News from NASADAD

• NASADAD releases section-by-section analyses of Helping Families in Mental Health Crisis Act and Mental Health Reform Act
• Steve Brazill announced as new NTN in Kansas
• Sarah Mariana announced as new Washington State NPN;  Michael Langer remains as NTN
• NASADAD attends Congressional briefing on the decriminalization of individuals with mental illness
• NASADAD attends Friends of NIAAA briefing on College AIM

News from the States

• New report finds more Alaska teenagers using e-cigarettes than regular cigarettes
• S. District Court ruling highlights State and federal disagreement over medical marijuana
• Ohio announces investment of up to $1.5 million a year into Ohio Automated Rx Reporting System

In the News

• NAATP releases statement on MAT for substance use disorders
• NCADD announces launch of new website

Upcoming Events

• CSH and National Council announce webinar discussing long-term substance use disorder recovery and integrated housing and service solutions

News from NASADAD

NASADAD releases section-by-section analyses of Helping Families in Mental Health Crisis Act and Mental Health Reform Act
Today NASADAD released section-by-section analyses of Rep. Tim Murphy’s (R-PA) Helping Families in Mental Health Crisis Act (H.R. 2646), and Sens. Cassidy (R-LA) and Murphy’s (D-CT) Mental Health Reform Act (S. 1945). The bills both propose a restructuring of the Substance Abuse and Mental Health Services Administration (SAMHSA) by creating a new Assistant Secretary for Mental Health and Substance Use Disorders. Rep. Murphy’s proposed H.R. 2646 will be marked up on November 3^rd and 4^th by the Subcommittee on Health in the House Energy and Commerce Committee.

Steve Brazill announced as new NTN in Kansas
Last week, Steve Brazill was announced as the new NTN representative in Kansas, as previous NTN, Charles Bartlett, announced that he is moving on to a new position. In his new role, Mr. Bartlett’s new duties will include oversight of Consumer Affairs, where he will remain committed to the development of peer support services. Mr. Bartlett will additionally work as the coordinator for forensic services and diversion from the criminal justice system, and as the liaison to the Governor’s Behavioral Health Service Planning Council for coordination and logistics. NASADAD thanks Mr. Bartlett for his contributions to the NTN, and welcomes Mr. Brazill.

Sarah Mariana announced as new Washington State NPN; Michael Langer remains as NTN
Earlier this week, Sarah Mariana was announced as Washington State’s new NPN delegate, effective December 1^st. Ms. Mariana previously led Washington’s Research Conference Program Committee, and has participated in many NPN-related meetings over the past several years. Washington’s previous NPN, Michael Langer, will maintain his role as Washington’s NTN delegate and will work with Ms. Mariana on relevant NPN issues.

NASADAD attends Congressional briefing on the decriminalization of individuals with mental illness

Brian Denten, Public Policy Intern, attended the briefing on Thursday, October 29^th. The briefing heard from a range of mental health and criminal justice professionals on the need for moving mental health treatment out of the criminal justice system and into communities. Once incarcerated, individuals with mental illness spend longer in the criminal justice system than those without mental illness due to safety and health concerns, further exacerbating already existing mental health and substance use disorders. Speakers highlighted the large financial and human costs associated with mental illness in the criminal justice system, as many jails spend up to three times on individuals with mental illness compared to the average prisoner. The briefing concluded with an affirmation of the need for a full continuum of mental healthcare to improve on disjointed mental healthcare delivery and produce better health and societal outcomes.

Speakers:

• Renee Binder, M.D.; Professor and Director of Psychiatry and Law Program, Associate Dean for Academic Affairs at UCSF School of Medicine; President, American Psychiatric Association
• Paton Blough; Mental Health Advocate, NAMI South Carolina State Board Member
• Commissioner Mary Ann Borgeson; Chair, National Association of Counties (NACo) Health Steering Committee
• Sheriff Rich Stanek; Hennepin County Sheriff’s Office
• Robert L. Trestman, M.D. PhD; Professor of Medicine, Psychiatry, and Nursing UConn Health; Executive Director, Correctional Managed Health Care, Interim Director, Center for Public Health and Health Policy

NASADAD attends Friends of NIAAA briefing on College AIM

Robert Morrison and Shalini Wickramatilake attended a Congressional briefing hosted by Friends of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) on the College Alcohol Intervention Matrix, or College AIM. The matrix is a comprehensive and easy-to-use tool to help college staff make informed decisions about evidence-based alcohol interventions. With College AIM, college officials can learn how their current strategies compare to other evidence-based alternatives; find new strategies to consider; and select a combination of approaches that best meets the particular needs of their students and campus.  College officials are in a unique position to improve the health and safety of their students – and they must choose alcohol interventions wisely.

Speakers:

• George F. Koob, Ph.D., Director, National Institute on Alcohol Abuse and Alcoholism, NIH
• Mary Larimer, Ph.D., Director, Center for the Study of Health and Risk Behaviors, University of Washington
• Jonathan Gibralter, Ph.D., President, Wells College, Aurora, NY

News from the States

New report finds more Alaskan teenagers using e-cigarettes than regular cigarettes
A new report released by the Alaska Department of Health and Social Services has found that Alaskan teenagers are using e-cigarettes at higher rates than regular cigarettes. The report was released by Valerie Davidson, commissioner of the Alaska Department of Health and Social Services, at the annual Alaska School Health and Wellness Institute earlier this week.  A Spring 2015 survey conducted as part of the report found that 11 percent of Alaskan high school students reported smoking cigarettes once in the past 30 days compared to 18 percent reporting e-cigarette use in the same time period. Ms. Davidson warned that the variety of e-cigarette flavors appeals to teenagers despite growing evidence that e-cigarettes are as or more harmful than traditional tobacco use. Following the report’s release, a number of advocacy groups – including the AARP, American Lung Association, and the American Heart Association – issued a press release in support of a statewide smoke-free workplace law.

