ÂÒÂ×ÊÓƵ

American Society of Addiciton Medicine

COURAGEOUS & COMPREHENSIVE ACTION

ON ADDICTION AND OVERDOSE.

ÂÒÂ×ÊÓƵ
Advocacy Impact Report 2023

2023 was a busy year for U.S. addiction policy, and ÂÒÂ×ÊÓƵ rose to the challenge, helping to develop . At a Congressional briefing in May 2023, ÂÒÂ×ÊÓƵ and several other national organizations unveiled the new policy platform while educating Congressional staff on the need to advance a strong reauthorization of the SUPPORT for Patients and Communities Act. Later that month, President-Elect Dr. Stephen Taylor, where he urged Congress to seize the opportunity to create a more sustainable and robust addiction care infrastructure. That summer, ÂÒÂ×ÊÓƵ applauded key provisions included in a House bill to reauthorize the SUPPORT Act, which eventually passed the full House. Later in the year, urging Senators to add sorely needed new pathways for improving access to evidence-based treatment to any SUPPORT Act reauthorization. The SUPPORT Act's fate will become more apparent in 2024.

2023 was especially busy for federal policy that affects addiction treatment with medications for opioid use disorder (OUD). In December 2022, the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) released in the context of opioid treatment programs. When finalized, the rules will significantly impact treatment at those programs. In April, SAMHSA also issued a new guidance to states, updating . In parallel, ÂÒÂ×ÊÓƵ advocated for passage of the Modernizing Opioid Treatment Access Act (MOTAA), which would allow addiction specialist physicians to prescribe methadone for OUD outside OTP settings. MOTAA was introduced by Senators Edward Markey (MA) and Rand Paul (KY), and Representatives Donald Norcross (NJ) and Donald Bacon (NE) immediately prior to the Addiction Medicine Advocacy Conference (AMAC) in March 2023. In addition, the Department of Justice and the Drug Enforcement Administration (DEA) issued proposed and temporary telemedicine rules for prescribing controlled substances, including buprenorphine, ultimately extending the COVID-19 telemedicine flexibilities for prescribing controlled medications through December 31, 2024 (or until a final rule is issued). ÂÒÂ×ÊÓƵ members, including Dr. Brian Hurley, ÂÒÂ×ÊÓƵ's President, were featured regularly in media outlets on the topic of telemedicine, helping to shape the public policy debate. This includes an essay in Health Affairs' Forefront blog, , which could prove relevant in 2024.

All the while, trends in the prevalence of addiction and overdose continued to evolve in the U.S.; and other novel psychoactive substances in the unregulated drug supply continued to make the use of unregulated substances highly unpredictable, and increasingly harmful and lethal, further complicating addiction treatment. In 2024, ÂÒÂ×ÊÓƵ will continue to urge our nation's policymakers to embrace a comprehensive and multifaceted public policy approach commensurate with the crisis's enormous human and societal costs.

 

What did ÂÒÂ×ÊÓƵ Advocacy do in 2023?

Encouraged policymakers to embrace Four Big Ideas:

  1. Prioritize prevention, health, wellness, and equity. 

  2. Establish universal access to addiction medications as standard of care. 

  1. Ensure appropriate coverage of, and reimbursement for, effective addiction care. 

  1. Strengthen the addiction care workforce.  

ÂÒÂ×ÊÓƵ had an influential federal legislative and regulatory addiction policy portfolio in 2023. Below are highlights.

  • With a robust public education effort, advanced legislation in the Senate that would allow physicians who are board-certified in addiction medicine and addiction psychiatry to use their clinical expertise in prescribing methadone for OUD treatment, which could be dispensed from community pharmacies, subject to the SAMHSA’s rules or guidance on supply of methadone for unsupervised use – a challenging effort to modify policy that has been unchanged for fifty years. Relatedly, provided . 

  • HHS, the Employee Benefits Security Administration, and the Internal Revenue Service’s proposed parity rule, “Requirements Related to the Mental Health Parity and Addiction Equity Act,” and strongly supported addressing treatment limitations to increase access to mental health and SUD treatment. In addition, .  

