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D.C. Update – June 22, 2015

News from NASADAD

  • NASADAD attends Alliance for Health Reform briefing on small businesses and health reform

Around the Agencies

  • CDC releases report on the provision of naloxone kits to laypersons, finding substantial increase in naloxone use over the past five years

In the News

  • Medicaid and CHIP Payment and Access Commission releases new report focusing on mental health and substance use disorders
  • PDMP Training and Technical Assistance Center releases guide discussing potential PDMP data errors
  • Colorado releases data on adult marijuana use
  • Trust for America’s Health releases new report on injury deaths, finding drug overdoses as leading cause
  • House Energy and Commerce Subcommittee on Health holds hearing on mental health reform legislation

Upcoming Events

  • FDA hosts series of meetings on issues surrounding naloxone
  • Child Welfare League announces 2016 annual conference focusing on the effect of substance use disorders on families

News from NASADAD

NASADAD attends Alliance for Health Reform briefing on small businesses and health reform
Brian Denten, Public Policy Intern, attended the briefing on small businesses and health reform hosted by the Alliance for Health Reform. The briefing featured several panelists speaking on the forthcoming Affordable Care Act (ACA) small business health care expansion. The pending expansion would take effect in 2016, and would redefine small businesses as employers with up to 100 employees.  The current ACA small business provision only applies to companies with 1-50 employees. The expansion would apply the ACA small business regulation to companies with 51-100 employees. Some panelists warned that this expansion would make it difficult for mid-sized firms to provide health care to employees, and suggested that mid-sized firms may leave the insurance marketplace rather than paying potentially higher rates. These panelists advised that the expansion in its current state would raise small group market premiums by 7 percent in 2016, and proposed either delaying the expansion entirely or permanently allowing States to determine the size of the small group market. Other speakers disagreed with this interpretation, believing that the small group expansion will help diversify the risk of the marketplace and eventually result in lower premiums.

Panelists:

  • Sabrina Corlette, Senior Research Fellow and Project Director, Georgetown University’s Center on Health Insurance Reforms
  • Terry Gardiner, Vice President, Small Business Majority
  • Katie Mahoney, Executive Director, Health Policy, U.S. Chamber of Commerce
  • Alissa Fox, Senior Vice President of the Office of Policy and Representation, Blue Cross Blue Shield Association

Around the Agencies

CDC releases report on the provision of naloxone kits to laypersons, finding substantial increase in naloxone use over the past five years
The Centers for Disease Control and Prevention (CDC) released a new report on the provision of naloxone kits to laypersons this past week. The CDC states that organizations providing naloxone kits to laypersons increased substantially over the past five years, with responding organizations increasing by 183 percent, local sites providing naloxone increasing by 243 percent, the number of laypersons provided naloxone kits increasing 187 percent, the number of reversals reported increasing by 160 percent, and a 94 percent increase in States with at least one organization providing naloxone. Despite these large increases, 20 States still do not have any organizations facilitating the provision of naloxone to laypersons. The report finds that the majority of laypersons receiving naloxone kits were people with substance use disorders, and that individuals with substance use disorders performed the majority of reported overdose reversals.

In the News

Medicaid and CHIP Payment and Access Commission releases new report focusing on mental health and substance use disorders
The Medicaid and CHIP Payment and Access Commission (MACPAC) released a new report focusing on mental health and substance use disorders this past week. The report is part of an annual series of MACPAC reports issued to Congress each year. The report discusses the prevalence of mental health and substance use disorders throughout the country, with sections focusing on comorbidity and the use of Medicaid to treat mental health and substance use disorder-related conditions. MACPAC finds that “adult Medicaid enrollees with any mental illness or substance use disorder are more likely to report having worse overall health status than those with private coverage or who are insured.” MACPAC attributes this disparity to differences in the socioeconomic status of Medicaid enrollees versus the rest of the country. The report further finds that 24.2 percent of expenditures for mental health disorders for adults age 18-64 were paid for by Medicaid; and that 24 percent of adults aged 18-64 with Medicaid coverage reported receiving “some mental health treatment during the past year, compared to 14 percent of privately insured and 10 percent of uninsured adults.” This data reflects the importance of Medicaid in increasing access to mental health and substance use disorder services to high-need populations.

