Governor J.B. Pritzker (D-Ill.) signed the SAFE-T Act (House Bill 3653) into law on February 22. The bill contains the Pretrial Fairness Act, which calls for new cash bail reforms to be gradually implemented until the practice is completely abolished by January 1, 2023. Judges will be required to impose the least restrictive conditions necessary to ensure that a defendant appears in court.

“All the reforms in this bill are long overdue. They’re long awaited,” Ben Ruddell, director of Criminal Justice Policy at the ACLU of Illinois, told Filter. “The expansion of the carceral state—it’s been a one-way street.” 

The legislation gives courts the discretion to disregard mandatory minimums in certain situations, including if the offense involved the use or possession of drugs, retail theft or driving on a revoked license due to unpaid fines or fees. 

A previous version of the bill would have applied “bans toward [mandatory] minimums basically wherever they exist, and sentenced defendants where the law currently doesn’t provide that as an option,” Ruddell said. But over the course of getting that part of the bill passed, amendments were added to reduce the number of offenses it covered. 

“The question that I have about it is, what’s left? What does it actually apply to?” Ruddell said. “Because, as I interpret the law, retail doesn’t carry a mandatory minimum. Nor does drug possession,” with the exception of methamphetamine. 

The new legislation also puts an end to the practice of suspending driver’s licenses for unpaid red-light and speed camera tickets. 

Under the Act, judges can still consider the defendant’s past drug or alcohol use when setting their bail. However, the Act repeals the Illinois statute giving courts the power to enact a drug testing program. Judges will no longer be permitted to require that people undergo periodic drug testing as a condition of their bail. 

Policy Changes for Deflection Programs

The SAFE-T Act builds on a bill that was signed into law in 2018, which officially authorized police officers to establish programs to “deflect” people who have overdosed or who have substance use disorders (SUD) away from the criminal legal system. 

The new legislation clarifies that first responders and co-responders, not just law enforcement officers, can be involved with deflection programs. It also adds that such programs are intended to not only deflect people away from contact with the criminal legal system, but from unnecessary admissions to the emergency department. 

First responders and co-responders (such as peer or social workers) involved with such deflection programs are also now eligible for funding from the Illinois Criminal Justice Information Authority. However, in order to be eligible for that funding, they must include a law enforcement agency.

This is for “administrative” reasons, Jac Charlier, the executive director of the Chicago-based TASC Center for Health and Justice, told Filter. “They know how to collect data,” Charlier said. “They know how to share data. Believe it or not these other entities like behavioral health, drug treatment, mental health, even EMS and fire who do well on the data, they’re not as used to doing partnerships with other entities.”  

“You could have done it prior to this, but you’re on your own. This legislation says, ‘We’ve got funding for you.'”

Charlier said the Act gives communities who are interested in setting up deflection programs a blueprint for navigating how to set them up. 

“You could have done it prior to this and you can do it without the legislation, but you’re on your own,” Charlier told Filter. “The legislation says, ‘We’ve got funding for you. We’ll give you a framework within which to set it.’” 

The Act emphasizes that such funding will go to communities that have been the most harmed by the criminalization of drugs. This includes communities “that have a police/community relations issue, and communities that have a disproportionate lack of access to mental health and drug treatment,” the legislation reads. (Illinois’s rollout of cannabis legalization recently fell short of the promises it made to award dispensary licenses to people from historically marginalized communities.)

Deflection programs will be required to receive training in a variety of drug-related topics, including treatment for SUD, eliminating stigma around people with SUD and mental health and the neuroscience of addiction for law enforcement.

Naloxone “and related supplies necessary for carrying out overdose reversal” are also eligible for funding.

Looking Ahead

Charlier hopes that organizations interested in implementing a deflection program carefully consider what they hope to gain from doing so, and what technical assistance they’ll need to succeed at it. 

“It needs to be done like everything else, with the thought around why we’re doing it … versus just saying, ‘Oh, this is a bright shiny object, the co-responder, let’s go do it,’” Charlier said.

For his part, Ruddell expects to see backlash to the SAFE-T Act in the form of legislation introduced to roll back portions of it. 

“Defending the bill is going to be a full time job,” Ruddell said. “There’s a lot of misinformation, disinformation and fear-mongering going on, some of which is being repeated uncritically by some media sources.”

Ruddell cited getting rid of qualified immunity for police officers as well as reducing excessive sentencing practices in Illinois as two goals to focus on in the near future.

He also suggested that the state reclassify simple drug possession from a felony to a misdemeanor. A bill introduced to the Illinois House on February 19 would, among other things, reduce the penalty for the delivery or possession of methamphetamine. 

Photo by George Hoden via PublicDomainPicture.net/Creative Commons

The post Illinois Moves to End Cash Bail, Reform Pretrial Procedures appeared first on Filter.

California Assemblymember Kevin McCarty (D), whose district includes Sacramento, introduced Assembly Bill 1542 on February 19. The bill would give the criminal legal system in Yolo County, located in the greater Sacramento area, the power to send people convicted of “drug-motivated crimes” to substance use disorder (SUD) treatment. It would set up a pilot program purporting to be a novel approach to helping unhoused people with SUD. 

The legislation, however, does not address the fact that most people convicted on drug-related charges do not have SUD and do not “need” treatment—certainly not mandatory treatment. As part of the pilot program, Yolo County’s health and human services agency would conduct a “risk and needs assessment, utilizing an assessment tool demonstrated to be appropriate for drug offenders” for each program participant.

Concerningly, the bill tasks police officers with flagging people they have arrested who, in their personal view, have SUD.

But it’s unclear whether that assessment will come before or after participants are diverted to the program. It’s also unclear how that assessment would “confirm” that someone has a SUD. McCarty’s office did not respond to Filter‘s request for comment by publication time.

Concerningly, the bill also tasks police officers with flagging people they have arrested who, in their personal view, potentially have SUD. Officers are encouraged to state whether they believe that someone they arrested has an SUD “that is in whole or in part a cause for the crime committed.” 

