News from the States

• Senate Committee on Homeland Security and Governmental Affairs holds field hearing on opioid epidemic, featuring testimony from OhioMHAS Director & NASADAD member Tracy Plouck
• Jefferson County, New York begins offering Vivitrol to incarcerated individuals leaving the criminal justice system

Around the Agencies

• GAO report finds DOD’s Military Health System does not meet mental health appointment requirements
• CMS clarifies stance on Medicaid eligibility for incarcerated individuals

In the News

• House Full Judiciary Committee Considers and Approves Opioid Bill (H.R. 5046)
• House Full Energy and Commerce Committee Completes Markup of Bills on Opioids
• University of California study finds seasonal increase in college student drinking rates
• Behavioral Health IT Coalition release Integrating Behavioral Health through Technology Act of 2016 (S. 2691) fact sheet
• NGA and NCJA launch State criminal justice reform initiative
• Pew Charitable Trusts article highlights State efforts to combat synthetic drugs

News from NASADAD

• NASADAD Moderates Panel During “Stepping Up Summit” in Washington, D.C.

Upcoming Events

• CDC announces webinar on its National Viral Hepatitis Campaigns
• SAMHSA announces 2016 National Prevention Week Kick-off webcast

News from the States

Senate Committee on Homeland Security and Governmental Affairs holds field hearing on opioid epidemic, featuring testimony from OhioMHAS Director & NASADAD member Tracy Plouck
The Senate Committee on Homeland Security and Government Affairs and Senators Rob Portman (R-OH) and Sherrod Brown (D-OH) held a hearing on the opioid epidemic in Cleveland on April 22^nd. The hearing featured testimony from several substance use disorder experts, including Ohio Department of Mental Health & Addiction Services Director & NASADAD member Tracy Plouck. Ms. Plouck thanked both Senators for their work in developing a comprehensive approach to the opioid crisis, and highlighted the actions Governor John Kasich’s task force has taken in the past several years. These actions include: comprehensive prescribing guidelines for the outpatient management of acute pain released in January 2016, ongoing improvements and investments into the Ohio Automated Rx Reporting System, the Start Talking! Statewide youth drug prevention initiative, and increased mechanisms for diverting individuals in the criminal justice system into substance use disorder treatment.

Read Ms. Plouck’s full testimony here.

Read more about the Ohio Governor’s Cabinet Opiate Action Team here.

Jefferson County, New York begins offering Vivitrol to incarcerated individuals leaving the criminal justice system
Jefferson County, New York will begin offering Vivitrol to incarcerated individuals whose release from the criminal justice system is imminent. Jefferson County Sheriff Colleen M. O’Neill states that the program will help incarcerated individuals exiting the criminal justice system maintain their sobriety during the critical 30-day period following their release, when many individuals with opioid use disorders are at greatest risk for relapse. Individuals participating in the program must still attend substance use disorder treatment programs at facilities approved by the New York State Office of Alcoholism and Substance Abuse Services (OASAS), which is led by Commissioner Arlene González-Sánchez, who is a member of NASADAD’s Board. All jail administrators, medical staff, and other relevant staff have been trained to administer the drug. Sheriff O’Neill plans for the program to be fully implemented by summer.

Read the full story here.

Around the Agencies

GAO report finds DOD’s Military Health System does not meet mental health appointment requirements
The U.S. Government Accountability Office released a report last week finding that the Department of Defense’s (DOD) Military Health System (MHS) does not meet requirements related to mental health appointment scheduling. Data on domestic and overseas direct care from April 2014 through August 2015 suggests that initial appointments for new or exacerbated conditions did not meet the 7-day access standard required by the DOD. The DOD reported that this deficiency is the result of incorrect coding that is hindering the ability of personnel to access the MHS. The GAO further found that follow-up appointments for mental health do not maintain the official DOD access standard required by federal internal controls. The report concludes that the DOD develop coding for initial appointments and access standards for follow-up appointments.

Read the full report here.

CMS clarifies stance on Medicaid eligibility for incarcerated individuals
Last week the Centers for Medicare and Medicaid Services (CMS) clarified its stance on Medicaid eligibility for incarcerated individuals in a Dear State Health Official letter. The clarification is an update of CMS’s 1997 letter that described the conditions precluding an incarcerated individual from being eligible for Medicaid. Current regulations stipulate that individuals classified as an “inmate of a public” institution are ineligible for federal financial participation for Medicaid services. Last week’s letter clarifies that “individuals on probation, parole, or community release pending trial and individuals in corrections-related supervised community residential facilities” retain Medicaid eligibility.

Read the full CMS letter here.

