Issue Category: Syringe Access Programs

Increases in Drug Overdose Death Rates Were Up Before COVID-19 and Are Continuing to Rise During the Pandemic

Trust for America’s Health and Well Being Trust Call for Renewed Focus on Preventing Deaths of Despair

DISTRICT OF COLUMBIA & OAKLAND, CA – Dec. 23, 2020 – According to data released this week by the National Center for Health Statistics, in 2019 age-adjusted drug overdose deaths increased slightly over the prior year.  Coupled with data released last week by the CDC showing increases in drug overdose deaths in early 2020, these reports demonstrate the continuing upward trajectory of drug deaths in the U.S, a trend that is being compounded by the COVID-19 pandemic.

The age-adjusted rate of drug overdose during 2019 was 21.6 per 100,000 deaths, up from the 2018 rate of 20.7 per 100,000. In 2019, 70,630 people died due to drug overdose in the United States.

Between 1999 and 2019 the rate of drug overdose deaths increased for all groups aged 15 and older, with people aged 35-44 experiencing the highest single year increase in 2019.  While rates of drug overdose deaths involving heroin, natural and semisynthetic opioids, and methadone decreased between 2018 and 2019 the rate of overdose deaths involving synthetic opioids other than methadone continued to increase.

2018 data showing only minor progress after decades of worsening trends, provisional drug overdose data showing an 18% increase over the last 12 months, and the recent CDC Health Alert Network notice on early 2020 increases in fatal drug overdoses driven by synthetic opioids all underscore the continued impact of the deaths of despair crisis and how the COVID-19 pandemic has further diminished the mental health and well-being of many Americans.

“These 2019 overdose rates and the outlook for 2020 are extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” said John Auerbach, President and CEO of the Trust for America’s Health. “As we work to recover from the COVID-19 pandemic, we must take a comprehensive approach that includes policies and programs that help Americans currently struggling and target upstream root causes, like childhood trauma, poverty and discrimination in order to help change the trajectory of alcohol, drug, and suicide deaths in the upcoming decades.”

Over the last five years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released a series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

“If leaders don’t act now to stymie America’s mental health and addiction crises, next year’s data will easily surpass the astounding numbers we’re seeing today,” said Dr. Benjamin F. Miller, PsyD, Chief Strategy Officer at Well Being Trust. “Overdose deaths can be prevented if individuals who are struggling are able to access the appropriate services and supports – and with greater demonstrated success if the care individuals receive is rooted in their immediate communities.”

 

Drug Overdose Deaths, 1999-2019 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7
2019 70,630 21.6

 Sources:
CDC – NCHS – National Center for Health Statistics
https://emergency.cdc.gov/han/2020/han00438.asp
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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About Trust for America’s Health
Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

 

About Well Being Trust
Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org Twitter: @WellBeingTrust

 

Policymakers and Health Systems Must Earn Trust within Communities of Color and Tribal Nations to Ensure COVID-19 Vaccine Receptivity, Say Health and Public Health Leaders

Policy brief calls for building vaccine acceptance in communities of color and tribal communities through data transparency, tailored communications via trusted messengers, ensuring ease of vaccine access and no out-of-pocket costs

(Washington, DC – Dec. 21, 2020) – A woeful history of maltreatment of communities of color and tribal nations by government and the health sector, coupled with present day marginalization of these communities by the healthcare system, are the root of vaccine distrust among those groups, according to a policy brief, Building Trust in and Access to a COVID-19 Vaccine Among People of Color and Tribal Nations released today by Trust for America’s Health (TFAH) and co-authors the National Medical Association (NMA) and UnidosUS.

This historic maltreatment, coupled with current day structural racism, has played out in COVID-19’s disproportionate impact on communities of color and tribal communities. These factors also make ensuring vaccine receptivity and access within those communities challenging and of critical importance to protecting lives and ending the pandemic.

In October 2020, TFAH, NMA and UnidosUS hosted a policy convening with 40 leading health equity, healthcare, civil rights, and public health organizations. The purpose of the convening was to advise policymakers on the barriers to vaccine receptivity within communities of color and tribal communities and how to overcome those barriers.

“Earning trust within communities of color and tribal communities will be critical to the successful administration of the COVID-19 vaccine. Doing so will require prioritizing equity, ensuring that leaders from those communities have authentic opportunities to impact vaccine distribution and administration planning, and, the resources to fully participate in supporting vaccine outreach, education and delivery in their communities,” said Dr. J. Nadine Gracia, Executive Vice President and COO of Trust for America’s Health.

The convening created recommendations for policy actions that should be taken immediately within six key areas:

Ensure the scientific fidelity of the vaccine development process.

