Will Humble Opioids, Wills Blog

Opioid Overdose Deaths Decline: A Turning Point Fueled by Harm Reduction & Settlements?

Over the past year, the U.S. has seen a significant decrease in opioid overdose deaths, including those involving fentanyl. After years of rising fatalities, this decline is promising and suggests that several key strategies are working together to reverse the trend.

Interestingly, there hasn’t been an across-the-board reduction in opioid deaths. Some states have done quite well in the last couple of years. For example, Nebraska has reduced opioid deaths by a remarkable 36%. Other states have seen big increases like Alaska with a 54% increase.

As you take a look at the charts above (courtesy AZPHA member and epidemiologist Allan Williams, PhD) you’ll see that Eastern and Midwestern states have been doing better than the western states. Arizona remained about the same – with a 1% increase in opioid deaths over the last couple of years.

One major factor for improvements in some states has been the wider distribution of naloxone (Narcan), the overdose-reversing drug. Communities across the country have increased access to naloxone by making it available without a prescription and training the public in its use.

This life-saving medication, when administered promptly, can reverse an opioid overdose, preventing deaths​ – but only if it’s in the right place at the right time – with first responders and bystanders.

KFF Health News

​Another factor contributing to the decline is the expansion of harm reduction programs. These include needle exchange programs, safe consumption sites, and medication-assisted treatment using drugs like buprenorphine and methadone. States that have adopted these measures have seen significant reductions in opioid-related fatalities. By focusing on keeping individuals safe and engaged with recovery services, these programs are proving effective at curbing overdose deaths.​

A new influx of opioid settlement dollars could be playing a key role in the reduction. In recent years, pharmaceutical companies involved in the opioid crisis have had to pay billions in settlements to states and local governments. These funds are being used to improve addiction treatment programs, enhance public health interventions, and expand harm reduction efforts. In many communities, this funding has led to better prevention, treatment, and recovery support​.

What’s Up with All that Opioid Settlement Money & How Come There’s No State Plan for It Yet?
More Opioid Settlement Money on the Way

Finally, state-level interventions and improved fentanyl monitoring have helped reduce fatalities in regions hardest hit by the opioid crisis. States like Vermont and North Carolina have seen overdose deaths decline by as much as 30%, thanks to coordinated efforts that combine law enforcement, public health, and community engagement​.

Opioid crisis: Fall in US overdose deaths leaves experts scrambling for an explanation | BMJ

It would be fascinating to do a crosswalk between the results among the states in terms of opioid death rates and the way their states and communities have been using their opioid settlement dollars. After all – a key tenant of public health practice is to make sure you measure and publish the results of your interventions so you can both measure your own performance and help others learn from you too.

Sadly, I couldn’t find a journal article that dives into the detail of how states are using their money and the trends that they’re seeing in the field. Sounds like a good practical project for an enterprising graduate student or professor of public health!

Overdose Deaths Are Finally Starting to Decline. Here’s Why. | Scientific American
Will Humble Disease Control, Vaccination, Wills Blog

Pertussis Surge in 2024: Why Arizona is at Greater Risk

Whooping cough, or pertussis, is making a big comeback in 2024. The CDC reports that pertussis cases this year have greatly increased – nearly five times higher than during the same period in 2023.

Whooping Cough Is on the Rise, Returning to Pre-Pandemic Trends | NCIRD | CDC

CDC says the increase is partly due to the lifting of COVID-19 precautions, like mask-wearing and social distancing, which had kept respiratory infections lower than they otherwise would have been. Unfortunately, even people who were vaccinated are at risk because protection from the vaccine fades over time​ (pertussis is a bacterial disease rather than viral which is partly why vaccine induced immunity fades over time).

Pertussis can infect people of all ages, but infants under one year are the most vulnerable to severe complications, including hospitalization. Most infants contract the illness from close family members, especially older siblings or caregivers who may not even realize they are sick.

That’s why it’s critical for children to follow the recommended vaccination schedule. The CDC recommends that children receive five doses of the DTaP vaccine to protect against pertussis. These doses are given at 2, 4, and 6 months, with booster shots at 15-18 months and again between 4-6 years old. Adolescents should then receive a Tdap booster at 11-12 years old to keep protection.​

While this surge is affecting the whole country, Arizona is particularly at risk for larger outbreaks. Vaccination rates among Arizona’s children are way too low. In fact, recent data show that herd immunity against measles, another vaccine-preventable disease, has dropped by half in Arizona kindergartens, signaling broader issues with vaccine coverage.

