By Taylor Knopf
North Carolina lawmakers passed their state budget compromise last week, and there was a noticeable change in the way they described funding to help people with substance use disorder.
Past budgets provided funds for “substance use disorder treatment” or “recovery services,” but failed to be specific about details. Either term could apply to many forms of treatment, such as provision of housing or job training or having people participate in abstinence-only addiction programs.
But when it comes to opioid use disorder, some treatments — such as methadone or buprenorphine — have much higher success rates than others. When using medications for opioid use disorder, people stay in treatment longer. In the latest budget, state lawmakers defined treatment for opioid use disorder and included the medications that have been most helpful for people.
For example, one line in the budget directs that $6 million from the opioid settlement funds go to state-funded behavioral health management agencies (known as LME-MCOs) for several purposes, including “to purchase all forms of medications approved by the federal Food and Drug Administration for the treatment of opioid use disorder and distribute them free of charge to jails located in their respective catchment areas,” the budget document states.
Rarely in the past have lawmakers specified that treatment include access to all three FDA-approved medications for opioid use disorder, namely methadone, buprenorphine and naltrexone. In fact, there’s been tension in the past about allowing access to all three.
Last year’s state budget included a $2 million grant program to start or expand opioid addiction treatment in jails, but limited that treatment to only one of the three approved drugs, NC Health News previously reported. The favored drug, naltrexone, known by brand name Vivitrol, is also the least effective of the three. Experts have said it puts people at higher risk of overdose because they have to detox to begin the medication and it does nothing to take away drug cravings. The drug’s manufacturer, Alkermes, had spent millions lobbying for its exclusive status in states across the country, including North Carolina.
While it may seem like a small tweak, language in the state budget that specifies access to all three medications is a big change.
Increased lobbying efforts
“We were obviously really excited to see the shift in budget language about how funds are allocated around all three FDA medications,” said Lee Storrow, director of regional & national policy at Community Education Group. Storrow, who formerly led the NC AIDS Action Network, said he and others have been involved in providing lawmakers with information about what the best medical practices are when it comes to reducing overdose deaths.
“There’s a really strong coalition of community members who have expertise in harm reduction, overdose death prevention, hepatitis C and HIV who I think actually have been more active in the last year,” Storrow said of educational efforts at the NC General Assembly.
Advocates say lawmakers have been listening to them.
“It’s heartening to see the improved language around substance use treatment in the proposed budget,” said Roxanne Saucier, a Raleigh-based harm reduction and drug policy advocate.
“Last year we saw tens of millions of public dollars earmarked for programs that fail to provide patients with standard medications for opioid dependence.”
Last year, state lawmakers gave millions to Christian-based ministries and other groups that deny program participants access to medications for opioid use disorder. Medical experts say these programs could do more harm than good if someone in an abstinence-only program returns to use and overdoses.
“This new budget does not make those same mistakes, by and large,” Saucier continued. She noted that treatment programs funded via the state’s network of LME-MCOs, “must provide gold-standard medications or facilitate a way for patients to receive them.”
The budget also states that the opioid settlement funds could be used to purchase equipment “for rapid analysis of opioids and other drugs causing overdose outbreaks.” Drug testing equipment, which state lawmakers decriminalized in 2019, would detect harmful additives in the street drug supply, such as fentanyl, an opioid 100 times stronger than morphine.
Fentanyl continues to drive overdose deaths across the country as it’s become more widespread in the street drug supply since the beginning of the pandemic. It’s mixed into many drugs, including methamphetamine, cocaine, and heroin, and is sometimes pressed into counterfeit pills disguised as prescription opioids.
“I’m particularly excited to see that settlement funds can be spent on harm reduction supplies, including low-cost versions of naloxone [an overdose reversal drug],” Saucier said. “And the option for funds to be spent on equipment to test for adulterants in drugs will allow people who use drugs to make more informed choices, while also helping public health systems improve responses to drug use.”
With the arrival of the opioid settlement funds, Storrow added that people from across the political spectrum are really interested in more information about the best ways to address the drug overdose crisis.
“I think legislators were really open to getting good information and being thoughtful about saving lives in North Carolina,” he said.
Housing with a caveat
State lawmakers agreed to give TROSA, a residential recovery program based in Durham, $1 million from the opioid settlement funds in the compromise reached last week. The money is “to fund the construction of additional units of housing on its Durham campus that must be used to provide housing support to individuals in recovery from opioid use disorder or individuals receiving Medication-Assisted Treatment for opioid use disorder,” the budget document reads.
Earlier this year, NC Health News and Kaiser Health News co-reported a story examining addiction medication restrictions at TROSA after state lawmakers gave the group $11 million to expand. While it’s unclear how this will play out, state lawmakers specify that the new housing is also for people taking medication for opioid use disorder.
In another recent development, the Department of Justice issued guidance in April saying it is a violation of the American with Disabilities Act to discriminate against someone taking medication for opioid use disorder. The Department of Justice guidance also says that a medical program with a blanket policy of excluding patients taking prescribed medications for their opioid use disorder violates legal protections under that law.