  • HHS and vaccine developers should release all available vaccine data at frequent and regular intervals to improve transparency and increase confidence in the vaccine evaluation process. Leadership at FDA and HHS must commit to advancing any vaccine only after it has been validated based on established federal and scientific protocols. Programs to monitor for adverse events must also be in place and transparent. Any perception of bypassing safety measures or withholding information could derail a successful vaccination effort.
  • FDA should engage health and public health professional societies, particularly those representing healthcare providers of color, local public health officials, as well as other stakeholders with a role in vaccination, and allow these groups to validate all available data, review the vaccine development and approval process, and issue regular updates on data to their patients, members, and the public.

 Equip trusted community organizations and networks within communities of color and tribal nations to participate in vaccination planning, education, delivery and administration.  Ensure their meaningful engagement and participation by providing funding.

  • Congress should fund CDC and its state, local, tribal, and territorial partners to provide training, support, and financial resources for community-based organizations to join in vaccination planning and implementation, including community outreach, training of providers, and participation in vaccination clinics. State, local, tribal, and territorial authorities should authentically engage and immediately begin vaccination planning with community-based organizations, community health workers/promotores de salud, faith leaders, educators, civic and tribal leaders, and other trusted organizations outside the clinical healthcare setting as key, funded partners.

Provide communities the information they need to understand the vaccine, make informed decisions, and deliver messages through trusted messengers and pathways.

  • Congress should provide at least $500 million to CDC for outreach, communication, and educational efforts to reach priority populations in order to increase vaccine confidence and combat misinformation. All communications must be culturally and linguistically appropriate and tailored as much as possible to reach diverse populations as well as generations within groups.
  • FDA and CDC should initiate early engagement with diverse national organizations and provide funding and guidance for state, local, tribal, and territorial planners to help shape messaging and engage locally with healthcare providers in communities of color and tribal communities, such as nurses, pharmacists, promotores de salud, community health workers, and others to ensure they have the information they need to feel comfortable recommending the vaccine to their patients. Congress and HHS should provide funding for training and engagement of trusted non-healthcare communicators to help shape messaging and to train informal networks, civic and lay leaders, and other trusted community leaders and community-based organizations to answer questions and encourage vaccination.
  • All messaging about the vaccine must be appropriate for all levels of health literacy. Communication should be realistic and clear about timelines and priority groups (and the rationale for these decisions), vaccine effectiveness, types of vaccines, the number of doses, costs, and the need for ongoing public health protections. Planners must provide information that meets people where they are (e.g., barber shops, bodegas, grocery stores, places of worship, etc.) and ensure that trusted messengers in those places have the information they need to be credible and authentic spokespeople.

 

Ensure that it is as easy as possible for people to be vaccinated. Vaccines must be delivered in community settings that are trusted, safe and accessible.

  • We urge the administration and Congress to appropriate the resources necessary to expand and strengthen federal, state, local, territorial, and tribal capacity for a timely, comprehensive, and equitable COVID-19 vaccination planning, communications, distribution, and administration campaign, including funding to support vaccine distribution at the local level and by community-based organizations.
  • Congress and HHS should allocate funding to increase access to vaccination services to ensure that people seeking to be vaccinated do not experience undue increased exposure to the virus as they travel to, move through, and return home from vaccination sites. Flexibility in funding is needed to enable transport of people to vaccination sites, increase accessibility to people without cars, and promote safety and minimize exposure at vaccination locations. Funding should also be provided to health and community-based agencies to assist those for whom transportation or childcare costs are an obstacle to receipt of the vaccine.
  • Planners should ensure that vaccination sites are located in areas that have borne a disproportionate burden of COVID-19, especially leveraging community-based organizations such as Federally Qualified Health Centers, community health centers, rural health centers, schools and places of worship. Mobile services will be particularly important in rural areas. Planners should prioritize congregate living facilities, such as long-term care, prisons, and homeless shelters. In addition, some families, displaced by the COVID economic fallout, may be living with relatives. Planners should ensure vaccination sites have services that meet the Americans with Disabilities Act (ADA) and HHS Office for Civil Rights (OCR) standards for disability and language access.
  • Federal state, local, tribal, and territorial officials must guarantee and communicate with the public that immigration status is not a factor in people’s ability to receive the vaccine and that immigration status is not collected or reported by vaccination sites/providers. Similarly, the presence of law enforcement officers or military personnel could be a deterrent for vaccination at locations, so planners should consider other means of securing sites.
  • In the initial phase, as communities vaccinate healthcare workers, planners must be sure to prioritize home health, long-term care, and other non-hospital-based healthcare workers, who are more likely to be people of color. Other essential workers that comprise large numbers of workers who are people of color and should be treated as within the vaccination priority groups are the food service industry, farmworkers and public transportation employees.

Ensure complete coverage of the costs associated with the vaccine incurred by individuals, providers of the vaccine, and state/local/tribal/territorial governments responsible for administering the vaccine and communicating with their communities about it.

