The Rockefeller Institute of Government convened several researchers, practitioners, and state legislators for the virtual “Developing Evidence-Based Drug Policy Conference” on October 14, 2021. The conference included several panels and showcased current findings and perspectives on how New York policymakers could approach funding, policy, and evidence-based treatment for individuals with substance-use disorder (SUD). The goal of the meeting was to connect policymakers to the latest research and help researchers better understand the issues on the policy agenda in the near future.

This post highlights the key takeaways from the policymakers who participated in the conference. Topics include the focus on evidence-based policymaking at the federal level, priorities identified by New York lawmakers, and considerations of how states like New York may want to allocate the expected influx of opioid settlement funding.

Presenters included:

• Keynote Speaker Robert Kent, general counsel at the Office of National Drug Control Policy (ONDCP)
• David Holtgrave, senior policy analyst, ONDCP, and dean of the University at Albany School of Public Health
• NYS Senator Pete Harckham (D-Westchester), chair, Committee on Alcoholism and Substance Abuse
• NYS Assemblymember Linda B. Rosenthal (D-Manhattan), chair, Committee on Social Services
• NYS Assemblymember Phil Steck (D-Albany), chair, Committee on Alcoholism and Drug Abuse

Federal Research Priorities

Using evidence-based research to inform federal (and state) policy decisions is critical. Robert Kent highlighted significant increases in federal funding for substance-use treatment and prevention in recent years through existing programs and COVID relief packages. Kent underscored the importance of research to understand the factors that contribute to the efficacy of substance-use prevention and treatment programs and policies. The findings will assist in distributing funding in areas that will generate positive outcomes.

Research will help us fight the stigma with facts… Research will help us make funding and policy decisions… It will help counter those who believe that addiction is a lack of willpower.

— Robert Kent

Based on his experience in both New York and at the federal level, Kent identified several high-priority research topics, including:

• Understanding the factors that bring people to seek treatment and why they choose to stay or leave.
• Defining success in substance-use disorder treatment.
• Understanding the effect of deflection programs, which are designed to divert people away from the criminal justice system and into behavioral health and substance-use treatment services.
• Determining the effectiveness of COVID-19 relief policies in expanding access to treatment and what should be retained moving forward.
• Analyzing the effects of substances that are currently federally controlled such as cannabis and fentanyl.
• Gathering data on the effectiveness of harm-reduction programs such as needle exchanges and naloxone distribution.

In addition to specific research topics, Kent stressed that public health research and policy must be executed using a health equity lens; the specific needs of marginalized communities, such as Black, Indigenous, and People of Color (BIPOC), must be addressed in designing, implementing, and assessing policy.

In an effort to integrate findings from evidence-based research into the policy discussion, Robert Kent highlighted the creation of the Office of Translational Research (OTR) within the ONDCP. Translational research uses a mix of qualitative and quantitative methods to develop evidence-based approaches for policymaking by connecting policymakers and policy researchers. David Holtgrave, a founding member of the OTR, stressed the importance of research in informing funding decisions, program evaluation, and policy impact modeling. The mission of the new OTR is to conduct, support, develop, implement, and evaluate evidence-based drug control policy in the US at the federal and state level.

State Policy Considerations

State policymakers have been working over the last decade to combat the opioid epidemic and address substance use in New York. Recent accomplishments include:

• Improving access to inpatient treatment by reducing co-pays and increasing the period of coverage before insurance review from 14 to 28 days.
• Expanding access to the harm reduction drug NARCAN (naloxone) and medication-assisted treatment (MAT).
• Giving greater access to MAT to justice-involved persons now that state prisons are required to provide incarcerated individuals MAT and a comprehensive plan to re-enter society. In addition, state correctional facilities must provide the legislature a report of individuals’ substance use.

Assemblymember Linda Rosenthal, a co-sponsor of the bills expanding MAT access in state prisons, explained that the expansion of services is a revolutionary step in harm reduction for imprisoned New Yorkers. Unlike other SUDs, opioids can be treated with prescribed medication for both detoxification and treatment. These drugs, including methadone, buprenorphine, and naltrexone, prevent physical withdrawal but do not provide a high to those taking the medication. MAT has been cited as the standard of care for substance-use disorder under the Office of Addiction Services and Supports (OASAS) and it is important that incarcerated individuals have access. If someone is in active use with no access to MAT upon entering prison, they go through painful withdrawal. If they are being treated for SUD with MAT prior to incarceration, they are denied their medications. The reentry plan is also significant as it ensures released individuals will have access to a minimum one-week supply of medication. The legislation directs individuals who do relapse to a treatment center instead of re-incarcerating them.