“Our efforts in California in treating those with SUDs, many of whom are homeless, have been an abject failure,” the bill reads. “Although there have been efforts to treat this population, to date, there has been little-to-no success.” 

For one county official, the lack of evidence to suggest that approach would be effective was a selling point rather than a cause for skepticism. 

“Well, I don’t know of another similar program like this,” Gary Sandy, the chairman of the Yolo County Board of Supervisors, said in a December meeting, according to the Daily Democrat. “So, it would be hard to have evidence supporting this. That’s why it’s a pilot program and we are hoping that the evidence will show that this type of program works.”

People eligible for the program include those “convicted of drug-motivated crimes as a result of their SUDs that victimize others.” People convicted of violent felonies and people convicted of simple possession are not eligible for the program. 

It remains unclear where the program will be physically located or what its operations will look like. The legislative agenda for the meeting stated that the District Attorney was interested in legislation “to convert excess detention space to be used as a drug diversion/treatment program for non-violent offenders.” 

“Yes, this would be a locked facility, but it would not be jail.”

“Sentencing would be determined by a judge and only after receiving input from drug and mental health counselors,” Sandy continued. “Yes, this would be a locked facility, but it would not be jail.”

There is good reason to suspect that the treatment facility in this pilot program will simply be jail by another name. In one Massachusetts treatment center, “patients” are required to wear orange uniforms and carry a badge with the word “inmate,” as Leo Beletsky and Denise Tomasini-Joshi pointed out in a New York Times op-ed. An investigation by Reveal exposed hundreds of rehab facilities across the country for requiring residents to work substantial hours without compensation. 

McCarty has not always supported legislation that reinforces the coercive nature of the criminal legal system. One bill that he introduced, AB 646, was approved by Gov. Gavin Newsom (D-Calif.) in September 2020. AB 646 removed the barriers that prevented people on parole for the conviction of the felony from registering to vote and voting. 

In 2019, McCarty co-sponsored Assembly Bill 1468, which died in the Assembly in March 2020. The bill would have required opioid manufacturers or wholesalers to pay a stewardship fee. Those fees would have gone into the newly created Opioid Prevention and Rehabilitation Program Fund for disbursement to counties or to local community-based organizations.  

Photograph of California State Assembly Chamber via Flickr/Creative Commons 2.0

The post California County Eyes Mandatory Drug Treatment Bill appeared first on Filter.

Over Trump’s final six months in office, he oversaw executions at an extraordinary pace—more than any president since the 19th century. During the final week of his administration, the federal government executed three people, including Lisa Montgomery, the first woman to be executed by the federal government in nearly 70 years.

Let the Lord Sort Them, a book tracing the rise and fall of the American death penalty over the past 50 years, was published in the following days. Authored by Maurice Chammah, an Austin-based staff writer with the Marshall Project, the book pays special attention to the history of capital punishment in Texas.

Filter spoke to Chammah about the importance of Texas’ role in nationwide capital punishment, moments of humor among those impacted by the death penalty and the future of capital punishment in this country. The interview has been edited for length and clarity.

Lucia Geng: In the first few chapters of your book you outline what makes the death penalty in Texas special. Could you walk through those factors? Why did you focus on Texas?

Maurice Chammah: I focused on Texas for two reasons. One is, just a broad, almost data-based reality that Texas is the epicenter of executions in the United States. There have been more than 1500 since the 1970s and more than a third of those were in Texas.

The second is I grew up here, and knew the cultural elements to that story. I had grown up hearing about a kind of frontier mentality and hearing about Texas as a Western state. Once I lived in other places and got a fuller perspective, I realized that we were also a Southern state, with a history of racial violence that had not been adequately talked about and thought about.

As I got deeper into the research, I saw that there was a very technical, legal and political story about how the Texas law was written in the 1970s that also paved the way for it to be such a center of the death penalty.

In the course of your research, what contradiction about the death penalty was the most interesting to unpack for you?

I actually think that the most interesting contradiction about the American death penalty is a little less true of Texas than it is of other places. It’s the idea that support fot the death penalty is very high, but then when it comes to actually carrying out executions there’s a lot of ambivalence. It would be, frankly, easier—bureaucratically and practically—for states to carry out lots of executions with the firing squad, or with hanging. But there were cultural reasons why we don’t do that, and those cultural reasons have never been fully excavated.

It used to be that executions were carried out before crowds of people, and now we’ve put them in quiet rooms behind tall prison walls. People say they support the death penalty, and in many cases that’s an authentic belief, but when it comes to actually carrying them out, there’s a sort of queasiness about really putting the death penalty in front of the public in the way that we used to. There doesn’t seem to be any cultural appetite for it. That contradiction was something I really wanted to explore.

In the book I talked about this one Texas legislator [then-state Senator Craig Washington] who, in the 1970s, tried to attach an amendment to the death penalty law that would force all of the legislators to personally vote on each execution, and to have the electric chair on the floor of the Texas State Capitol building. All the other legislators uncomfortably reacted to this idea, but what he wanted them—and all of us—to understand with that suggestion is that there’s a refusal to take ownership of this punishment. In states like Nevada, California and Pennsylvania, there are very large death rows. There’s no hesitation to send people to death, but then there is a huge hesitation to actually execute them.

The death penalty is traumatic, but in the book you mention “little moments of levity” on death row. There are a lot of wonderful anecdotes. What were moments that made you hopeful?

I wanted the book to capture the gravity of the subject, but not the impossibility, because it’s just so heavy. We as humans contain a lot. We contain the capacity for incredible sadness and also levity in the sadness, and I think I was constantly looking for moments where people on death row joked with each other or found some levity in their days.