Herd immunity in AZ kindergartens drops by half

The Vaccines for Children program, which provides free vaccines for uninsured and low-income families, has been hampered by regulatory hurdles, making it harder for providers to participate and get vaccines to the kids who need them most.

Years of Full Court Press Childhood Vaccination Advocacy Pays Off: ADHS Finally Overhauls their Vaccines for Children Policies – AZ Public Health Association

Increasing vaccine hesitancy, paired with these bureaucratic barriers, means more children are vulnerable to diseases like pertussis. Without improving access to vaccines and addressing vaccine hesitancy, Arizona could face even more serious outbreaks in the future.

While AZPHA is encouraged that the Arizona Department of Health Services has revised their policy documents to make their implementation of the Vaccines for Children program less punitive, we remain vigilant to ensure that the critical cultural change at the Agency is underway to actually implement the new policies in good faith.

Time will tell.

Will Humble Health Insurance, Public Health, Wills Blog

Harris Pitches Idea to Have Medicare to Cover In-Home Care: The Proposal

Vice President Kamala Harris recently proposed an expansion of Medicare to cover in-home care services for seniors. The plan aims to help families care for aging relatives at home, reducing the reliance on nursing facilities, which are often far more expensive.

If passed as discussed by the VP this week, Medicare would cover services like home health aides, aiding with daily living activities such as bathing, dressing, and managing medications.

This proposal is targeted at middle-income families who don’t qualify for Medicaid in their state but still often struggle to afford long-term care (e.g. Assisted Living).

Kamala Harris to propose new Medicare home care benefit for seniors

Currently, Medicare only covers in-home care under limited circumstances like short-term skilled nursing after a hospital stay, or part-time help with physical therapy and medical management.

The new proposal would expand eligibility to cover more routine, non-medical care, which is currently either out-of-pocket or falls under Medicaid for low-income individuals.

Note: Medicaid is the biggest payer for long-term care insurance in the country, with nearly 50% of long-term care paid through Medicaid (AHCCCS in our state). But, in order to qualify for long term care under Medicaid people generally have to spend most of their money first.

I couldn’t find a Congressional Budget Office analysis of the costs and offsets for the plan, but the campaign website said they believe the “change would be funded through savings generated by Medicare’s ability to negotiate lower drug prices.”

That’s pretty much all the details I could find for the proposal – but thought y’all might be interested.

Will Humble Medicaid, Public Health, Wills Blog

Telehealth in Arizona Medicaid: How AHCCCS Is Expanding Access to Care

Unlike Medicare, which is a federal program that’s managed ‘top-down, Medicaid (which provides healthcare to low-income persons and others with disabilities etc.) is a shared federal and state responsibility and provides more flexibility. As such – state Medicaid programs aren’t dependent on Congress for allowing for telehealth services.

Telehealth has been revolutionizing healthcare access for millions of people, and AHCCCS has been at the forefront of this transformation in the last couple of years… finally embracing telehealth services especially in areas like behavioral health.

AHCCCS Telehealth Services: What’s Covered?

AHCCCS’ Telehealth Policy Manual allows members to receive medically necessary services remotely using electronic communication tools like video conferencing, phone calls, or secure messaging for certain services like:

  • Behavioral Health Services: Counseling, psychiatric evaluations, and medication management are all available via telehealth. This is particularly important for those in rural or underserved areas who may struggle to access in-person behavioral health support.
  • Chronic Disease Management: Members can manage chronic conditions, like diabetes or hypertension via regular telehealth check-ins with their healthcare providers. This helps avoid unnecessary hospital visits and improves disease management.
  • Primary Care Visits: Routine checkups, some follow-up appointments, and preventive care can now be done remotely, providing members with greater flexibility.
  • Therapy and Rehabilitation: Physical therapy, occupational therapy, and speech therapy services are also available via telehealth, making these services more accessible to members who may have transportation or mobility challenges.

The Role of the Arizona Telehealth Advisory Committee

Arizona law requires that AHCCCS listen to their Telehealth Advisory Committee as they make decisions about what kinds of telehealth services to authorize and encourage.

