Medication for Opioid Use Disorder (MOUD), sometimes referred to as Medication-Assisted Treatment (MAT), is a life-saving, evidence-based treatment method considered the gold standard for addressing opioid use disorders. Unfortunately, however, there are a number of barriers — both legal and cultural — that prevent some patients from accessing the treatment they need.
MOUD combines the use of prescription medications (like buprenorphine, methadone, and naltrexone) with counseling and behavioral therapies to provide comprehensive treatment in an inpatient or outpatient setting.
Due to stigma toward MOUD from patients and providers, as well as an overall lack of providers certified to dispense MOUD, there are currently more prescribing rules in the U.S. for the drugs used in MOUD, like buprenorphine, than for opioids. Major legal barriers include provider limits on the number of patients to whom they can offer MOUD, restrictions on which facilities can provide in-patient MOUD treatment, and insurance pre-authorization requirements.
New data from the Center for Public Health Law Research captures the wide variety of mitigation policies from all 50 states and DC intended to prevent further spread and lessen the potential impact of the current COVID-19 pandemic.
This data currently includes orders and laws from 20 states from January 20, 2020 through April 30, 2020. Laws and orders from the remaining 30 states and DC will be added in the coming weeks.
By The Temple University Center for Public Health Law Research
This week, the Center for Public Health Law Research and Trust for America’s Health (TFAH) published the first two of 13 comprehensive datasets on laws that can support cost-savings for states and promote health and well-being. Researchers from Center used the scientific policy surveillance process to create datasets that provide states with detailed information about the current state of U.S. laws.
We spoke with Adam Lustig, MS, the manager of the Promoting Health & Cost Control in States (PHACCS) project at TFAH.
CPHLR: These new datasets are the first two of 13, what other topics are being mapped, and how were these topics chosen?
Adam Lustig: We are incredibly excited for the release of the remaining eleven datasets through the summer of 2020. For a preview of things to come, we anticipate releasing datasets on Smoke-Free policies, Alcohol Pricing Strategies, Complete Streets, Ban the Box, and Earned Income Tax Credit in the first quarter of 2020. Following those datasets, we will publish the remaining datasets on School Nutrition Programs, Earned Sick Leave, Paid Family Leave, Rapid Re-Housing, Universal pre-K, and Housing Rehabilitation Loan and Grant Programs throughout the summer of 2020.
CPHLR: These first two datasets, and one forthcoming on alcohol pricing, focus specifically on harm reduction for substance use. Why are harm reduction strategies integral to cost control? Read More
Federal District Judge Gerald McHugh of the Eastern District of Pennsylvania ruled today that the operation of a safe injection site to prevent overdose, HIV, and other harms associated with drug injection would not violate the federal Controlled Substances Act. The ruling came in an action for declaratory and injunctive relief brought by the local U.S. Attorney, seeking to prevent the opening of “Safehouse” by a private group led by former Pennsylvania Governor and Philadelphia Mayor Edward G. Rendell. The judge denied the requested relief.
“Stigma is fundamentally about alienation and exclusion,” said stigma expert Dr. Daniel Goldberg, Associate Professor at the University of Colorado Anschutz Medical Campus’s Center for Bioethics and Humanities, in a recent interview. “Even when you control for access, people who are stigmatized get sicker and die quicker. And of course, we are social creatures. If stigma exists persistently and longitudinally, the more likely you are to be socially isolated, and social isolation is one of the most powerful predictors of mortality.”
Just last year, one in five high school students and one in 20 middle school students across the country used electronic cigarettes (e-cigarettes). According to the 2018 National Youth Tobacco Survey, more than 3.6 million middle and high school students used electronic cigarettes, more than double the number of youth using e-cigarettes in 2017. This increase is concerning given what is known about the adverse health effects of e-cigarettes. Recent research shows that nicotine has a negative effect on the developing brain. Other chemicals found in e-cigarettes are toxic to cells and have been linked to cardiovascular and lung diseases, including cancer.
