Federal government removes contingency management barrier
The Biden administration eliminated a major barrier to contingency management, a treatment that provides patients with financial incentives in exchange for reduced substance use.
Why it’s important: Overdose deaths involving stimulants have been rising.
No medications are available to treat stimulant use disorder.
Contingency management has been proven to be an effective treatment but is underutilized.
The barrier: Historically, many federal grants meant to support contingency management have capped incentives for patients at $75 per year, a level too low for the treatment to be effective.
This limit is due to concerns that providing larger financial incentives would violate federal anti-kickback laws.
Despite the evidence, this cap has been continued, largely due to stigma and the often negative perception of giving money to people who use drugs.
The solution: The Biden administration announced that Substance Abuse and Mental Health Services Administration (SAMHSA) grants can now fund contingency management services with up to $750 in incentives per year.
The bigger picture: In addition to allowing for larger, more effective incentives, the move also carries symbolic weight. It is the largest show of support ever from the federal government for contingency management and could shift private insurers’ and health providers’ attitudes toward the treatment.
BPC: Youth behavioral health care overhaul recommendations
The Bipartisan Policy Center’s Youth Mental Health and Substance Use Task Force released a report on redesigning the health care system to better meet the needs of youth.
The details: The task force focused on and provided recommendations in five key areas:
Opportunities across the health care system to build new workforce capacity, make the existing workforce more effective and redirect care to more appropriate sites
Ways to increase compliance with existing screening and treatment requirements, including network adequacy standards and parity requirements
Further integrating primary care and behavioral health services in pediatric settings
Services for youth with the highest acuity behavioral health needs, many of whom have experienced significant emotional and physical trauma, may be involved in the child welfare or justice systems and require immediate, intensive and specialized care
Strengthening the patchwork of crisis and stabilization services to improve the experience and outcomes of youth in crisis
The details: It shares Murthy’s recommendations for how Americans can cultivate health, happiness and fulfillment by rebuilding community centered around relationships, service and purpose — the triad of fulfillment.
The Prescription details each of those three elements and how they impact our health.
Murthy calls for a shift in culture, policy and programs that will strengthen community as the critical path to health, happiness and fulfillment.
The broader view: Murthy believes that health involves the whole person, and he has sought to understand the root causes of pain and unhappiness.
In his reports on the dangers of social isolation, parental stress, alcohol use and social media, Murthy has highlighted how Americans’ loneliness has led to a mental health crisis and political polarization.
Murthy warns against forming communities around fear and animosity and calls for leading with love. He urges small actions, such as reaching out to friends more.
Congress has largely ignored the calls to action Murthy has issued in his reports, but his advisories could help raise awareness and spur action.
The main point: A study on trends in buprenorphine dispensing from retail pharmacies to adolescents and young adults 2020-2023 found that it remains low, and many who might benefit from treatment did not receive it.
The findings:
The overall number of adolescents and young adults who were dispensed buprenorphine declined 6.5% annually 2020-2023.
The decline was driven by the significant decreases among young adults ages 20-24. The number of adolescents dispensed buprenorphine increased, but numbers remained low.
Buprenorphine dispensing varied by prescriber specialty, with nurse practitioners prescribing more buprenorphine to adolescents and young adults than other specialties. Pediatricians prescribed to the fewest number of adolescents in 2020 but had the largest increase 2020-2023.
The explanation:
The increases in buprenorphine prescriptions among adolescents likely reflect successful outreach to pediatricians, enhanced prescribing through telehealth and elimination of the waiver requirement to prescribe buprenorphine.
Yes, but: These changes might differentially affect young adults, who might be less likely to access health care. The reasons for decreases in buprenorphine prescriptions among young adults might include lower opioid use disorder prevalence or changes in treatment-seeking behaviors or health care coverage among young adults with substance use disorder (SUD).
Barriers to treatment may include few treatment facilities, lack of comfort with prescribing buprenorphine among youth-serving clinicians and stigma.
Recommendations: Youth-serving clinicians and health systems can expand access to buprenorphine for adolescents and young adults through clinician education, resources to support SUD care for youth, linking buprenorphine and behavioral health services and addressing stigma and other barriers to care.