U.S. District Court ruling highlights State and federal disagreement over medical marijuana
A U.S. District Court ruling, issued by Judge Charles R. Breyer in San Francisco, removed a federal injunction against the Marin Alliance for Medical Marijuana this week. Judge Breyer stated that the Justice Department was “defying the will of Congress and improperly intruding on California’s medical marijuana laws” in his decision. The ruling follows four years of legal battles after federal officials closed down the Marin Alliance for Medical Marijuana in 2011. Judge Breyer’s decision is seen as a test of a federal appropriations bill amendment signed by President Obama in 2014 that banned “any expenditure of Justice Department funds to prevent States from implementing laws ‘that authorize the use, distribution and possession of medical marijuana.’”

Ohio announces investment of up to $1.5 million per year into Ohio Automated Rx Reporting System
Ohio’s Governor John Kasich announced an investment of up to $1.5 million per year into Ohio’s prescription drug monitoring program (PDMP) database this past week. The  investment aims to integrate the Ohio Automated Rx Reporting System (OARRS) with electronic medical records and pharmacy information systems throughout the State in an effort to reduce the prevalence of prescription drug diversion and misuse. The investment marks Ohio as the first State to integrate its prescription drug monitoring database Statewide.

In the News

NAATP releases statement on MAT for substance use disorders
The National Association of Addiction Treatment Providers (NAATP) released a statement regarding the use of medication-assisted treatment (MAT) for substance use disorders this week. The statement highlights NAATP’s belief in the importance of evidence-based treatment methods such as MAT in developing a robust continuum of care for individuals with substance use disorders. The NAATP supports “bio-psycho-social-care, including 12-step care and peer driven support” in conjunction with MAT to provide a full spectrum of treatment options.

NCADD announces launch of new website
The National Council on Alcoholism and Drug Dependence (NCADD) announced the launch of its new website this week. The new website compiles a broad array of information about alcoholism and its associated disorders, and connects individuals seeking help with healthcare providers in their local communities. The website further provides a number of recovery stories that highlight successful treatment of alcohol use disorders.

Upcoming Events

CSH and National Council announce webinar discussing long-term substance use disorder recovery and integrated housing and service solutions
CSH: The Source for Housing Solutions and the National Council for Behavioral Health have announced a new webinar discussing long-term substance use disorder recovery and integrated housing and service solutions, to be held on Friday, November 6^th from 1:30 to 2:45 PM EST. The webinar will include presentations from several field experts about innovative ways communities are integrating housing with treatment and recovery support to aid in the long term recovery of individuals with substance use disorders. CSH and the National Council recently released a summary report of their 2014 convening on housing and substance use disorders. The report highlights potential opportunities and challenges surrounding the integration of housing and substance use disorder treatment, and underlines the evidence supporting better access to housing in treating substance use disorders.

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.

Around the Agencies

• NIAAA survey finds marijuana use among adults has doubled over the past decade
• GAO study finds need for additional performance measures for National Guard’s State Counterdrug Program
• HHS announces $2.2 billion in Ryan White HIV/AIDS Program grants were awarded in FY 2015

News from the States

• 3 in 10 Maryland residents report having known someone with an opioid use disorder

News from NASADAD

• NASADAD releases section-by-section analysis of the Improving Treatment for Pregnant and Postpartum Women Act

In the News

• Senate passes Protecting Our Infants Act to address neonatal abstinence syndrome
• CBO releases cost estimates for reconciliation bill repealing major provisions of the Affordable Care Act
• Individuals with substance use disorders step out of anonymity to fight stigma

Upcoming Events

• Alcohol Policy Conference abstract proposal submissions deadline announced for November 15^th
• NCSL announces webinar on State-based strategies for addressing prescription drug misuse

Around the Agencies

NIAAA survey finds marijuana use among adults has doubled over the past decade
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that the prevalence of marijuana use and marijuana use disorders doubled between 2001-2002 and 2012-2013 in a survey released last week. Adults using marijuana in the past year increased from 4.1 percent to 9.5 percent of United States adults, with rates of marijuana use disorders increasing from 1.5 percent to 2.9 percent in the same period. Symptoms of marijuana use disorders include using large amounts of the drug over long periods of time, an inability to reduce use, and a failure to meet professional responsibilities as a result of marijuana use. The survey found that young adults ages 18-29 were at highest risk for using marijuana and developing marijuana use disorder, “with use increasing from 10.5 percent to 21.2 percent and disorder increasing from 4.4 percent to 7.5 percent over the past decade.” Black and Hispanic populations also experienced significant increases in marijuana usage and marijuana use disorders over the same time period. The NIAAA recommends that the scientific community expand efforts to educate the public about the risks of marijuana use in response to the results of the survey.

GAO study finds need for additional performance measures for National Guard’s State Counterdrug Program
The Government Accountability Office (GAO) released a new study finding a need for additional performance measures for the National Guard’s State Counterdrug Program last week. The counterdrug program’s funding ranged from $219.3 million to $242.1 million between FY 2004 and 2014, with FY 2015 funding decreasing significantly. The GAO found that the program’s current performance measures are not adequate for overseeing State-level programs. The GAO’s report recommends that the Department of Defense (DOD) determine what additional information is needed to properly evaluate State-level programs and develop new measuring tools to more equitably distribute funding to States.

HHS announces $2.2 billion in Ryan White HIV/AIDS Program grants were awarded in FY 2015
The Department of Health and Human Services (HHS) announced that over $2.2 billion in Ryan White HIV/AIDS Program grants were awarded in FY 2015 to a variety of State and local community organizations. The Ryan White HIV/AIDS Program is managed by the Health Resources and Services Administration (HRSA) as part of a larger effort to increase treatment quality for individuals with HIV/AIDS in the United States. Acting HRSA Administrator, James MacRae, emphasized the importance and success of the Ryan White HIV/AIDS Program last week, stating that “in 2013, 81 percent of program clients were retained in care and more than 78 percent of those who were in care are virally suppressed.”

