News from the States

• Ohio launches naloxone public awareness campaign for counties experiencing high rates of fentanyl overdose
• Rhode Island Senate approves legislation addressing opioid crisis

In the News

• House of Representatives passes package of bills addressing opioid epidemic
• Poison control centers report increase in exposure to e-cigarettes among children
• Mathematica Policy Research highlights success of evidence-based treatment and the cost of excessive drinking in recognition of National Prevention Week
• Senate Judiciary Committee holds hearing on supporting youth in the foster care and juvenile justice systems

News from NASADAD

• NASADAD attends National Viral Hepatitis Roundtable briefing on ending hepatitis C

Legislation Related to Opioids

• House of Representatives passes package of bills addressing opioid epidemic

News from the States

Ohio launches naloxone public awareness campaign for counties experiencing high rates of fentanyl overdose
Ohio has launched a new public awareness campaign advocating for increased usage of naloxone in counties experiencing high rates of fentanyl overdoses. The campaign will focus on 15 counties that experienced 80 percent of Ohio’s fentanyl-related overdose fatalities in 2014. Family members and friends of individuals with opioid use disorders will be encouraged to obtain naloxone kits to reverse overdoses before first-responders arrive. The campaign will be supported by both the Ohio Department of Health (ODH) and the Ohio Department of Mental Health and Addiction Services (OhioMHAS), of which NASADAD member Tracy Plouck serves as Director. Fentanyl-related deaths have substantially increased in Ohio over the past several years, rising from 84 in 2013 to 503 in 2014.

Read the full press release here.

Rhode Island Senate approves legislation addressing opioid crisis
Last week the Rhode Island State Senate approved a series of bills addressing the opioid crisis. The bills were crafted in partnership with Governor Gina Raimondo’s Overdose Prevention and Intervention Taskforce. Legislators aim for the bills to deliver a more comprehensive approach to prevention and enhance the availability of substance use disorder treatment. The bills contain provisions requiring insurance companies to cover medication-assisted treatment medications, including methadone, buprenorphine, and naltrexone, as well as providing prescription coverage for opioid antagonists to family members and friends of individuals with opioid use disorders. Other provisions include the expansion of residential substance use disorder treatment and additional prescribing limits for pain medications used for acute pain. The bills now move to the Rhode Island House of Representatives.

Read more about the legislation here.

In the News

Poison control centers report increase in exposure to e-cigarettes among children
A new study conducted by the Center for Injury Research and Policy of the Research Institute and the Central Ohio Poison Center reports that poison control centers throughout the United States have observed an increase of calls related to e-cigarette exposure among children. Total number of e-cigarette exposures in children younger than 7 years old increased approximately 1,500 percent between 2012 and 2015, with ingestion of liquid nicotine being the most common form of exposure. Between 2012 and 2015, poison control centers received more than 29,000 calls related to e-cigarette and other tobacco exposure, with e-cigarettes accounting for 14 percent of the calls versus 60 percent for traditional cigarettes, and 16 percent of for other forms of tobacco. The researchers found that “young children exposed to liquid nicotine were more than five times more likely to be admitted to the hospital, and two-and-a-half times more likely to have a severe medical outcome, compared with children exposed to traditional cigarettes.”

Read the full story, and access the article here.

Mathematica Policy Research highlights success of evidence-based treatment and the cost of excessive drinking in recognition of National Prevention Week
Earlier this month Mathematica Policy Research highlighted two of its projects advancing substance use disorder awareness in recognition of National Prevention Week. The first study observed data from Mathematica’s national cross-site evaluation of Regional Partnership Grants (RPGs), which aim to strengthen families and treat substance use disorders.  Mathematica found that at time of enrollment, 35 percent of adults enrolled in RPG services had high levels of drug and alcohol use, with marijuana, amphetamines, and alcohol as the most commonly used substances. Nine percent of RPG-enrolled adults used heroin and 40 percent used other opiates.

The second study highlighted by Mathematica explores the cost of excessive drinking in the United States. High rates of drinking cost the United States almost $250 billion in 2010, with “two out of every five dollars paid for by the government, and three-quarters of the costs related specifically to binge drinking.” Mathematica goes on to discuss a November 2015 article published in the American Journal of Preventive Medicine finding that evidence-based prevention strategies may help reduce excessive drinking and its associated costs.