There was also a kind of gallows humor that emerged among lawyers who worked on death penalty cases, especially defense lawyers. They worked in this bubble where it felt like the whole [country] hated them for defending the worst of the worst, but they would rib each other and they just developed this very warm culture. I found that really invigorating to read about. Even in the darkest moments for them professionally, they were capable of joy. They didn’t let the difficulty of the work completely destroy them.

When that Texas legislator said, “let’s have the electric chair on the floor of the Capitol,” there were other legislators who said, “let’s have an amendment to carry out executions in a rodeo arena and we’ll charge tickets and we’ll use the money to fund schools.” These moments are horrifying, but then you realize they’re not being serious and they’re just trying to goad their fellow legislators into admitting the contradictions of their views. The way they go about that is so creative. The creativity of that resistance was very inspiring to me.

I focused on lawyers, and I say in a kind of almost snarky tone, because they do most of the talking. They’re the ones who are convincing juries and the public that a particular person on the one hand is evil, or on the other hand, that they are capable of mercy and redemption. I could totally see an alternate version of the book, where the person you follow for a lot of the book is the mother of someone on death row — I sometimes regret that I didn’t spend more time [on family members]. There’s a bit in the book about the family members of people on death row, but could have devoted the entire book to those people. Their emotional experiences are so complex and their grief and their trauma is so under-studied and under-reported.

For all of the spectacle around the death penalty, it directly impacts relatively few people each year. What would you say to someone who asks, “Why should I care about the death penalty?”

I think the death penalty matters a lot for two reasons. One is that it’s the pinnacle of the larger turn that our country took towards harsh sentencing. When you have the death penalty—just on the books, whether or not you carry it out—it makes a life without parole sentence seem more lenient. This played out repeatedly in state legislatures, where life without parole was passed as a less-harsh alternative to the death penalty as another option for juries and prosecutors. To understand the larger punitive turn in our culture and politics over the last 40 years, the death penalty is the heart of that.

The other reason I think the death penalty matters a lot is that because it’s the harshest punishment, and because the stakes feel so high, it attracts really good lawyers. It also attracts a sense among the legal system that nobody should be executed without having a lawyer, so we always have lawyers working on these cases. And the importance of having lawyers work on these cases is that problems are unearthed, and those problems don’t just apply to death penalty cases.

It was through death penalty cases that we started to learn about problematic forensics, and the ways in which crime labs and experts were allowing non-scientific types of evidence into the courtroom. It was through the death penalty that we started to understand more about brain science and the way that brain injuries and trauma and mental illness shape people’s paths in life. And I think a lot of the lessons that have come out of the very limited world of the death penalty have [implications] for the larger criminal justice system as we try to unpack why crime happens, what produces it and how a society can have both less crime and a more mercy-oriented approach to crime when it does happen.

There was a lot of activism and uproar around the executions of Brandon Bernard and Lisa Montgomery especially. How do you feel the level of discourse about the death penalty today compares to the past?

The idea that we all understood that Lisa Montgomery was guilty of the things she was accused of, but also that her execution was also problematic because of her trauma and mental illness—defense lawyers may have been making those arguments in the ’90s, but they were not gaining traction in the public sphere in the same way at all. I think Trump’s run of executions has ironically shown just how much the country has turned against the punishment and turned against the kinds of sensibilities around it that marked a generation or two generations ago.

One lesson I think of 1972 and Furman v. Georgia is that we’ve been here before. We, as a country, abandoned the death penalty before. When the Supreme Court ruled against the death penalty while it was all around the country, there was a tremendous amount of backlash. When change happens at an elite level, whether it’s the Supreme Court, or Congress, without a lot of grassroots support among Americans, people can feel very betrayed and angry at their leaders in Washington.

I think that the death penalty is still on the decline. For America to really embrace the death penalty again would take a lot of cultural and political changes that are very hard to predict and, at least for me, very hard to see. But it’s the nature of history that it’s incredibly unpredictable. One lesson of the past is that these changes don’t really stick unless we take a step back, and assess how we got here, and make a more thoughtful collective decision to make the future different.

Photograph of book cover courtesy of Maurice Chammah

The post The Rise and Fall of the Death Penalty in the US appeared first on Filter.

First in Line, published by the DC Fiscal Policy Institute on February 16, lays out eight recommendations for ensuring an equitable recreational cannabis industry in DC. They span three areas: addressing historic and current harm; designing a cannabis industry that fosters racial inclusion; and devoting cannabis tax revenue to build community wealth.

“I don’t want this to just be a report that sits on the shelf,” Doni Crawford, the report’s author and a policy analyst with DCFPI, told Filter. “I want to make sure that we’re implementing and working with our policymakers to make sure that Black and Brown communities are deeply embedded in this process and included in our recreational sale industry here in DC.”

Crawford began writing First in Line after DC Mayor Muriel Bowser released a bill to legalize recreational sales of cannabis in May 2019. The DC Council was permitted to hold legislative hearings on the topic despite a Congressional amendment banning legislation that would allow cannabis sales. But Bowser’s bill, the Safe Cannabis Sales Act of 2019, died in committee.

Black people have been disproportionately impacted by DC’s cannabis policing practices. In 2010, 91 percent of the people arrested in DC for cannabis possession were Black, even though just under half of DC residents are Black. The report calls for the DC government to facilitate people with cannabis-related criminal records getting involved with the cannabis industry.  

“Their prior involvement with cannabis should be a skill, not another penalty,” Crawford wrote in the report.

The report comes just a few months after the implementation of a DC Council bill decriminalizing drug paraphernalia. Black people comprised 82 percent of DC residents arrested on paraphernalia-related charges between 2010 and 2016. The District’s racist policing did not resolve when it legalized cannabis possession (up to 2 ounces) in 2015; in 2016, Black DC residents were still nearly 11 times more likely to be arrested for public consumption of cannabis than white residents. 

One key proposal in First in Line is that the District ought to direct revenue generated from a cannabis tax towards the communities who have been harmed most by the criminalization of drugs.

