News from NASADAD

• NASADAD attends briefing on health care incentives
• NASADAD attends briefing on trauma-informed care
• NASADAD attends briefing on the international impacts of changing marijuana policies in the US

Around the Agencies

• CMS announces new model for ACOs in Medicare
• CMS announces effort to help enrollees in the new Marketplace stay covered

Capitol Hill News

• Senator Markey releases report on prescription drug and heroin epidemic

In the News

• National Safety Council releases white paper on pain medication efficacy

 

News from NASADAD

NASADAD attends briefing on health care incentives

Thomas Friedlander, Public Policy Intern attended the briefing, “Incentives 2.0: Is Paying for Performance Enough?” on October 14^th, hosted by the Commonwealth Fund and the Alliance for Health Reform. The briefing discussed how to make the “pay-for-performance” (P4P) system of incentives work among diverse health care systems. Panelists discussed the “Incentives 2.0” approach, which takes into account behavioral economics such as risk aversion, uncertainty, and organizational culture. “Incentives 2.0” also features a rewards system that encourages more consistent improvement over single-payment programs, which panelists argued did not promote health care responses.

Moderators:

Ed Howard, Alliance for Health Reform

Anne-Marie Audet, the Commonwealth Fund

Panelists:

Ashish Jha, Harvard School of Public Health

Ateev Mehrotra, Harvard Medical School

Patrick Herson, Fairview Medical Group

NASADAD attends briefing on trauma-informed care

Colleen Haller, Public Policy Associate and Shalini Wickramatilake-Templeman, Research Analyst attended the briefing, “Trauma-Informed Care: Change the Culture to Change the Outcome,” on October 14^th hosted by the American Institutes for Research. The briefing discussed the impact of traumatic stress events, and how failing to properly address these events can lead to long-term damaging health effects. In light of this, providers have been working on a model for “trauma-informed care,” which can help improve outcomes for traumatic stress survivors. Distinct from trauma-specific clinical services that treat survivors’ symptoms, trauma-informed care is an organizational structure that understands, recognizes, and responds to all the effects of trauma. Panelists discussed the specifics of trauma-informed care, as well as the impact of successfully implemented trauma-informed approaches. Panelists also addressed the projected needs for implementation and the cultural and organizational changes one may expect from trauma-informed care.

Moderator:

Jane Stevens, Aces too High News

Panelists:

Larke N. Huang, Substance Abuse and Mental Health Services Administration (SAMHSA)

Cheryl Sharp, National Council for Behavioral Health (NCBH)

Bonnie Stone, Women in Need (WIN)

NASADAD attends briefing on the international impacts of changing marijuana policies in the US

Colleen Haller, Public Policy Associate attended the event, “International Impacts of the U.S. Trend towards Legal Marijuana,” hosted by The Brookings Institution on October 17^th. The panelists discussed the international implications of changes to marijuana policies in some US States. The panelists particularly discussed the impacts of US drug policies in various Latin American countries and how changes in the US marijuana policy landscape have prompted similar discussions in parts of Central and South America. The panelists also raised questions about how changes in US policy related to marijuana and other illicit drugs affect international drug control treaties, of which the US is a signatory.

Moderator:

John Walsh, Senior Associate, Washington Office on Latin America

Panelists:

Wells Bennett, Fellow, Governance Studies, The Brookings Institution

Sandeep Chawla, Former Deputy Executive Director and Director of Research and Policy, UN Office on Drugs and Crime

Martin Jelsma, Director, Drugs and Democracy Program, Transnational Institute

Lisa Sanchez, Program Manager, Mexico Unido Contra la Delincuencia and Transform Drug Policy Foundation

Around the Agencies

CMS announces new model for ACOs in Medicare

The Centers for Medicare & Medicaid Services (CMS) announced the availability of a new investment model for accountable care organizations (ACOs) in the Medicare Shared Savings Program on October 15^th. The new model will give ACOs in Medicare more flexibility in setting goals for quality and financial goals. Under the new model, the CMS Innovation Center will invest $114 million in up to 75 ACOs across the country. CMS will recover this investment through an offset of an ACO’s earned shared savings. ACOs that joined the Shared Savings Program in 2012, 2013, 2014, and 2016 will be eligible to apply for funds (AHA News Now).