News from the States

3 in 10 Maryland residents report knowing someone with an opioid use disorder
A new Washington Post-University of Maryland poll has found that 3 in 10 Maryland residents report having a close friend or family member currently or formerly struggling with an opioid use disorder. Residents in Baltimore City and County reported the highest number of personal connections, with nearly 40 percent of respondents stating they know someone with an opioid use disorder. The poll found that personal connections with substance use disorders were associated with a desire for increased State spending on treatment. Fifty-two percent of Maryland residents knowing someone with an opioid use disorder believe Maryland spends too little on treatment, compared to only 38 percent among residents without a personal connection. Governor Larry Hogan created a task force in February 2015 to determine ways to improve access to treatment for individuals with substance use disorders. The task force released its initial report to Governor Hogan earlier this month. Recommendations include “earlier and broader incorporation of heroin and opioid prevention into the health curriculum, the infusion of heroin and opioid prevention into additional disciplines, student-based heroin and opioid prevention campaigns, and Maryland State police training on the Good Samaritan law.”

News from NASADAD

NASADAD releases section-by-section analysis of the Improving Treatment for Pregnant and Postpartum Women Act
Today NASADAD released a section-by-section analysis of Rep. Luján’s (NM) Improving Treatment for Pregnant and Postpartum Women Act of 2015. This Act would reauthorize the Substance Abuse and Mental Health Services Administration’s Grant Program for Residential Treatment for Pregnant and Postpartum Women. Additionally, the legislation would create a pilot program to give States the flexibility to implement family-based substance use disorder services for pregnant and postpartum women at various levels of care, not only residential settings. The pilot program would help State substance abuse agencies address gaps in services for pregnant and parenting women along the continuum of care, and encourage new approaches and models of service delivery.

In the News

Senate passes Protecting Our Infants Act to address neonatal abstinence syndrome
Last week the Senate unanimously approved the Protecting Our Infants Act of 2015 (S. 799). The Act would require the Agency for Healthcare Research and Quality (AHRQ) to develop a report on prenatal opioid abuse and neonatal abstinence syndrome (NAS). The report would provide an assessment of existing research on NAS, as well as an evaluation of the causes, treatment, and barriers to treatment of opioid use disorders among women of reproductive age. The report would also provide recommendations on preventing, identifying, and treating opioid dependency in women and infants with NAS.

CBO releases cost estimates for reconciliation bill repealing major provisions of the Affordable Care Act
The Congressional Budget Office (CBO) released its cost estimates for the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 (H.R. 3762) last week, asserting that if passed the bill would result in a $130 billion decrease in deficits over 2016-2025. The legislation repeals several major provisions of the Affordable Care Act (ACA), including the individual and employer mandates, and the “Cadillac tax” imposing taxes on medical devices and certain types of employer-provided healthcare coverage. The CBO further estimated that enacting the bill would leave 15 percent of the non-elderly population uninsured after 2016, compared to only 10 percent under current law. The full House considered the bill on Friday, October 23^rd, and was passed with a vote of 240 – 189. In the Senate, the Act may face more resistance, as several Republican leaders have expressed reluctance to support a bill not fully repealing the ACA. Other Senate Republicans oppose provisions in the bill eliminating federal funding for Planned Parenthood, as they face reelection in blue-leaning States in 2016.

Individuals with substance use disorders step out of anonymity to fight stigma
Many individuals with substance use disorders have begun stepping out of anonymity in order to fight stigma associated with substance use, as the Washington Post reported earlier this month. Many advocates cite stigma surrounding substance use disorders as a large barrier to expanding the quality and quantity of treatment options. Research suggests that increased exposure to individuals with substance use disorders changes attitudes, as a John Hopkins study recently found. The study exposed participants to over 4,000 stories of people successfully treated for mental or substance use disorders. Researchers found that exposure to the stories led to “less desire for social distance, greater belief in the effectiveness of treatment and less willingness to discriminate against persons with these conditions.” Efforts to increase the visibility of substance use disorders amongst the public have occurred simultaneously with a push to change the language associated with substance use. Advocates have continuously asserted that the use of terms such as “addicts” and “abuse” increase stigma and are counterproductive for increasing access to treatment.

Upcoming Events

Alcohol Policy Conference abstract proposal submissions deadline announced for November 15^th
The Alcohol Policy Conference announced that the deadline for submission of abstract proposals for this year’s conference is November 15^th. The planning committee requests proposals focus on alcohol control measures, high-risk alcohol consumption, links between alcohol use and cancer, and community-based efforts to combat alcohol-related problems – among a number of additional topics. The Alcohol Policy Conference will be held in Arlington, Virginia from April 6^th-8^th, 2016. The conference will highlight methods for applying alcohol policy research to public health systems at the community, state, national, and international levels.

NCSL announces webinar on State-based strategies for addressing prescription drug misuse
For those unable to attend the National Prevention Network’s (NPN) conference November 17^th-19^th, the National Conference of State Legislatures (NCSL) has announced a new webinar focusing on prescription drug misuse and risks associated with methadone treatment. The webinar will be held on Tuesday, November 17^th from 2:00-3:00pm EST.  Research suggests that methadone-related overdoses have risen due to healthcare providers increasingly prescribing methadone for pain management instead of substance use disorder treatment. The webinar will discuss options available to States for managing the risks associated with methadone, and will feature commentary from representatives from West Virginia’s House of Delegates on their State’s experiences.

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.