Crawford recommended in the report that the District send cannabis tax revenue toward reparations and re-entry services, as well as free tuition at the University of the District of Columbia for those harmed by past policies. These efforts, she wrote, should be paired with “immediate outreach and education on these services and programs.”

“When we talk about public policies and solutions for making sure we’re being inclusive in a number of areas—including the cannabis industry—I think at the end of the day, the only way to solve the problem is reparations,” Crawford told Filter. “Working at a think tank, oftentimes we get stuck in proposing what’s politically feasible and not necessarily what’s needed to address root causes.”

Future Reforms

Crawford believes that attainable goals for the DC Council to act on during their current Council Period include protecting cannabis consumers from employer discrimination, ensuring that people with criminal records can work in the medical cannabis industry and securing an equitable distribution of cannabis dispensaries and cultivation centers in DC.

The Council is currently revamping its Comprehensive Plan, which guides land use and economic development. That will give Councilmembers a chance to consider the report’s recommendation of fair access to dispensaries and cultivation centers for the District’s residents.  

In December 2020, the Council passed a bill that prohibits the DC government from discriminating against people participating in the District’s medical cannabis program. But they declined to pass a bill that would have prohibited cannabis testing as a job requirement, except where required by federal law, and for certain safety-sensitive positions.  

“I did hear that that is still on their radar for this year, so they’ll likely take up this bill after budget season here in DC,” Crawford told Filter.  

A few months before that, the Council introduced a bill that would allow for formerly incarcerated people to have a greater involvement in the medical cannabis industry. That bill died in committee, but Crawford is hopeful it will be re-introduced this session.

Photograph of U.S. Capitol via Flickr/CC 2.0

The post What Could Cannabis Reparations Look Like In DC? appeared first on Filter.

In December 2020, a bipartisan group of US Senators introduced the Comprehensive Addiction and Recovery Act (CARA) 2.0. The act builds on the original CARA legislation from 2016, which authorized funding for a federal response to the nation’s opioid-involved overdose crisis. The bill is the latest effort at the federal level to expand telehealth services relating to medications for opioid use disorder (MOUD).

One of CARA 2.0’s key provisions is that it would permanently allow providers to prescribe MOUD to patients without a prior in-person visit. Currently, the 2008 Ryan Haight Act makes it illegal for a provider to prescribe a patient a controlled substance without an in-person visit.

Since January 31, 2020, OUD patients have been permitted to be prescribed buprenorphine after either an audio-visual or audio-only telehealth visit. Buprenorphine maintenance appointments can be conducted virtually as well. But that’s due to a temporary suspension of regulations by multiple federal agencies, which is scheduled to lapse whenever the coronavirus pandemic is declared over. In another notable improvement implemented for the duration of the pandemic only, providers are currently not required to test patients’ urine to monitor their adherence.

“The moment that they feel like they want treatment is the moment they should be able to access it.”

“Once the regulatory changes were implemented, we really were able to utilize telehealth to meet patients exactly where they are, whenever they are free, and wherever they are,” said Dr. Linda Wang, director of the buprenorphine treatment program at Mount Sinai’s REACH Program.

Prior to the pandemic, patients who needed buprenorphine in New York City needed to wait an average of one week to initiate treatment, according to a recent article of which Wang was the primary author. Those in Upstate New York, meanwhile, waited an average of 12 weeks.

“The moment that they feel like they want treatment is the moment they should be able to access it,” Wang said. “Things in their lives can change very rapidly, and I think the quicker we’re able to provide them with an evaluation to get them medication, the better.”

Reimbursement Parity

Besides the change in federal regulations, one key policy change in New York that eased the shift to telehealth services for providers was audio-visual visits becoming eligible for the same level of reimbursement as in-person visits. Prior to the pandemic, clinicians who provided audio-visual visits were reimbursed at a lower rate than if they had provided in-person ones.     

Thanks to the change, “the stars were finally aligned for us” to provide telehealth services, said Tiffany Lu, the medical director at the Montefiore Buprenorphine Treatment Network. Lu authored the New York State Department of Health AIDS Institute’s clinical guidelines for OUD treatment during COVID-19.

Lu told Filter that at Montefiore, providers were able to get telehealth appointments up and running by the end of March 2020.  

“Even if I try to provide the highest quality care I possibly can between a mix of phone visits and in-person visits, via reimbursement it makes it so that people who are trying to do their job engaging patients don’t necessarily get paid the same,” Lu said. “And this is a little bit punitive.”     

Audio-only telephone visits are still not reimbursed at the same level as audio-visual or in-person ones.

In July, New York Governor Andrew Cuomo (D) signed Senate Bill 8416 into law, adding audio-only and video-only services to the state’s definition of teleservices. The bill also categorized these services as being eligible for reimbursement under Medicare.  

Bridging the Digital Divide

Allowing audio-only telehealth services to be covered under insurance could increase access to healthcare for people who have insurance and have reliable access to a cell phone, but who are not able to videoconference. Roughly one-quarter of American adults don’t have access to home broadband service, and a disproportionate amount are low-income internet users. 

A push toward telehealth may widen the digital divide that the COVID-19 pandemic has exposed and exacerbated. It may also compound existing health disparities by, for example, leaving behind patients who don’t have access to a computer, phone or housing. 

Wang’s team at the REACH Program at Mount Sinai anticipated this problem early on, and acquired a grant that helped them distribute 120 iPhones with unlimited data and texting plans to their patients. But such initiatives have their limitations.

“Not all patients are savvy enough with phones to know how to use technology,” Wang said. “And the phones got stolen, or people lost them.”  

Even though Lu’s office does not require the video component, many of her patients are essential workers who still face structural barriers that make it difficult for them to access telemedicine, including limited minutes on their phones.

“I’m literally having conversations with patients who are taking a break in between their shifts, and they don’t have privacy,” Lu told Filter. “If you don’t have privacy, then how can you really have meaningful healthcare with your provider?”

