The New A.G. Asks Leadership to Rollback Medical Marijuana Stand
(Summer 2017) In a letter to Congressional leaders, Attorney General Jeff Sessions asked that leadership undo the prohibitions that have been in place since 2014 which restrict use of federal funds to prevent certain states from implementing their own laws that, “authorize the use, distribution, possession or cultivation of medical marijuana.” He cites the American drug epidemic and documented criminal activity as reasons the Justice Department needs the availbility to use “…all laws to combat the transnational drug organizations and traffickers who threaten American lives.”
Rhode Island Supreme Court Decision Could Have Broad Impact
(Summer 2017) The Rhode Island Supreme Court made a recent decision that could affect not only employers in Rhode Island but could open the doors in other states. At the heart of the Callaghen vs. Darlington Fabrics Corporation case is the provision within the Rhode Island Medical Marijuana Act that prohibits an employer from refusing to hire solely based on the applicant being a registered card holder.
In this case, the applicant explained during the hiring process that she was a card holder was currently using marijuana, and would test positive in a pre-employment drug screening. The company shared with her that not being able to pass the test “would prevent the Company from hiring her” and in a call subsequent to that exchange, announced they were unable to hire her.
The court found that while state law prevents an employer from making hiring decisions based on medical marijuana card holder status and does not require an employer to accommodate medical use of marijuana in any workplace, the statute does in some way, require employers to accommodate the medical use of marijuana outside the workplace.
Had the court found in favor of the company (which it did not) it would have placed the applicant, who would test positive due to her routine medical marijuana use, in a worse position than a recreational user who could stop smoking long enough to pass the drug test and get hired. The patient could not stop using long enough to pass the drug test even though her use was necessary to “treat or alleviate pain, nausea, and other symptoms associated with certain debilitating conditions.”
The court also sided with the applicant on the discrimination elements of her case related to Rhode Island’s Civil Rights Act which protects against all forms of employment discrimination, including disability. Since the applicant was clearly suffering from a “debilitating medical condition” in order to qualify for the medical marijuana card the court’s reasoning is that she then qualifies as disabled under the law.
Aetna Lowers Hurdle for Opioid Addiction Treatment
(Summer 2017) As of March, Aetna became the third health insurance company to drop preauthorization for opioid addiction treatment on commercial plans. The insurer joins Cigna and Anthem in this move. The other two companies revised their procedures when confronted by New York State’s Attorney General Eric Schneiderman, who accused that the companies’ policies may be unjustly preventing customers from accessing treatment.
In situations where preauthorization for opioid addiction treatment drugs such as Suboxone is required, it may take hours or even days for the prescription to be filled. Unfortunately, many opioid-addicted individuals who seek treatment and do not receive it immediately often do not pursue it further.
DOD Increases Drug Screening for New Recruits
(Summer 2017) As of April 3rd, the Department of Defense (DOD) requires military applicants to be drug tested for the same substances active-duty members are tested. The new policy is designed to match the use of both illegal and prescription drug abuse among the general population as well as the rise in the use of synthetic drugs and heroin.
Presently members of the military can be random drug tested up to three times a year. They are tested for 26 drug types including cocaine, marijuana, methamphetamine and amphetamines, designer amphetamines such as MDMA (commonly called Ecstasy or Molly) and MDA (also called Adam), codeine, morphine, heroin, oxycodone, hydrocodone, oxymorphone, hydromorphone, synthetic marijuana (also called spice), and benzodiazepine sedatives.
More than 279,000 volunteers are screened for acceptance into the U.S. military each year. Approximately 2,400 of them do not pass the drug test. Another 450 individuals are anticipated to fail with the implementation of the more stringent drug testing requirements.
Those who fail the new screening will be permitted to reapply after three months. Anyone who tests positive twice will not be considered further for any type of military service.
VA Works to Limit Employee Drug Theft
(Summer 2017) The Department of Veterans Affairs (VA) recently tightened its monitoring of physicians, nurses and other employees after admitting that the organization had been lax on drug testing and inspections. In the past, this oversight led to an escalation of opioid theft.
In only a smattering of these cases – a shockingly low 3% — were VA employees held accountable for their infractions. As of 2010, about 370 workers had been disciplined for a drug or alcohol-related violation.
Complicating the issue is that not all VA hospitals are stringent with their drug inventories. Some of them were found to disregard monthly inspections of drug levels, while others were charged with ignoring various mandatory procedures. In fact, the health care director at the Government Accountability Office reported that between 85% and 90% of VA sites had significant issues with inspections. Additionally, the VA inspector general’s office uncovered that over a one-year span the department did not drug test over 15,000 new staff who were in sensitive VA positions such as a physician, nurse or police officer.