In the News

House Full Judiciary Committee Considers and Approves Opioid Bill (H.R. 5046)
On Wednesday, April 27, the House Judiciary Committee considered and passed the Comprehensive Opioid Abuse Reduction Act of 2016 by Rep. Sensenbrenner (R-WI) by voice-vote.  The Judiciary Committee is Chaired by Rep. Goodlatte (R-VA) and the Ranking Member is Rep. Conyers (D-MI).

The Comprehensive Opioid Abuse Reduction Act authorizes the Attorney General within 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 use 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; and
• developing, implementing or expanding an integrated and comprehensive opioid abuse response 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 criminal justice 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; and
• a veterans court.

Additional 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.

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.”

House Initiative differs from CARA:  H.R. 5046 differs from CARA in that H.R. 5046 authorizes grants exclusively within the Department of Justice (DOJ).  Overall, CARA authorizes a number of distinct programs targeted towards different aspects of the opioid problem (prevention, treatment, recovery, media campaigns, naloxone and more) not only within DOJ but also within certain Department of Health and Human Services’ (HHS) operating divisions that include the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), and others.   In the House, as previously reported, a number of bills related to opioids impacting federal health agencies are being considered in the Energy and Commerce Committee.

To view the Comprehensive Opioid Abuse Reduction Act (H.R. 5046), please visit https://judiciary.house.gov/wp-content/uploads/2016/04/HR-5046.pdf

Other bills passed by the Judiciary Committee:  In addition to H.R. 5046, the Judiciary Committee considered and approved

• H.R. 5052, the Opioid Program Evaluation Act which would require an evaluation of the grants authorized in H.R. 5046 (Rep. McCarthy, R-CA and Rep. Hoyer, D-MD)

• H.R. 5048, the Good Samaritan Assessment Act of 2016, which would require a GAO report on the extent to which ONDCP has reviewed Good Samaritan Laws and the results or findings from these reviews along with a compilation of Good Samaritan Laws in effect in the States (Rep. Guinta, R-NH)

House Full Energy and Commerce Committee Completes Markup of Bills on Opioids
The Full House Energy and Commerce Committee considered and passed on Wednesday, April 27 and Thursday, April 28 a number of bills aimed at address the opioid problem.  The Chairman of the Committee is Rep. Upton (R-MI) and the Ranking Member is Rep. Pallone (D-NJ).

On Thursday, April 28, the Committee reconvened and passed three more bills related to opioids:

• 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, 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. Both amendments passed.

• 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 (Rep. Sarbanes, D-MD)

• 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)

The Committee considered and approved the following opioid-related bills on Wednesday, April 27:

• 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. 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. 4981, Opioid Use Disorder Treatment Expansion and Modernization Act: The Opioid Use Disorder Treatment Expansion and Modernization Act (H.R. 4981), would change the number of patients to whom a practitioner can prescribe buprenorphine from 100 to 250. During the markup four amendments were offered to H.R. 4981. The first, offered by Congresswoman DeGette (D-CO), aimed to increase the cap to 500 patients, and the second by Ranking Member Pallone would increase the cap to 300. In a roll call vote, neither of the amendments to further increase the cap passed. Congresswoman Yvette Clarke (D-NY) offered an amendment to raise awareness of safe prescribing of opioids for the treatment of pain, but she later withdrew the amendment. Finally, Congressman Ben Ray Luján (D-NM) offered an amendment to authorize $1 billion for opioid use disorder prevention and treatment, primarily in the form of State targeted response cooperative agreements as proposed by the Administration. With a vote of 22-24, Congressman Luján’s amendment did not pass. (H.R. 4981 was introduced by Rep. Bucshon, R-IN and Rep. Tonko, D-NY)

• 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. 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)

• H.R. 3250, DXM Abuse Prevention Act would prohibit the sale of medicine containing dextromethorphan (DXM) to individuals under 18 without a prescription (Rep. Johnson, R-OH and Rep. Matsui, D-CA)

NASADAD will continue to track relevant legislation and provide updates to membership.

University of California study finds seasonal increase in college student drinking rates
The University of California – San Diego published a study finding seasonal increases in drinking rates among college students earlier last month. The study examined 462 college freshmen at eight different points during their first year. Researchers found that the freshmen’s drinking decreased 29 percent in the summer, increased 31 percent in the spring, and increased another 18 percent around spring break.

Read more about this study here.

