U.S. House Passes American Health Care Act (AHCA)

Source: | May 5th, 2017
It was a razor-thin victory: 217-213. With the exception of U.S. Rep. Will Hurd, R-Helotes, who voted against the plan, the Texas delegation voted along party lines. The vote occurred so swiftly that the nonpartisan Congressional Budget Office had yet to weigh in with cost predictions and estimates of the impact on how many people will lose their health coverage. The GOP’s proposal allows states to define which benefits all insurance plans must cover; such as mental health & substance abuse disorders which is currently required under Obamacare. According to several health care experts, it would likely drive down premiums, as plans with skimpier coverage would spring up in states which granted more flexibility. But it could drive up costs for out-of-pocket expenses and reliance on medically indigent state services.
  • Cuts Medicaid Benefits and Shifts Costs to States. The AHCA would fundamentally change Medicaid financing from an open-ended federal and state matching formula into per capita based block grants. This change is estimated to save the federal government $882 billion over 10 years. With less federal funding, states would be forced to contribute more of their own dollars, or cut enrollee benefits and/or provider reimbursement.
  • Greatly Weakens Mental Health and Addiction Parity. By removing the EHB requirement, many health plans may decide not to cover mental health and addiction services. Additionally, it weakens parity by allowing large employers to choose minimum benefit requirements from any state, skirting state mandates and resulting in decreased coverage for those in employer-sponsored plans as well.
  • Ends Medicaid Expansion. The AHCA ends enhanced federal funding for the Affordable Care Act’s (ACA) Medicaid expansion. Without these funds, many states will likely choose to end their Medicaid expansion programs
  • Allows Americans With Pre-existing Conditions to be Charged More. States could opt out the ACA prohibition against insurers charging sick patients more for coverage, so long as the state sets up a high-risk pool for people with pre-existing conditions. The latest amendment to the bill provides $8 billion over five years to help people with pre-existing conditions, but health care experts say this amount is completely inadequate.
  • Reduces Subsidies on the Individual Market. The AHCA would repeal subsidies that help individuals purchase insurance on the individual market and replaces them with much less generous tax credits.
  • Allows Older Americans to be Charged More. The AHCA allows insurers charge older customer up to five times as much as younger enrollees.

Trump Appoints New HHS Asst. Secretary of Mental Health & Substance Use

Source: | May 1st, 2017
One of the provisions of the 21st Century Cures Act was to create a new deputy level position at the Health and Human Services Department to direct mental health and substance use programs. Trump has named Dr. Elinore McCance-Katz. She is currently serving as the Chief Medical Officer for Rhode Island’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Her position must be approved by the Senate.  McCance-Katz served two years under President Obama as the Chief Medical Officer at SAMHSA and prior to that she was the Medical Director of the Physicians’ Clinical Support System for Buprenorphine and the Prescribers’ Clinical Support System for Opioid Therapies at SAMHSA he was the Medical Director of the Physicians’ Clinical Support System for Buprenorphine and the Prescribers’ Clinical Support System for Opioid Therapies. She has worked in the field of addiction medicine for over 20 years as a clinician, teacher, and clinical researcher. Her specialty areas include pharmacotherapy for substance use disorders, clinical pharmacology of drugs of abuse, drug interactions, cocaine/alcohol/opioid medications development, and co-occurring HIV disease and addiction.


Powdered Alcohol Should be Banned, Not Regulated

Source: | April 21st, 2017
The Texas Legislature is considering several bills that would regulate powdered alcohol just like a bottle of whiskey, beer or wine. Technically it is legal in our state, but it’s not available for purchase anywhere in Texas. If the bills pass and regulations are put in place, sellers of powdered alcohol will begin to market in Texas. 30 states have already banned powdered alcohol completely. According to Texans Standing Tall, the lead advocate organization on this issue, Texas should follow other states and pass a ban instead of creating regulations because:
  1. The powder could be added to other alcoholic drinks, to increase potency, and it could also be snorted. Both can cause a rapid and dangerous rise in alcohol blood levels which increases the potential to harm oneself and others.
  2. Powdered alcohol is easy to conceal.
  3. It is a product that appeals to youth. Powered alcohol manufacturers have created flavors like cosmopolitan, margarita and lemon drop. These are exactly the kind of flavors that appeal to underage drinkers.
Public health and safety experts across the country have expressed concern over what they see as the potential risks of using powdered alcohol. In June 2016, the American Medical Association (AMA) announced its support for federal and state bans of powdered alcohol.