PDMP Training and Technical Assistance Center releases guide discussing potential PDMP data errors
The Prescription Drug Monitoring Program (PDMP) Training and Technical Assistance Center (TTAC) released a new guide discussing errors involved with PDMP data collection this past week. The guide was compiled following an October 2014 work group meeting that examined issues surrounding prescription data. TTAC’s new guide explores current PDMP data collection practices, and identifies potential areas in the data collection process where errors may occur.  The guide concludes with a discussion about possible corrective measures for errors and best practices for prescribers, dispensers, and other relevant stakeholders to consider in the future.

Colorado releases data on adult marijuana use
Colorado released a new infographic featuring data on adult marijuana use in 2014 collected from the Colorado Behavioral Risk Factor Surveillance System. The infographic states that 13.6 percent of Colorado adults reported using marijuana during the past month, and of those who currently use, 33.2 percent use marijuana daily. 18.8 percent of marijuana users reported driving after using marijuana. Colorado further found that marijuana use is highest among adults with lower household incomes, and that marijuana use dramatically decreased with age.

Trust for America’s Health releases new report on injury deaths, finding drug overdoses as leading cause
Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) have released a new report on injury deaths in the United States. The report finds that injury deaths are responsible for nearly 193,000 deaths per year, making injuries the leading cause of death for Americans age 1 to 44. TFAH and the RWJF find that drug overdoses are the leading cause of injury death, with nearly 44,000 people overdosing from substances each year. Drug overdose related deaths have more than doubled in the past 14 years. The report states that half of this increase comes from prescription drug overdoses (22,000 deaths per year). Overdose rates have significantly increased in 26 states and Washington, D.C. over the past four years.

House Energy and Commerce Subcommittee on Health holds hearing on mental health reform legislation
The House Energy and Commerce Subcommittee on Health held a hearing on mental health reform legislation this past week. The hearing heard testimony from several current and former elected officials and a variety of other stakeholders. Representative Tim Murphy (R-PA) proposed the Helping Families in Mental Health Crisis Act (H.R. 2646). Representatives asked the panelists about their insight on the proposed law and other issues related to mental health services.

Witnesses:

  • Creigh Deeds, Senator, Senate of Virginia
  • Patrick J. Kennedy, Former U.S. Representative (RI), Founder, Kennedy Forum
  • Jeffrey A. Lieberman, M.D., Chairman, Department of Psychiatry, Columbia University College of Physicians and Surgeons
  • Paul Gionfriddo, President and CEO, Mental Health America
  • Steve Coe, Chief Executive Officer, Community Access
  • Mary Jean Billingsley, Parent, National Disability Rights Network
  • Harvey Rosenthal, Executive Director, New York Association of Psychiatric Rehabilitation Services

Upcoming Events

FDA hosts series of meetings on issues surrounding naloxone
The Food and Drug Administration (FDA) will host a series of meetings on issues surrounding uptake of naloxone in certain medical settings on July 1st and 2nd. The meetings aim to open a public discussion about uptake of naloxone on ambulances and in association with prescriptions for opioid use disorders; in addition to introducing naloxone to new settings to help reduce opioid overdose fatalities. Legal, regulatory, logistical, and clinical aspects related to naloxone availability will also be discussed. The meetings will feature several panels of academic, policy, and industry experts throughout the two days. Rob Morrison, Executive Director, and Colleen Haller, Public Policy Associate, will attend the meetings.

Child Welfare League announces 2016 annual conference focusing on the effect of substance use disorders on families
The Child Welfare League of America (CWLA) in partnership with Children and Family Futures (CFF) will host the CWLA 2016 National Conference on August 1-3, 2016 in Orange County, California. This year’s conference will focus on the effect of substance use disorders on children, youth, and families. CWLA intends for the conference to create increased national awareness of issues surrounding substance use, in addition to promoting multidisciplinary collaboration among stakeholders to advance best practices and policies for families dealing with substance use disorders. The CWLA is currently accepting proposals for presentations at the conference.

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

D.C. Update – June 11, 2015

News from NASADAD

  • NASADAD attends Capitol Hill briefing on opioid use among college students
  • NASADAD releases section-by-section analysis of the Treatment and Recovery Investment Act

Around the Agencies

  • SAMHSA releases report examining impact of Medicaid in providing and increasing access to mental health and substance use disorder services
  • CDC releases new treatment guidelines for those with or at-risk for sexually transmitted diseases
  • GAO issues report on electronic cigarette import volume and tariff revenue
  • CDC issues report on adverse health effects associated with synthetic cannabinoid use