News from the States

• Ayotte writes letter to major health insurance companies in support of mental health and substance use disorder parity
• Colorado’s Rocky Mountain High Intensity Drug Trafficking Area releases report on impact of marijuana legalization
• Ohio State Board of Pharmacy redesigns prescription drug monitoring program website
• Harlem Parole Reentry Court study highlights importance of reentry programs for reducing substance use by parolees

In the News

• Luján introduces Improving Treatment for Pregnant and Postpartum Women Act of 2015
• Johns Hopkins study finds that 80 percent of individuals with opioid use disorders do not receive treatment
• Several States move to increase smoking age to 21
• Kaiser Family Foundation report examines Medicaid enrollment and payment trends

Around the Agencies

• HHS announces planning grant awards for Certified Community Behavioral Health Clinics
• CDC website updated with new resources on FASDs
• CMS releases guide aiding ICD-10 transition
• CDC report finds opioid pain relievers prescribed twice as frequently in some States
• CMS releases bulletin guiding early treatment intervention for young adults experiencing psychosis

News from NASADAD

• NASADAD attends NHTSA briefing on new tools for fighting DUIs

News from the States

Sen. Ayotte writes letter to major health insurance companies in support of mental health and substance use disorder parity
Senator Kelly Ayotte (R-NH) urged major health insurance companies to comply with mental health and substance use disorder parity in a letter sent last week. In the letter, Sen. Ayotte states her concern that individuals with mental health and substance use disorder are being denied health insurance coverage. Sen. Ayotte drafted an additional letter with Sen. Chris Murphy (D-CA) and a bipartisan group of twenty-two Senators calling on the Department of Health and Human Services (HHS) and Department of labor (DOL) to take immediate action to fully implement mental health parity. The messages follow a recent communication from Sen. Ayotte to the Government Accountability Office (GAO) regarding implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Despite going into effect in January 2014, implementation of mental health parity has proven difficult, as many individuals continue to report denial of coverage for substance use disorder treatment by health insurance companies. In the letter, Sen. Ayotte expresses her concern that large barriers to accessing treatment for substance use disorders remain despite the passage of the law, and suggests the GAO review insurance company compliance with mental health parity.

Colorado’s Rocky Mountain High Intensity Drug Trafficking Area releases report on impact of marijuana legalization
Colorado’s Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) released a new report on the impact of marijuana legalization in Colorado last week. The report finds that marijuana-related traffic deaths increased 92 percent from 2010 to 2014, and that positive marijuana toxicology DUI reports increased 45 percent since retail marijuana businesses began operating in early 2014. Colorado youth and adults have begun using marijuana at higher rates in recent years, with “11.6 percent of Colorado youth ages 12 to 17 years old considered current marijuana users compared to 7.15 percent nationally,” and “10.13 percent of adults aged 26 years old and over considered marijuana users compared to 5.45 percent nationally.” Marijuana-related emergency room visits and hospitalizations have also substantially increased, with a 29 percent increase in marijuana-related emergency room visits and a 38 percent increase in marijuana-related hospitalizations in the first year of legalization.

Ohio State Board of Pharmacy redesigns prescription drug monitoring program website
The State of Ohio Board of Pharmacy redesigned the State’s prescription drug monitoring program (PDMP) website last week. The redesigned website seeks to offer a better user experience by streamlining access to information contained within the PDMP system. In addition to offering several new training videos and documents, the redesign adds a new statistics feature that allows anyone to create custom reports and maps with PDMP data. Ohio’s PDMP, also known as the Ohio Automated Rx Reporting System (OARRS), was established in 2006 and remains the only Statewide database collecting information on all controlled substance prescriptions issued within the State.

Harlem Parole Reentry Court study highlights importance of reentry programs for reducing substance use by parolees
A recently released randomized control trial study of the Harlem Parole Reentry Court has emphasized the importance of reentry programs for reducing substance use by parolees. The “Coming Home to Harlem” study compared recidivism, employment, and substance use between regular parolees and parolees processed through the Harlem Parole Reentry Court. The Harlem Parole Reentry Court serves approximately 200 parolees each year in a program partnered with the New York State Department of Corrections and New York City Mayor’s Office of Criminal Justice. The program seeks to increase the availability of support services such as cognitive behavioral therapy to new parolees. The study found that parolees in the Harlem Parole Reentry Court made easier transitions into society, with study participants “60 percent less likely to be reconvicted for felonies within 18 months of release than traditional parolees.” Additionally, 65 percent of Harlem Parole Reentry Court parolees were not using drugs one year after release – compared to only 39 percent of regular parolees.

In the News

Rep. Luján introduces Improving Treatment for Pregnant and Postpartum Women Act of 2015
On October 6^th, Rep. Luján (NM) introduced the Improving Treatment for Pregnant and Postpartum Women Act of 2015. This proposed bill would reauthorize the Substance Abuse and Mental Health Services Administration’s Grant Program for Residential Treatment for Pregnant and Postpartum Women. Additionally, the legislation would create a pilot program to give States the flexibility to implement family-based substance use disorder services for pregnant and postpartum women at various levels of care, not only residential settings. The pilot program would help State substance abuse agencies address gaps in services for pregnant and parenting women along the continuum of care, and encourage new approaches and models of service delivery.

Johns Hopkins study finds that 80 percent of individuals with opioid use disorders do not receive treatment
A new study conducted by the Johns Hopkins School of Public Health has found that 80 percent of individuals with opioid use disorders do not receive treatment. The study investigated substance use disorder treatment rates and trends from 2004 to 2013. Outpatient treatment and self-help groups remained the most common treatment options across the observed time period, finding that “the percentage of patients receiving care in a doctor’s office rose from 25 percent in 2004 to 35 percent in 2013.” The study concludes that statutory restrictions and overcrowded or unavailable treatment programs are key factors in limiting access to substance use disorder treatment.

Several States move to increase smoking age to 21
Several States across the country have begun drafting legislation to increase the legal age for purchasing tobacco from 18 to 21, as Pew Charitable Trusts reported last week. Hawaii successfully passed legislation increasing the smoking age this past summer. California, Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, and Washington have also introduced measures to increase the smoking age, although none have passed thus far. Efforts to increase the smoking age are driven by new reports suggesting that increasing the smoking age to 21 would cut smoking by 12 percent, in addition to preventing 223,000 premature deaths. Researchers believe that the increase will prevent more people from starting to smoke, as “90 percent of adults who become daily smokers say they started before the age of 19.” Several smokers’ rights groups and retailers have warned against increasing the smoking age, suggesting that cigarette taxes comprise an important segment of State tax revenue.

