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D.C. Update – July 11, 2016

News from the States

  • Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries

Around the Agencies

  • ASPE issues report examining the effects of the Affordable Care Act’s Medicaid Expansion in 2014 and 2015
  • Obama Administration issues final rule on MAT for opioid use disorders
  • CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths

In the News

  • Obama Administration issues final rule on MAT for opioid use disorders
  • House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
  • Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
  • National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
  • Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
  • Ellen Weber rejoins Legal Action Center to serve as Vice President for Health Initiatives

 

News from the States

Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries
Maryland’s Court of Appeals has issued a ruling holding adults who provide alcohol to underage drinkers responsible for any deaths and injuries that occur as a result. The ruling follows several years of deliberation by the Maryland General Assembly on how to penalize adults who hold parties and supply alcohol to underage drinkers. The court stated that, “Children under 21 are often less able to make responsible decisions regarding the consumption of alcohol and, as a result, are more susceptible to harming themselves or others when presented with the opportunity to drink . . . The adult increases the risk of harm to themselves and others by facilitating the improper conduct of another.” This is the first time the Maryland Court of Appeals has addressed “social host liability”—referring to individuals who negligently serve alcohol. Maryland’s legislature passed a bill increasing fines and jail time for adults providing alcohol to underage drinkers last May.

Read more about this story here.

Around the Agencies

ASPE issues report examining the effects of the Affordable Care Act’s Medicaid expansion in 2014 and 2015
Last month the Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report examining the effects of the Affordable Care Act’s (ACA) Medicaid expansion. The report is broken down into four sections: 1) examining the evidence to date on the impact of Medicaid expansion on health insurance coverage; 2) exploring the impact on beneficiaries by examining access to care and utilization; 3) examining research to date on affordability; and 4) examining quality including enrollee financial well-being, satisfaction and experience. Key findings include that Medicaid expansion States experienced a 9.2 percent reduction in the number of uninsured adults, compared to a 7.9 percent reduction in non-expansion States. ASPE’s report also finds that Medicaid expansion has increased access to primary care and prescription medicine, and that low-income adults reporting problems paying medical bills declined by 10.5 percent, from 34.7 percent pre-expansion to 24.2 percent post-expansion.

Read the full report here.

CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths
The Centers for Disease Control and Prevention (CDC) issued a report last week examining the relationship between methadone sales, diversion, and overdose deaths. The report, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), highlights the study performed by Dr. Chris Jones, Director of the Division of Science Policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS. The report’s main findings include that methadone overdose rates for most demographics peaked between 2005 and 2007 before declining in subsequent years. The observed decline in methadone overdose rates is suggested to be a result of national and State actions reducing the use of methadone in pain treatment. The report concludes that methadone-related harms may be further reduced by implementing additional clinical guidelines restricting the use of methadone for pain, increasing the use of care coordination plans, and strengthening public health policies for pain management.

Read the full report here.

In the News

Obama Administration issues final rule on MAT for opioid use disorders

Last week the Administration released its final rule on Medication-Assisted Treatment for Opioid Use Disorders, which allows eligible practitioners to request approval to treat up to 275 patients. Before being able to treat 275 patients, qualified practitioners must undergo a one year trial period where they are only allowed to treat a maximum of 30 patients at a time.

The final rule can be found here.

House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
The House of Representatives passed the conference report for the Comprehensive Addiction & Recovery (CARA; S. 524) with a vote of 407-5 on Friday afternoon. During floor statements preceding the vote, House Democrats reiterated the need for funding to address the opioid crisis, but ultimately showed support for the bill and indicated the need for resources to be allocated through the regular appropriations process. The bill now requires a vote by the Senate. Senate Majority Leader Mitch McConnell (R-KY) has indicated that he hopes to hold a vote on the conference report before adjourning for recess this week.

As a reminder, the bill includes the following provisions that NASADAD has been tracking throughout the legislative process, among many others:

  • Evidence-Based Prescription Opioid and Heroin Treatment and Interventions Demonstration: The bill authorizes a grant within CSAT for State substance abuse agencies, local governments, nonprofit organizations, and tribes to support treatment for opioid use disorders where medication-assisted treatment is an allowable use of funds.  This mirrors the current CSAT “MAT-PDOA” grant. For the current fiscal year, the MAT-PDOA grant is receiving $25 million.  The President proposed $50 million for FY 2017, and the Senate Appropriations has proposed $60 million in FY 2017.  However, in the conference report, there is only an authorization of appropriations of $25 million (level with FY 2016). NASADAD expressed the importance of authorizing this program for at least $60 million in CARA (to align with Senate Appropriations Committee’s recommendation), but NASADAD will continue to track the appropriations process as it relates to MAT-PDOA and other priority programs.
  • Improving Treatment for Pregnant and Postpartum Women: This provision reauthorizes the residential services for pregnant and postpartum women program (PPW) grant program within SAMHSA’s Center for Substance Abuse Treatment (CSAT).  This program supports family-centered substance use disorder services for women and young children in residential settings. This provision would also create a pilot program for State substance abuse agencies to use up to 25 percent of 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.  The legislation would require SAMHSA to lead a process in which State substance abuse agencies, experts in addiction services, and others would meet to develop the new application for the pilot program. A section-by-section summary of the bill as originally introduced can be found here.

The conference report language includes the House “trigger” language, in which the pilot program would not move forward unless funding for the PPW program is above the FY 2016 level ($15.9 million). The conference report would authorize $16.9 million for FY 2017 through FY 2021. Language has also been added that would give award prioritization for the residential services grant program to programs serving rural areas, areas with a health professional shortage, and areas with a shortage of family-based treatment options. Additionally, language has been added that would require the report to Congress on outcomes of the pilot program to also include a recommendation by the Director of CSAT as to whether the pilot program should be extended beyond 5 years.

  • Opioid Use Disorder Treatment Modernization (Buprenorphine Prescribing): Prior to finalizing the conference report, the House and Senate had markedly different proposals regarding the buprenorphine patient limit cap. The House version would have allowed physician assistants (PAs) and nurse practitioners (NPs) to prescribe for three years, and  included a non-binding “Sense of the Congress” that the cap should be raised to 250. The Senate version would permit PAs and NPs to prescribe with no time limit, and it proposed raising the cap to 500 patients, but would require physicians to (1) participate in the State’s PDMP; (2) completed 24 hours of training; (3) maintain records on whether on-site counseling services are provided and the extent such services are provided; the extent to which practitioners refer patients to counseling services off-site and the percentage of patients using such services; the number of times patients terminate services against medical advice; and other data.

The language included in the conference report does not change the current bupe cap of 100 (30 in the first year), but it does include language stating that the Secretary of HHS may change the cap by regulation. The conference report also amends the Controlled Substances Act by adding to the category of “qualifying practitioner” a nurse practitioner or physician assistant who satisfies various criteria.

Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
The House of Representatives passed the Helping Families in Mental Health Crisis Act (H.R. 2646) by Rep. Tim Murphy (R-PA) last week with a vote of 422-2. Some of the provisions in the bill that impact the substance use disorder field include: 1) the creation of an Assistant Secretary for Mental Health and Substance Use Disorders, who would assume all the authorities of the SAMHSA Administrator; 2) establishment of a National Mental Health and Substance Use Policy Laboratory that would assume the authorities of the Office of Policy, Planning, and Innovation (OPPI); and 3) amending the section of the Public Health Service Act that authorizes the Center for Substance Abuse Treatment (CSAT) to use “substance use disorders” instead of “substance abuse,” and to incorporate person-first language where appropriate.

National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
The National Governors Association (NGA) released a resource detailing State efforts to combat the opioid epidemic last week. The resource, titled “Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States,” aims to help officials determine new policies to address the opioid epidemic in their own States by providing background information on the epidemic, steps to address the crisis, and a summary of evidence-based health care and public safety strategies to reduce the prevalence of opioid misuse and overdose. The resource also includes an appendix containing State data sources and sample State plans for addressing the opioid epidemic.

The NGA plans to continue discussing next steps for addressing the growing prevalence of opioid overdoses at their upcoming Summer Meeting held in Des Moines, IA between July 14th and July 17th. Health and Human Services (HHS) Secretary Sylvia Burwell will attend the meeting to discuss State strategies.

Access the opioid road map here.

Access more information about the NGA’s Summer Meeting here.

Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
The Legal Action Center released a new guide exploring the Mental Health Parity and Addiction Equity Act (MHPAEA) last month. The guide, titled “Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law” aims to provide a summary of federal parity law and the protections it affords. The Legal Action Center’s guide provides a list of “red-flags” indicating than an insurer may be violating the law, and helps educate consumers about their health insurance coverage plan.

Read more, and download the guide here.