Other MOUD Legislation

If passed, CARA 2.0 would also establish a five-year pilot program to study the use of mobile methadone clinics in rural and underserved communities. The bill would authorize a total of $765 million to go towards education, treatment, recovery and criminal justice programs. Of that amount, $300 million would be spent towards expanding MOUD. 

Such a program would tackle the problem of long driving times to methadone clinics that residents of rural areas often face. A 2019 study focused on Indiana, Kentucky, Ohio, Virginia and West Virginia found that the average driving time facing patients in those states was at least 40 minutes. By comparison, the average driving time in large central metropolitan areas in those same states was under eight minutes. 

The number of mobile methadone clinics is currently restricted due to a nationwide moratorium that the Drug Enforcement Administration placed in 2007 on approving registrations for new methadone clinics. In April 2020, the DEA proposed lifting the requirement that methadone providers must obtain a separate registration for their mobile component, but it has yet to actually do so.

In June 2020, Sen. Rob Portman (R-Ohio) introduced the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act. If passed, the TREATS Act would permanently allow clinicians to provide audio-only telehealth services for substance use disorders to patients covered through Medicare, as long as a provider has already conducted an in-person or audio-visual medical evaluation of the patient.

Cuomo announced two rounds of funding for NYS addiction telehealth services in 2020. The money came from the federal State Opioid Response Grant and was distributed through the state’s Office of Addiction Services and Supports. 

Beyond COVID

Both Wang and Lu, like other providers, would like to see the temporary regulatory changes brought on by the pandemic stay even after the pandemic ends.

Wang cautioned against treating telehealth as an answer to everything. There are many unanswered questions pertaining to best practices in telehealth, such as how long providers should wait to have an in-person follow-up visit after they perform a telehealth intake.

“If this goes away, we’re just going to be shutting doors on people.”

But she also argued that it can be less stressful for some patients to have their first visit over the phone, since many institutions “can and do reproduce stigma.” She believes some clinicians find telehealth “really attractive, and it potentially could be a really positive thing to engage patients over the phone, and then follow up with them in person at some point to really solidify that relationship.”

Lu pointed to the work of the Buprenorphine Telehealth Consortium, which has advocated for the temporary removal of barriers to buprenorphine during the pandemic to become permanent.

“They should not go away,” Lu said. “If this goes away, we’re just going to be shutting doors on people.”

Photograph via Pixabay

The post Telehealth Services Are Expanding OUD Medication Access—For Some appeared first on Filter.

The SOAR Columbus app was launched in November 2020 by the SOAR Initiative, a harm reduction organization run by Ohio State University students. The app is available on the Apple App Store and Google Play Store, and received funding from the city’s public health department.

After first checking a box to verify that they are not a law enforcement officer, app users can sign up for “Deadly Batch” email or text alerts whenever a concerning batch of drugs is reported in Columbus or its suburbs. They can also view a color-coded map displaying locations in the area that provide harm reduction supplies like syringes, naloxone, drug-checking strips and HIV and hepatitis C testing.

“Really, the system was designed with the idea of people helping people, so we want this to be very grassroots,” said SOAR Executive Director Pranav Padmanabhan, a junior at OSU studying geography and public health.

The app’s genesis was a few SOAR members starting to volunteer at Safe Point, a Columbus syringe service program. Collectively, they realized that was “a gap between the existing public health and harm reduction services, and reaching a lot of the population of people who actually use drugs,” Padmanabhan told Filter.

The group’s other initiatives are accessible to people who don’t have smartphones.

The SOAR team looked to Baltimore’s Bad Batch Alert text messaging system for inspiration. They also drew on the work of Brave Co-Op, which builds technological services to alert responders to overdoses near them, with a presence in both Vancouver and Columbus.

The SOAR Columbus app supplements the group’s other initiatives to support people who use drugs, which are accessible to people who don’t have smartphones. Before the app’s development, the group sent out alerts from Columbus Public Health and the coroner’s office via SMS text messaging. They’ll continue to do so. The organization also distributes fentanyl test strips in-person and is working to distribute them by mail.   

Building Trust, Expanding Services

SOAR’s members describe their greatest challenge in developing the app as producing something that people who use drugs would trust and want to use. They ran multiple focus groups to ensure that the app’s design would fit the needs of their targeted audience, said Joey Esposito, a sophomore majoring in data analytics and the app’s back-end developer.

SOAR performed extensive outreach to harm reduction providers in the area in order to create its built-in map, and made sure that the app’s technological aspects were ethical and aligned with the mission of serving people who use drugs. Esposito said that the team is proud to store users’ data securely and to not collect any unnecessary data.

“I feel like a lot of the times people in the tech world get a little bit too carried away with what they can do, and a little bit too not as focused on what they should do,” Esposito said. 

Kate Luckerman, a sophomore studying computer and information science who is the app’s front-end developer, agreed that the group’s “biggest challenge is constantly trying to keep in mind how we can best serve the interests of our audience and prioritize a relationship of mutual trust through something so distant and hands-off as an app.” The app does not require its users to be tech-savvy.

SOAR hopes to expand its reach to other cities across Ohio. The group has already set up a number with a Cleveland area code to which people can text “SOAR” to sign up for Deadly Batch alerts. Their next step is to create a similar app that can serve Cleveland, which they hope to debut this spring.

“It’s actually not too difficult to set up the system in the first place,” Padmanabhan said. “So now it’s all about just maintaining the systems and spreading out and building the connections with the community and building the trust. “

SOAR’s planned expansion to Cleveland is personally meaningful to Esposito, whose family has been affected by opioid issues. “I would love to see this app serve the same use for them and help them in the ways I’ve seen it help people in Franklin County,” he said.

He added that he’d like to advance SOAR’s overall mission of convincing people who doubt the value of harm reduction to embrace it. “The main thing that we want to do as an organization is change the minds of these people, so that … we can hopefully move towards helping users in a way that is more productive, in a way that makes sense, in a way that we treat them as people and not as potential fatalities.”