Behavioral Health IT Coalition release Integrating Behavioral Health through Technology Act of 2016 (S. 2691) fact sheet
The Behavioral Health IT Coalition, of which NASADAD is a member, has released a fact sheet summarizing the Integrating Behavioral Health through Technology Act of 2016 (S. 2691). The legislation was recently introduced by Senator Sheldon Whitehouse (D-RI) and establishes a pilot program in up to five states, where incentive payments may be made to eligible professionals and behavioral health facilities for the adoption and use of certified Electronic Health Record (EHR) technology. Preference would be given to States that have a statewide health information exchange that includes mental health and substance use disorder data. Senator Whitehouse’s legislation aims to increase collaboration between mental health, substance use disorder, and primary care providers to improve overall health outcomes.

NGA and NCJA launch State criminal justice reform initiative
The National Governors Association (NGA) and the National Criminal Justice Association (NCJA) announced a joint program to support State criminal justice reform efforts last week. The program, titled the National Criminal Justice Reform Project, will support the implementation of evidence-based practices targeting recidivism, pretrial release, and mental health and substance use disorders in up to five States. The five States will be selected for the program following a meeting of twenty State teams this fall.

Read the full story here.

Pew Charitable Trusts article highlights State efforts to combat synthetic drugs
The Pew Charitable Trusts published an article last week highlighting State efforts to combat the spread of synthetic drugs in communities across the country. The most popular synthetic drugs are placed into two categories: synthetic cathinones (bath salts) and synthetic marijuana products that are commonly sold in stores. Thirty-two States have passed laws making the process to classify synthetic drugs as illegal easier since 2010. Despite these efforts, legislators continue to face significant difficulties in making synthetic drugs illegal through scheduling, as manufacturers can change just one molecule of an illegal synthetic drug to create a new legal version. This complication has spurred States to reexamine the traditional scheduling process. Florida and Washington, DC passed laws to make the scheduling of drugs include consideration of the type of drug and its reaction rather than just its chemical makeup. This adjustment makes it easier for States to keep up with the constantly shifting synthetic drug market.

Read the full article here.

News from NASADAD

NASADAD Moderates Panel During “Stepping Up Summit” in Washington, D.C.
On Tuesday, April 19, Robert Morrison, NASADAD Executive Director, served as a moderator of a panel titled “Meeting the Needs of People with Co-occurring Substance Use Disorders and Mental Illnesses” held in conjunction with the Stepping Up Summit.  The session focused on systems-level coordination and reform efforts to address co-occurring substance use and mental health disorders.  The panel was designed to explore opportunities to reduce the number of people with co-occurring disorders in jails.

Participants included:

• The Honorable Alisha Bell, Commissioner, Wayne County, Michigan (Presider)
• Mitchell Katz, MD, Director, Los Angeles County Health Agency, Los Angeles County, California
• Faye Taxman, PhD, University Professor, Criminology, Law and Society Department, and Director of the Center for Advancing Correctional Excellence, George Mason University
• Rob Morrison, NASADAD, Moderator
• Sara Wurzburg, Grantee Technical Assistance Manager, Council of State Governments (CSG), organized and supported the panel.  Sarah previously served as Research Analyst at NASADAD.

Earlier in the day, NASADAD member Tracy Plouck, Director of Ohio’s Department of Mental Health and Addiction Services, served as a featured speaker during a plenary session titled “Strategies for Financing Your Plan.”

The Stepping Up Initiative was launched by CSG, the National Association of Counties (NACo), the American Psychiatric Association Foundation in May 2015.  The goal of the initiative is to reduce the number of people with mental illness in jails.  NASADAD is a partner in the initiative.

To learn more about the Stepping Up Initiative, visit https://stepuptogether.org/

Upcoming Events

CDC announces webinar on its National Viral Hepatitis Campaigns
The Centers for Disease Control and Prevention (CDC) has announced a webinar discussing its two National Viral Hepatitis Campaigns. The webinar will provide an overview of both campaigns and the new resources associated with them.  The Know Hepatitis B campaign promotes hepatitis B testing among Asian Americans and Pacific Islanders, while the Know More Hepatitis campaign encourages hepatitis C testing in people born from 1945 to 1965. The webinar will be held on Wednesday, May 4^th at 3 PM EST.

Register for the webinar here.

Read more about the Know Hepatitis B campaign here.

Read more about the Knew More Hepatitis campaign here.

SAMHSA announces National Prevention Week 2016 Kick-off webcast
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced the kick-off webcast for National Prevention Week 2016 in partnership with Morgan State University. The webcast will highlight communities throughout the country that have bolstered overall community health through increasing prevention-related public awareness programs surrounding mental health and substance use disorders. The webcast will be held on Monday, May 16^th from 11:00-11:45 AM EST. National Prevention Week 2016 will be observed from May 15-21, 2016.

Register for the webcast here.

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.