Kaiser Family Foundation report examines Medicaid enrollment and payment trends
A new Kaiser Family Foundation report released last week examines Medicaid enrollment and payment trends, finding that Medicaid enrollment increased an average of 13.8 percent, and Medicaid spending increased an average of 13.9 percent in FY 2015 as a result of Affordable Care Act (ACA) expansions. The report used information gathered from the annual survey of Medicaid Directors conducted by the Kaiser Commission on Medicaid and the Uninsured. Medicaid enrollment and payment is expected to slow in FY 2016, as only two additional States plan to expand Medicaid coverage.

Around the Agencies

HHS announces planning grant awards for Certified Community Behavioral Health Clinics
Today the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare & Medicaid Services (CMS), and Assistant Secretary of Planning and Evaluation (ASPE), announced planning grants to 24 States to provide community-based mental and substance use disorder treatment. The planning grants are part of an effort to integrate mental health, substance use disorder, and physical health care services, and improve access to high quality care.  States will use the planning grants to certify community behavioral health clinics, establish prospective payment systems for demonstration reimbursable services, and prepare an application to participate in the demonstration program.  Populations to be served with grant funds will include adults with substance use disorders, serious mental illness, and children with serious emotional disturbance.

CDC website updated with new resources on FASDs
The Centers for Disease Control and Prevention (CDC) updated their website with several new web resources last week. The new resources include maps documenting State information on alcohol use by pregnant women, a new fact sheet on alcohol use and pregnancy, and a new fact sheet on fetal alcohol spectrum disorders (FASDs). Recent CDC studies “have identified 0.2 to 1.5 infants with fetal alcohol syndrome (FAS) for every 1000 live births in certain areas of the United States.”

CMS releases guide aiding ICD-10 transition
The Centers for Medicare & Medicaid Services (CMS) released a new guide aiding the October 1^st transition to the International Classification of Diseases, 10^th Revision (ICD-10) last week. The new guide provides Medicare- and Medicaid-specific contacts for healthcare providers with questions about the transition. CMS advises any claims-related questions be directed to the provider’s Medicare Administrative Contractor or State Medicaid Agency. The ICD-10 includes new codes for medical diagnoses and hospital procedures that aim to better identify complex medical conditions, in addition to increasing the coordination of care among health providers.

CDC report finds opioid pain relievers prescribed twice as frequently in some States
The Centers for Disease Control and Prevention (CDC) released a new report last week finding that opioid pain relievers are prescribed twice as frequently in some States compared to others. The report was released in the CDC’s October Morbidity and Mortality Report (MMWR). The MMWR is the first multi-state report from the Prescription Behavior Surveillance System, which captures State prescription drug monitoring program (PDMP) data from California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia. The study additionally found that “opioid pain relievers are prescribed twice as often as antianxiety and insomnia medication,” and that the top 10% of prescribers provide over half of opioid prescriptions. The CDC suggests that this report’s findings indicate the need for improved prescribing practices.

CMS releases bulletin guiding early treatment intervention for young adults experiencing psychosis
The Centers for Medicare and Medicaid Services (CMS) released a new bulletin on creating early treatment intervention benefit packages for young adults experiencing first episode psychosis. The bulletin was a collaborative effort with the National Institute of Mental Health (NIMH), Centers for Medicare and Medicaid Services’ Center for Medicaid and CHIP Services (CMCS), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Untreated psychosis increases a person’s risk for suicide, involuntary emergency care, and poor clinical outcomes. However, early intervention can alter this illness trajectory and enable individuals experiencing first episode psychosis to live in community settings and participate fully in family and community life.

News from NASADAD

NASADAD attends NHTSA briefing on new tools for fighting DUIs
Shalini Wickramatilake-Templeman, Public Policy Associate, attended the briefing hosted by the National Highway Traffic Safety Administration (NHTSA) on Wednesday, October 14^th. The briefing focused on two newly developed assessment tools to be used in DUI offender populations: the Computerized Assessment and Referral System (CARS) and the Impaired Driving Assessment (IDA) Tool. CARS is a structured diagnostic assessment that can be used in DUI treatment settings, developed by the Cambridge Health Alliance through funding from the Foundation for Advancing Alcohol Responsibility (FAAR).  CARS is based on research findings indicating a strong association between repeat DUI offences with co-morbid mental health and substance use disorders. After the assessment has been completed, the tool generates a diagnostic report based on the DSM-IV, and provides an individualized and geographically tailored referral.  Several DUI offender treatment facilities are implementing CARS to assess the usability of the assessment among treatment professionals and clients.

The IDA, developed by the American Probation and Parole Association (APPA), with support from NHTSA, is designed to assist probation and parole officers in identifying DWI offenders’ risk of repeating their offense, and in determining the most effective supervision that will reduce such risk.  APPA is currently developing a computerized version of this tool to make it more widely accessible.

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.

News from NASADAD

• NASADAD attends briefing on enhancing access to healthcare among minority and low-income communities
• NASADAD attends briefing on prescriber preparation for opioid crisis
• NASADAD attends Alliance for Health Reform briefing on  home and community-based care services

Around the Agencies

• CMS releases EHR reporting period final rule

In the News

• Parental substance use disorders drive growth in number of children in foster care
• AMA Task Force releases report for increasing access to naloxone
• Kelly Ayotte requests study of implementation and enforcement of the Mental Health Parity and Addiction Equity Act
• Governing magazine releases story on challenges facing State Medicaid programs

Upcoming Events

• ASAM announces webinars discussing evidence-based clinical treatment of opioid use disorders

News from NASADAD

NASADAD attends briefing on enhancing access to healthcare among minority and low-income communities
Brian Denten, Public Policy Intern, attended the event hosted by the National Journal on Thursday, October 9^th. Two panels of individuals working in the healthcare industry spoke about healthcare access among minority and low-income communities. Despite the Affordable Care Act’s (ACA) expansion of healthcare coverage, many newly insured remain unclear on how to access and utilize health insurance. Panelists discussed the importance of telehealth in disseminating information to minority and low-income communities about where and how to receive healthcare, stating that many people still rely on emergency departments as their primary source of healthcare. Several panelists emphasized cultural competency among medical professionals as essential in improving healthcare outcomes. Speakers further asserted the need for greater continuity of care within the healthcare system for treating the newly insured.