Read the full article here.

Senate Judiciary Committee holds hearing on supporting youth in the foster care and juvenile justice systems
The Senate Judiciary Committee held a hearing on supporting youth in the foster care and juvenile justice systems on Tuesday, May 17^th. Brian Denten, Public Policy Intern, attended the hearing. The hearing featured testimony from several public officials engaged in both foster care and juvenile justice systems at the State level. Witnesses stated that a lack of communication between foster care and the juvenile justice system remains commonplace throughout many states, making it difficult for systems to identify “crossover” foster youth that have been placed within the juvenile justice system. While some States have developed working practice models to address this lack of communication, problems continue to pervade both systems. Several witnesses advocated for the reauthorization of the Juvenile Justice and Delinquency Prevention act to ensure prevention and early intervention initiatives continue to receive funding.

Witnesses:

• Sonya Brown; New Orleans, LA
• Lisa Nelson; Juvenile Court Officer, Third Judicial District, State of Iowa
• Jeff Lind; Social Services Division Director, Beltrami County Health and Human Services, Bemidji, MN
• Macon Stewart; Senior Program Manager, Center for Juvenile Justice Reform, McCourt School of Public Policy, Georgetown University

News from NASADAD

NASADAD attends National Viral Hepatitis Roundtable briefing on ending hepatitis C
On May 23^rd, Brian Denten, NASADAD Public Policy Graduate Intern attended the briefing hosted by the National Viral Hepatitis Roundtable. The briefing featured several presentations from researchers working on ending hepatitis C and expanding access to hepatitis C medications to wider populations. Between 2013 and 2015, several hepatitis C medications were developed that effectively “cure” the disease for many individuals who properly adhere to the treatment regimen. Despite the success of this medication, insurance costs negatively affect adherence to treatment as many people find the mediation prohibitively expensive. Speakers highlighted the need to reform payment and financing options to ensure that individuals diagnosed with hepatitis C are able to begin treatment immediately before the more debilitating symptoms of the disease develop, stating that large cost savings may be realized from treating hepatitis C in this way. Hepatitis C has experienced an alarming rise in prevalence among young people as a result of the ongoing opioid crisis. CMS sent guidelines to State Medicaid agencies in November 2015 suggesting that agencies address the large costs of hepatitis C medications.

Speakers:

• Jay Bhattacharya, MD, PhD; Professor of Medicine at the Center for Primary Care and Outcomes Research Stanford University
• Ryan Clary; Executive Director, National Viral Hepatitis Roundtable
• Anupam Jena, MD, PhD; Associate Professor of Health Care Policy, Harvard Medical School
• Darius Lakdawalla, PhD; Quintiles Chair in Pharmaceutical Development and Regulatory Innovation, School of Pharmacy at the University of Southern California

Read the CMS guidance to State Medicaid agencies on hepatitis C medication here.

Legislation Related to Opioids

House of Representatives passes package of bills addressing opioid epidemic

On May 13^th, the House of Representatives voted 400 to 5 in favor of a package of bills designed to address the opioid crisis. On March 10^th, the Senate voted 94 to 1 in favor of the Comprehensive Addiction and Recovery Act (CARA).  A “conference committee” composed of House and Senate “conferees” shall be formed to iron out the many differences between the House opioids package and CARA. The Senate has not appointed conferees.  The House of Representatives has appointed the following conferees:

Rep. Bob Goodlatte (R-VA)
Rep. Jim Sensenbrenner (R-WI)
Rep. Lamar Smith (R-TX)
Rep. Tom Marino (R-PA)
Rep. Doug Collins (R-GA)
Rep. Dave Trott (R-MI)
Rep. Mike Bishop (R-MI)
Rep. Fred Upton (R-MI)
Rep. Joseph Pitts (R-PA)
Rep. Leonard Lance (R-NJ)
Rep. Brett Guthrie (R-KY)
Rep. Adam Kinzinger (R-IL)
Rep. Larry Bucshon (R-IN)
Rep. Susan Brooks (R-IN)
Rep. Lou Barletta (R-PA)
Rep. Buddy Cater (R-GA)
Rep. Gus Bilirakis (R-FL)
Rep. Jackie Walorski (R-IN)