CMS announces effort to help enrollees in the new Marketplace stay covered

The Centers for Medicare & Medicaid Services (CMS) announced the beginning of a communications effort to ensure that consumers enrolled in coverage in the new Marketplace know how to renew their coverage for 2015. Consumers will begin receiving notices that explain the renewal process and how they can return to the Marketplace from November 15^th to December 15^th (open enrollment) to update their application and review policies to make sure they choose the best plan. In addition to mailed notices, CMS will also use email, digital marketing efforts, and telephone calls. CMS also developed the 5 Steps to Staying Covered: Review, Update, Compare, Choose, and Enroll and released a two-page consumer fact sheet.

Capitol Hill News

Senator Markey releases report on prescription drug and heroin epidemic

Senator Edward Markey (D-MA) released a comprehensive report outlining a federal strategy to combat the growing drug epidemic in the US. The report, titled, “Overdosed: A Comprehensive Federal Strategy for Addressing America’s Prescription Drug and Heroin Epidemic,” focuses primarily on opioid painkillers, which have shown the most dramatic increase in abuse and overdose over the last several years. The report is organized into three categories: Prevention, Treatment, and Enforcement. In this report, Senator Markey recommends many policies which have shown positive results, such as take-back programs and expanding Medicaid coverage.

In the News

National Safety Council releases white paper on pain medication efficacy

The National Safety Council (NSC) released a white paper titled, “Evidence for the Efficacy of Pain Medications,” which discusses alternatives to highly addictive opioid medications in treating acute pain. The paper states that over-the-counter pain medications, such as ibuprofen and acetaminophen, are more effective under some circumstances than prescription painkillers. This paper coincides with the recent Drug Enforcement Administration’s (DEA) reclassification of hydrocodone products from Schedule III to Schedule II, making them harder to prescribe and to obtain. While opioid painkillers have been shown to be effective in certain treatment processes, the paper argues that the risk of addiction and the increasing number of opioid-based overdoses strengthens the logic behind alternative medications. You can also access a short version of the paper.

News from NASADAD

• NASADAD releases section-by-section analysis of opioid treatment bill by Rep. Foster (D-IL)
• NASADAD attends panel discussion on tobacco sales

Around the Agencies

• Hospitals urge DEA to delay substance disposal requirements
• HHS to host a webinar on quality of life for patients with chronic conditions
• ONDCP hosts substance abuse prevention Twitter chat
• Toxicology associations release joint statement on naloxone
• SAMHSA publishes paper on trauma and trauma-informed care
• CDC releases data on alcohol involvement in drug overdose

News from the States

• New Jersey Governor signs executive order establishing task force to address addiction – Promotes battle against stigma
• NASADAD members present at National Academy of State Health Policy (NASHP) in Atlanta, GA

In the News

• Wall Street Journal publishes article on efforts to develop safer Zohydro formulation
• Republicans urge against taxpayer spending on insurance risk corridor program

 

News from NASADAD

NASADAD releases section-by-section analysis of opioid treatment bill by Rep. Foster (D-IL)

NASADAD released the analysis of a bill introduced by Rep. Foster (D-IL) in August. The bill, the “Expanding Opportunities for Recovery Act of 2014,” was co-sponsored by Rep. Etsy (D-CT), Rep. Maloney (D-NY), Rep. Ryan (D-OH), and Rep. Shea-Porter (D-NH). The legislation would authorize the Substance Abuse and Mental Health Services Administration (SAMHSA) to award grants to States to increase access to treatment for substance use disorders. Grants would be administered by State substance abuse agencies. Services to be expanded must be evidence-based, including medication-assisted treatment, and must be clinically appropriate. Grant-funded services would be provided to individuals without health insurance or with insurance that does not adequately cover the services. The bill also states that grant funds may not be used to pay for the cost of more than 60 consecutive days of substance use disorder treatment.