  • of at least $50,000,000 for the Health Resources and Services Administration (HRSA)’s Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program, as well as appropriations in FY 2024 of $30,000,000 for HRSA’s Addiction Medicine Fellowship Program. STAR-LRP is due to be reauthorized in the SUPPORT for Patients and Communities Reauthorization Act.  

  • of $36,700,000 for SAMHSA’s Minority Fellowship Program and supported federal legislation to include the specialty of addiction medicine as a statutory category within this fellowship.   

  • In coordination with the Bipartisan Mental Health and SUD Task Force, and in collaboration with the American College of Emergency Physicians, the American Psychological Association, the American Psychiatric Association, and Faces & Voices of Recovery, held a briefing for the 118th Congress, moderated by Mr. Lev Facher of STAT News. Along with Dr. Brian Hurley, a panel of experts from each organization advised Congressional representatives and staff to build on the SUPPORT for Patients and Communities Act of 2018. Later, provided specific SUPPORT Act reauthorization recommendations to the

  • Provided in response to HHS’ proposed rule on Confidentiality of SUD Patient Records, as well as on an HHS request for information on its proposed framework to support and accelerate treatment and remission from nicotine/tobacco use disorder (TUD, which emphasizes serving populations and communities disproportionately impacted by smoking-related morbidity and mortality. 

  • Endorsed legislation including the Reentry Act, which would amend the Medicaid Inmate Exclusion Policy to allow incarcerated individuals to receive Medicaid-supported medical services thirty days prior to their release, , which would remove the federal ban prohibiting individuals with felony drug convictions from receiving Supplemental Nutrition Assistance Program (SNAP) benefits, as well as , which would allow Medicaid coverage for pretrial detainees. 

 

In several public policy statements, ÂÒÂ×ÊÓƵ made recommendations to address a range of critical addiction policy issues.

ÂÒÂ×ÊÓƵ's public policy statements guide advocacy efforts, and in 2023, ÂÒÂ×ÊÓƵ published: 

  • In recognition of SAMHSA’s Prevention month, a public policy statement on “Prevention,” highlighting four areas of prevention: general prevention measures, neglected opportunities within the healthcare system, substance specific measures, and the future of prevention; with twenty-two specific recommendations to advance the reach of evidence-based prevention initiatives.  

  • “,” to encourage states to enact strong GSLs that include protections against arrest and save more lives by encouraging people to call emergency services during an overdose. 

ÂÒÂ×ÊÓƵ assisted dozens of state chapters in their advocacy efforts. Below are highlights from 2023.

  • Alabama – On June 1, 2023, HB433/SB239 was enacted into Alabama law. In light of the removal of the federal “X-waiver,” this legislation repeals a state law requiring the Alabama Board of Medical Examiners to adopt rules governing the prescribing and use of buprenorphine to treat opioid use disorder (OUD) in nonresidential settings. The Alabama Society of Addiction Medicine (ALSAM) supported this legislation.  

  • Arkansas – On April 4, 2023, HB 1558 was enacted into Arkansas law. This legislation removes prior authorization on injectable medications for SUD. The Arkansas Society of Addiction Medicine (ARSAM) supported this legislation.  

  • Kentucky – On March 31, 2023, Kentucky Governor Andy Beshear signed HB 353 into law. This bipartisan legislation removes drug testing equipment, including fentanyl test strips (FTS), from drug paraphernalia classification under state law. Additionally, this bill provides legal immunity for possession of trace amounts synthetic opioids. The Kentucky Society of Addiction Medicine (KYSAM) supported this legislation.  

  • Oregon – On August 4, 2023, Oregon Governor Tina Kotek signed HB 2395-A into law. A major harm reduction package, this legislation enhances naloxone access, expands Good Samaritan legal protections, exempts fentanyl test strips from drug paraphernalia classification, and allows bulk purchases of naloxone. The Oregon Society of Addiction Medicine (ORSAM) strongly supported this legislation.  

  • Tennessee – In March 2023, the Tennessee Society of Addiction Medicine (TNSAM) sent a letter expressing concern with HB665/SB733. This harmful legislation would prohibit licensed practitioners from prescribing buprenorphine until a patient signs a document acknowledging the risks of receiving opioid use disorder (OUD) treatment with buprenorphine during pregnancy. The 2023 legislative session in Tennessee concluded without advancing this legislation.  

