Proposed federal mandates cloud opioid treatment

Key Takeaways

Following a series of proposed federal mandates that would change how counties tackle substance use disorder, a policy expert provided an overview on what’s to come and panelists shared the importance of collaboration in recovery work at NACo’s Opioid Solutions Leadership Network peer exchange held in Washington, D.C. on May 1.

Regina LaBelle, director of the center on addiction policy for Georgetown University’s O’Neill Institute for National and Global Health Law, shared an update of what changes, and proposed changes, to health and human services have come out of the Trump Administration in its first 100 days.

Changes include the reduction of 20,000 full-time Department of Health and Human Services employees, the rescission of $11 billion in COVID-19 relief grants (which is subject to litigation) and the termination of numerous grants coming out of the National Health Institute that deal with diversity, equity and inclusion, many of which are related to HIV and addiction, according to LaBelle. 

Additional proposed changes through the Office of National Drug Control Policy’s drug policy priorities, which it released on April 1, include cutting first responder training for Naloxone and programs that support recovery treatment services for youth, the unhoused and pregnant and parenting women, she added. 

“There’s a lot up in the air,” LaBelle said. “The only thing I would say is that counties and cities, this is where the rubber hits the road — you’re going to feel it first. And I know that members of Congress really are anxious to hear from you.”

The future of Section 1115 Medicaid waivers, which allow states to provide medication-assisted treatment to incarcerated individuals with substance use disorder prior to re-entry, is unknown at the time, LaBelle said. No existing waivers have been rescinded, but no new waivers have been approved during this administration, she added.

Medicaid expansion was a “game-changer” for Seattle and King County, Wash., and it being up-in-the-air makes the future unknown for the area’s most vulnerable population, said Brad Finegood, a strategic advisor for King County, Wash. Public Health.

Medicaid expansion “allowed people to get basic baseline services that they were never able to get before,” Finegood said. 

“We know that about 50% of the people who die in Seattle and King County are either living unsheltered or they’re in the homeless service system, so we know that people who are really low income are impacted by our really toxic drug supply. And so, that’s a big unknown, because if people get that service taken away, that’s huge.”

While overdoses are going down in recent years nationally, substance use is an ongoing fight that counties must face and continue to tackle head-on, according to LaBelle.

“Even in the face of reduced overdose death rates, we can’t let up,” LaBelle said. 

“It’s still ridiculous. The number is ridiculous. And this is not success. This is a bipartisan issue — it’s always been bipartisan, and it needs to remain bipartisan, and we have to be consistent.”

Neighboring counties sometimes have a “black wall,” in which they don’t, or rarely, coordinate or communicate with each other, which can prevent progress, said Walworth County, Wis. Supervisor Brian Holt. Coordinating with surrounding counties leads to better programming and better outcomes — Walworth County worked with the nearby counties of Jefferson, Rock and Waukesha on its substance use analysis, and it provided a better picture data-wise of what the priorities in the area were than if it were focused on a singular county, Holt said.   

“I’m in a border county, we border Illinois, and there’s very little to no communication across the border there, but people don’t operate that way,” Holt said. “That’s not how traffic patterns are or movement patterns, or where people choose to live, or even where the flow of substances is. What you can do to coordinate with your surrounding counties is a huge advantage.”

Collaboration is “key,” echoed Amanda Peters, director of the Northern Kentucky Office of Drug Control Policy. The Office is part of a prevention hub that brings together social and case workers, law enforcement, jail staff and housing coordinators to address substance use in the community, she said. 

“Something that we like to do and say is ‘public policy can be improved by better public health and public safety — how do we marry all of that together?’” Peters said. 

“Because this is a public safety and public health issue, and it’s also a private health issue … We’re looking at building a recovery-oriented system of care and making that spectrum from prevention all the way to reentry.”

Federal funding needs to be more flexible, Peters said. With opioid use declining on the whole, it’s important to have funding to also combat polysubstance use and alcoholism, the latter of which is the biggest problem in her community, she noted.

“So many things are so rigid, of what you can’t fund and what you can,” Peters said. “And it should really be tailored to the local community, depending on who your partners are and what you need … We need to be able to target opioids, but as the drug trends change, we need to be able to adapt in that way, to look at strategies that work for our local communities.”

Finegood said that the Trump administration’s focus on deregulation could benefit access to medication-assisted treatment. 

“This federal administration is about deregulation, reportedly, and so there’s a number of places where deregulation, I think, can really help making access to methadone, to long-acting injectable medication a lot easier in the field where people are.” Finegood said. 

“And especially with Medicaid providing more local flexibility on what Medicaid can do and how it can serve people, because so many regulation services have to be encountered in a certain way in a certain location that it makes it really hard to get to those who are suffering most, which are those vulnerable out in the field, often living unsheltered.”