NASADAD attends panel discussion on tobacco sales

Colleen Haller, Public Policy Associate attended the round table discussion, “‘Counter’ Marketing: An In-Depth Look at Tobacco Retail Sales,” on October 7^th, hosted by Legacy as part of their Warner Series. The panelists discussed the implications of tobacco sales in a retail environment, as well as practices used by tobacco companies to promote retail sales. The panelists also discussed challenges to addressing tobacco sales, such as cheap, flavored cigars marketed towards minors and young adults. The discussion featured Elizabeth Kilgore, Director of Communications for the New York City Department of Health and Mental Hygiene, who provided a local perspective, and Larry Merlo, President and CEO of CVS Health which recently went tobacco-free.

Moderator:

Toni Clarke, FDA Reporter, Reuters

Panelists:

Larry Merlo, President and CEO, CVS Health

Thomas R. Kirchner, Schroeder Institute for Tobacco Research and Policy Studies

Kurt Ribisl, PhD, Professor of Health Behavior, University of North Carolina

Elizabeth Kilgore, New York City Department of Health and Mental Hygiene

Around the Agencies

Hospitals urge DEA to delay substance disposal requirements

The American Health Association (AHA) and several other organizations wrote a letter, expressing their concern over upcoming Drug Enforcement Administration (DEA) requirements for controlled substance disposal, set to take effect on October 9^th, 2014. The letter, written on October 6^th, describes how the proposed changes in requirements would leave over 5,000 hospitals and health systems unprepared to handle their communities’ drug disposal. While the AHA supports the requirements issued by the DEA, many hospitals currently lack the necessary technology such as incinerators or safe syringe disposal programs to properly implement the new requirements. The AHA concluded the letter by asking for a reasonable delay as well as a meeting with the DEA to discuss a timetable of implementation.

HHS to host a webinar on quality of life for patients with chronic conditions

The Department of Health and Human Services (HHS) will host a webinar focused on improving the health and quality of life for individuals with multiple chronic conditions (MCC) at 2:00 pm EST on Thursday, October 16^th. HHS estimates that one quarter of adult Americans – and two thirds of Medicare beneficiaries – are living with MCC. These individuals also account for two thirds of the nation’s health care costs. This webinar will discuss the health care challenges in managing MCC, HHS progress in improving the health and quality of life for persons with MCC, and well as opportunities to incorporate efforts for individuals with MCC into larger HHS programs. The webinar will feature experts from the Centers for Medicare & Medicaid Services (CMS), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

To join the webinar on October 16^th, please use this link and dial-in information: https://www.mymeetings.com/nc/join.php?i=PW8754886&p=8423024&t=c

Toll Free Number: 800-857-0455

Participant passcode is:  8423024

ONDCP hosts substance abuse prevention Twitter chat

In recognition of National Substance Abuse Prevention Month, the Office of National Drug Control Policy (ONDCP) will be facilitating a Twitter chat at 7:00 pm EST on Tuesday, October 14^th. The discussion will focus on substance abuse prevention among youth, as well as the connection between prevention and academic achievement. Members of the Science and Engineering Festival (USASEF) Youth Advisory Board and the National Youth Leadership Institute (NYLI) will be joining ONDCP for the discussion. The panelists will discuss tips on how to establish and strengthen primary youth prevention in communities.

To participate in the chat on Tuesday night, tweet your questions and replies using the hashtag: #PrevMonth, starting at 7:00pm. Additionally, please sign up for the Twitter chat.

Moderator:

David Mineta, ONDCP

Panelists:

Ritankar Das, USASEF

Jack Andraka, USASEF

Lauren Foisy, NYLI

Toxicology associations release joint statement on naloxone

The American Association of Poison Control Centers (AAPCC), joined with the American Academy of Clinical Toxicology (AACT) and American College of Medical Toxicology (ACMT), released a statement regarding the use of naloxone to prevent deaths from opioid overdose. The organizations expressed their support for expanded naloxone intervention training, including a “Bystander Naloxone Training” program, which would help bystanders learn to administer naloxone at the immediate moment of overdose. The organizations stated that the fear of police involvement prevents many people from calling 911 during a drug overdose, making naloxone bystander training even more important so that friends and family members can respond to an overdose regardless of their fear of calling 911.