Source: Texas Tribune

State Reforms Reverse Decades of Incarceration Growth

Source: | April 14th, 2017
The Pew Charitable Trust has published a Chartbook that examines the long-term increase in U.S. incarceration and highlights three key drivers of the recent decline:  1) Research has identified effective alternatives to incarceration; 2) States have shown it is possible to reduce imprisonment and crime rates at the same time; and, 3) Voters across the political spectrum strongly support criminal justice reform. Their data analysis revealed that from the mid-1970s to the mid-2000s, the U.S. incarceration rate more than quadrupled as federal and state lawmakers mandated longer criminal sentences and placed restrictions on inmates’ release from prison. By 2007, 1 in 100 American adults was behind bars, and 1 in 31 was under some form of correctional control, including probation or parole. Meanwhile, combined local, state and federal taxpayer spending on corrections had soared to more than $74 billion a year. Starting with Texas in 2007, more than 30 states have advanced reforms, including reducing lengthy prison sentences, eliminating mandatory minimum sentences, expanding parole eligibility, establishing and strengthening diversion programs and investing the savings in evidence-based prison alternatives that can help break the cycle of recidivism. These policies are directed at reserving costly prison space for violent and career offenders and expanding prison alternatives for nonviolent offenders. Between 2007 and 2015, the incarceration rate receded to 1 in 115 adults, the correctional control rate dropped to 1 in 37, and the overall crime rate continued its downward trend.


Christie to Lead Presidential Commission on Opioid Crisis

Source: | April 7th, 2017
As a candidate, Donald Trump promised states hit hard by opioid addiction that he’d solve the epidemic ravaging their communities. At the end of March President Trump took a step toward fulfilling that campaign promise by creating a new high-level commission on opioids. New Jersey Gov. Chris Christie has been tapped to lead the commission which also includes Attorney General Jeff Sessions, HHS Secretary Tom Price, VA Secretary David Shulkin, Defense Secretary James Mattis and as many as five other members. The composition is interesting because there are contrasting viewpoints among the appointed members. Gov Christie is a proponent of prevention and treatment and a public health approach to solving the opioid crisis, whereas Attorney General Sessions holds a more punitive view of drug use. The Commission has been charged with the tasks below. In 90 days, the commission will submit an interim report with its findings to President Trump. A final report is expected later this year. The commission will disband after issuing its final report.


Sources:  Fox News; Politico
  • Review the funding and availability of treatment;
  • Determine best practices for prevention and recovery;
  • Evaluate federal programs and the U.S. health system to identify regulatory barriers or ineffective initiatives; and
  • Recommend changes to federal criminal law or other processes.

7 in 10 U.S. Workplaces Hit by Opioid Abuse

Source: | March 16th, 2017
70 percent of businesses say prescription drug abuse affects their workers, per a survey released by the National Safety Council. The report found:
  • While 71 percent of employers believe that abuse of prescription painkillers is a disease that requires treatment, 65 percent also consider it a justifiable reason to fire a worker.
  • Only 19 percent of employers said they felt “extremely prepared” to deal with prescription drug abuse in their workplace, only 13 percent were “very confident” that workers could spot signs of misuse, and 76 percent do not offer training on the topic.
  • 57 percent of employers said all employees underwent drug testing. Of those who conduct drug testing, 41 percent do not test for synthetic opioids such as oxycodone, hydrocodone, and fentanyl, the findings showed.
  • The survey also found that 81 percent of employers’ policies lack at least one major element of an effective drug-free workplace program.
  • 88 percent of employers said they would be interested in having their insurer cover alternative pain relief treatments so workers could avoid taking narcotic painkillers, but 30 percent of those employers said they would not act on that interest.
  • On a positive note, 70 percent of employers did say they would help workers struggling with prescription drug abuse return to their jobs after completing treatment.

    Source: WEB MD

Stopping Smoking Helps People Stay Sober

Source: | March 10th, 2017
Researchers at Columbia University’s Mailman School of Public Health and the City University of New York have discovered that smokers in recovery from substance use disorders are at greater risk of relapsing three years later compared with those who do not smoke cigarettes. The researchers assessed subjects at two time points, three years apart, daily smokers and non-daily smokers had approximately twice the odds of relapsing to drug use at the end of the three-year period compared with nonsmokers. “If research continues to show a relationship between smoking and relapse to substance use among those in recovery, making tobacco treatment a standard part of treatment for illicit substance use disorders may be a critical service to provide to adults toward improving substance treatment outcomes over the long term,” suggested Renee Goodwin, Ph.D., Mailman School of Public Health.
Source: Psych Central