In the News

  • New study examines methadone treatment for incarcerated individuals
  • American Society of Addiction Medicine releases new guidelines for treatment of opioid use disorders
  • Parity Implementation Coalition and Kennedy Forum release new guide on mental health and substance use disorder parity
  • Collaborative for Effective Prescription Opioid Policies publishes USA Today column discussing opioid epidemic
  • Alliance for Health Reform releases recap of King v. Burwell briefing
  • ONDCP Director Michael Botticelli appears on Diane Rehm Show

News from NASADAD

NASADAD attends Capitol Hill briefing on opioid use among college students
Rob Morrison, Executive Director, and Colleen Haller, Public Policy Associate, attended the briefing, “Prevention Opioid Deaths among Young People,” hosted by the Hazelden Betty Ford Foundation Institute for Recovery Advocacy on June 10th. The briefing was well attended and included appearances by several members of Congress: Majority Leader Kevin McCarthy (R-CA), Sen. Sheldon Whitehouse (D-RI), Sen. Klobuchar (D-MN), and Co-Chair of the Prescription Drug Abuse Caucus, Rep. Stephen Lynch (D-MA). The panelists discussed results from a recent survey of college students on their attitudes to drug use, and particularly the misuse of prescription pain relievers. Panelists also shared their personal stories of recovery, as well as their efforts to establish collegiate recovery programs. Greg Williams, Director of the Anonymous People, also highlighted an upcoming national recovery event on the National Mall: UNITE to Face Addiction scheduled for October 4, 2015.

Panelists:

  • William Moyers, Vice President of Public Affairs and Community Relations, Hazelden Betty Ford Foundation
  • Amelia Arria, Director, Center on Young Adult Health and Development at Univ. of MD School of Public Health
  • Sarah Nerad, Director of Recovery, Ohio State University
  • Joseph Lee, Medical Director, Hazelden Betty Ford Foundation’s Youth Continuum
  • Greg Williams, Director of the Anonymous People and Campaign Director for UNITE to Face Addiction
  • Ivana Grahovac, Executive Director, Transforming Youth Recovery

 

NASADAD releases section-by-section analysis of the Treatment and Recovery Investment Act
NASADAD released a section-by-section analysis of the Treatment and Recovery Investment Act this past week. The bill, sponsored by Senator Ed Markey (D-MA), would amend the Public Health Service Act to authorize the Director of the Center for Substance Abuse Treatment (CSAT) to award grants to State substance abuse agencies, units of local government, and Indian tribes or tribal organizations to create or expand substance use disorder services. The legislation would also create separate grant programs for opioid use disorder treatment, treatment for pregnant and parenting women with opioid use disorders, and treatment plans for adolescents with substance use disorders. An additional grant program aimed at expanding and enhancing recovery support services, including education and peer-mentoring networks, is also authorized in the bill. The legislation contains language that would increase the budget authorization for the Substance Abuse Prevention and Treatment Block Grant.

Around the Agencies

SAMHSA releases report examining impact of Medicaid in providing and increasing access to mental health and substance use disorder services
The Substance Abuse and Mental Health Services Administration (SAMHSA) released a new report examining the impact of Medicaid in providing and increasing access to mental health and substance use disorder services. The report was compiled by SAMHSA’s Center for Financing Reform and Innovation, and discusses information on Medicaid fee-for-service spending on prescription drugs. The report further compares spending for dually-eligible Medicare-Medicaid enrollees versus spending for enrollees without dual eligibility. SAMHSA aims to help inform policy makers, program staff, and providers with better knowledge on the spending and utilization of mental health and substance use disorder services.

CDC releases updated treatment guidelines for those with or at-risk for sexually transmitted diseases
The Centers for Disease Control and Prevention (CDC) released new treatment guidelines for those with or at-risk for sexually transmitted diseases (STDs). The guidelines were compiled following a Spring 2013 conference in Atlanta. The new guidelines discuss alternative treatment options for gonorrhea, alternative treatment options for genital warts, best practices for HPV vaccine recommendations and counseling, transgender treatment, and annual testing for hepatitis C for at-risk individuals, among several other topics.

GAO issues report on electronic cigarette import volume and tariff revenue
The United States Government Accountability Office (GAO) has issued a new report on import volume and tariff revenue for electronic cigarettes. The report notes that electronic cigarette import volume and tariff revenue is currently unknown due to the Harmonized Tariff Schedule of the United States (HTS) not tracking data specific to electronic cigarettes or any associated accessories. The GAO does not make any recommendations in its report.