SAMHSA publishes paper on trauma and trauma-informed care

The Substance Abuse and Mental Health Services Administration (SAMHSA) released the paper titled “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach,” on October 7^th, 2014. The paper describes a framework for SAMHSA’s concept of trauma which can be understood and applied by researchers, practitioners, and trauma survivors alike. The paper also describes how a provider can become trauma-informed, and how this understanding can be adapted to many service sectors such as education, health care, and criminal justice. The paper also includes extensive guidelines for implementing a “Trauma-Informed Approach,” using ten implementation domains.

CDC releases data on alcohol involvement in drug overdose

The Centers for Disease Control and Prevention (CDC) released data suggesting a correlation between alcohol use and drug overdose. The data was collected from emergency departments (ED) across 13 states, and focuses on alcohol’s connection to Opioid Pain Reliever (OPD) and Benzodiazepine abuse-related ED visits and drug-related deaths. The study revealed that alcohol was involved in 18.5% of OPR and 27.2% of Benzodiazepine abuse-related ED visits. Furthermore, the data shows that alcohol was involved in over 21% of drug-related deaths for both drug categories. The CDC suggests that education initiatives and intervention methods must be strengthened to lower this statistic.

News from the States

New Jersey Governor signs executive order establishing task force to address addiction – Promotes battle against stigma

Governor Chris Christie of New Jersey signed Executive Order Number 163 creating the “Facing Addiction Task Force.” According to the announcement, the taskforce will help “…develop a strategy to destigmatize, prevent, and treat the disease of addiction with a comprehensive and multi-faceted approach.” Some specific responsibilities of the taskforce include (1) developing additional strategies to reduce the stigma associated with addiction; (2) reviewing the continuum of treatment services and developing recommendations for strengthening the treatment systems; (3) developing additional prevention strategies and efforts in New Jersey; and (4) advising the Governor on matters related to stigma, addiction, and substance abuse. This announcement comes after the launch of a campaign that urges people to share their own stories regarding addiction called #BeAFACE.

NASADAD members present at National Academy of State Health Policy (NASHP) in Atlanta, GA

Kathy Skippen, State Director from Idaho and member of the NASADAD Board of Directors and Hilary Jacobs (MA), member of the Opioid Treatment Network (OTN) and owner of www.dryeyesclinic.co.uk/blepharitistreatment participated in a panel held at the NASHP held in Atlanta, Georgia. The panel was titled “State Innovations in Preventing, Managing, and Treating Substance Abuse.” Other panelists included Jane Beyer of Washington State and Tami Mark of Truven Analytics. Ms. Jacobs discussed work moving forward in Massachusetts to address the opioid issue while Ms. Skippen discussed actions taking place in Idaho to launch recovery services. Ms. Skippen supported NASADAD’s Department of Research and Program applications to visit Idaho and record Idaho’s work to launch a Statewide recovery community organization. A document was developed that is designed to show Idaho’s experience and allow other States to have access to this information.

In the News

Wall Street Journal publishes article on efforts to develop safer Zohydro formulation

The October 1^st article reports that the makers of the opioid painkiller, Zohydro ER are developing a new version of the drug they hope will prevent misuse. Zohydro ER, made by Zogenix Inc. contains a high dose of pure hydrocodone, raising concerns about its safety and potential for misuse. This new version of the drug contains a gel that makes it more difficult to use by injecting or snorting it. Zohydro ER, which is designed to provide relief for more long-lasting pain, has sparked controversy since it was approved by the FDA last fall despite objections by its advisory committee.

Republicans urge against taxpayer spending on insurance risk corridor program

A group of Senate Republicans wrote a letter urging Speaker John Boehner (R-OH) to “prohibit the Obama Administration,” from spending money on, “an Obamacare taxpayer bailout.” The letter sources opinions from the Government Accountability Office (GAO), which stated that additional funding authority would be necessary to facilitate payments to insurance companies under the Affordable Care Act’s risk corridor program. The law establishes a temporary risk corridor program where both gains and losses on insurance premiums are shared between the Department of Health and Human Services (HHS) and the insurance companies in an effort to keep health insurance premiums stable during the transition to the new Marketplaces. Without additional authority, the Republicans cite fears that taxpayers will bear the burden of insurance company payments. The Senators wrote that without appropriation, any money spent to cover insurance company losses would be unlawful. The GAO states that under 2014 appropriations, the program is lawful, but would need to be included in the 2015 appropriation statement as well.