New Approach Reduces Teen Risk for Drug Addiction

Source: | February 28th, 2017

Emerging research suggest programs that improve impulse control are the best method to prevent substance abuse. The findings emerged from a final assessment of 387 young people, ages 18-20, who were recruited as 10 to 12-year-olds in 2004 for a long-term study by the Annenberg Public Policy Center of the University of Pennsylvania in collaboration with the Children’s Hospital of Philadelphia. Drug use in adolescence is often linked to later substance-abuse problems. The new study finds that key risk factors include a combination of weak working memory and cognitive processing which can lead to poor impulse control. Working memory refers to the ability to concentrate on a task without being easily distracted. Youth with weak working memory tend to have problems controlling their impulses and thus appear to be at greater risk of continuing drug use. There is a lot of research that links early onset of use to later substance use disorders. “Drug prevention strategy in the schools typically focuses on middle school when early drug use tends to take place and assumes that any drug use at all is a problem,” said co-author Dan Romer, research director of the Annenberg Public Policy Center. “Our study advances the field by showing that just addressing early use is not going to solve the problem.” Interventions that strengthen working memory and cognitive processing related to inhibiting impulsive responses need to be developed to help adolescents better navigate drug-related temptations.

Source: PsychCentral

Future of SUD Policy Under Trump Administration

Source: | February 15th, 2017

During the last Administration, there was significant attention and policy action regarding addiction – much of it propelled by the Prescription Drug and Opioid epidemic. There is mounting concern among SUD advocates that these policy advances may be stalled or reversed by the Trump administration. Observers note the “Repeal and Replace” effort driven by Trump and THE GOP majority Congress may not include provisions which expanded access to mental health and addiction treatment by designating it as an “essential benefit” that must be covered through the A.C.A. marketplaces and expanded Medicaid.  And, there will likely be a return to a tough law and order approach to the drug crisis which could reverse recent trends in sentencing reductions and treatment in lieu of incarceration policies. But advocates are also concerned that there doesn’t seem to be a policy strategy formed and the White House’s website currently does not list addiction as one of the issues they intend to address. On the campaign trail, Trump highlighted construction of the border wall as his main response to the addiction crisis and the Executive Order he signed last week claims, “The trafficking by cartels of controlled substances has triggered resurgence in deadly drug abuse and a corresponding rise in violent crime related to drugs.” The other indicator this administration will likely double down on tough enforcement is the confirmation of Sen. Jeff Sessions as Attorney General.  Sessions has a history of supporting “drug war” policies.

Sources:  The Fix – The Hill – The Fiscal Times

42 CFR Rule Changes Finalized

Source: | January 26th, 2017

The U.S. Department of Health and Human Services (HHS) finalized changes to Confidentiality of Alcohol and Drug Abuse Patient Records regulations, (42 CFR Part 2) to facilitate health integration and information exchange within new health care models while continuing to protect the privacy and confidentiality of patients seeking treatment for substance use disorders. The new rule is published in Federal Register. Major provisions finalized in Final Rule include:

  • SAMHSA will allow any lawful holder of patient identifying information to disclose Part 2 patient identifying information to qualified personnel for purposes of conducting scientific research if the researcher meets certain regulatory requirements. SAMHSA also permits data linkages to enable researchers to link to data sets from data repositories holding Part 2 data if certain regulatory requirements are met. These will enable more needed research on substance use disorders.
  • SAMHSA will continue to apply Part 2 rules when a program is federally assisted and holds itself out as providing substance use disorder diagnosis, treatment, or referral for treatment.
  • SAMHSA will allow a patient to consent to disclosing their information using a general designation to individual(s) and/or entity(-ies)(e.g., “my treating providers”) in certain circumstances. This change is intended to allow patients to benefit from integrated health care systems. This provision also ensures patient choice, confidentiality, and privacy as patients do not have to agree to such disclosures.
  • SAMHSA has added a requirement allowing patients who have agreed to the general disclosure designation, the option to receive a list of entities to whom their information has been disclosed to, if requested.
  • SAMHSA has made changes that outline the audit or evaluation procedures necessary to meet the requirements of a CMS-regulated accountable care organization or similar CMS-regulated organizations (including CMS-regulated Qualified Entities). This change will ensure CMS-regulated entities can perform necessary audit and evaluations activities, including financial and quality assurance functions critical to Accountable Care Organizations and other health care organizations.
  • SAMHSA has updated and modernized the rule to address both paper and electronic documentation.
  • SAMHSA will monitor implementation of the final rule and is working to develop additional sub-regulatory guidance and materials on many of the finalized provisions.