VA officials conceded the organization’s poor performance with drug inventory control as well as employee drug testing and shared that the organization is now taking steps to correct the situation. All new hires in sensitive positions will be drug tested, and holes in the current drug screening process will be filled. The VA has also instituted 72-hour inventory checks and tighter security on medications to reduce theft at its facilities. Additionally, the VA plans to hire more inspectors to monitor the drug inventories of its 1,000 clinics and 160 medical centers and computer systems are also being updated to identify all employees who fall under drug testing requirements.
In recent years, reports of missing or stolen drugs at federal hospitals rose over 1,000%, rising from 272 incidents in 2009 to more than 2,900 in 2015 before dropping to about 2,400 in 2016. These sites include those of the VA, seven correctional hospitals and approximately 20 hospitals providing services to American Indian tribes.
Drug Wholesalers Neglect to Flag Suspect Opioid Orders, Pay Millions in Settlement
(Summer 2017) Charged with claims that they did not submit questionable orders for opioids to the Drug Enforcement Administration (DEA), two large drug wholesalers have agreed to pay millions of dollars to settle lawsuits against them. Such wholesalers play an important role in the drug supply chain, acting as intermediaries between pharmaceutical manufacturers and pharmacies. McKesson Corporation, the country’s top drug wholesaler, agreed to a $150 million fine at the beginning of the year. Meanwhile, Cardinal Health consented to a $44 million penalty in addition to an extra $20 million earmarked for West Virginia – one of the states that has been most affected by the opioid crisis.
A third distributor, AmerisourceBergen, will also award the drug-ridden Mountain State $16 million.
Senate Expands Unemployment Drug Screening
(Summer 2017) In March, the Senate struck down the prior administration’s mandate that restricted the scope of drug testing that states could require of those receiving unemployment benefits. This overturns a Labor Department rule restricting the industries that could mandate testing before receiving unemployment money. It is anticipated that President Trump will approve the legislation when it reaches his desk.
The reversal is not popular with labor unions and civil rights organizations, such as the AFL-CIO and the American Civil Liberties Union.
Workers Compensation Programs Strive to Lower Opioid Rx Rates
(Summer 2017) The liberal prescribing of opioid painkillers by some health care practitioners is a contributing factor to the country’s opioid epidemic. Attempting to curb this practice, state workers’ compensation groups are taking action to reduce the number of these drugs prescribed to employees hurt while on the clock. For example, New York State’s Workers Compensation Board now allows insurance companies to hold hearings to investigate if claimants should be taken off their opioid medication. Ohio’s BWC is also working to reduce prescription rates by implementing new measures that allow reimbursement for opioids to be declined if it is suspected that a physician is overprescribing.
To realize the scope of impact workers’ compensation rules can have on this situation, consider that 2.8 million private industry workers and 752,000 public sector employees sustained nonfatal injuries while on the job in 2015 often resulting in pain; a survey by CompPharma uncovered that over $1.5 billion in opioid prescriptions were covered by workers’ compensation that same year; Workers’ compensation opioid expenditures account for 13% of total opioid pharmacy costs in U.S. (2015).
Creative Law Enforcement Focuses on Treatment
(Summer 2017) Unfortunately, drug overdose fatalities continue to rise across our nation. Over 60% of these deaths are opioid-related. In fact, more than 91 Americans perish each day from an opioid overdose. Because many first-responders to an overdose call are law enforcement, those users lucky enough to survive a brush with death are often charged with crimes.
Given this fact, what does the general population of our prison system currently look like when it comes to drug use? According to the National Center on Addiction and Substance Abuse, close to 67% of the 2.3 million individuals incarcerated in the U.S. are afflicted with a substance use disorder (SUD). In addition to the toll taken on lives, the opioid crisis also bears a high financial cost. A 2016 study showed that opioid misuse, abuse, overdose and dependence cost the penal system $7.7 in criminal justice -related costs. A majority of this cost was paid for by local and state governments.
But is this the wisest commitment of resources? The prosecution and incarceration process does virtually nothing to deal with the addiction condition, the SUD. From a monetary standpoint, each dollar committed to SUD treatment results in a savings of four dollars in health care spending and seven dollars in the criminal justice budget.
Law enforcement officers nationwide are keying into the importance of SUD treatment and developing new lines of attack for the opioid crisis. Sheriff and police departments are using naloxone for overdoses, working to provide treatment access instead of jail time to nonviolent offenders and supporting the provision of treatment for those entering the criminal justice system. A large percentage of jails are choosing to allocate portions of their own funds to establish and run these initiatives.
Sheriff departments across the country are also working in tandem with lawmakers to tackle the SUD problem. Some are working to suspend, instead of terminate, Medicaid coverage while violators are imprisoned. Others, such as in Charlotte County, Florida, are replicating the very promising ANGEL program, started in Gloucester, Massachusetts, allowing drug-addicted individuals access to treatment and the ability to surrender their drugs without the threat of prosecution. Meanwhile, Ohio’s Franklin County has developed a drug court. In just two years, it has shaved $1 million off the county’s budget and reclaimed many lives in the Columbus area.