  • Utah – On March 15, 2023, Utah Governor Spencer Cox signed SB 86 into law. This legislation removes fentanyl test strips (FTS) and other testing equipment from drug paraphernalia classification under state law and allow healthcare facilities, substance use harm reduction services programs, and drug addiction treatment facilities to temporarily possess controlled substances to test for their safety. The Utah Society of Addiction Medicine (UTSAM) actively supported this legislation and urged its passage.  

 

ÂÒÂ×ÊÓƵ developed new state advocacy resources in 2023 to better serve its members: 

  • In January, ÂÒÂ×ÊÓƵ hosted the first of its State Advocacy Learning Collaborative (SALC) Quarterly Meetings. These virtual meetings were hosted every three months throughout the year and included state policy updates, issue-based presentations, guest speakers, and open forums for member discussion. 

  • In July, ÂÒÂ×ÊÓƵ released its second Mid-Year Legislative Report summarizing recently passed state legislation with implications for addiction medicine.

  • In October, ÂÒÂ×ÊÓƵ released a first of its kind National Overview of States' Adult Use Cannabis Programs and Public Health Guide. The guide includes an overview of the public health policies on the books in 23 states with an adult use cannabis programs. This guide can assist advocates in aligning the policies found in state programs for adult use cannabis with ÂÒÂ×ÊÓƵ’s public health policy recommendations.  

 

ÂÒÂ×ÊÓƵ advocates for federal regulatory reforms to empower the addiction workforce:  

  • Supported a that aims to better integrate harm reduction strategies throughout the agency. This effort was led by the Legal Action Center (LAC).   

  • Provided and submitted comments on the major provisions of the Centers for Medicare and Medicaid Services’ proposed rules to revise CY 2024 payment policies and   

  • In a from a broad coalition, urged Congress to support the Centers for Medicare and Medicaid Services' (CMS) proposal to implement G2211, the Medicare ‘add-on’ billing code, in the MPFS final rule. This code is billed with codes of office/outpatient evaluation and management (E/M) visits to better recognize the inherent resource costs clinicians incur when managing a patient's health longitudinally or treating a single, serious, or complex chronic conditions. 

ÂÒÂ×ÊÓƵ advanced its advocacy priorities through multiple channels.

  • ÂÒÂ×ÊÓƵ members garnered high profile coverage through quotes and op-eds on critical issues in addiction policy in top national publications, including in MedPage Today, in Health Affairs’ Forefront, in the Seattle Times, and in STAT News. 

  • Generated thousands of social media impressions of stories highlighting ÂÒÂ×ÊÓƵ policy positions.   

  • With members participating from around the country, held the third Addiction Medicine Advocacy Conference (AMAC) in partnership with ACMT, ACAAM, SoAP, and AOAAM.  

  • Engaged in national addiction-related coalitions, councils, and committees, including the Legal Action Center’s and the . 

PREVENT AND TREAT ADDICTION.

REDUCE HARM AND SAVE LIVES.

ÂÒÂ×ÊÓƵ
Advocacy Impact Report 2022

2022 was a critical year for addiction policy in the United States.  In March, President Biden highlighted the need to expand access to evidence-based prevention, treatment, harm reduction, and recovery support services in his .  In April, the White House Office of National Drug Control Policy released a groundbreaking , proposing targeted actions to implement the President’s plan.  At year end, Congress passed legislation containing sweeping changes, impacting addiction care for years to come.    

At the same time, America had been confronting an alarming addiction and overdose crisis, with worsening racial disparities in death rates.  Throughout 2022, ÂÒÂ×ÊÓƵ continued to urge policymakers to take bold, comprehensive action to address the human and societal costs of addiction and advance racial justice and health equity. We held our largest virtual Addiction Medicine Advocacy Conference (AMAC) ever, during which ÂÒÂ×ÊÓƵ members advocated for strengthening the addiction workforce as a cornerstone of the federal response to addiction and overdose.  