Ellen Weber rejoins Legal Action Center to serve as Vice President for Health Initiatives
The Legal Action Center announced that Ellen Weber, who previously worked at the Legal Action Center from 1985 to 2002, will be rejoining the organization as of July 5th to serve as Vice President for Health Initiatives. Ms. Weber will focus on the Mental Health Parity and Addiction Equity Act’s (MHPAEA) enforcement – as well as State-based health insurance support and other national health care policies. Since her previous time at the Legal Action Center, Ms. Weber has served on the faculty of the University of Maryland Carey School of Law, where she directed the school’s Drug Policy and Public Health Strategies Clinic. Throughout the next year, Ms. Weber plans to continue to work on Maryland health care initiatives in collaboration with the Open Society Institute-Baltimore as a part-time Carey Law School faculty member.

Read the full story 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.

D.C. Update – June 27, 2016

News from NASADAD

  • NASADAD releases updated summary of FY 2017 appropriations for NASADAD’s priority programs
  • NASADAD Annual Meeting slides now available on website

News from the States

  • Ohio Governor John Kasich signs Good Samaritan law protecting those seeking medical help for overdoses

Around the Agencies

  • SAMHSA reintroduces the Substance Abuse and Mental Health Data Archive
  • FDA approves buprenorphine implant for treatment of opioid use disorders
  • HHS releases fact sheet on the opioid epidemic
  • HHS details objectives of its Mental Health and Substance Use Disorder Parity Task Force
  • NIH study reveals the role of endocannabinoids in habit forming behavior
  • CDC releases results from the 2015 National Youth Risk Behavior Surveillance System Survey
  • NIH study finds rates of nonmedical prescription opioid use and opioid use disorders have doubled in the past decade

In the News

  • Senate names Conferees for Comprehensive Addiction and Recovery Act (CARA)
  • Vera Institute of Justice releases report summarizing State trends in sentencing and corrections from 2014-2015
  • Pew Charitable Trusts report discusses growing prevalence of “sober dorms” in universities
  • New report on strategies for utilizing MAT within drug courts

Upcoming Events

  • Ramstad-Kennedy Award Nominations Due July 8th

News from NASADAD

NASADAD releases updated summary of FY 2017 appropriations for NASADAD’s priority programs
NASADAD has updated its summary of FY 2017 appropriations for NASADAD’s priority programs within the Department of Health and Human Services (HHS) and the Department of Justice (DOJ). The updated summary now contains language from the Senate Appropriations Committee’s report, as well as both Senate and House report language for programs housed within DOJ. For FY 2017, the Senate Appropriations Committee recommends level funding of $1.8 billion for the Substance Abuse Prevention and Treatment (SAPT) Block Grant, a $14 million increase for the Center for Substance Abuse Prevention (CSAP), and an increase of $2.6 million for the Center for Substance Abuse Treatment (CSAT).

Read the full summary here.

NASADAD 2016 Annual Meeting slides now available on website
NASADAD has uploaded slides from the presentations at the 2016 Annual Meeting in Salt Lake City, Utah onto our website. Plenary session topics included: Federal Initiatives on the Opioid Epidemic, SAMHSA/State Efforts to Prevent Opioid Misuse and Overdose, Substance Use Disorder Services for Women and the Family, SSAs in Criminal Justice Reform, Pathways to Recovery Housing, SAMHSA Key Initiatives, Role of the SAPT Block Grant in non-Medicaid Expansion States, and Role of the SAPT Block Grant in Medicaid Expansion States.

Access the slides here.

News from the States

Ohio Governor John Kasich signs Good Samaritan law protecting those seeking medical help for overdoses
Ohio Governor John Kasich has signed a Good Samaritan law, which will provide immunity from arrest, prosecution, or conviction to individuals seeking medical help as a result of a drug overdose. The bill (HB 110) also requires emergency medical services to “report the administration of naloxone on request of a law enforcement agency in specified circumstances and for specified purposes.”

Read more about the legislation here.

Around the Agencies

SAMHSA reintroduces the Substance Abuse and Mental Health Data Archive
The Substance Abuse and Mental Health Services Administration (SAMHSA) reintroduced the Substance Abuse and Mental Health Data Archive (SAMHDA) late last month. The enhanced SAMHDA website provides centralized access to several public use databases related to substance use disorders, including the National Survey on Drug Use and Health (NSDUH) and the Treatment Episodic Data Set – Admissions (TEDS-A). SAMHSA plans to continue updating the archive throughout this year by adding an online analysis tool in late summer 2016 and providing approved researchers access to restricted-use data in early winter 2016.

Access the SAMHDA website here.