October 13, 2014

NASADAD releases section-by-section analysis of comprehensive SUD bill by Sens. Portman (R-OH) and Whitehouse (D-RI)

The bill, the “Comprehensive Addiction and Recovery Act of 2014 (S. 2839),” was introduced by Senator Rob Portman (R-OH) and Senator Sheldon Whitehouse (D-RI) on September 17^th. Senator Amy Klobuchar (D-MN), Senator Kelly Ayotte (R-NH), and Senator Patrick Leahy (D-VT) co-sponsored the legislation. In announcing the bill, Sen. Portman said, “We’ve learned that we can’t keep people from falling into the traps of addiction through a top-down, one-size-fits-all approach…We need a comprehensive strategy that starts from the grassroots up.” Senator Whitehouse echoed Mr. Portman’s sentiments saying, “In Rhode Island, more than 100 people have died from drug overdoses already this year. This legislation identifies a series of specific steps that will help us combat addiction and support those in recovery, and provides the tools needed for States and local governments…It’s a comprehensive approach to a problem that demands our full attention.”

The bill includes six titles and a variety of initiatives related to prevention, treatment, recovery, criminal justice, and fatal overdose prevention. The provisions address a wide range of topics including prescribing best practices; treatment alternatives to incarceration; medication-assisted treatment; recovery services for youth and recovery communities; population-specific initiatives that focus on pregnant and parenting women, families, veterans, and individuals involved in the criminal justice system; and other comprehensive approaches to reducing opioid misuse. Some key provisions include the following:

• Evidence-Based Opioid and Heroin Treatment and Interventions Demonstration: This grant program would be housed within the Center for Substance Abuse Treatment (CSAT) in the Substance Abuse and Mental Health Services Administration (SAMHSA). The program would allow the Director of CSAT to award grants to agencies or organizations, including State substance abuse agencies, to expand access to evidence-based substance use disorder treatment, including medication-assisted treatment. The bill authorizes $10 million for fiscal year 2016 and any additional funds deemed necessary for each of the fiscal years 2016-2020.
• Competitive Grants to Address Opioid and Heroin Abuse by Pregnant and Parenting Female Offenders: This grant program would be jointly awarded to a State substance abuse agency and State criminal justice agency to expand State services for pregnant and parenting female offenders who use opioids, heroin, and other drugs. The two agencies may use grant funds to facilitate or enhance collaboration between the two agencies in order to carry out programs that address the use of opioids by pregnant and parenting women offenders. The bill authorizes $5 million for each of the fiscal years 2016-2020.
• Law Enforcement Naloxone Training Implementation Pilot: This grant program would make grants available to create law enforcement pilot programs to prevent opioid overdose deaths. State, local, or tribal law enforcement agencies would be eligible to apply for grants to be used to purchase naloxone, train and provide resources for law enforcement officers on carrying and administering naloxone, and establish mechanisms for referrals to treatment. Applicants must describe how law enforcement agencies would coordinate with their State substance abuse agency to identify protocols and resources that are available to victims and families, including information on treatment and recovery resources. The bill authorizes $5 million for each of the fiscal years 2016-2020.
• National Education Campaign: This grant program would award grants to States, units of local government, or nonprofit organizations to expand educational efforts to prevent substance abuse, understand addiction as a chronic disease, and promote treatment and recovery. The educational and prevention efforts can be focused on parents and caretakers, teenagers, college students/college-age individuals, adults, and older adults. The funds may be used for primary prevention and/or the promotion of treatment and recovery. The bill authorizes $2.5 million for each of the fiscal years 2016-2020.

The complete section-by-section analysis is available on the NASADAD website and provides a description of all of the initiatives proposed in the bill.