Panelists:

• Nadine Gracia, M.D.; Deputy Assistant Secretary and Director, Office of Minority Health, U.S. Department of Health and Human Services
• Georges Benjamin, M.D.; Executive Director, American Public Health Association
• Patrice Harris, M.D.; Chair-Elect, American Medical Association
• Justine Handelman; Vice President of Legislative and Regulatory Policy, Blue Cross Blue Shield Association
• Seiji Hayashi, M.D.; Executive Vice President for Transportation and Innovation, Practicing Physician, Unity Health Care
• McCrae Parker; Managing Director, Zero Divide
• Ruth Perot; Executive Director and CEO, Summit Health Institute for Research and Education (SHIRE)
• Ramanathan Raju, M.D.; President and CEO, New York City Health and Hospitals Corporation
• Diane Rowland; Executive Vice President, Kaiser Family Foundation
• Michael Scott; Chief Equity Officer, President, and Co-Founder, Equity Matters

NASADAD attends briefing on prescriber preparation for opioid crisis
Robert Morrison, Executive Director, and Shalini Wickramatilake-Templeman, Public Policy Associate, attended the briefing sponsored by the Hazelden Betty Ford Institute for Recovery Advocacy and National Council for Behavioral Health on Tuesday, October 6^th.  Speakers, including members of Congress, discussed the increasing prescription opioid and heroin problem in the United States. In particular, speakers emphasized the importance of prescriber education in the prevention of opioid use disorders.

Speakers:

• Kelly Ayotte (R-NH)
• Shelley Moore Capito (D-WV)
• Mary Bono, Principal, FaegreBD Consulting
• Michael Botticelli, Director, Office of National Drug Control Policy
• Joe Manchin (D-WV)
• Edward Markey (D-MA)
• Mehmet Oz; Host of The Dr. Oz Show
• Mackenzie Phillips; Actress and Person in Long-Term Recovery from an Opioid Use Disorder
• Dr. Marvin Seppala; Chief Medical Officer, Hazelden Betty Ford Foundation
• Dr. Jeannie Sperry; Adult Pain Rehabilitation Clinical Director, Mayo Clinic
• John Tilley; Kentucky House of Representatives

NASADAD attends Alliance for Health Reform briefing on home and community-based care services
Brian Denten, Public Policy Intern, attended the briefing sponsored by the Alliance for Health Reform. Several panelists working to identify ways to improve the provision of home and community-based healthcare services spoke at the event. As the United States’ population continues to age, home and community-based caretaker services for the elderly will become an increasingly large percentage of healthcare costs. Institutional solutions for the elderly, such as nursing homes, have trended downwards since the late 1990s, with home and community-based services making up the largest percentage of Medicaid long-term care expenditures in 2013. Several panelists discussed methods for improving the quality of long term-services and support (LTSS), including increasing affordability and access, increasing the amount of providers to choose from, increasing quality of life and care, and providing additional support for family caregivers.

Panelists:

• Anne Montgomery; Altarum Institute
• Bea-Alise Rector; Department of Social and Health Services, Washington State
• Abby Marquand; Paraprofessional Healthcare Institute (PHI)
• Jean Accius; AARP

Around the Agencies

CMS releases EHR reporting period final rule
The Centers for Medicare & Medicaid Services (CMS) released a final rule for the Medicare and Medicaid Electronic Health Records Incentive Programs in 2015 (EHR) this past week. The rule adjusts the EHR reporting period to 90 days in order to align with the remainder of the calendar year.  The rule further includes additional measures including “reducing the share of patients that must use the patient portal from 5% to at least one patient, and modifying the summary care requirements.”

In the News

Parental substance use disorders drive growth in number of children in foster care
Parents with substance use disorders are a major cause for the increase of children in foster care services, according to a new article by Pew Charitable Trusts. The number of children living in foster care began to increase in 2013, after years of decline. 415,000 children were living in foster care in 2014 according to an Administration for Children and Families (ACF) report, many as a result of their parents’ substance use disorders. Ohio saw a 19 percent increase from 2010 to 2013 in the percentage of child welfare cases involving heroin or cocaine, with seventy percent of children less than a year old in foster care as a result of parents using drugs. Similar trends were observed in Indiana and Vermont. Child welfare cases involving drug addiction present unique challenges, as many parents have difficulty recovering from their substance use disorder in the time allotted by federal law to reunite with their children.

AMA Task Force releases report for increasing access to naloxone
The American Medical Association (AMA) Task Force to Reduce Opioid Abuse issued a new report compiling resources for States and physicians to consider when increasing access to naloxone this past week. The report includes several webinars and overdose prevention resources from a variety of organizations, including the Harm Reduction Coalition and the American Academy of Addiction Psychiatry. One of the AMA Task Force’s primary goals is the encouragement of physicians to “co-prescribe naloxone to a patient or prescribe naloxone to a family member or close friend when it is clinically appropriate.” The report also provides an overview of naloxone laws in States across the country.

Sen. Kelly Ayotte requests study of implementation and enforcement of the Mental Health Parity and Addiction Equity Act
Senator Kelly Ayotte (R-NH) requested a study of the implementation and enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 in a letter to the head of the U.S. Government Accountability Office (GAO) last week. Despite going into effect in January 2014, implementation of mental health parity has proven difficult, as many individuals continue to report denial of coverage for substance use disorder treatment by health insurance companies. In the letter, Sen. Ayotte expresses her concern that large barriers to accessing treatment for substance use disorders remain despite the passage of the law, and suggests the GAO review insurance company compliance with mental health parity.