  • Congress, the Centers for Medicare and Medicaid Services, and private payers must guarantee that people receiving the vaccine have zero out-of-pocket costs for the vaccine, related health care visits, or any adverse events related to the vaccine, regardless of their health insurance status.
  • HHS, with emergency funding from Congress, should provide funding so that state, local, tribal, and territorial governments do not bear any cost of vaccine communication efforts, working with their communities, organizing sites, training their staff, and providing personal protective equipment (PPE).

 Congress must provide additional funding and require disaggregated data collection and reporting by age, race, ethnicity, gender identity, primary language, disability status, and other demographic factors on vaccine trust and acceptance, access, vaccination rates, adverse experiences, and ongoing health outcomes.

  • CDC, and state, local, tribal, and territorial authorities should include leaders from communities of color and tribal communities and to plan on-going data collection on vaccination efforts, interpret data, add cultural context, share data with communities, and determine implications and next steps.
  • CDC, and state, local, tribal, and territorial authorities should use these data to inform ongoing prioritization of vaccine distribution and rapidly address gaps in vaccination that may arise among subpopulations by race, ethnicity, neighborhood, or housing setting.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @healthyamerica1

 

COVID-19 School Closures Put 30 Million Children at Risk of Hunger

Many States with High COVID-19 Infection Rates Also Have Highest School-Meal Programs Participation Rates

(Washington, DC – July 16, 2020) – As COVID-19 infection rates continue to increase in states across the country, many of those jurisdictions are facing the complex dilemma of high infections rates complicating school re-openings and thereby limiting students’ access to school-based meal programs. Among the states with spiking infection rates and a high percentage of students participating in school-based meal programs are Arizona, Florida, Louisiana, Mississippi and South Carolina.

In March schools across the country began closing to stop the spread of the COVID-19 virus. In response, and recognizing the important source of nutrition school-based meals were to millions of American children, the U.S. Department of Agriculture’s Food and Nutrition Service began approving nationwide waivers to provide school systems flexibility in how meals were provided to students.  For example, these waivers enable schools to serve meals in non-congregate settings and outside of standard mealtimes, serve afterschool snacks and meals outside of structured environments, and waive requirements that students be present when meals are picked up.

Over half of all students in elementary and secondary schools across the country depend on the National School Lunch Program, and 12.5 million of those students also participate in the School Breakfast Program. As the COVID-19 pandemic closed schools this spring, these students were placed at risk of not having enough to eat.

A new policy brief, Beyond School Walls: How Federal, State and Local Entities are Adapting Policies to Ensure Student Access to Healthy Meals During the COVID-19 Pandemic, released today by Trust for America’s Health, reviews steps the federal and state governments have taken to ensure students’ access to healthy meals when schools are closed and what needs to be done to ensure continued meal access as all school systems face uncertainties about how to safely reopen for the 2020-2021 school year.

“School meal programs are the most important source of nutritious food for millions of American children. To the degree possible, school systems, with financial and regulatory relief from the federal government,  should continue to be innovative about how to deliver meals to students and should strive to meet or exceed federal nutrition standards for these meals despite product shortages created by the pandemic,” said Adam Lustig, Project Manager at Trust for America’s Health and the brief’s author.

Due to the economic impact the pandemic has had on millions of American families and the numerous uncertainties about how to safely re-open schools, the currently in place program waivers should be extended through the summer and may need to be kept in place during the 2020–2021 school year, the brief says.

Many of the states hardest hit by COVID also have highest school meal programs participation rates

States with some of the highest rates of COVID-19 infections also have high percentages of students who depend on school meals for much of their nutrition. States in which both COVID-19 infection rates are above national medians and school meals program enrollment is high include Arizona, Florida, Georgia, Louisiana, Mississippi, and South Carolina.

States in which more than half of students are enrolled in school-meals programs are:

Percentage of students enrolled in school meal programs

D.C.                                        76.4%

Mississippi                           75.0%

New Mexico                         71.4%

South Carolina                    67.0%

Arkansas                              63.6%

Louisiana                             63.0%

Oklahoma                            62.5%

Georgia                                62.0%

Nevada                                60.8%

Kentucky                             58.7%

California                            58.1%

Florida                                 58.1%

Arizona                                57.0%

Missouri                              52.7%

New York                            52.6%

Illinois                                 50.2%

Alabama                              51.6%

Oregon                                 50.5%

Hunger, poor nutrition and food insecurity can increase a child’s risk of developing a range of physical, mental, behavioral, emotional, and learning problems. Hungry children also get sick more often and are more likely to be hospitalized. Maintaining children’s access to nutritious meals despite school closures not only ensure they do not go hungry, but also promotes children’s health.

“State and federal guidelines waivers have allowed school systems to provide meals to students during the pandemic response, keeping them in place this summer and into the 2020-2021 school year will be the difference between kids who have enough to eat and kids who go hungry,” Lustig said.