The committee evaluates the effectiveness of telehealth services, helps set standards for delivery, and advises on any changes necessary to improve patient outcomes. This collaboration ensures that AHCCCS continues to expand and improve telehealth offerings in ways that are both effective and cost-efficient.

AZPHA commends AHCCCS for its recent commitment to embracing telehealth as a vital part of the healthcare in Arizona. 

Will Humble AzPHA Breakfast & Learns, Professional Development, Public Health, Wills Blog

AZPHA Breakfast & Learn – Arizona’s 2024 Ballot Measures: A Public Health Perspective

AZPHA Breakfast & Learn

Arizona’s 2024 Ballot Measures:

A Public Health Perspective

There will be 13 ballot measures on your November ballot. The vast majority of them (11) were placed directly on the ballot by the legislature – largely because the Governor had earlier vetoed the measure or certainly would have. Others are designed to permanently change the state constitution. AZPHA has taken positions against 5 of the ballot measures and is supporting two of them (both citizen initiatives). This session will cover each of the ballot measures with color commentary from Will Humble about the pluses and minuses of each.

Our Speaker:

Will Humble, MPH

Executive Director

Arizona Public Health Association

View the Webinar 

Passcode: *5R*5?5=
View Our PowerPoint
Will Humble Federal Budget, Prevention, Wills Blog

The Future of Telehealth in Medicare: Why Congress Needs to Act to Preserve Access & Improve Care

The COVID-19 pandemic forced the US to rethink how care could be delivered safely and effectively, especially for older and underserved populations. One of the most significant developments was the expanded use of telehealth services within Medicare.

As the country shifted to remote care, telehealth became a lifeline for millions of Medicare members. It let people get care without the risks associated with in-person visits, especially for high-risk populations. It also really helped out in rural areas that have weak networks for behavioral health, psychiatric and other critical care.

Now that the public health emergency is over – the benefits of telehealth for Medicare members are also expiring at the end of 2024 (telehealth was temporarily extended when the PH emergency ended).

The question before congress isn’t just whether telehealth should remain a part of Medicare – but how it can be structured to improve care and ensure long-term sustainability.

The Pandemic’s Lessons:
Improved Access Through Telehealth

The expansion of telehealth during the pandemic showed remarkable improvements in access to care. As documented in a Kaiser Family Foundation report, before the pandemic, Medicare’s telehealth coverage was limited. Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology.

The public health emergency lifted these barriers, enabling all Medicare beneficiaries to use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits. A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions benefitted the most.

Telehealth made it easier for patients to stay connected with their providers, avoiding travel, and waiting times. Patient and provider satisfaction surveys showed a high level of approval for telehealth, with many beneficiaries preferring virtual visits for routine care.

A Crucial Moment for Telehealth Policy

Before the end of the telehealth extension is here (12/31/24) Congress will need to decide whether to again temporarily extend telehealth or make permanent the telehealth flexibilities enacted during the pandemic. There’s a current proposal for a two-year extension of these flexibilities, which would provide a temporary solution but falls short of addressing long-term needs.

A two-year extension is better than allowing the COVID-era policies to expire altogether, but it’s only a stopgap.

But… the bipartisan CONNECT for Health Act offers a more comprehensive and forward-looking solution. This bill proposes permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and eliminates in-person visit rules for behavioral health.

Importantly, it also includes measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.

The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.

Not all medical issues are suited for telehealth, but many conditions—particularly in behavioral health—benefit greatly from continued virtual access. The CONNECT Act emphasizes this distinction, ensuring that telehealth is used where it can be most effective without undermining the need for in-person care.

The Stakes: What Happens If Congress Fails to Act

If Congress doesn’t at least extend the current Medicare telehealth policies seniors could lose access to a vital service -especially for behavioral health services and in rural areas, erasing the gains in access achieved in the last 4 years.

While a two-year extension would temporarily keep access, it doesn’t provide the certainty needed to build sustainable, long-term solutions for telehealth in Medicare.

A Call to Action

Congress needs to act by December 31 to prevent the rollback of important Medicare telehealth services. While a two-year extension is a start, it really just kicks the can down the road. Passing the CONNECT for Health Act would ensure that telehealth stays a permanent and sustainable part of the Medicare program.

