVID hit. Fentanyl now has few places left to spread, the isolation of the COVID pandemic is over, the people most likely to die have already done so, more people have rejected opioid use and people who use opioids have learned how to use fentanyl more safely. Second, policymakers have increased access to naloxone and addiction treatment, which have saved lives. However, overdose deaths remain above 100,000, and the introduction of a new substance could still increase that toll again. To speed up the drop in deaths, policymakers could require health insurance plans to cover treatment, fund more high-quality treatment, reduce the price of naloxone and better coordinate with China and Mexico to reduce the flow of fentanyl.

Source: Has Fentanyl Peaked? (The New York Times)

Federal news

FAA reauthorization includes provision to add naloxone to airplane emergency medical kits

President Biden signed into law last week the Federal Aviation Administration (FAA) Reauthorization Act of 2024, which includes language from a bill from Rep. Trone (D-MD) to direct FAA to update aircraft emergency medical kits to include overdose reversal medication. The FAA Reauthorization Act includes language that expresses the need for medical experts to examine and update the list of mandated contents for emergency medical kits to include opioid overdose reversal medication and requires a rulemaking within two years for medical kits, first aid and training for crewmembers.

Source: Trone Applauds House Passage of Bill to Include Naloxone in Airplane Emergency Medical Kits (Congressman David Trone)

Lawmakers debate closing the loophole for intoxicating hemp products in the next farm bill

As lawmakers debate the Farm Bill, some marijuana companies and trade groups are pushing Congress to close a loophole that allows the production and sale of intoxicating substances derived from legal hemp, while the hemp industry is asking lawmakers to leave the federal definition of hemp unchanged. Similar fights are happening in state houses around the country. With a House markup of the farm bill this week, it is unclear whether House Agriculture Committee Republicans have enough support in their own caucus to bring an amendment that would either put more guardrails around hemp products or prohibit them from having any amount of THC (right now, hemp products can have up to 0.3% THC). Following the legalization of hemp in the 2018 farm bill, intoxicating hemp derivatives such as Delta-8 and Delta-10 THC became popular. The products challenged struggling state-legal marijuana markets due to their cheaper cost and greater availability.

Source: Hemp and marijuana go to war (Politico)

State and local news

National League of Cities launches opioid settlement dashboard

The National League of Cities launched the National Opioid Settlement Dashboard, providing insight into the level of funding that cities and counties can expect to receive from the national opioid settlement (currently only distributors and Johnson & Johnson). The dashboard estimates the total amount a city can expect to receive over 18 years and offers tailored investment recommendations based on the level of settlement dollars. Opioid settlement investment recommendations and strategies are organized into four categories – collaboration; research and data; treatment and harm reduction; and prevention and recovery.

Source: Launching NLC’s National Opioid Settlement Dashboard: Focusing on Solutions (National League of Cities)

LAPPA releases model legislation on pharmacist collaboration for MOUD

The Legislative Analysis and Public Policy Association released the Model Pharmacist Collaboration for Medication for Opioid Use Disorder Act to expand access to and availability of medications for opioid use disorder (MOUD). It would increase the workforce that provides MOUD by authorizing pharmacists to prescribe MOUD and refer patients for long-term treatment and to prescribe, initiate, monitor and adjust long-term treatment pursuant to collaborative practice agreements for collaborative drug therapy management. It would require Medicaid and private health insurance coverage for pharmacists’ comprehensive patient care and medication management services provided as part of a standing protocol or drug therapy management collaborative practice for MOUD. It would also establish a grant program to incentivize and sustain interprofessional collaborations that include pharmacists through educational programs, statewide initiatives, community programs and pilot programs.

Source: Model Pharmacist Collaboration for Medication for Opioid Use Disorder Act (Legislative Analysis and Public Policy Association)

Report outlines actions for states to use school Medicaid for substance use services

A Healthy Students, Promising Futures report outlines how states can shape their school Medicaid program to increase reimbursement for substance use services and supports. Drawing on recent legislative and regulatory policy changes, as well as new guidance from the Centers for Medicare and Medicaid Services, it includes 10 specific, practical measures to help school districts get reimbursed for all services covered by the Medicaid state plan. Recommendations include providing clear guidelines for covering substance use prevention (in addition to screening and treatment) and ensuring that providers who specialize in school-based substance use prevention are included in the list of qualified Medicaid providers.

Source: Maximizing School Medicaid for Substance Use Prevention, Early Intervention & Treatment: 10 Actions States Can Take Now (Healthy Students, Promising Futures)

California's Medicaid program is running a contingency management pilot

Medi-Cal, California’s Medicaid program, is running a contingency management pilot. In the coming fiscal year, the state is expected to allocate $61 million to the program. Since April 2023, 19 counties have enrolled a total of about 2,700 patients. Patients can earn as much as $599 a year through the rewards for urine samples free of stimulants. Participants receive at least six weeks of additional behavioral health treatment after the urine testing ends. To qualify, patients must have moderate to severe stimulant use disorder. California was the first state to cover contingency management as a benefit in its Medicaid program, through other states have since followed, including Montana. Participants get paid via retail gift cards, even if the sample is positive for other kinds of substances, including opioids. If participants test positive for stimulants, there are no consequences. They simply do not get paid that day and can show up and try again.

Source: California Pays Meth Users To Get Sober (KFF Health News)

Michigan enacts parity law

Michigan Governor Whitmer signed parity legislation requiring insurers to cover treatments for mental health and substance use disorders at the same level as physical health services. It reiterates the verbiage of the federal Mental Health Parity and Addiction Equity Act.

Source: Gov. Whitmer Signs Bill to Ensure Equal Insurance Coverage for Mental Health and Substance Use Disorder Treatments (Governor Gretchen Whitmer)

Wyoming is now the only state without an overdose Good Samaritan law

With Kansas’s enactment of a Good Samaritan law earlier this month, Wyoming is the only state without such a law. There is a renewed push for a Good Sam law in Wyoming, but the legislation is early in the process. Such legislation was first introduced in Wyoming in 2017, but it faced pushback from lawmakers who were concerned about people intentionally misusing the immunity. There was also concern about the bill’s language potentially giving law enforcement too much leeway over searches when responding to an overdose. After soaring through the House and committees, the bill died in the Senate after a third reading in a 15-15 vote. The latest effort is a bit more robust than the last. The bill now has support from law enforcement, health providers, several health organizations and recovery organizations.

Source: Wyoming now only state without protections for those who help overdosing friends (WyoFile)

Other news in addiction policy

The impact on families is a crisis within the larger mental health crisis

The mental health crisis is not just about individual patients but also about families. There are inadequate services for families dealing with mental illness generally, and there are even fewer for families dealing with crisis events (such as a family member living on the street, institutionalizing a loved one who is a threat to themselves or others, rushing a family member to the ER with a substance-related overdose, self-harm or suicide). The number of families experiencing a very serious mental health-related event is so large that it may constitute a crisis within the larger mental health crisis, and it does not receive enough attention. In a 2022 survey, half of Americans reported experiencing one or more of these severe crises, and many report that the crises have major mental health, personal and financial impacts on their own lives. Many do not know who to call for a family in crisis or are afraid to call for fear of alerting law enforcement or child protective services.

Source: The Mental Health Crisis Within the Mental Health Crisis (KFF)