Massachusetts Criminal Justice Reform and Public Health: Part 1, Medical Parole
Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment [from American Journal of Preventive Medicine]
By Elisabeth J. Ryan
In April 2018, Massachusetts Governor Charlie Baker signed a major criminal justice reform bill, the result of years of efforts by legislators and advocates to implement changes to many existing “tough-on-crime” laws. The bill, at more than 120 pages, contains a plethora of changes, including raising the minimum age for juvenile justice involvement from 7 to 12, restricting the use of solitary confinement, and eliminating mandatory minimums from most drug crimes except for trafficking. However, the bill also creates new crimes, like trafficking in fentanyl and carfentanil.
PHLW will be looking at various provisions of the bill and how they intersect with public health. First, we look at the creation of “medical parole” in the Commonwealth.
It's Time for Uncomfortable Solutions to the Opioid Epidemic [from The Fix]
George Consortium member Rebecca L. Haffajee has a new article in the American Journal of Preventive Medicine focusing on some of the reasons why only 40% of people with opioid use disorder actually receive medication-assisted treatment. One major reason is that so few physicians are licensed to even prescribe buprenorphine (such as Suboxone). As the article details, numerous workplace barriers contribute to this lack of licensing, including insufficient training, lack of peer support, inadequate reimbursement, and regulatory hurdles.
For complete article with footnotes, please see: https://www.sciencedirect.com/science/article/pii/S0749379718300746
New Dangers For Immigrants and the Health Care System [from Health Affairs Blog]
We are thrilled to present some work from brand new George Consortium member Abraham Gutman! This piece from The Fix discusses the fact that we need to get creative, and uncomfortable, in addressing the opioid crisis. Be sure to follow Av's great Twitter feed at @abgutman.
The results of the War on Drugs: an America that is the most incarcerated nation in the world, a sharp decrease in the price of heroin, and a new Jim Crow for Black communities.
Not every problem has a solution that we are comfortable with. The opioid epidemic and the overdose crisis are two examples of such problems. There has been a lot of work by states and cities to tackle the epidemic and mitigate harm. Laws limiting opioid prescriptions have been enacted (controversially), DEA regulations on who can administer treatment were laxed, Prescription Drug Monitoring Programs were founded, and states of emergency were declared.
Q&A: Holding Drugmakers Accountable for Opioid Crisis
PHLW's Wendy E. Parmet and Elisabeth J. Ryan co-authored an article posted on the Health Affairs Blog about the potential changes to the definition of "public charge" and how that will negatively impact health care and the health care system.
New Dangers For Immigrants And The Health Care System
By Wendy E. Parmet and Elisabeth Ryan
The Trump administration’s crackdown on immigrants may soon create new perils for the health care system if a set of proposed regulations by the Department of Homeland Security (DHS), leaked last month to the Washington Post, are promulgated. The regulations would dramatically expand the definition of “public charge,” a criteria used in immigration law to determine both admissibility to and deportability from the United States. As a result, many immigrants, including many low wage health care workers, may be deterred from using publicly-funded health care benefits to which they and their dependents, including their citizen children, are legally entitled.
Public Health Law Watch Comments on HHS Regulation Proposal: Protecting Statutory Conscience Rights
Recently, George Consortium member and University of Michigan professor Rebecca Haffajee gave an interview to the Associated Press, addressing issues around opioid companies and litigation:
Legal Skills Through a Health Justice Lens: First-Year Northeastern Law Students Work Toward Health, Equity, and Justice for Two Oppressed Groups
Public Health Law Watch, joined by our friends at the Public Health Law Center, submitted official comments to the U.S. Department of Health and Human Services proposed amendments to 45 CFR 88, "Protecting Statutory Conscience Rights; Delegations of Authority." Based on our combined expertise in public health law and policy, we offered comments on five main issues: (1) the lack of evidence that these rule revisions are necessary; (2) the absence of consideration for patients who face refusal of care; (3) the potentially dangerous expansion of existing definitions around “conscience protections;” (4) the potential harm these rules will cause for the LGBTQ population; and (5) the detriment these proposals would cause to reproductive health and rights.