Governing magazine releases story on challenges facing State Medicaid programs
Governing magazine released a story on the challenges facing State Medicaid programs last week, featuring commentary from several State Medicaid Directors on the current status of Medicaid. Medicaid programs have grown substantially in recent years, yet State Medicaid Directors assert that they have not been given extra resources—such as more administrative positions, salary increases, and more technical assistance—to handle the increased capacity.  Matt Salo, Director of the National Association of Medicaid Directors, states that Medicaid’s role has evolved from being “bill payer” to having a number of new responsibilities. Many States do not consider Medicaid a separate agency, and include Medicaid programs within larger agencies such as health and human services.

Upcoming Events

ASAM announces webinars discussing evidence-based clinical treatment of opioid use disorders
The American Society of Addiction Medicine (ASAM) has announced a series of webinars discussing evidence-based clinical treatment of opioid use disorders to be held throughout the remainder of 2015. These webinars will discuss recommendations from the new ASAM National Practice Guideline for physicians treating patients with opioid use disorders, including the primary components of patient assessment and diagnosis, the use of pharmacotherapy (including buprenorphine, methadone, naltrexone, and naloxone), and the needs of special populations (including pregnant women, adolescents, and individuals within the criminal justice system). The webinars will be held on Wednesday, October 28 at 3PM EST; Tuesday, November 17 at 12PM EST; and Thursday, December 10 at 12PM EST.

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.

Around the Agencies

• CDC study examines alcohol use and binge drinking among women of childbearing age
• CAPT web area moves to the Programs and Campaigns section of the SAMHSA website
• NIDA reorganizes divisional structure to emphasize research on neuroscience and brain development

News from the States

• Maryland opioid task force releases series of recommendations to Governor Larry Hogan
• Indiana governor announces new task force on substance use disorders
• Oregon communities prevent recreational sale of marijuana

In the News

• New article examines provider application of SBIRT to young people
• Study finds substance use disorders associated with increased risk of death after release from prison
• Center for Health Care Strategies releases new tool on mental health and substance use disorder integration into Medicaid accountable care organizations
• States warn insurance agencies against using consumer reports to determine premiums
• Governors Highway Safety Association reports increase in drug use as cause of fatal car crashes
• Affordable Care Act amendment passes Senate, expects to be signed by President Obama

Upcoming Events

• IRETA announces webinar discussing substance use disorders in the military

Around the Agencies

CDC study examines alcohol use and binge drinking among women of childbearing age
The Centers for Disease Control and Prevention (CDC) released a new study this past week examining alcohol use among women of childbearing age. The study used Behavioral Risk Factor Surveillance System (BRFSS) data from 2011-2013 to form its conclusions. Fifty-three percent of non-pregnant women reported alcohol use and 18percent of non-pregnant women reported binge drinking.  Ten percent of pregnant women reported alcohol use and 3 percent of pregnant women reported binge drinking. Within the category of pregnant women, “women aged 35-44 years reported a significantly higher prevalence of any alcohol use (18.6%) than all other age groups.” Alcohol use among pregnant women with college degrees was twice as high compared to pregnant women with a high school diploma or less. The study notes an overall increase in alcohol use and binge drinking among pregnant and non-pregnant women compared to a similar study examining 2006-2010, but cautions that this increase may be a result of methodological changes in the BRFSS rather than an increase in alcohol use. The CDC recommends a “comprehensive approach to reduce alcohol use and binge drinking among pregnant women, and binge drinking among women of childbearing age” as a result of the study.

CAPT web area moves to the Programs and Campaigns section of the SAMHSA website
The Center for the Application of Prevention Technologies (CAPT) web area has moved to the “Programs and Campaigns” section of the Substance Abuse and Mental Health Services Administration (SAMHSA) website. The move is intended to streamline access to related resources on SAMHSA’s overall website. The new CAPT web area features the same content as its previous location, and will continue to be updated over the next several months. CAPT online courses will remain on a separate, password-protected online portal.

NIDA reorganizes divisional structure to emphasize research on neuroscience and brain development
The National Institute on Drug Abuse (NIDA) has reorganized its internal structure to emphasize research on neuroscience and brain development. The reorganization follows an evaluation by a NIDA Advisory Council Workgroup in response to reduced staffing and new scientific advances. The Advisory Council Workgroup found that “advances in addiction neuroscience outpaced or rivaled those achieved for any other brain disease.” The new structure will “strengthen functional integration throughout NIDA and continue to emphasize translational neuroscience, brain development, and neurobehavioral interventions research as core elements of NIDA’s mission.”

NIDA’s Division of Clinical Neuroscience and Behavioral Research (DCNBR) will merge with the Division of Basic Neuroscience and Behavioral Research to form the Division of Neuroscience and Behavior as a result of the restructuring. Additionally, DCNBR’s behavioral treatment portfolio will merge with the Division of Pharmacotherapies and Medical Consequences of Drug Abuse to form the Division of Therapeutics and Medical Consequences (DTMC). The focus of the new Division will be treatment development and interventions targeting the “brain circuits” associated with substance use disorders. The new structure is effective October 1^st.

News from the States

Maryland opioid task force releases series of recommendations to Governor Larry Hogan
The Maryland Heroin and Opioid Emergency Task Force submitted its initial report and series of recommendations to Governor Larry Hogan last month, as the National Governors Association (NGA) reports. The task force was created by Governor Hogan in February 2015 to advise the governor on ways to improve access to treatment, healthcare quality, and alternatives to incarceration for individuals with substance use disorders. The initial series of recommendations include “earlier and broader incorporation of heroin and opioid prevention into the health curriculum, the infusion of heroin and opioid prevention into additional disciplines, student-based heroin and opioid prevention campaigns, and Maryland State Police training on the Good Samaritan Law,” among several other suggestions. The task force also released ten funding announcements to treatment facilities in an effort to expand access to treatment and overall quality of care. The task force’s final report is expected to be released in December 2015.