Addiction is not a choice, it’s a public health crisis.

— Assemblymember Linda Rosenthal

State lawmakers expressed excitement in working with Governor Kathy Hochul to continue to develop and enact substance-use policy. The governor has already shown support for policies and programs that address substance use. Since taking office in August, she has signed multiple substance-use related bills. As lieutenant governor, she served as chair of the Task Force on Heroin and Opioid Addiction.

New York State Senator Pete Harckham, chair of the Committee on Alcoholism and Substance Abuse, and Assemblymember Phil Steck, chair of Committee on Alcoholism and Drug Abuse, discussed their policy priorities in the near- and long-term. The State legislative committees will be working to address challenges in areas of prevention, harm reduction, treatment, and recovery. Topics under consideration include: supervised consumption sites (the first one in the nation just opened in New York City); community based-prevention programs; expanded funding for NARCAN and test strips used to detect fentanyl in unregulated drugs; and school-based mental health treatments. The state has also funded pilot projects that address the challenges facing those in recovery, including support for transportation and housing, that will be considered for expansion. Another pressing issue is the workforce crisis. Substance-use treatment facilities are finding it challenging to recruit and retain qualified workers, so it is essential that we also focus on building up the workforce.

A policy issue that lawmakers are considering in the upcoming year is the integration of SUD treatment and mental health programs. Both Senator Harckham and Assemblymember Steck addressed the need for an integrated system of care. Those receiving treatment for SUD may also need medical interventions to address mental health. How that integration will occur is under debate. Senator Harckham advocated for the merger of OASAS and the Office of Mental Health to lower barriers and create integrated programs. Assemblymember Steck voiced his support for the Integrated Service Bill (S.4351), and stressed the importance of integrated treatment which does not necessarily necessitate merging state agency activities.

This is a nonpartisan issue; we strive to work in a nonpartisan matter. It’s not Republicans or Democrats dying.

— Senator Pete Harckham

We have a long way to go on the concept of integrated treatment. The medical community isn’t prepared to make medical diagnosis when there is drug involvement… and bigger bureaucracies are not better bureaucracies.

— Assemblymember Phil Steck

Allocation of State Opioid Settlement Funding

In recent years, pharmaceutical manufacturers, distributors, and retailers have faced legal action from states arguing their misleading marketing and negligent business practices contributed to the opioid crisis. These lawsuits are now generating financial settlements for states and municipalities. On October 4, 2021, Attorney General Letitia James announced the distribution of up to $1.5 billion in funding awarded in the lawsuit that held drug manufacturers responsible for the opioid epidemic in New York. The suit alleged that the Sackler Family (owners of Perdue Pharma) participated in “years of false marketing” and ignorance to “prevent unlawful diversion of controlled substances” with their “suspicious order monitoring programs.” The court found the manufacturer pushed false statements that their prescription opioids were “less addictive” than others on the market and used sales teams to communicate these statements to providers. The lawsuit charged that the ready availability of potent prescription opioids caused by these actions substantially contributed to the overdose public health crisis and the rise in illicit opioids once stricter prescription monitoring was put in place. AG James announced funds from the lawsuit will be allocated across each of the ten economic development regions of New York State.

Distribution of Opioid Settlement Funds

SOURCE: Office of the NYS Attorney General (October 4, 2021).

In the near future, state and local public health officials will need to ensure the funding is prioritized appropriately to expand access to treatment and help those struggling substance-use disorder. Evidence on the effectiveness of treatment and prevention policies and programs will be critical for making informed policy decisions and can contribute to reducing the number of overdose deaths.

Conclusion

Better understanding the policy landscape will help researchers identify projects that can have real-world impacts. Policymakers expressed interest in learning more about the current research before making funding and programming decisions. Events like the conference are critical for promoting a dialogue between the two groups. The Rockefeller Institute will continue to work with legislators and other policymakers to identify their research needs and connect them with researchers and practitioners that can help them develop the policies with the greatest impacts.

Click here to view the conference panel videos.

ABOUT THE AUTHOR

Abigail Guisbond a graduate research assistant at the Rockefeller Institute of Government