Rep. Frank Pallone of (D-NJ)
Rep.  John Conyers of (D-MI)
Rep.  Robert C. “Bobby” Scott (D-VA)
Rep.  Jim McDermott (D-WA)
Rep.  Gene Green (D-TX)
Rep. Sheila Jackson Lee (D-TX)
Rep.  Joe Courtney (D-CT)
Rep.  Steve Cohen (D-TN)
Rep.  John Sarbanes (D-MD)
Rep.  Ben Ray Luján (D-NM)
Rep. Judy Chu (D-CA)
Rep. Elizabeth Esty (D-CT)
Rep. Ann Kuster (D-NH)
Rep.  Raul Ruiz (D-CA)

Although some are calling for a final bill to be sent to the White House by the end of this month, it may take more time will be needed to develop a final product.

The Senate version of CARA includes a number of distinct, authorized programs within the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) designed to address the crisis.  The Senate Judiciary Committee coordinated with the Senate Health, Education, Labor and Pensions Committee (HELP) as the legislation moved forward.

To see a summary of the Senate Judiciary Committee-approved version of CARA, please click here.

The House package includes three core components with many parts:  (1) a large grant program housed within DOJ that contains a number of “allowable use of funds,” (2) a number of health related bills considered and approved by the House Energy and Commerce Committee and (3) other bills considered by other Committees of jurisdiction.

The bills considered and passed by the House of Representatives include the following:

Within the jurisdiction of the House Committee on the Judiciary:

• The Comprehensive Opioid Abuse Reduction Act (H.R. 5046) authorizes the Attorney General within Department of Justice (DOJ) to make grants to States, units of local government and non-profits “to provide services primarily relating to opioid abuse” where a number of “allowable uses” of funds are listed.  These allowable uses include:

• providing training and resources for first responders on carrying/administering an opioid overdose reversal drug approved by the FDA ad purchasing such drug or device for first responders who have received training;
• investigations to locate or investigate illicit activities related to the unlawful distribution of opioids;
• developing, implementing or expanding a medication-assisted treatment program used or operated by a criminal justice agency, which may include training;
• developing, implementing or expanding PDMPs;
• developing, implementing or expanding programs to prevent and address opioid abuse by juveniles;
• developing, implementing or expanding an integrated and comprehensive opioid abuse response program, including prevention and recovery programs;
• developing, implementing, or expanding a program (which may include demonstration projects) to utilize technology that provides a secure container for prescription drugs that would prevent individuals, particularly adolescents, from gaining access to opioid medications that are lawfully prescribed for other individuals;
• developing, implementing, or expanding a program to prevent and address opioid abuse by veterans; and
• developing, implementing, or expanding a prescription drug take-back program.

One section emphasizes coordination between State criminal justice agencies and substance abuse agencies:  The bill notes that in the case where a State is the applicant, a core focus of the grant activities would be “…facilitating or enhancing planning and collaborating between State criminal justice agencies and State substance abuse systems in order to more efficiently and effectively carry out programs described in paragraph (1) that address problems related to opioid abuse.”  The programs listed in paragraph 1 include:

• developing, implementing, or expanding treatment alternative to incarceration program, which may include pre-booking or post-booking components;
• training for criminal justice agency personnel on substance use disorders and co-occurring mental illness and substance use disorders;
• a mental health court;
• a drug court;
• a veterans court;
• a focus on parents whose incarceration could result in their children entering the child welfare system; and
• a community-based substance use diversion program sponsored by a law enforcement agency.

Prevention provisions added to H.R. 5046. Senate-passed CARA includes an enhancement grant program for current and former Drug-Free Communities grantees to tackle prescription drug abuse and methamphetamines in their communities. While this program is not included in H.R. 5046, the House bill was amended that makes prevention an allowable use of grant funding.