Diverse strategies have emerged to curb the youth e-cigarette epidemic, including million-dollar campaigns from CVS Health and school policies implementing random nicotine testing. Most notable is the recent ordinance passed by San Francisco, the first city to institute a large-scale sales restriction. The city-wide ban prevents residents from purchasing any e-cigarettes in stores or online until products have undergone a premarket review by the U.S. Food and Drug Administration (FDA). The ban is motivated in part to decrease youth access to e-cigarettes. From 2016 to 2017, current e-cigarette use among California high school students increased from 8.6% to 10.9%, according to the California Student Tobacco Survey.The San Francisco ban is not the first law implemented to impact youth access to e-cigarettes. California state law sets various online purchasing requirements for e-cigarettes: online purchasers must provide proof of age, distributors must deliver to verified mailing addresses, and online purchaser age must be verified by a third-party service. These laws were in place in 2016 and 2017, but it is unclear whether these state laws had any impact on the 2.3% increase in youth vaping because, problematically, there is no current research exploring the link between the laws and youth e-cigarette use.
Inclusionary zoning (IZ) laws are one such approach, and are intended to create affordable housing through collaboration between public and private developers. These laws create requirements and incentives for developers, such as unit size minimums and establishing income eligibility criteria. IZ laws counter preceding ‘exclusionary zoning’ policy where large-lot zoning is used to prevent low-income integration into rising developments. Contrary to the original intent, IZ laws have been criticized for creating potential financial disincentives to develop in low-income areas and increasing housing price inflation.
To combat this risk, states like New Jersey, Massachusetts, and California have added additional incentives such as density bonuses, expedited approvals, and fee waivers. These have been presented to developers as part of state ordinances and regulations. Under its Affordable Housing Act, Illinois seeks to create grants, mortgages, and loans to rehabilitate, develop, operate, and maintain housing for low-income and very-low-income families. The Act requires local governments to create affordable housing plans based upon their municipalities’ median incomes. For example, based upon population median incomes and housing values, the town of Evanston, Illinois is required to provide 4,993 affordable housing units to accommodate its population of 75,472 who have an area median income of $63,327.
The Cook County Health Department in Illinois just published a dataset to LawAtlas.org as part of a yearlong legal epidemiology project funded by the CDC Public Health Law Program and ChangeLab Solutions. The health department created a policy surveillance dataset tracking IZ laws in 10 municipalities across the country, concentrating on residential areas around Cook County and the Chicago Metropolitan area: Boulder, Colorado; Burlington, Vermont; Cambridge, Massachusetts; Evanston, Illinois; Highland Park-Lake County, Illinois; Irvine, California; Lake Forest-Lake County, Illinois; San Diego, California; Santa Fe, California; Stamford, Connecticut.
One common provision of IZ policies are set-asides. These are ordinances that require developers to reserve a portion of the new development for low-income residents. Through its policy surveillance project, the health department found that nine of the jurisdictions have implemented mandatory IZ policies and six jurisdictions have established preferences for who can live in set-aside units. The percentage of set-aside required for low-income housing varies by jurisdiction – from 10 percent in two jurisdictions, up to 25 percent in one. Of the 10 jurisdictions studied, one (Stamford, Connecticut) doesn’t require any set-aside, and nine allow for alternatives to set-asides, such as fee-in-lieu (nine jurisdictions), land dedication (six jurisdictions), and alternative proposals (four jurisdictions). For those jurisdictions with fee-in-lieu alternatives, seven provide those payments to Affordable Housing Funds.
While extensive literature provides evidence for a positive association between levels of wealth in an area and the levels of health in that area, more research is needed to establish the efficacy of IZ laws. Governments are increasingly implementing relevant policies to combat the negative effects of gentrification and IZ policies could be part of the mix, particularly when used in conjunction with efforts to preserve existing community culture beyond property interest, as neighborhoods provide important social support networks for residents. “Revitalization without displacement” is a rising standard for preserving the positive economic benefits of gentrification without destroying communities through displacement. This policy advocates increasing the total population by filling vacancies and increasing housing densities and preserving community bonds. Experts consider ‘social mix’ to be a common good.
The ten policies in this dataset are just the tip of the iceberg, but they do offer an interesting, important look into the complexity and variation of these laws.