Photographs courtesy of the SOAR Initiative

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“We are thrilled that a friend of the harm reduction community will serve as acting director of the White House Office of National Drug Control Policy,” AIDS United tweeted after the announcement. 

LaBelle has been particularly interested in increasing access to medication for opioid use disorder (MOUD) for people in detention centers. She’s praised a MOUD program in New York’s Albany County jail, and helped to develop a model law for access to MOUD in correctional settings. 

The administration hasn’t yet named a long-term “drug czar,” as the role is known, but that isn’t unusual. The position is usually filled after inauguration day, according to Grant Smith, deputy director of national affairs with the Drug Policy Alliance (DPA)*. Regardless, some advocates are excited by the prospect of pushing the yet-to-be-named drug czar to embrace harm reduction—and have already laid out the agenda items that they’d like to see the new administration pursue.

DPA was one of 212 organizations to sign a recent letter—addressed to Rahul Gupta, the Biden transition team’s ONDCP team lead—calling for sweeping changes to federal drug policy. 

“I think all of us hope that [not yet picking a permanent drug czar] signals that they are vetting a director based off of what over 200 organizations, as well as many people who were not in that letter, like experts, are saying where we need to move at this moment,” said Jasmine Budnella, a drug policy campaign coordinator with VOCAL-NY, another organization behind the letter. 

After sending the letter, which Smith described as a “roadmap for this new administration for its first 100 days, as well as looking long-term,” the writers asked the Biden administration if they could meet with the new ONDCP director once the decision is made. Budnella said the administration agreed to stay in contact.

Here’s a snapshot of the demands that harm reductionists are making of the Biden administration, both for the first 100 days and beyond. 

Funding for Syringe Service Programs

The harm reduction community’s “most immediate request” to the Biden administration is the ask to increase federal funding to syringe service programs (SSP) in the next COVID relief package, according to Smith. 

“We’re in a real dire situation where many providers of harm reduction services are struggling to remain afloat,” Smith told Filter.  Some New York harm reductionists, faced with a statewide shortage of syringes and other supplies, are fronting the bill themselves. Harm reductionists in other states, like Minnesota, are also facing shortages . 

Funding SSPs is an especially critical public health issue when many harm reductionists are uniquely able to foster relationships of trust with people who use drugs—and thereby help them reduce the spread of COVID. 

Rollbacks of Restrictive Federal Regulations

Harm reductionists are also demanding curtailment of federal restrictions on the distribution of methadone and buprenorphine, and on the operation of safe consumption sites (SCS).

“We’re continually getting to a point where we’re butting up against federal policies that prevent us from being able to move in a significant way to achieve ending the overdose crisis and the drug war,” Budnella, who runs VOCAL-NY’s city and statewide campaigns, told Filter.

As the pandemic hit in spring 2020, the federal government relaxeed regulations on methadone and buprenorphine. Under the new and currently temporary accommodations, patients are no longer required to meet in-person with providers before being prescribed buprenorphine, and certain patients who were not previously permitted to do so can now take home more than 14 days’ worth of methadone.  

The letter calls for those accommodations to be made permanent. But the issue is also that they “didn’t fully trickle down” when they were introduced, said Budnella.

Federal policy has also compounded state-level obstructions against opening SCS in New York, Budnella said. New York harm reductionists have not only had to fight against Gov. Andrew Cuomo’s reluctance to open the sites, but also had to keep in mind the Department of Justice’s lawsuit against the opening of Safehouse in Philadelphia. The letter’s signatories call for the Biden administration not to prosecute organizations or people who operate SCS, and for Biden’s DOJ to withdraw the litigation challenging Safehouse.

Ending the DEA’s Fentanyl Analogue Ban

The letter’s authors call for the federal government to allow the class-wide Drug Enforcement Administration ban on all fentanyl analogues to expire. The ban currently classifies all fentanyl-related substances as Schedule I drugs, which then allows prosecutors to seek fentanyl-related mandatory minimum sentences. The ban is scheduled to expire on May 6, 2021. 

That expiration date was the result of a compromise brokered in January 2020 between the federal government—which wanted a permanent ban on fentanyl analogues—and drug policy reform advocates. 

The Biden administration’s opportunity to let the ban expire “will be a first major test of this administration to honor its pledge not to exacerbate mass incarceration, not to perpetuate mandatory minimums,” Smith said. “Any effort by this administration to apply pressure on Congress to extend this [ban] again will be a betrayal of those pledges.”  

* DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

Photo via US National Archives/Public Domain

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“This 20 percent increase over current funding levels is necessary to reach those not now getting help,” the National Campaign for Harm Reduction Funding (NCHRF) wrote in a December 22 letter addressed to the Biden-Harris transition team and recently shared with Filter.

The current federal budget for addiction treatment and prevention stands at $18 billion per year. But that funding is not reaching the majority of people who use drugs—especially Black and Brown people, who have been disproportionately impacted by both the COVID-19 pandemic and the overdose crisis, the letter writers point out.

The campaign members call for an additional $3.7 billion per year to “meet people who use drugs where they are,” since federal funding has largely gone to abstinence-only treatments in the past.

NCHRF hopes that the additional funding would be used for a variety of services, including syringe programs, naloxone training and distribution, and harm reduction psychotherapy. The campaign also recently presented its demands in a meeting with a representative from the Biden transition team’s Agency Review Team for Health and Human Services.

NCHRF’s letter doesn’t specifically mention safe consumption sites (SCS), however, the legal status of which has not been definitively determined in the US. (Most recently, an appellate three-judge panel ruled that Safehouse, a would-be SCS in Philadelphia, would violate the federal “crack house statute.” However, that ruling is currently only binding in the Third Circuit states of Pennsylvania, New Jersey and Pennsylvania.)

Providing funding directly to non-governmental organizations would help speed up the process.