Indiana Governor Mike Pence announces new task force on substance use disorders
Indiana Governor Mike Pence announced a new task force focusing on combating substance use disorders last month, as the National Governors Association (NGA) reports. The Task Force will employ Indiana experts from a variety of backgrounds to examine substance use disorders within the State. Key goals of the Task Force include assessing the existing resources used to treat substance use disorders, identifying ways for federal, State, and local law enforcement to collaborate, identifying best practices for substance use disorder treatment, and identifying successful prevention programs. The Task Force will meet on a monthly basis for the remainder of the year before issuing a series of final recommendations to the Governor.

Oregon communities prevent recreational sale of marijuana
Several Oregon cities have moved to prevent the recreational sale of marijuana in their communities, despite recreational marijuana being legal in the State. Oregon Live reports that many rural communities are fearful that the recreational sale of marijuana will lead to increases in adolescent use and crime. The recreational sale of marijuana was legalized last year in Oregon through the ballot initiative Measure 91, which stipulated that “any local attempt to ban sales would have to go to the ballot after 10 percent of local voters signed a petition.” To date 13 counties in eastern Oregon have voted to ban medical and recreational marijuana sales of any type, with eight other cities planning similar votes next year.

In the News

New article examines provider application of SBIRT to young people
A new article written by Alexa Eggleston, Senior Program Officer at the Conrad N. Hilton Foundation, examines the growing application of screening, brief intervention and referral to treatment (SBIRT) to young people. Many health care providers do not currently examine adolescent patients for substance use disorders, despite the negative health implications alcohol and drugs can have on patients’ lives. Young people in recovery for substance use disorders often lament “missed opportunities” for intervention by health professionals, according to many recovery advocates. SBIRT provides a robust methodology for healthcare providers to approach the topic of substance use with adolescent patients, and screen them for substance use disorders if necessary. Positive feedback is provided to youth not using alcohol and drugs, while those who have begun using substances are advised on stopping use and remaining safe. Several organizations have partnered to increase the use of SBIRT, including the American Academy of Pediatrics, the School-Based Health Alliance, YouthBuild USA, Reclaiming Futures, and Young People in Recovery.

Study finds substance use disorders associated with increased risk of death after release from prison
A new study tracking formerly-incarcerated individuals in Sweden has found that inmates with substance use disorders experienced higher rates of death post-incarceration than inmates without substance use disorders. The study examined individuals released from prison in Sweden from January 1, 2000 to December 31, 2009, finding an “estimated probability of death within 5 years of release from prison of 10.2% among men with substance use disorders compared to 3.2% among those without.” Women with substance use disorders exhibited a probability of death within 5 years of 6.5% compared to 2.6% among those without. The study’s authors conclude that more expansive treatment options are required “beyond the immediate period after incarceration,” and suggest investigating alternatives to incarceration for individuals with substance use disorders.

Center for Health Care Strategies releases new tool on mental health and substance use disorder integration into Medicaid accountable care organizations
The Center for Health Care Strategies released a new tool examining State integration of mental health and substance use disorders into Medicaid accountable care organizations (ACOs) last week. Many States have begun developing ACOs for Medicaid populations in order to reduce health care costs and improve health care quality by increasing communication across the continuum of care. The Center for Health Strategies asserts that many Medicaid patients with co-occurring mental health and substance use disorders are not receiving optimal care due to the fragmented nature of the healthcare delivery system. ACOs address this problem through greater mental health and substance use disorder integration. The new tool explores strategies States can use when creating ACO systems.

States warn insurance agencies against using consumer reports to determine premiums
Several States have warned insurance agencies against using consumer reports to determine premiums, as Pew Charitable Trusts reports. Ten States (including California, Florida, Indiana, Maine, Maryland, Ohio, Pennsylvania, Rhode Island, Vermont, Washington, and the District of Columbia) have issued warnings to insurance agencies using spending habits or shopping history as factors in determining insurance premium increases. State agencies and the Consumer Federation of America (CFA) have expressed concern that if left unchecked, insurance companies’ technology will outpace the ability of insurance regulators to regulate the industry – leading to larger annual premium increases. Insurance companies have countered these assertions by stating that new “price optimization” practices only analyze groups of people, and that the practice is necessary to stay competitive.

Governors Highway Safety Association reports increase in drug use as cause of fatal car crashes
A new Governors Highway Safety Association (GHSA) report has found increased rates of driving while under the influence of drugs as the cause of increased fatal car accidents over the past decade, as the Washington Post reports this week. The report finds that 40 percent of fatally injured drivers tested positive for drugs in 2013, compared to 29 percent in 2005. The report analyzed federal data from the National Highway Traffic Safety Administration (NHTSA), finding that driving under the influence of drugs has increased as a result of the proliferation of prescription medications and the legalization of marijuana. The GHSA recommends the NHTSA issue best practices on preventing marijuana-impaired driving in response to the report, concluding that “marijuana is by far the most common drug that is used… and found in fatally-injured drivers.”

Affordable Care Act amendment passes Senate, expects to be signed by President Obama
An amendment to the Affordable Care Act (ACA) was passed by the Senate lastweek and is expected to be signed by President Obama. The amendment (HR 1624) modestly adjusts the categorization of midsized employers under the ACA, allowing business with 51 to 100 workers to be placed into the large employer category, while providing States discretion to categorize them as small employers if they choose. The bill aims to prevent midsized employers from being forced to change coverage and absorb large premium increases associated with the small group marketplace. The bill additionally provides $205 million to “a Medicare improvement fund that was cut under the health law.”

Upcoming Events

IRETA announces webinar discussing substance use disorders in the military
The Institute for Research, Education & Training in Addictions (IRETA) announced a new webinar discussing substance use disorders in the military last week. The webinar will be held on October 14^th from 1-2PM EST. Ariel David, Project Coordinator of the Armed Services Network of Louisiana, will present on the aspects of substance use disorders unique to the military and the best practices used to address them. The webinar will also examine ways health care providers can be more productive when dealing with members of the military.

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.