New White House Action on Drug Policy
During a press call last night, the White House laid out new naloxone regulations, new funding, and said that fentanyl is not a WMD.
Last night, President Biden’s drug policy director Rahul Gupta and assistant Secretary of Health and Human Services Miriam E. Delphin-Rittmon laid out new drug policy proposals and action items aimed at curbing the historic rise in overdose deaths.
More than 108,000 people died in just a 12-month period. The White House is clearly feeling pressure to implement policy and do stuff that will slow this beast down.
The big ticket item on the call was an additional $1.5 billion inopioid response funding awarded to all states and tribal territories. Another big announcement on the call was an FDA guidance to facilitate the distribution of naloxone products, making bulk orders much easier for harm reduction programs. See the wonderful folks from Remedy Alliance celebrate the move.
Some other things: More money for law enforcement and HIDTA programs (High Intensity Drug Trafficking Areas), which… hard to say what this money really accomplishes; there’s some extra funds for the Rural Communities Opioid Response Program (RCORP); and there’s $20.5 million going toward “recovery supports.”
Here is a link to the White House fact sheet on all the new stuff they announced.
The beginning of the call was all about celebrating National Recovery Month. There was some time left at the end of the call for reporters to ask questions. The White House people didn’t call on me (sad face). But some interesting things were still said.
Meryl Kornfield of the Washington Post asked whether the Biden Adminstration plans to classify fentanyl a “weapon of mass destruction” and whether drug cartels are “terrorist organizations.”
Rahul Gupta, President Biden’s drug policy director, quickly jumped on the question with this stern answer:
Let me be clear: Since day one of this administration we’ve been acting against transnational criminal organizations, including Mexican drug cartels and human smugglers. The fact is, our actions have resulted in degradation of these cartels, and the capture of drugs and traffickers. To give you seizure data: We’ve had twice as much drugs seized as in 2020, and four times that amount of 2019. We’re going to continue to focus on this because American lives are at risk.
Now, having said that, the threat of illicit fentanyl is serious for our nation and across the globe. This is the reason that simply designating it—or any drug—as a “WMD” would not provide us with any authorities, capabilities, or resources that we do not already have and are already applying to this problem.
First, it is really important for us to make sure that we are working to save lives first and foremost. Second, all of the fentanyl—not just fentanyl, but fentanyl-related substances of which there are several—are already under the strictest legal controls in the United States…. Thirdly, we’re putting historic investments in this issue. But make no mistake, the federal government is committed to apply the full weight of its efforts and resources against beating this problem.
Reading between the lines, Gupta responded to the WMD question in a way that sounded a bit like: Gimme a fucking break. To me, the tone in Gupta’s voice conveyed:
This WMD idea is a right-wing hack job. It’s a distraction. It’s worst than useless. It won’t help us accomplish anything positive. This adminstration is busy actually pulling policy levers that actually help people. Focusing on a non-existent and totally theoretical “terrorist threat” in the form of fentanyl is silly and there is no reason for us to focus on this because fentanyl is medicine—for fuck sakes. Hospitals store these medicines. What’s next: Do you want me to call nuclear weapons inspectors in to every hospital? STFU!
So that was fun for me to listen to.
And during that whole exchange I imagined several attorneys general, wierdos at the Heritage Foundation, and a bunch of reactionary parent groups standing there with a deflated party balloon and the Charlie Brown sad boy music playing as their big drug war proposal—label fentanyl a WMD—be torn to shreds by people who actually know a thing or two about drug policy. If you want to learn more about why the WMD designation is such an idiotic and pointless idea, this piece in VICE by the excellent Manisha Krishnan breaks it down.
Alright. Moving on from that fun stuff. There was a useful question asked by Joyce Frieden from MedPage Today on what’s going to happen to telemed access for drugs like buprenorphine and the relaxed rules for methadone when the public health emergency declaration ends.
The Assistant Secretary of Health and Human Services, Miriam E. Delphin-Rittmon, answered:
“We are currently looking to continue those flexibilities for one year beyond the public health emergency and then certainly, we’re having conversations working out potential language for next steps there. Potentially expanding those [flexibilities]. It’s all in process and under discussion. But currently, at least one year beyond public health emergency the flexibilities continued.”
So, those rules will extend at least one year beyond the declaration. And it sounds like people are working on ways to (hopefully) extend them even longer. When Delphin-Rittmon first answered the question, she acknowledged that people all over the country have experienced the benefits of the relaxed telemed rules. So that’s some good news. It seems HHS, SAMHSA, etc. get that taking these rules away would be a big problem.
Absent from the call, however, was the DEA, and they play a big role in regulating controlled substances. So, I’m not sure where they’re at on this and they do not respond to my emails.
Had I been called on, I was going to ask whats up with methadone.
Last March, the Office of National Drug Control Policy sponsored a workshop with the National Academies of Science, Engineering and Medicine (NASEM) to investigate the federal and legal barriers that keep methadone inaccessible, and what needs to change to improve and liberalize access. So I wanted to ask what, if any, changes to the methadone clinic system are on the horizon. My hunch is that Gupta and his people are very aware that the methadone system is old, that it sucks, and that it needs to change by like, yesterday.
Just two days ago, Gupta and a few others co-authored an article in the New England Journal of Medicine titled: “Transforming Management of Opioid Use Disorder with Universal Treatment.” I think folks working in federal drug policy truly do feel the imperative to slow down and reverse the massive overdose death curve. I think they see naloxone uptake and medication treatment as two major items that could accomplish this, and start showing results quickly. in NEJM they write:
[Medication for opioid use disorder] can significantly reduce the risk of overdose death; a recent study showed that people with OUD were 82% less likely to die of an overdose when they were receiving MOUD than when they were not.
It’s just glaringly obvious that methadone and buprenoprhine keep people alive. The more people on these medications, the fewer overdose deaths there will ultimately be. This also aligns with the importance of keeping telemedicine going as long as possible. It’s clearly the case that way more people can maintain access to life-saving drugs if they can just keep getting their scripts through phone and video calls with their prescribers. Between new naloxone rules, extended telemed flexibilities, and expanding access to medication treatments, that some progress on this horrorific tragedy can be made.
In sum, I’ll certainly be keeping my eye out for any developments along these lines. I hope you found this quick recap to be helpful. As always, thanks for subscribing to Substance. Please, tell your friends!
Zach
New subscriber here. Thank you for this. I enjoyed Zach's translation of government talk. I'm looking forward to reading more.