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 Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter:@HealthyAmerica1

Annual Deaths Due to Alcohol, Drugs or Suicide Exceeded 150,000According to the Most Recent Data – And Could Get Worse Due to COVID-19

Despite decreases in overall opioid overdose deaths, deaths involving synthetic opioids, cocaine and other psychostimulants increased sharply and alcohol and suicide deaths are also up.

(Washington, DC and Oakland, CA – May 21, 2020) – Newly released data show that 151,964 Americans died due to alcohol, drugs or suicide in 2018. This national death rate for alcohol, drug and suicide deaths was only very slightly lower than what it had been in 2017 despite progress in reducing some types of opioid overdose, according to a new study by Trust for America’s Health (TFAH) and Well Being Trust (WBT).

For the year, alcohol deaths were up 4 percent and suicide deaths were up 2 percent. The new data also show a continuing shift within the opioid crisis with reductions in deaths due to prescription opioid overdose but increases in deaths involving synthetic opioids, including fentanyl.

Death rates for all opioids were down 2 percent, but the death rate for synthetic opioids was up 10 percent. Additionally, heroin involved overdose deaths were lower but deaths involving cocaine and other psychostimulants, such as methamphetamine, ecstasy, amphetamine and prescription stimulants, were higher.

While still disturbingly high, the s2018 data is the first time since 1999, when the current data collection began, that there has not been a sizable increase in the alcohol, drugs and suicide deaths per 100,000 rate. However, this stabilization in the deaths rate was not uniform. Some places and population groups are experiencing stable or decreasing deaths rates while rates among other groups or in other places continue to rise.

“These data are a clarion call to action,” said John Auerbach, President and CEO of Trust for America’s Health. “We know what works to address deaths of despair but progress has been uneven and death rates continue to climb, with communities of color experiencing higher rates of increases in drug-induced and alcohol deaths. And there’s another immediate concern: the COVID-19 crisis has increased the health burdens and economic pressures on many communities of color.”

American Indians, Asians, Blacks, Latinos and older adults all experienced increases in drug-induced deaths between 2017 and 2018. Blacks and American Indians had the largest absolute increase. Black now have higher synthetic opioid overdose rates (10.7 per 100,000), cocaine overdose rates (8.8 percent per 100,000) and nearly the same overall drug-induced rate (21.8 per 100,000) as Whites, after decades of having substantially lower rates.

Population groups that experienced lower drug-induced death rates in 2018 included adults ages 18-54 and Whites.

“Quite simply, too many Americans are dying from preventable causes. The profound racial health disparities seen in these data show that many ethnic minority groups are being left behind in our response efforts,” said Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust. “The nation needs a comprehensive framework for excellence in mental health and well-being, one that intentionally provides solutions for American Indians, Blacks, Asians and Latinos. With all the other COVID-19 related investments, it’s time for the federal government to fully invest in mental health now and for all states to take action.”

The reduction in certain opioid deaths suggests that the policies and programs targeting the opioid epidemic may be taking hold in some populations – but many racial and ethnic groups are not seeing the same progress as Whites. The nation should build on the small degree of success and bring the same focus to populations who are at increasing risk, especially Blacks, Latinos and American Indians.

Policy recommendations outlined in the report include:

  • Investing in prevention by addressing the upstream factors that create the conditions that improve outcomes. Numerous factors contribute to well-being or the lack of it including Intergenerational poverty, systemic racism, ethnic discrimination, and homophobia/transphobia are among the social, economic, and environmental factors that elevate risk. Government agencies at all levels should take steps to promote racial equity and combat racism and discrimination.
  • Reducing risk factors and promoting resilience in children, families, and communities. Support equitable policies and programs that reduce traumatic and adverse experiences—such as exposure to violence, unstable housing, racial and ethnic discrimination, and implicit bias—which have profound long-term impacts on later substance use and mental health.
  • Integrating, increasing access to, and improving healthcare by engaging all sectors of society in addressing mental health and substance use disorders. Schools, workplaces, community centers, libraries, and public-facing programs should all incorporate ways to address mental health and addictions issues, from boosting awareness and reducing stigma, to providing crisis intervention training and facilitating referrals, and even integrating healthcare into their programming where possible.
  • Limiting access to lethal means of suicide. Promote safe storage of medications and firearms by providing public education; restricting access to firearms for children and individuals in crisis or at risk of suicide; and creating protocols for health care providers, counselors, and first responders on how to interact with and counsel patients and families to create safe environments. Implement universal background checks for gun purchases and extreme-risk protection orders nationwide, and expand programs to engage stakeholders—like the Gun Shop Project, which educates gun store staffs on suicide prevention.

2018 Data Summary

Deaths by Drug Type

Synthetic Opioids Overdose Deaths – in 2018, 31,355 Americans died from synthetic opioid-involved overdose; up 10 percent since 2017. In total, the synthetic-opioid-involved overdose death rate has increased nearly 10-fold since 2013.