Language on veterans services:  The bill includes additional language authorizing services to “qualified” veterans.  The bill defines a qualified veteran as a “…preliminary qualified offender who served on active duty in any branch of the Armed Forces, including National Guard or Reserves, and was discharged or released from such service under conditions other than dishonorable.”  The additional language authorizes a Veterans Court program within DOJ, along with a Veterans Assistance Program.

Inclusion of services for pregnant women under family-based substance abuse treatment has been added. Since the bill was introduced in April, a provision was added to amend the Omnibus Crime Control and Safe Streets Act to add pregnant women to the list of eligible recipients of family-based substance abuse treatment as an alternative to incarceration.

A provision has been added that would require the GAO to study existing programs and research gaps on substance use among adolescents and young adults. This new provision would require the Comptroller General of Government Accountability Office (GAO) to conduct a study on how the Department of Justice (DOJ) is addressing prevention, treatment, and recovery services for adolescents and young adults.

Medication Assisted Treatment (MAT) defined:  The bill defines “medication-assisted treatment” as “the use of medications approved by the Food and Drug Administration for the treatment of opioid abuse.”

• H.R. 5048, Good Samaritan Assessment Act of 2016 requires the Government Accountability Office to submit a report about the Office of National Drug Control Policy’s (ONDCP’s) review of State and local Good Samaritan laws that exempt from criminal or civil liability any individual who administers an opioid overdose reversal drug or device or who contacts emergency services providers in response to an overdose (Rep. Guinta, R-NH).

Within the jurisdiction of the House Committee on Energy and Commerce:

• H.R. 3691, Improving Treatment for Pregnant and Postpartum Women Act would reauthorize the residential services for pregnant and postpartum women program (PPW) grant program within SAMHSA’s Center for Substance Abuse Treatment (CSAT). The bill would also create a pilot program for State substance abuse agencies to use up to 25 percent of these funds for services to pregnant and parenting women in non-residential settings. The purpose of the pilot program is to spur innovation and fill gaps in family-centered services across the continuum of care.

A section-by-section summary of the bill can be found here.

In FY 2016, the PPW grant program was funded at $15.9 million.  The bill as introduced authorized $40 million for the PPW and pilot program.  During the markup by the Committee on Energy and Commerce last month, an amendment was offered to change the authorization of funds in the bill from $40 million to $16.9 million.  Further, Rep. Ben Ray Luján (D-NM), the original sponsor of the bill, offered an amendment that would authorize the use of funds for the pilot program only if the amount for the overall PPW program exceeded FY 2016 funding levels. The bill passed the House as amended, with the “trigger language” and an authorization level of $16.9 million.

• H.R. 4978, Nurturing and Supporting Healthy Babies Act which would mandate the Government Accountability Office (GAO) to write a report neonatal abstinence syndrome (NAS) – including prevalence, coverage available under Medicaid, any federal barriers to treatment, particularly in non-hospital settings, and more.

• H.R. 4641, To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes (Rep. Brooks, R-IN and Rep. Kennedy, D-MA).

• H.R. 3680, Co-Prescribing to Reduce Overdoses Act of 2015, for the Secretary of Health and Human Services to carry out a grant program for the co-prescribing of opioid overdose reversal drugs for patients at high risk of overdose (Rep. Sarbanes, D-MD). The Energy and Commerce Committee included an offset to pay for the bill when it considered the legislation earlier this month.

• H.R. 1818, Veteran Emergency Medical Technician Support Act of 2016 amends the Public Health Service Act to direct the Department of Health and Human Services to establish a demonstration program for States with a shortage of emergency medical technicians (EMTs) to streamline State requirements and procedures to assist veterans who completed military EMT training to meet state EMT certification, licensure, and other requirements (Rep. Kinzinger, R-IL and Rep. Capps, D-CA).

• H.R. 4969, John Thomas Decker Act of 2016 to authorize a grant program within CDC to educate teens and youth injured playing sports regarding the dangers of prescription drug misuse and abuse (Rep. Meehan, R-PA).

• H.R. 4586, Lali’s Law, to authorize grants to States for developing standing orders and educating health care professionals regarding the dispensing of opioid overdose reversal medication without person-specific prescriptions, and for other purposes (Rep. Dold, R-IL).