CDC issues report on adverse health effects associated with synthetic cannabinoid use
The Centers for Disease Control and Prevention (CDC) issued a report on the adverse health effects associated with synthetic cannabinoid use this past week. United States poison centers have reported a substantial increase in calls related to synthetic cannabinoid usage in the past year. Calls increased 330% from 349 in January 2015 to 1,501 in April 2015. The most frequently reported adverse health effects include agitation (35.3%), tachycardia or faster than normal heart beat (29.0%), drowsiness (26.3%) and vomiting (16.4%). Most users reported consuming synthetic cannabinoids by inhalation (80.3%) or ingestion (19.5%). The CDC suggests that increasing rates of synthetic cannabinoid usage pose an emerging public health threat.

In the News

New study examines methadone treatment for incarcerated individuals
A new Brown University study has found that individuals taken off of methadone treatment while in custody are “two times less likely than those staying on the medication to return to methadone treatment in the community within a month after release.” The study, led by Josiah Rich, MD, MPH, was performed from 2011-2013 within the Rhode Island Department of Corrections. Researchers randomly assigned inmates to either continue methadone treatment or begin a tapered withdrawal in accordance with existing correctional guidelines. Nearly all of the inmates who continued treatment while incarcerated returned to community clinics within a month after release, while only 20 percent of inmates forced to undergo withdrawal returned to methadone treatment after release. Rhode Island has responded to the findings by adjusting methadone tapering protocols, extending the tapering period from one to six weeks.

American Society of Addiction Medicine releases new guidelines for treatment of opioid use disorders
The American Society of Addiction Medicine (ASAM) released new guidelines for the usage of medication when treating opioid use disorders this past week. The guide aims to educate clinicians and providers about the benefits of using treatment medications for patients in recovery. Despite the medications’ benefits, less than 30% of treatment programs currently offer any medication options in their treatment regimens. ASAM President Jeffrey Goldsmith notes that these guidelines are the first to address all the available FDA-approved medications used to treat opioid use disorders.

Parity Implementation Coalition and Kennedy Forum release new guide on mental health and substance use disorder parity
The Parity Implementation Coalition (PIC) and Kennedy Forum have released a new guide discussing the mental health and substance use disorder parity law. The guide was primarily created to educate individuals seeking mental health or substance use disorder services on their rights and benefits under current parity law. The PIC and Kennedy Forum believe the guide will promote increased communication with insurance plans, in addition to helping resolve disputes with health plans over coverage and reimbursement for mental health and substance use disorder services. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was passed in 2008, with final regulations published in 2013. The PIC and Kennedy Forum continue to strive for better consumer and advocate understanding of the full parity regulations.

Collaborative for Effective Prescription Opioid Policies publishes USA Today column discussing opioid epidemic
The Collaborative for Effective Prescription Opioid Policies (CEPOP) published a USA Today column discussing ongoing efforts to address the opioid epidemic this past week. CEPOP identifies the complexity of the crisis in the column, stating the challenges associated with ensuring access to adequate pain management while balancing the serious risks of addiction associated with these medications. The Centers for Disease Control and Prevention notes that the number of prescribed opioid painkillers has increased substantially in the past several decades, representing a need for robust patient and provider education. CEPOP concludes the column with a call for stakeholders to work together to develop a comprehensive plan to address the epidemic through effective government and private sector solutions.

Alliance for Health Reform releases recap of King v. Burwell briefing
The Alliance for Health Reform has released a recap of last week’s briefing on potential implications of the King v. Burwell ruling. A Supreme Court ruling for the King petitioners would likely eliminate the ability for individuals to receive subsidies to purchase health insurance through federal marketplaces. As of February 2015, 87% of people selecting a marketplace plan receive premium subsidies. According to the briefing, a ruling for the King petitioners would make these subsidies no longer available in States with federally-run marketplaces, and would essentially render any affected health insurance exchanges inoperable. Several speakers noted that affected States may be able to create new State-based exchanges by using other States’ infrastructure or by leasing federal IT services. Republicans are expected to prepare a legislative response to the ruling in the event the King petitioners are successful.

ONDCP Director Michael Botticelli appears on Diane Rehm Show
Michael Botticelli, Director of the White House Office of National Drug Control Policy (ONDCP), appeared on the radio show on June 11th. Director Botticelli shared his personal recovery story, as well as information on ONDCP’s work to expand prevention, treatment, and recovery. Director Botticelli highlighted the supports that assisted his journey to sustained recovery and commented on how the federal government can expand access to those supports. Director Botticelli also discussed the science of addiction, the role of criminal justice reform, and the ways that federal drug policy can make positive changes in the lives of individuals with substance use disorders and their families.

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