Cocaine Overdose Deaths – In 2018, 14,666 Americans died from cocaine-involved overdoses; up 5 percent since 2017. The overall cocaine overdose death rate has increased by 187 percent since 2013.

Other psychostimulants Overdose Deaths – In 2018, 12,676 Americans died from overdoses involving psychostimulants and 52,279 have died over the past decade due to psychostimulants abuse.  The 2018 psychostimulants overdose death rate was 22 percent higher than it was in 2017.

Alcohol-induced Deaths

In 2018, 37,329 Americans died due to alcohol-induced causes; the rate of alcohol-induced deaths in 2018 was 4 percent higher than the prior year.

Alcohol induced deaths are highest among American Indians (30.0 per 100,000) and adults ages 55 to 74 (27.6 per 100,000). All population groups had higher rates of alcohol deaths in 2018 as compared to the prior year except youths ages 0-17, whose rate held steady.

Suicide Deaths

In 2018, 48,344 Americans died as a result of suicide. Nationally, the 2018 suicide rate was two percent higher than the prior year (after a four percent increase in 2017). Suicide rates increased across all demographics, except for adults ages 18-54 whose rate remained stable. In addition, all racial and ethnic minority groups experienced larger proportional changes in suicide rates than did Whites.

Death by suicide in 2018 was highest among males (23.4 percent per 100,000), those living in rural areas (19.7 per 100,000), Whites (16.8 per 100,000) and American Indian/Alaska Natives (14.1 per 100,000).

State Trends

Between 2017 and 2018, 27 states experienced higher rates (above 0.04%) of alcohol, drug and suicide deaths. Twenty-three states and the District of Columbia had lower alcohol, drug and suicide deaths during the same period.

States with the highest alcohol, drugs and suicide death rates in 2018 were: West Virginia (84.9 per 100,000), New Mexico (82.8 per 100,000), New Hampshire (68.2 per 100,000) and Alaska (67.8 per 100,000).

States with the lowest alcohol, drug and suicide rates in 2018 were: Texas (31.7 per 100,000), Mississippi (31.7 per 100,000) and Hawaii (34.6 per 100,000).

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  www.tfah.org. Twitter:@HealthyAmerica1

 

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org. Twitter: @WellBeingTrust

 

 

 

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response

Nation must prepare for immediate and long-term impacts of COVID-19 on the nation’s mental health

(Washington, DC – March 20, 2020) — A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response. Such consideration is especially important as the anxiety and social isolation related to the COVID-19 pandemic are likely to increase the need for mental health and substance misuse care, according to the group’s leaders.

In a letter sent to Vice President Pence and House and Senate leadership today, the group recognizes the importance of social distancing but also cites the need to proactively address the short and long-term impacts of social isolation on Americans’ mental health. Of particular concern are those people who are currently being treated for a mental health or substance misuse issue, treatment that may be interrupted by illness, stay-at-home orders, business shut-downs or the loss of income or health insurance.

Access to mental health and substance misuse treatment is an ongoing concern, likely to be exacerbated by the COVID-19 crisis. Currently, 112 million Americans live in a mental health professional shortage area. Furthermore, loneliness and social isolation are already a daily reality for many Americans and is estimated to shorten a person’s life by 15 years – the equivalent impact of having obesity or smoking 15 cigarettes a day. This problem will only increase as further social distancing requirements are put in place.

The cross-sector group is calling for immediate action to address Americans’ mental health and substance misuse needs during the COVID-19 response. And, for the longer term, strengthening the nation’s mental health and substance misuse treatment system so it meets the needs of all Americans, regardless of their socioeconomic status, their employment status or where they live.

The group is following for the following action steps: The Administration and/or Congress should:

Immediately implement measures to ensure access and continuation of mental health and substance use services to all individuals during the COVID-19 response and during future public health emergencies including:

  • HHS should issue guidance clarifying that mental health and substance use clinicians and professionals are included in priority testing for COVID-19as well as targets of emergency medical supplies including masks, respirators, ventilators, and other needed resources for health care professionals during this crisis.
  • CMS should issue guidance for various care contingencies should substance use treatment providers become sick or unable to work and affect required quotas for reimbursement.
  • SAMHSA should issue guidance to support remote recovery support groups.
  • Congress should pass S. 2244/H.R. 4131, the Improving Access to Remote Behavioral Health Treatment Act, to clarify the eligibility of community mental health and addiction treatment centers to prescribe controlled substances for opioid use disorder via telemedicine. HHS recently waived the Ryan Haight restrictions for this pandemic, but this ends once the national emergency ends which could create treatment gaps.
  • HHS should launch a special enrollment period for commercial health insurance in the healthcare.gov marketplace during this crisis and future public health crises.
  •  Congress should ensure that all government health plans provide extended supplies and/or mail order refills of prescriptions.
  •  Congress should allow for all current discretionary and block grant funds for mental health and substance use programs, including prevention, intervention, treatment, and recovery support, across all relevant agencies across the federal government that cannot be spent this fiscal year due to the pandemic to be automatically extended into Fiscal Year 2021.