The group also recommends “funding at $250 million a year geographic-based cooperative grants to non-governmental organizations and public health agencies involved in addressing the needs of people who use substances who are not actively engaged in formal treatment.”

Providing funding directly to non-governmental organizations would help speed up the process of ensuring that harm reduction resources get to wherever they’re needed. It would also cut down on the amount of federal funding that gets squandered. For example, states had not withdrawn $1.4 billion of State Opioid Response grant funds from the federal government as of August 2020, according to a December 14 report by the Government Accountability Office.

NCHRF includes harm reduction organizations from all over the country, as well as advocacy organizations and groups of medical professionals.

One of the coalition’s strengths is its willingness to embrace organizations all across the “harm reduction-recovery continuum,” according to Dr. Andrew Tatarsky, the founder and director of the Center for Optimal Living and a harm reduction psychotherapy expert.

“Traditionally, there has been a really unfortunate split between traditional recovery communities and the harm reduction world,” Tatarsky told Filter. But now, he thinks “that traditional split is being healed” thanks to the “sea change” of traditional recovery organizations being more willing to embrace harm reduction principles. He pointed to Enzo Recovery and the Levenson Foundation, both signers of the campaign’s letter, as examples of such groups.

Tatarsky added that there’s a historical precedent for what NCHRF is demanding: In 1990, Congress enacted the Ryan White CARE Act, which created a specific program to fund the medical care of low-income people with HIV.

“There has not been an analogous effort around federal government support for harm reduction,” Tatarsky said.

The campaign views its demands of shifting towards a public health approach through a racial justice lens.

Three main reasons triggered the formation of NCHRF, according to Heather Haase, a NCHRF member.

First, the campaign members anticipated that the new Biden administration would be more responsive to the harm reduction community.

Second, while the COVID-19 pandemic “completely exacerbated the overdose crisis,” according to Haase, it also created new opportunities to address the crisis in the form of telehealth, as well as relaxed regulations around methadone and buprenorphine.

Third, the police killings of George Floyd and Breonna Taylor brought the importance of criminal justice reform to the forefront for NCHRF’s members. The campaign views its demands of shifting towards a public health approach (rather than a punitive one) through a racial justice lens. And it did not shy away from that stance during the meeting with a representative from the new administration’s HHS team.

“The ‘War on Drugs’ approach has been particularly harmful to Black and Brown communities,” Dr. Samuel K. Roberts, a professor at Columbia University’s Mailman School of Public Health, said during the meeting. “Making the shift to harm reduction is a scientific way to begin to repair the racial, political, economic and health inequalities experienced by these communities.”

What’s Next?

Going forward, NCHRF plans to welcome even more organizations into its fold, and hopes to continue its advocacy efforts in the long term, “definitely long beyond the transition to the new administration,” Haase told Filter. Individuals will also be able to sign on to the letter at a later date, according to Tatarsky.

Current initiatives in the policy realm could advance the goals of the harm reduction movement as well, said Jennifer Flynn Walker, senior director of mobilization and advocacy at the Center for Popular Democracy, and one of the signers of the letter.

Flynn Walker mentioned the Comprehensive Addiction Resources Emergency (CARE) Act, introduced to Congress in 2019 by then-Rep. Elijah Cummings (D-Md.) and Sen. Elizabeth Warren (D-Mass.). Passing the CARE Act, which was inspired in part by the Ryan White CARE Act, would provide $100 million in federal funding over the next 10 years.

It would also ensure that there are programs “actually designed by drug users,” Flynn Walker told Filter, since the act would set up “localized planning councils” that would give people who use drugs a seat at the table to decide where money goes.

Flynn Walker also brought up Biden’s calling for 100,000 public health jobs in his coronavirus relief “American Rescue Plan.” She said it would be crucial to remind Biden that “we need to have as part of those public health jobs harm reduction outreach workers.”

Such a strategy would not only tackle the public health crisis of overdoses but address the coronavirus pandemic as well.

Harm reduction organizations “are the places where people can go with no judgment,” Flynn Walker said. “Those are also the places that are going to help with vaccine distribution because those are the people that can talk to people on the street about the importance of getting the vaccine.”

Photograph of Joe Biden in February 2020 by Gage Skidmore via Wikimedia Commons/CC 2.0

Correction, January 20, 2021: A previous version of this article misstated Heather Haase’s title. 

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In the first US pilot trial exploring a physician-pharmacist collaborative model for delivering buprenorphine care to OUD patients, over 90 percent of participants reported being “very satisfied” with their overall experience. The research, published in Addiction on January 11, was supported by the National Institute on Drug Abuse (NIDA).

Typically, patients receiving buprenorphine see their physician and a pharmacist monthly to refill their prescriptions. Under this care model, physicians are responsible for prescribing the buprenorphine (and for monitoring the patient), and pharmacists are responsible for dispensing it.

Under the new collaborative model explored in the study, physicians are still responsible for prescribing buprenorphine. Pharmacists, however, take on a role in counseling and educating patients about their drug use—eliminating the need for patients to visit their physician on a regular basis. This arrangement also freed up time for the physicians to see more patients.

The vast majority of Americans with OUD do not receive medication for it (MOUD): Only around 18 percent received MOUD in 2019. But around 90 percent of Americans live within five miles of a community pharmacy—meaning community pharmacists have the potential to connect more patients to MOUD. 

Meanwhile, almost 20 million Americans live in a county without a practitioner licensed to prescribe buprenorphine. In part, that’s because less than 10 percent of primary care providers possess the waiver required to provide it to OUD patients. 

Benefits for All Parties 

The NIDA pilot enrolled 71 patients with OUD regularly receiving buprenorphine, six buprenorphine-waivered physicians and six pharmacists across three clinic-community pharmacy partnerships in North Carolina. After agreeing to participate in the study, patients had their treatment transferred from their provider’s clinic to the partner pharmacy for six months.