Additionally, the sheriff’s department in McClean County, Illinois has rolled out an initiative to curb recidivism rates by helping inmates enroll in Medicaid so they have health care coverage when leaving prison. The project is being widely instituted across the country.
However, these and similar programs nationwide may be in danger. Indicators from the Trump administration appear to foreshadow an emphasis on prosecution instead of treatment.
Federal Government Appointees Poised to Take on Drug Crisis
(Summer 2017) With a new president in the Oval Office, changes are taking place with the nation’s war on drugs. House Representative and early Trump supporter, Tom Marino, is in line to spearhead the initiative as the next Office of National Drug Control Policy (ONDCP) Director, aka “Drug Czar”. This agency is charged with forming the National Drug Control Strategy, a plan that is revised each year and engages all pertinent federal agencies in the creation of its objectives and results.
Marino is a three-term Congressman from Pennsylvania who is well-known for his drug-control efforts. He was tapped in 2016 to join a House committee working to reduce the rampant opioid problem. Prior to that, Marino introduced two pieces of legislation that were passed:
- the Transnational Drug Trafficking Act to reduce drug movement between countries
- a measure to foster cooperation between the Drug Enforcement Administration (DEA) and prescription drug distributors
Pressure is mounting to make all levels of government – from municipalities to foreign governments– responsible for reaching goals to curb both drug trafficking and illicit use. However, with Congress working to reduce spending, Marino may face additional challenges in these areas as his ONDCP may be subject to some funding cuts.
President Trump has also chosen New Jersey Governor Chris Christie to head the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The President aims to bolster both legal and preventative actions in this area. Christie’s job will be to devise the best method of fighting America’s drug crisis and treating individuals in need of help.
Meanwhile, new Attorney General Jeff Sessions issued a memo reversing Obama-era strategies that took a softer tack on some drug charges. Sessions feels the less-severe approach, which included a decrease in the prosecution of drug and gun crimes during the previous administration, led to a subsequent uptick in murders. Several years ago, then-Attorney General Eric Holder (under the Obama administration) encouraged prosecutors to circumvent mandatory minimum sentences in select situations by not including the amount of drugs seized in charging documents. Sessions’ memo encourages prosecutors to “charge and pursue the most serious, readily provable offense” which will likely result in stricter prosecution of drug violations, more serious indictments and extended incarceration.
In addition to new appointments, the Trump administration is poised to release $485 million in grant funding to states for opioid abuse prevention, treatment and recovery services. States and territories have been allotted money according to both overdose fatality data and the number of individuals unable to attain treatment for opioid addiction. This subsidy represents the first two rounds earmarked in the 21st Century Cures Act, a measure approved by President Obama last December. Secretary of Health and Human Services Tom Price said that $500 million in state grants will also be made available in 2018.
ACA Changes Expected to Result in Less Treatment Access
(Summer 2017) According to a study conducted by the Johns Hopkins Bloomberg School of Public Health, the number of individuals with mental health and substance abuse disorders covered by insurance increased in 2014 due to greater access provided by the Affordable Care Act (ACA). Efforts of the Trump Administration, to strip away the ACA would negate any forward momentum experienced and could be particularly damaging to the fight against the U.S. opioid epidemic, warned Michael Botticelli, former director of the White House Office of National Drug Control Policy. The ACA’s repeal, according to a health economist at Harvard Medical School, may terminate coverage for 1.8 million people who have been treated for mental health or addiction issues, reduce expenditures in these areas by $5.5 billion, and lift a mandate that Medicaid cover addiction and mental health treatment in states that elected to enlarge the federal health care plan.
Medicaid currently insures a large majority of individuals who would be impacted by the ACA’s rollback. In its place, the Trump administration has proposed issuing block grants to the states, allowing each state to implement its own Medicaid system. Some experts believe the block grants will come with lower funding, which would, in turn, result in fewer benefits. Close to 1.3 million Americans currently access treatment for addiction and mental health conditions through Medicaid’s expansion.
The new Trump strategy would also permit the states that took advantage of a wider Medicaid safety net to choose whether or not to incorporate mental health and addiction treatment as of 2020. States that could opt out of these benefits are some of the ones mired most in the opioid epidemic, such as Ohio, West Virginia and Kentucky.
With the proposed changes announced, 19 state attorneys general are now speaking out. The group recently sent a letter to President Trump and congressional Republicans demanding that any substitution for the ACA address drug treatment satisfactorily. The letter goes on to warn of the drug crisis’ severity, which disrupts communities across the country and is currently responsible for the unprecedented rate of overdoses.