ÂÒÂ×ÊÓƵ members look forward to more work ahead in 2023, as they advance evidence-based addiction policy across the country. 

What did ÂÒÂ×ÊÓƵ Advocacy do in 2022?

With ÂÒÂ×ÊÓƵ Advocacy Principles as their guide, ÂÒÂ×ÊÓƵ members continued to help create a future where addiction is met with compassion and ethical, equitable, evidence-based care.

Working with others, ÂÒÂ×ÊÓƵ helped secure numerous federal legislative wins in 2022 that will advance addiction policy and practice across the country. Below are highlights. #TreatAddictionSaveLives

  • Successfully advocated for concurrent enactment of the Mainstreaming Addiction Treatment (MAT) Act and the Medication Access and Training Expansion (MATE) Act, which are set forth in Sections 1262 and 1263 of the .  Together, the MAT and MATE Acts eliminate the separate x-waiver for prescribing buprenorphine for opioid use disorder and ensure controlled medication prescribers receive at least eight hours of education on treating and managing patients with substance use disorder. 
  • Successfully advocated for the enactment of federal legislation giving States the option to allow eligible juveniles to continue receiving Medicaid-funded health care while awaiting trial.  This policy reform is set forth in Section 5122 of the . 
  • Successfully advocated for the enactment of the making it easier for researchers to study cannabis, potentially opening the door to additional cannabis-derived medicines and therapies. 
  • Successfully advocated for Congressional appropriations of $40,000,000 for fiscal year 2023 for the Health Resources and Services Administration (HRSA)’s . 
  • Successfully advocated for Congressional appropriations of $25,000,000 for fiscal year 2023 for HRSA’s to foster robust community-based clinical training of addiction medicine or addiction psychiatry physicians in underserved, community-based settings, as well as the reauthorization of the program through 2027.  The reauthorization of the AMF Program is set forth in Section 1311(b)(9) of the . 
  • Backed the introduction of groundbreaking federal legislation, known as the , which would have allowed specially registered opioid treatment program (OTP) clinicians and addiction specialist physicians to prescribe up to a one-month supply of methadone for OUD, to be dispensed from a pharmacy, subject to the Substance Abuse and Mental Health Administration’s “time in treatment” regulations or guidance.  
  • Successfully advocated for the enactment of federal legislation extending mental health and addiction parity requirements to nonfederal governmental health plans, as set forth in Section 1321 of the . 
  • Successfully advocated for the enactment of federal legislation improving uptake of the Collaborative Care Model, as set forth in Section 1301 of the . 
  • Successfully advocated for the enactment of federal legislation providing for the distribution of 200 additional Medicare-funded graduate medical education residency positions for Fiscal Year 2026, with 100 of those positions set aside for psychiatry or  residencies, as set forth in Section 4122(a)(3) of the . 

ÂÒÂ×ÊÓƵ ensured that the addiction medicine community stayed on top of cutting-edge policy issues in the field of addiction medicine with its national public policy statements.

ÂÒÂ×ÊÓƵ's national public policy statements guide its advocacy efforts. In 2022, ÂÒÂ×ÊÓƵ issued the following public policy statements to help advance evidence-based addiction policy:

ÂÒÂ×ÊÓƵ provided technical assistance and consultation to several state chapters in connection with their state advocacy efforts. Below are highlights from 2022.