Pass, implement, and/or appropriate funding to strengthen crisis services and surveillance including:

  •  S. 2661/H.R. 4194, the National Suicide Hotline Designation Act, which would formally designate a three-digit number for the Lifeline.
  • H.R. 4564, The Suicide Prevention Lifeline Improvement Act, which would implement a set of quality metrics to ensure resources are effective and evidence-based.
  • H.R. 4585, the Campaign to Prevent Suicide Act, which establishes an educational campaign to advertise the National Suicide Prevention Lifeline and suicide prevention resources.
  • H.R. 1329, Medicaid Reentry Act, which would allow Medicaid-eligible incarcerated individuals to restart their benefits 30 days pre-release.
  • Increase funding for the Disaster Distress Helpline.
  • Increase funding to serve people who are homeless and to divert people who are at immediate risk of becoming homeless during this crisis.

Pass and implement reforms to ensure long-term availability of care, especially for populations at higher risk of self-harm or substance misuse, including:

  • S. 824/H.R. 1767, the Excellence in Mental Health and Addiction Treatment Expansion Act, which would expand the Certified Community Behavioral Health Clinic Program.
  • S. 1122/H.R. 1109, the Mental Health Services for Students Act which expands SAMHSA’s Project AWARE State Educational Agency Grant Program to support the provision of mental health services.
  • S. 2492/H.R. 2599, the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act, which would create and implement suicide prevention training policies in states, tribes, and school districts.
  • Enforce mental health parity and pass S. 1737/H.R. 3165, the Mental Health Parity Compliance Act and S. 1576/H.R. 2874, the Behavioral Health Transparency Act.
  • Expand HRSA’s NHSC Substance Use Disorder Workforce Loan Repayment Program H.R. 2431, the Mental Health Professionals Workforce Shortage Loan Repayment Act, which would establish a loan repayment program for mental health professionals working in shortage areas.
  • S. 2772/H.R. 884, the Medicare Mental Health Access Act, which would allow expanding the definition of “physician” under Medicare, allowing psychologists to practice to the full extent of their state licensure without physician oversight of Medicare facilities.

HHS should consider the mental health and substance use effects of future pandemics and national emergencies including:

  • Establishing an interagency taskforce or advisory committee on disaster mental health and substance use to ensure future responses take proper measures to coordinate care, allocate resources, and take appropriate measures to ensure recovery.
  • Convening a working group to review current research and funding on disaster mental health through NIH, AHRQ, CDC, SAMHSA, HRSA, FDA, and the Department of Justice, and other relevant agencies and identify gaps in knowledge, areas of recent progress, and necessary priorities.

Signing on to the letter were:

2020 Mom, AAMFT Research & Education Foundation, Active Minds, Addiction Connections Resource, Advocates for Opioid Recovery, African American Health Alliance, American Academy of Addiction Psychiatry, American Art Therapy Association, American Association for Marriage and Family Therapy, American Association for Psychoanalysis in Clinical Social Work, American Association of Suicidology, American Counseling Association, American Dance Therapy Association American Foundation for Suicide Prevention American Group Psychotherapy Association, American Mental Health Counselors Association, American Psychological Association, American Public Health Association, Anxiety and Depression Association of America, California Pan-Ethnic Health Network Center for Law and Social Policy (CLASP)Centerstone, Children and Adults with Attention-Deficit/Hyperactivity Disorder, Clean Slate Medical Group -Addiction Treatment, Clinical Social Work Association, Coalition to End Social

Isolation & Loneliness, College of Psychiatric and Neurologic Pharmacists (CPNP )Colorado Children’s Campaign Columbia Psychiatry, Community Anti-Drug Coalitions of America (CADCA, )Community Care Alliance Davis Direction Foundation, Depression and Bipolar Support Alliance, Easterseals, Eating Disorders Coalition, Families USA, Flawless Foundation, Foundation for Recovery, Global Alliance for Behavioral Health and Social Justice, Greater Philadelphia Business Coalition on Health, Health Resources in Action, Hogg Foundation for Mental Health, InnovaTel, Telepsychiatry International, OCD Foundation,