The vast majority—nearly 89 percent—of patients remained enrolled in the study for all six months. Of those participants, none experienced an overdose during that time, and all but one said they would re-enroll if the study pilot was offered again.

The majority of physicians and pharmacists agreed that the collaborative care model was “more effective” than the standard one, and all reported being “very satisfied” with the overall experience.

There has been only one previous report of such a model for buprenorphine treatment in the US. In that instance, a pilot program involved 12 patients receiving buprenorphine care at a suburban health department, but patient satisfaction and outcomes were not formally studied the way they were in the NIDA pilot.

“We have underutilized the infrastructure that we get from pharmacies across the country,” NIDA director Dr. Nora Volkow told Filter. “The involvement of pharmacies in administering the flu vaccine represents an example about how we can use them in ways that can facilitate treatment and health outcomes.”

What’s Next?

Expanding this collaborative model to different types of pharmacies and environments will be crucial. The study’s authors note that, in particular, further research in rural areas—where residents face access issues in obtaining buprenorphine care—is needed. 

Volkow told Filter “it will be very much of interest” to see how pharmacies can get engaged in dispensing not just buprenorphine, but also methadone and naltrexone. Naltrexone is the third and newest MOUD to be approved by the FDA, but has not been shown to reduce rates of fatal overdose the way that methadone and buprenorphine have. 

Greater pharmacy involvement would also benefit patients “who don’t want to be associated with a methadone clinic,” Volkow said. “Canada has been using pharmacies to provide treatment for a long, long time. And that has not been in any way associated with any ill effects.”

France has allowed buprenorphine to be prescribed by general practitioners since 1995. Within four years, France’s overdose deaths dropped by 79 percent. 

Photograph via Pixabay

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Since 2005, Warnock has been the senior pastor of Atlanta’s Ebenezer Baptist Church, where Martin Luther King, Jr., served as co-pastor from 1960 until his assassination in 1968. In that role, Warnock has decried the drug war and led community initiatives to back up his words.

But Warnock’s anti-drug war activism began long before he gained access to Ebenezer’s pulpit. Although he hasn’t publicly commented on issues like safe consumption sites, syringe service programs, naloxone access or medication for opioid use disorder, here’s where Warnock stands on the critical harm reduction issues he’s addressed so far. 

HIV/AIDS

Warnock started advocating for expanded health care access while at Morehouse College (also King’s alma mater). As a freshman, he helped lead a teen peer health education program.

In 2001, Warnock became a pastor at Douglas Memorial Community Church in Baltimore. His first weekend there, he led a series of public discussions on the HIV/AIDS epidemic; and he ended one service that year by getting tested himself.

“Everything I do is theologically and biblically informed,” Warnock told the Baltimore Sun in 2001. “The Old Testament prophet Hosea said, ‘My people are destroyed for lack of knowledge.’ I am saying that that is literally the case with regard to HIV/AIDS. People do not know what they need to know about the virus itself, and they do not know their HIV status. If the clergy went to get tested en masse, we could create a climate where you remove the stigma.”

In 2020, Warnock told Project Q that as a US Senator he “would work to make prescription drugs, including PrEP, accessible and affordable and support increased funding for HIV and AIDS prevention, treatment and research.”

Criminal Justice

For Warnock, criminal justice reform is a personal issue. In 1997, his older brother Keith was sentenced to life in prison on a first-time drug charge. Keith was released in June 2020 due to COVID-19 concerns; the younger Warnock was there to greet him, just hours after delivering a eulogy for Rayshard Brooks, a Black man murdered by police officers in Atlanta.

Warnock has criticized the carceral state extensively. In 2019, he gave a lecture at Harvard’s Memorial Church titled “Let My People Go: The Scandal of Mass Incarceration,” in which he shared his brother’s story. In 2018, he condemned the racist origins of the drug war during a service to commemorate the 50th anniversary of King’s assassination.

“For 35 years we’ve had a war on drugs,” Warnock said. “Back then we were dealing with heroin, crack. Now we’re dealing with meth, opioids. It’s interesting to me that now we have a public health emergency. I’m glad we’ve become so enlightened now that the bodies are suburban, rural and white.”

His words highlighted that an overdose crisis among Black Americans going back decades was met not with a public health response, but rather a government decision to criminalize and pathologize drug use.

“In a war, you have enemy combatants,” he continued at that service. “Public health crisis, you have patients.”

In 2016, Warnock’s church partnered with local officials to run the first one-stop expungement event in Fulton County for people convicted on minor charges. “These expungement events reduced what used to take 120 days to one day,” Warnock said in his Harvard lecture.

Warnock doesn’t advocate for outright abolition of the prison-industrial complex. He supports ending cash bail, but only for “nonviolent” misdemeanor charges. He does not support defunding the police.

Marijuana Policy

Warnock has not included support of full legalization in his platform, although he has spoken out repeatedly about marijuana decriminalization and sentencing reform. In a June 2019 speech at a conference on ending mass incarceration, Warnock shared with his audience an anti-racist argument for decriminalization, calling it a “terrible irony” that “there are some folk who are becoming billionaires for selling the same stuff that’s got our children locked up all across America.”

“Where is the justice?” Warnock continued. “It’s not enough to decriminalize marijuana. Somebody’s got to open up the jails and let our children go.”

The elections of Warnock and fellow Georgia Democrat Jon Ossoff to the US Senate have given the Democrats an effective majority in the chamber. Assuming a party-line vote, the Democrats will be able to bring legislation such as the historic Marijuana Opportunity and Reinvestment (MORE) Act up for debate on the Senate floor. 

But getting the act passed would require 60 Senate votes. That’s unlikely to happen, as it would require at least 10 Republicans to vote in favor of the act. In December 2020, Senate Majority Leader Mitch McConnell (R-KY) criticized the Democratic-majority House’s decision to bring forth a vote on the MORE Act. 

Photo via Wikimedia Commons/Creative Commons 4.0

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