FDA approves buprenorphine implant for treatment of opioid use disorders
The U.S. Food and Drug Administration (FDA) has approved the first buprenorphine implant for the treatment of opioid use disorders. The implants, named Probuphine, “provide constant, low-level doses of buprenorphine to patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program.” Probuphine is administered through the surgical implantation of four, one-inch rods under the skin of the patient’s inside upper arm. The unique nature of the implants requires specific training through the Probuphine Risk Evaluation and Mitigation Strategy (REMS) program administered by the FDA.  Clinical trials examining the effects of Probuphine demonstrated the implants’ success, with 63 percent of Probuphine-treatment patients exhibiting no signs of illicit opioid use throughout the six month treatment period.

Read the full story here.

HHS releases fact sheet on the opioid epidemic
The Department of Health and Human Services (HHS) has released a fact sheet on the opioid crisis. The fact sheet features several maps displaying drug overdose and opioid misuse rates throughout the United States, stating that the opioid epidemic has a $55 billion impact on health and social costs each year. The fact sheet goes on to evaluate and discuss next steps for HHS’s opioid initiative. While HHS successfully designed several grant programs to aid States most acutely affected by the opioid epidemic, the fact sheet notes that more work remains.

Read the full fact sheet here.

HHS details objectives of its Mental Health and Substance Use Disorder Parity Task Force
The Department of Health and Human Services (HHS) detailed the objectives of its Mental Health and Substance Use Disorder Parity Task Force on its webpage earlier this month. The Task Force was created in March 2016 via a memorandum signed by President Obama. The Task Force’s objectives include increasing the awareness of protections provided by federal mental health and substance use disorder parity laws, improving the understanding of parity among health plans, insurers, and State regulators, and increasing the transparency around compliance with parity. The White House Domestic Policy Council, the Department of the Treasury, the Department of Defense, the Department of Justice, the Department of Labor, the Department of Health and Human Services, the Department of Veterans Affairs, the Office of Personnel Management, and the Office of National Drug Control Policy comprise the Task Force. The Task Force will submit its findings in a report to the White House by October 31, 2016.

Read more about the Mental Health and Substance Use Disorder Parity Task Force here.

NIH study reveals the role of endocannabinoids in habit forming behavior
A study published by the National Institutes of Health earlier this month reveals the relationship between endocannabinoids and habit forming behavior. The study was conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in an effort to understand previously unknown brain functions that regulate habitual behaviors. The NIAAA’s study used mice to demonstrate that endocannabinoid receptors in the brain influence the prevalence of habit forming behavior. Mice with endocannabinoid receptors used habitual responses to obtain food rewards, while those with the endocannabinoid receptors removed used “goal-directed” responses instead. The authors of the study assert that it demonstrates “the existence of parallel brain circuits that mediate goal-directed and habitual behaviors,” and could explain how marijuana affects memory and decision making.

Read the full study here.

CDC releases results from the 2015 National Youth Risk Behavior Surveillance System Survey
The Centers for Disease Control and Prevention (CDC) released results from the 2015 National Youth Risk Behavior Surveillance System (YRBSS) survey last week. The YRBSS monitors a range of health risk behaviors among high school students at the national, State, and local levels by conducting surveys among representative samples every two years, with students in 37 different State and 19 large urban school districts participating in the 2015 survey. The results indicate that while current cigarette use has decreased from 28 percent in 1991 to 11 percent in 2015, e-cigarette use among high school students is on the rise, with 24 percent reporting use in the past 30 days. The survey further finds that high school students reporting past-month alcohol consumption has decreased from 50.8 percent in 1991 to 32.8 percent in 2015.

Read the full results here.

NIH study finds rates of nonmedical prescription opioid use and opioid use disorders have doubled in the past decade
A National Institutes of Health (NIH) study examining the rates of nonmedical prescription opioid use and opioid use disorders in the United States has found that both have nearly doubled in the past decade. The study, conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), found that “10 million Americans, or 4.1 percent of the adult population, used opioid medications in 2013-2013 without a prescription or not as prescribed in the past year.” The study notes that this is an increase from the 1.8 percent reporting nonmedical use in 2001-2002. Over 2 million adults, or 0.9 percent of the adult population, reported symptoms of nonmedical opioid use disorder in 2012-2013.

Read more about the study here.