Mental Health America, NAADAC, the Association for Addiction Professionals, National Association of County Behavioral Health and Developmental Disability Directors, National Association for Rural Mental Health (NARMH), National Alliance on Mental Illness, National Association for Children of Addiction (NACoA, )National Association of Community Health Workers, National Association of Counties, National Association of Social Workers, National Association of Social Workers -Texas Chapter, National Association of Social Workers at the University of Southern California, National Association of State Mental Health Program Directors, National Council for Behavioral Health, National Eating Disorders Association, National Federation of Families for Children’s Mental Health, National Organization on Fetal Alcohol Syndrome, National Register of Health Service Psychologists, Network of Jewish Human Service Agencies, Neurofeedback Advocacy Project, New Jersey Association of Mental Health and Addiction Agencies, Inc., O’Neill Institute for National and Global Health Law, Postpartum Support International, Prevention Institute, Public Health Foundation, Residential Eating Disorders Consortium, Robert Graham Center, San Francisco AIDS Foundation, San Juan County Behavioral Health Department, Sandy Hook Promise SMART Recovery, Staten Island Partnership for Community Wellness, Suicide Awareness Voices of Education, Texans Care for Children, The Confederation of Independent Psychoanalytic Societies (CIPS), The Gerontological Society of America, The Institute for Innovation & Implementation at UMBSSW, The Jed Foundation, The National Alliance to Advance Adolescent Health, The Trevor Project, The Voices Project, Trust for America’s Health, United States of Care, University of Southern California, Well Being Trust.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

New Maps Track Laws Related to Tobacco Pricing Strategies and Syringe Service Programs in US

(Philadelphia, Pa – Novermber 19, 2019)  Two new maps published to LawAtlas.org today — syringe service programs (SSPs) and tobacco pricing strategies — offer a comprehensive look at US laws that address tobacco pricing strategies and access to clean syringes through syringe service programs.

“States have a vital role to play in promoting the health and well-being of their residents. These datasets, along with other resources produced under the Promoting Health and Cost Control (PHACCS) in States initiative, will provide decisionmakers, advocates, and other key stakeholders with the evidence and business case for the adoption of policies that have been shown to improve community health,” said Adam Lustig, MS, Manager and Co-Principal Investigator of the PHACCS initiative.

The maps are the first two legal data resources in a new series created and maintained by the Center for Public Health Law Research at Temple University’s Beasley School of Law (CPHLR)  with the Trust for America’s Health (TFAH).

Researchers from the Center used the scientific policy surveillance process in collaboration with experts from TFAH to provide states with detailed information about the current state of US laws that could be used to improve community health through cost-saving policy changes.

“You must first measure a policy to understand its impact on health and cost. These maps give policymakers, advocates, practitioners and other stakeholders a comprehensive look into what these laws say and how the nuanced characteristics differ across the US,” said Lindsay Cloud, JD, Director of the Policy Surveillance Program at CPHLR. “The policy surveillance process we use is the gold standard for legal research because it creates objective, detailed legal data that can be used for evaluation and provides a clear visual to identifying gaps and areas for policy improvement.”

The project will include 13 datasets on a variety of public health topics through the end of 2020, ranging from universal pre-kindergarten and school nutrition standards, to housing and economic policies like the Earned Income Tax Credit and paid sick and family leave laws. The laws displayed were in effect as of August 1, 2019.

The two datasets released today, on syringe service programs and tobacco pricing strategies, represent two of the harm reduction-focused datasets in the series.


Syringe Service Programs

Syringe service program (SSP) policies authorize the legal sale and exchange of sterile syringes, and are one of the most effective and scientifically-based methods for reducing the spread of HIV and Hepatitis. This legal map identifies where SSPs have been explicitly authorized by the law, legal exemptions for individuals who access SSPs if they’re in possession of paraphernalia if stopped by law enforcement, and additional services an SSP must provide directly or through referrals.

Some key findings from this dataset include:

  • 31 states have passed laws that explicitly authorize SSPs. This number has nearly doubled since 2014 (18 states as of August 1, 2014).
  • In four of the 31 states – Delaware, Florida, Hawaii, and Maine – the law requires a one-for-one exchange of syringes.
  • In three states – Colorado, Georgia and Ohio – SSPs are also required to provide HIV and Hepatitis screenings.


Tobacco Pricing Strategies

Tobacco use and exposure to second-hand smoke are leading causes of preventable death in the US. One strategy to decrease tobacco use and promote quitting is to increase the price of tobacco products. This legal map details US laws that apply taxes or set pricing limits for tobacco products, like traditional cigarettes, e-cigarettes, and others.

Some key findings from this dataset include:

  • All 50 states and the District of Columbia tax cigarettes.
  • All 50 states and the District of Columbia have taxes on non-cigarette tobacco products.
  • 14 states and the District of Columbia also tax e-cigarettes, either by taxing the device, the liquid, or both.
  • 31 states and the District of Columbia prohibit selling cigarettes, non-cigarette tobacco products, or both below cost.
  • 32 states preempt local taxation of tobacco, either through explicit prohibitions on local tobacco taxation or through general limitations on the power of local governments to impose their own excise taxes.

Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Learn more at www.tfah.org

The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org

 

 

States Can Improve Residents’ Health and Reduce Healthcare Spending by Adopting Policies Outside of the Healthcare Sector, New Report Shows

February 21, 2019

Policies that can improve health and save money include: Pre-K and school nutrition programs, syringe access, tobacco and alcohol taxes, paid family leave, the Earned Income Tax Credit and rapid rehousing.