  • Maine – The Governor signed legislation that removes the previous one-to-one limit on the exchange of sterile hypodermic apparatuses by syringe service programs (SSPs). The Northern New England Society of Addiction Medicine (NNESAM) testified in support of this legislation and sent a letter in support. The legislation also extends the state’s existing Good Samaritan protections to all individuals present at the scene of an overdose, barring any violent crimes. 
  • Michigan – The Michigan Governor signed legislation that removes prior authorization on addiction medications within the state’s Medicaid program. The Michigan Society of Addiction Medicine wrote a letter in support.  
  • Tennessee – The Tennessee Governor signed Tennessee Society of Addiction Medicine (TSAM) endorsed-legislation that enhances the accessibility of naloxone by allowing health organizations to easily acquire, store, and distribute naloxone. TSAM wrote a letter urging for the Governor’s signature. 
  • Wisconsin – The Wisconsin Governor signed legislation that exempts fentanyl test strips from drug paraphernalia classification under state law, decriminalizing their possession and use. The Wisconsin Society of Addiction testified in support of this legislation. 
  • Colorado – The Colorado Society of Addiction Medicine (COSAM) sent a letter opposing policy changes that would allow law enforcement access to Prescription Drug Monitoring Program (PDMP) information without obtaining court approval. Subsequently, the Colorado PDMP Task Force did not these changes. 
  • Illinois – The Illinois Governor signed Illinois Society of Addiction Medicine-endorsed-legislation that prohibits Medicaid and private payers from charging co-pays on opioid antagonists such as naloxone.
  • Louisiana – The Louisiana Governor signed legislation that exempts fentanyl test strips from drug paraphernalia classification under state law and requires opioid treatment programs to provide addiction medications to pregnant and parenting people. The Louisiana Society of Addiction Medicine wrote two letters in support. 
  • Florida – Following two resolutions submitted by the Florida Society of Addiction Medicine, the Florida Medical Association’s (FMA) House of Delegates adopted new policies that prohibit the sale or distribution of kratom in Florida, while still allowing opportunity for proper scientific research, and encourage the FMA to identify opportunities with stakeholders to work with officials to support and promote the Opioid Allocation and Statewide Response Agreement. 

ÂÒÂ×ÊÓƵ developed new advocacy resources in 2022 to better serve its members: 

  • ÂÒÂ×ÊÓƵ released its first ever mid-year state legislative recap. The recap featured a summary of general trends and a synopsis of enacted legislation from the state legislative sessions.    
  • ÂÒÂ×ÊÓƵ launched a new community on the platform. The community serves to connect state advocates from across the country to share updates, strategies, and best practices.  
  • ÂÒÂ×ÊÓƵ held its second virtual State Advocacy Summit. This three-hour, members-only event was divided into five main sessions and included ÂÒÂ×ÊÓƵ members from 33 states, who represent 32 of ÂÒÂ×ÊÓƵ’s state chapters.  
  • ÂÒÂ×ÊÓƵ released a new , which are exclusive to ÂÒÂ×ÊÓƵ members. 

 

ÂÒÂ×ÊÓƵ created new practice management resources for members and advocated for federal regulatory reforms to empower the addiction workforce:  

  • Developed a and detailing the potential issues at pharmacies impacting the availability of prescription buprenorphine to treat opioid use disorder. 
  • an addendum to the Reimbursement for Medications for Addiction Treatment Toolkit, and a and addiction medicine overviewing important statutes and regulations telehealth and ÂÒÂ×ÊÓƵ’s related advocacy actions.
  • Summarized and provided comments on the major provisions of the Centers for Medicare and Medicaid Services’ proposed rule to revise CY 2023 payment policies under the Medicare Physician Fee Schedule (PFS).  
  • Supported clarifying Rural Emergency Hospitals’ Conditions of Participation to increase access to evidence-based addiction treatment, in a letter with partner organizations.
  • Advocated for the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Administration (SAMHSA) to during the national public health emergency declared in response to the opioid crisis.  
  • Released a designed to help clinicians navigate credentialing, privileging, and network enrollment processes. 

ÂÒÂ×ÊÓƵ advanced its advocacy priorities through multiple channels.

      • Engaged in national addiction-related coalitions, councils, and committees, including the , the and the . 
      • Shaped the media narrative through high profile coverage in NPR, CNN, CQ/Roll Call, and other national outlets.
      • Led introduction and passage of a in the AMA House of Delegates documenting AMA support for federal legislation that would expand the parity and non-discrimination protections of the Paul Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act of 2008 to Medicare and require Medicare to cover all levels of mental health and substance use disorder care. 
      • Held ÂÒÂ×ÊÓƵ’s second Addiction Medicine Advocacy Conference in partnership with ACMT, ACAAM, and AOAAM.  
      • Facilitated ÂÒÂ×ÊÓƵ physician leader op-eds on addiction policy that were featured in national publications, such as  , , , and .
      • Generated thousands of social media impressions of stories highlighting ÂÒÂ×ÊÓƵ policy positions.