In the News

Senate names Conferees for Comprehensive Addiction and Recovery Act (CARA)
On June 16th the Senate voted 95-1 in favor of going to conference on the Comprehensive Addiction and Recovery Act (CARA; S. 524). The Senate conferees will work with the House conferees to send the final version of the opioids bill to the President. Senate conferees include chairmen and ranking members from the Judiciary Committee [Sen. Grassley (R-IA) and Sen. Leahy (D-VT)]; the Health, Education, Labor and Pensions Committee [Sen. Alexander (R-TN) and Sen. Murray (D-WA)]; and the Finance Committee [Sen. Hatch (R-UT) and Sen. Wyden (D-OR)]; as well as Majority Whip John Cornyn (R-TX), and Sen. Jeff Sessions (R-AL). The House conferees include: Reps. Goodlatte (R-VA), Sensenbrenner (R-WI), Smith (R-TX), Marino (R-PA), Collins (R-GA), Trott (R-MI), Bishop (R-MI), Upton (R-MI), Pitts (R-PA), Lance (R-NJ), Guthrie (R-KY), Kinzinger (R-IL), Bucshon (R-IN), Brooks (R-IN), Barletta (R-PA), Carter (R-GA), Bilirakis (R-FL), Walorski (R-IN), Pallone (D-NJ) , Conyers (D-MI), Scott (D-VA) , McDermott (D-WA), Green (D-TX), Jackson Lee (D-TX), Courtney (D-CT), Cohen (D-TN), Sarbanes (D-MD), Luján (D-NM), Chu (D-CA), Esty (D-CT) , Kuster (D-NH), and Ruiz (D-CA).

During the vote, the Senate also approved a measure by Sen. Shaheen (D-NH) that instructs the conferees to insist that the final conference report include funding for the opioid crisis. There is no guarantee that the final report will include language related to funding, but Sen. Shaheen’s motion—which passed with a vote of 66-29—conveyed a message that funding is crucial for State and local prevention, treatment, and recovery efforts.

Vera Institute of Justice releases report summarizing State trends in sentencing and corrections from 2014-2015
The Vera Institute of Justice has released a report summarizing State trends in sentencing and corrections policy during 2014 and 2015. The report finds that 46 States made at least 201 changes to sentencing and corrections laws during this time, an increase over the 85 bills passed in 35 States in 2013. The Vera Institute reports that most of these 201 changes can be placed into three main categories: “1)creating or expanding opportunities to divert people away from entering the system; 2) reducing prison populations by making certain offenses eligible for community-based sentences, reducing the length and severity of custodial sentences, adding early release options, and reducing the number of people re-admitted for violating probations or parole; and 3) supporting reentry into the community for those leaving prison.”

View a summary of Vera’s report here.

Read Vera’s full report here.

Pew Charitable Trusts report discusses growing prevalence of “sober dorms” in universities
The Pew Charitable Trusts issued a report earlier this month discussing the growing prevalence of “sober dorms” in universities throughout the country. The article discusses the difficulties many college students face in maintaining recovery while attending college. More than 35 percent of American college students report having more than five drinks in one sitting in the past two weeks, compared to 29 percent of their non-college peers. In addition, “daily marijuana use among full-time college students has more than tripled in the past 20 years.” In response to this growing problem, States have begun passing legislation and creating programs facilitating the ability of students to live in “sober dorms” during their time at school. In 2014, New Jersey Governor Chris Christie signed a law requiring that all State colleges in New Jersey offer sober housing if at least one quarter of students reside on campus. The University of Vermont launched a similar program in 2010 through its Catamount Recovery Program for students in recovery. Other universities, while not creating sober housing, have begun investing in recovery initiatives to aid students in need.

Read the full report here.

New report on strategies for utilizing MAT within drug courts
The Center for Court Information, the Legal Action Center, and the New York State Unified Court System’s Office of Policy and Planning have released a new report discussing recommended strategies for the utilization of medication-assisted treatment (MAT) within drug courts. The report contains profiles of three New York State drug courts (each in a different region of the State), as well as nine components of successful MAT programs. These components include the provision of counseling and other services, strong relationships and regular communication with treatment programs, monitoring for the illicit use and diversion of MAT medication, and ensuring judges and court staff fully understand and rely on the clinical judgment of treatment providers. The report additionally highlights problems unique to drug courts located in rural areas.

Read the full report here.

Upcoming Events

Ramstad-Kennedy Award Nominations due July 8th
The Ramstad-Kennedy Award was established in 2008 to recognize a Single State Authority (SSA) Director who has demonstrated outstanding leadership in support of recovery and National Recovery Month, and to acknowledge Congressmen Ramstad and Kennedy for their commitment to recovery and recovery-oriented policies. This year’s Ramstad-Kennedy award will be presented on August 10th, 2016 at the 2016 SAMHSA National Block Grant Conference. Selection is based on the following criteria: a State Director who as provided outstanding leadership and innovation in promoting the goals of National Recovery Month in their State; strengthened and expanded Recovery Month activities within their agency and throughout other State agencies; provided support to strengthen and expand Recovery Month activities throughout their State; expanded the number and impact of National Recovery Month activities in their local communities; and encouraged and expanded recovery organizations in their State.

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.