(Washington, DC) — States can improve their residents’ health and well-being, and lower healthcare costs, by implementing a range of policies in sectors beyond healthcare, according to a new report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-being through Policy Change, released today by Trust for America’s Health (TFAH).

The new report analyzes state action on 13 policies outside the healthcare sector that have a long-term impact on health and an evidence base showing their effectiveness. They include: tobacco and alcohol taxes, syringe access programs, universal pre-K and rapid rehousing laws, among others. The wide policy lens of the report, which covers numerous sectors, including taxation, employment, education, housing and transportation, underscores the many economic and social factors beyond medical care that influence health.

In the context of the longest decline in life expectancy since World War I, and, insufficient resources dedicated to preventing health problems before they arise, this new report serves as an urgent call to state policymakers to take concrete steps to improve residents’ health. The report was made possible by financial support from the Robert Wood Johnson Foundation and Kaiser Permanente.

“In the current environment, states have an even more vital role to play in promoting the health and well-being of their residents,” said John Auerbach, President and CEO of Trust for America’s Health. “Our goal in creating this report is to provide state public health officials and policymakers the evidence and business case for the adoption of policies that have been shown to improve community health.”

Policies Analyzed in the Report Number of States with the Policy
Universal Pre-K program* 10 (incl. DC)
School breakfast program 31 (incl. DC)
School lunch program 20
School competitive foods (snacks and drinks) 28 (incl. DC)
Syringe access programs 27 (incl. DC)
Smoke-free laws** 29 (incl. DC)
Tobacco taxes*** 51 (incl. DC)
Alcohol taxes*** 51 (incl. DC)
Complete streets 30 (incl. DC)
Housing rehabilitation loan and grant programs**** 40 (incl. DC)
Rapid re-housing laws 9 (incl. DC)
Earned income tax credit 30 (incl. DC)
Paid sick leave 12 (incl. DC)
Paid family leave 7 (incl. DC)
Fair hiring protections (ban the box) 34 (incl. DC)

The economic benefits of these policies can be substantial. For example:

  • Pre-K education programs can generate $4.63 in benefits to participants, taxpayers, and others in society for every $1 spent on such programs.
  • Expanding syringe exchange programs could return $7.58 for every $1 invested in the long run, by lowering HIV rates and reducing treatment costs. There is no evidence such programs lead to higher drug use.
  • Rapid re-housing programs, which focus on getting homeless individuals into stable housing before addressing other challenges, can reduce hospital admissions and jail bookings. One pilot study found that such an approach saved more than $36,000 in treatment costs per person over the course of a year, nearly twice what the program cost.

“While the healthcare sector plays an important role in providing health services when someone gets sick, many of the factors that keep people healthy are outside the healthcare system and involve where people live, work, play and learn,” said Adam Lustig, Manager of the Promoting Health and Cost Control in States initiative and one of the report authors.  “This report gives state policymakers a menu of evidence-based policies that have been shown to improve individual and community health.”

“I encourage all state policymakers to read this important report.  Doing so will give them access to proven solutions to the challenge of run-away healthcare spending yet so little improvement in health outcomes. To improve Americans’ health, we have to think beyond the healthcare sector and about the many factors that impact health,” said Anand Parekh, MD, MPH, Chief Medical Advisor, Bipartisan Policy Center and a member of the Promoting Health and Cost Control in States Advisory Board.

To create the report, TFAH reviewed approximately 1,500 evidence-based programs and strategies.  The 13 policies ultimately included in the report all:

  • Have a strong health impact and economic evidence of that impact, such as cost avoidance or reduction.
  • Focus on prevention at the population health level, i.e., are designed to prevent illness or injury at the community level rather than the individual level.
  • Focus on primary prevention, preventing an injury or illness rather than treating it.
  • Can be implemented by state legislative action.

The findings show dramatic variability in how states approach these health-promoting policies. For instance, all 50 states plus DC institute tobacco and alcohol taxes. But only nine states and DC have laws in place to encourage universal pre-K programs, which have been shown to set children up for better health later in life. Universal pre-K programs are state funded programs that support pre-K for nearly 50 percent or more of the state’s 4-year-olds. Only six states and DC support paid family leave, even though data show such policies support maternal and child health, and, can save employers money in the long run.

“Action is imperative,” said Auerbach.  “As a nation, we spend trillions of dollars a year on healthcare and yet Americans are getting less healthy.  The solution is two-fold: direct more spending to prevention efforts and address the social determinants of health instead of their impact after someone is sick.”

Notes:
*states that support state-funded pre-K to nearly 50% or more of the state’s 4-year-olds.
**comprehensive smoke-free as per the American Lung Association
*** rates vary, and higher taxes are generally more effective
**** many states fund such programs in the absence of statewide legislation

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  www.tfah.org