• H.R. 4599, Reducing Unused Medications Act of 2016 to amend the Controlled Substances Act in order to allow partial fills of schedule II controlled substances (Rep Clark, D-MA).

• H.R. 4976, Opioid Review Modernization Act to require the Food and Drug Administration (FDA) to seek recommendations from an advisory committee before approval of certain new opioid-based drugs without abuse-deterrent properties (Rep. Sean Maloney, D-NY).

• H.R. 4982, Examining Opioid Treatment Infrastructure Act of 2016 would require the GAO to develop a report on the availability of substance use disorder treatment in inpatient, outpatient and detox settings (Rep.  Foster, D-IL).

Within shared jurisdiction of the House Energy and Commerce Committee and House Committee on the Judiciary:

• S. 32, Transnational Drug Trafficking Act of 2015 amends the Controlled Substances Import and Export Act to prohibit the manufacture or distribution of a controlled substance in schedule I or II, or a listed chemical by individuals having reasonable cause to believe that such substance or chemical will be unlawfully imported into the United States (Rep. Marino, R-PA and Rep. Pierluisi, D-PR; Sen. Dianne Feinstein, D-CA and Sen. Udall D-NM).

• H.R. 5052, OPEN Act to direct the Attorney General and the Secretary of Health and Human Services to evaluate the effectiveness of grant programs that provide grants for the primary purpose of providing assistance in addressing problems pertaining to opioid abuse (Rep. McCarthy, R-CA and Rep. Hoyer, D-MD).

• R. 4981, Opioid Use Disorder Treatment Expansion and Modernization Act: As passed by the House Committee on Energy and Commerce, the Opioid Use Disorder Treatment Expansion and Modernization Act (H.R. 4981) would have changed the number of patients to whom a practitioner can prescribe buprenorphine from 100 to 250. However, the bill was modified from the version approved by the Energy and Commerce Committee due to cost concerns.  The bill approved by the House last week includes only a “Sense of Congress” (language which doesn’t have the force of law) that HHS should increase the caps on buprenorphine prescribing by physicians to 250 patients. Additionally, the bill only temporarily permits nurse practitioners and physician assistants to prescribe buprenorphine for 3 years, whereas the bill as approved by the Committee would have permanently allowed them to prescribe. On the floor, bill sponsor Rep. Tonko (D-NY) called on Congress to replace the Sense of Congress with a statutory increase and permanently permit mid-level prescribing during the House/Senate negotiation process (Rep. Bucshon, R-IN and Rep. Tonko D-NY).

Within the jurisdiction of the House Committee on Education and the Workforce:

• H.R. 4843, Infant Plan of Safe Care Improvement Act to amend the Child Abuse Prevention and Treatment Act (CAPTA) by requiring the Department of Health and Human Services (HHS) to provide information about best treatment practices for infants born affected by illicit drug exposure, withdrawal symptoms, or a Fetal Alcohol Spectrum Disorder. States will be required to submit data reports that “include the total number of such infants for whom a plan of safe care was developed, and for whom referrals are made for appropriate services, including services for the affected family or caregiver” (Rep. Barletta, R-PA and Rep. Walberg, R-MI).

Within the jurisdiction of the House Committee on Veterans’ Affairs:

• H.R. 4063, Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act or the Jason Simcakoski PROMISE Act to improve the use of opioids by the Secretary of Veterans Affairs in treating veterans (Rep. Bilirakis, R-FL and Rep. Kind, D-WI).

Within the jurisdiction of the House Committee on House Foreign Affairs and Committee on the Judiciary:

• H.R. 4985, Kingpin Designation Improvement Act of 2016 amends the Foreign Narcotics Kingpin Designation Act to allow classified information to be submitted to a reviewing court ex parte or in camera in a judicial review of a determination by the President that a foreign person is subject to sanctions as a significant foreign narcotics trafficker. (Rep. Katko, R-NY and Rep. Rice, D-NY).

 

Should you have any questions, or require additional information, please do not hesitate to contact Robert Morrison, Executive Director, (202) 293-0090 or Shalini Wickramatilake-Templeman, Public Policy Associate, at (202) 293-0090.