Whether you pick up a newspaper, turn on the television, or get your news online, it’s all politics, all the time right now. And this year, the issue of addiction has made its way into the political arena. The presidential debates of both parties have had a focus on addiction – Focus On Heroin Drug Addiction, Mental Health Treatment At Fourth Democratic Debate, In New Hampshire, GOP 2016 Hopefuls Discuss Addiction, and For 2016 Candidates, Fight Against Addiction Is Often Personal.
The unfortunate reality is that this issue has become too big for the candidates to ignore. The statistics, which we have covered over the past year, are frightening:
- There has been an increase in the use of illegal drugs, particularly the intensity of heroin and prescription painkillers – between 2013 and 2014, illegal drug use among the population over the age of 12 increased from 9.4% in 2013 to 10.2% in 2014 (see Illegal Drug Use In U.S. Rises From 9.4% In 2013, To 10.2% In 2014 and Prescription Opioid Epidemic Has Evolved: High-Intensity Use Continues To Increase).
- There has been a troubling growth in overdose deaths – between 2012 and 2013, heroin overdose deaths in the United States increased by 39%, from 5,925 in 2012 to 8,257 in 2013; and from 1999 through 2011, the rate of opioid-analgesic poisoning deaths increased by nearly 400% – from 1.4 per 100,000 in 1999 to 5.4 per 100,000 in 2011 (see More Than 47,000 Americans Died Of Drug & Opioid Overdoses In 2014, Up 6.5% Over 2013 and Drug-Related Deaths – Prescription Meds Still Top The List).
- The growing problem of heroin and opioid addiction is affecting new demographics and geographic areas – in recent years, heroin users were older, more evenly split between men and women, more likely to be white, and located more in suburban areas (see Demographics Of Heroin Users Change Over Past 50 Years and Heroin Dependence Rose 150% Between 2007 & 2013). This rise in rates of addiction and overdose death, accompanied by the demographic changes has put the topic at the forefront of the national conversation.
This dramatic rise in heroin and opioid-related drug abuse issues, as well as the change in demographics has resulted in high-profile stories that have captured the national spotlight – such as last year’s incredible outbreak of HIV in rural Indiana due to intravenous abuse of prescription opioid painkiller Opana (see Opioid Epidemic Sparks HIV Outbreak In Tiny Indiana Town and Drug-Fueled Indiana HIV Outbreak Was ‘Preventable’) and the tragic story of a young woman whose story of addiction led President Obama to push for drug policy reform, dying last month of a heroin overdose (see The Heroin Addict Who Inspired Barack Obama To Act On Drugs Has Died).
The addiction situation has commanded the attention of the Obama Administration and Congress. On March 10, the Comprehensive Addiction and Recovery Act of 2016 passed in the Senate with a vote of 94 to 1 and now goes to the house. If passed, it will expand the availability of naloxone; shift resources towards identifying and treating incarcerated people who are suffering from addiction; prohibit the Department of Education from including questions about the conviction of an applicant for the possession or sale of illegal drugs on the Free Application for Federal Student Aid (FAFSA) financial aid form; and provide $25 million in grants to states that mandate provider participation in computerized Prescription Drug Monitoring Programs (state-run databases that track the prescribing and dispensing of controlled prescription drugs) (see S. 524: Comprehensive Addiction and Recovery Act of 2016).
Additionally, President Obama has included $1.1 billion in his 2017 budget request to Congress, to pay for drug treatment for people addicted to prescription painkillers and heroin (see President Obama Proposes $1.1 Billion in New Funding to Address the Prescription Opioid Abuse and Heroin Use Epidemic) – funding that includes:
- $920 million to support cooperative agreements with States to expand access to medication-assisted treatment (MAT) for opioid use disorders. States will receive funds based on the severity of the epidemic and on the strength of their strategy to respond to it. States can use these funds to expand treatment capacity and make services more affordable.
- $50 million in National Health Service Corps funding to expand access to substance use treatment providers. This funding will help support approximately 700 providers able to provide substance use disorder treatment services, including MAT, in areas across the country most in need of behavioral health providers.
- $30 million to evaluate the effectiveness of treatment programs employing MAT under real-world conditions and help identify opportunities to improve treatment for patients with opioid use disorders.
In addition to this budgetary focus, the Obama administration as also announced the establishment of a Mental Health and Substance Use Disorder Parity Task Force – tasked with advancing access to mental health and substance use disorder treatment; promoting compliance with best practices for mental health and substance use disorder parity implementation; and developing additional agency guidance as needed (see Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic).
And state legislators have been focused on the addiction issue as well. Over the past year, we have seen a number of new pieces of legislation at the state and federal level aimed at addressing the issue of addiction, several within just the past couple months:
- Washington State – On March 29, 2016 the state legislature overrode a previous veto by Governor Jay Inslee, protecting the relationship between individuals in addiction recovery programs and their sponsors during civil proceedings (see Washington Legislature Passes Groundbreaking Addiction Recovery Law).
- Massachusetts – On March 14, 2016 Massachusetts passed the first law in the nation that limits an opioid prescription to a 7-day supply for first-time adult prescriptions and a 7-day limit on every opiate prescription for minors (see State Legislators Pass Substance Addiction Legislation).
- Indiana – On March 21, 2016 Indiana Governor Michael Pence signed legislation to establish stricter sentences for drug offenders with multiple convictions, expand the medical necessity criteria for Medicaid detox, and increase access to naloxone (see Signs Legislation To Combat Drug Abuse In Indiana).
- Connecticut – On July 15, 2015, Connecticut Governor Dannel Malloy signed legislation to improve the state’s prescription monitoring program, promote more education and training for health care professionals, and increase access to naloxone (see Gov. Malloy Signs Bill Combating Substance Abuse and Opioid Overdose).
In addition to this legislation that has already passed, there are several important pieces of pending legislation that we’re keeping an eye on:
- Ohio – U.S. Sen. Sherrod Brown (D-OH) announced new legislation that he describes as “a comprehensive approach to address the entire spectrum of addiction, from crisis to recovery”, and that would expand the number of opioid patients a doctor could treat past the current cap of 100 (see Brown Introduces Legislation To Fight Opioid Addiction From Prevention To Recovery).
- New York – Assemblyman Michael Montesano (R,C,I-Glen Head) is co-sponsoring the Family Crisis Addiction Act, which will allow certain family members of people suffering from addiction to intervene through involuntary rehabilitation and treatment programs (see Montesano Sponsors Legislation To Help New York Families Tackle Addiction). Additionally, the state already passed another bill aimed at addressing the heroin and opioid addiction problem in June of 2014 (see Governor Cuomo Signs Legislation to Combat Heroin, Opioid and Prescription Drug Abuse Epidemic).
This focus on addictions is not without its controversies. The Obama Administration is pushing Medicaid expansion as a solution to increase access to addiction treatment – Feds Make Case To GOP Governors: Expand Medicaid To Tackle Addiction. And, there are calls of racism in the current push to decriminalize addiction since the problem has spread to a broader demographic – In Heroin Crisis, White Families Seek Gentler War On Drugs.
What is the impact of this focus for consumers? Opioid medications will require more “paperwork.” There will be more one-time grant money available for paying for treatment for the uninsured population. The coverage of addictions will be largely through health plans, with their preference for using community-based, medication-assisted treatment approaches (see If MAT For Addictions Is So Good, Why Aren’t More Consumers Using It?). For more, look for our continuing coverage of changes in the addiction treatment landscape in the upcoming April edition of the OPEN MINDS Management Newsletter – and how new policy and financing models, as well as new treatment options, are reshaping the options.