 

Will Humble Professional Development, Public Health, Wills Blog

Grant Opportunities (Compiled by the Vitalyst Health Foundation)

Due October 3rd: Rural Initiative Program

Due October 4th: The Hellene Henrikson Fund of the Lutheran Church of the Foothills (Behavioral Health in Southern Arizona)

Due October 7th: WaterSMART Drought Response Program: Drought Resiliency Projects

Due October 8th: Capacity Building Grant

Due October 8th: Impact Fund

Due October 10th: Tribal Program Support Cooperative Agreements

Opens October 10th: Firehouse Subs Public Safety Foundation

Due October 15th: Wayne & JoAnn Moore Charitable Foundation

Due October 15th: Pathways to Removing Obstacles to Housing

Opens October 15th: Research Grant

Opens October 15th: Project Grant

Due October 16th: Ambulatory Program Application Kit (Tribal)

Due October 16th: Recreation Economy for Rural Communities

Due October 25th: Tribal Tourism Grant Program

Due October 30th: Family Unification Program

Due October 31st: Community Action Fund (Defend Indigenous Peoples’ Rights)

Will Humble Marijuana, Wills Blog

Far Out: Cannabis in Rural Healthcare

Thursday, October 17, 2024

12:00 – 1:00 pm MST

Far Out: Cannabis in Rural Healthcare

A webinar series focused on providing technical assistance to rural stakeholders to issue research findings, policy updates, best-practices and other rural health issues to statewide rural partners and stakeholders throughout the state.

Learning objectives:

  • Identify how recreational and medical marijuana laws interact with rural communities.
  • Reflect health equity concerns for rural communities as it relates to cannabis access and safety.
  • Engage with harm reduction resources for responsible adult cannabis use.

Meeting Registration – Zoom

Will Humble Medicaid, Social Determinants, Wills Blog

AHCCCS Addressing Social Determinants of Health Via Community Reinvestment

AHCCCS continues to innovate in its approach to healthcare. In their latest move, they’re focusing on the broader social factors that affect health.

For example, their recently updated ACOM Policy 303 – Community Reinvestment is looking to require their contractors to reinvest a portion of their net profits into initiatives that directly address the social determinants of health across Arizona.

AHCCCS has had a community reinvestment requirement for many years – but this is the first time the agency has proposed that their contractors invest specifically in the social determinants of health.

For AHCCCS contractors, this means that up to 10% of net profits must be spent on community reinvestment projects. The proposal includes a sliding scale so that the contractors with lower net after tax profits are expected to invest a lower percentage of that profit.

By targeting factors like housing, education, employment, and food security, AHCCCS is taking concrete steps to address the root causes of poor health outcomes, not just the symptoms.

This policy shows the agency’s commitment to improving the health of vulnerable populations while building stronger, healthier communities.

What’s exciting is that AHCCCS leadership is not just focusing on healthcare within clinic walls. They’re acknowledging that factors like stable housing, access to nutritious food, and a supportive community are critical to health outcomes.

This forward-thinking (and evidence-based) policy recognizes that social determinants are key in creating healthier lives for Arizonans.

See also: AHCCCS Tackling Housing Instability with Their New ‘H2O’ Program – AZ Public Health Association

AHCCCS is currently seeking public feedback on this proposal, with the comment period open until October 15. You can share your thoughts and help shape this critical policy by submitting comments online at: https://ahcccs.commentinput.com/?id=iePSEUFNp.

This initiative is a great step forward, and we commend AHCCCS leadership for addressing health from a broader perspective.

Will Humble Uncategorized

FDA: Adolescent E-Cigarette Use Declines Nationally

The FDA announced this week that youth e-cigarette use in the US has dropped to its lowest level in a decade! This decline is encouraging news and, according to the FDA, largely attributed to ‘comprehensive federal and state efforts to reduce tobacco use among adolescents, including education campaigns and regulations that limit access to e-cigarettes’.

Nationally, the percentage of high school students who reported current e-cigarette use dropped from 14% in 2022 to 10.6% in 2023… inching closer to the Healthy People 2030 goal of reducing adolescent e-cigarette use to 10% or lower.

Results from the Annual National Youth Tobacco Survey | FDA

In Arizona, about 16% of high school students reported using e-cigarettes in 2023’ Youth Risk Behavior Survey. The downward national trend is a step in the right direction, reflecting the impact of ongoing state and local measures, including tobacco-free policies and youth prevention initiatives.

To continue this progress, it’s crucial to support policies that limit the availability of e-cigarettes and educate young people about the risks by focusing on comprehensive tobacco control policies and community education initiatives.

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