The PORTAL Literature Scan for March
We have a really special post today - George Consortium member Jason Potter describes his innovative work as a professor and the work of his students here at Northeastern University School of Law. These first year law students studied legal skills through a lens of health justice and turned health justice theory into practice by partnering with non-profit organizations and creating tangible guidance on issues of safe consumption facilities and barriers to health care for transgender individuals. The students will present their work at two upcoming community presentations - if you are local to Boston, please join us!
Law Office 7’s presentation of their research to the community, entitled, Establishing a Safe Consumption Facility in Massachusetts: An Interdisciplinary Review of Legal Barriers and Avenues to Harm Reduction, will take place on Thursday, Mar. 29, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
Law Office 8’s presentation of their research to the community, entitled Winning Gender-Affirming Care for Transgender Medicaid Recipients in New York, will take place on Thursday, Apr. 5, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
Medicaid Work Requirements Would Put Very Few People to Work [from philly.com]
Every month, our friends at the Program on Regulation, Therapeutics, and Law (PORTAL) - part of a collaboration between Harvard Medical School and Brigham & Women’s Hospital - publish a great list of the best and most interesting studies, policy analyses, and editorials about regulation, therapeutics, and law. Below, we're featuring one in particular co-authored by George Consortium member Lainie Rutkow. You can find the rest of this month's list here: https://www.portalresearch.org/literature-scan.html
The Promising Potential of Gun Violence Protection Orders
[crosspost from Health Cents, philly.com]
By Robert I. Field
The Trump administration recently agreed to let states get tough on Medicaid recipients who don’t work. Kentucky was the first to win approval of a plan to kick those who can work but don’t off the roles, and at least ten other states would like to do the same. Under these plans, in order to maintain coverage, able-bodied adults would have to prove that they are either employed in some form or are actively trying to be.
Fighting Fire With Lighter Fluid: Trump Administration Housing Policy Proposals Would Exacerbate the U.S. Affordable Housing Crisis, Heightening Health Inequities
By Elisabeth J. Ryan
While mass shootings account for just a small fraction of the more than 36,000 lives lost to firearms in the United States every year, these devastating, large-scale events have become not only more frequent but also deadlier in recent years. On February 14, a student who had been expelled from school returned to Marjory Stoneman Douglas High School in Parkland, Florida and killed 17 people using a high-powered AR-15 rifle. At first, the cycle of outrage, grief, “thoughts and prayers,” and demands for gun law reform seemed doomed to repeat and fizzle out, as they already had many times after many similar mass shooting tragedies. But something new emerged out of Parkland – the surviving students who refused to remain silent about gun law reform and refused to back down in the face of politicians and the NRA who advocate for fewer restrictions on guns, such as nationwide concealed carry reciprocity. But in large part due to the Parkland students’ indefatigable activism, the gun lobby has not been able to triumph again via a quiet return to the status quo. Instead, some serious and concrete discussions about gun law reform have taken place across the country. While some suggestions - like the President’s NRA-backed idea of arming teachers - are patently unrealistic; others – like “red flag” laws – have both potential political viability and established track records.
A Response to "Unintended Consequences: Medicaid and the Opioid Crisis"
By Madeline Morcelle
Emerging policy proposals from the Trump administration would exasperate the U.S. affordable housing crisis, heightening heath inequities. On February 12, the Trump administration released its 2019 budget proposal, advocating for deep cuts to already chronically underfunded housing programs, as well as drastic rent increases and reforms to encourage “work and self-sufficiency” for low-income individuals and families receiving rental assistance. Draft legislation (1) leaked from the Department of Housing and Urban Development (HUD) earlier this month articulated these proposals in greater depth.
Let's Get Fewer People to Die (from Northeastern Law Magazine)
Today, Public Health Law Watch sent a letter (both electronically and on paper) to every member of the U.S. Senate Committee on Homeland Security & Governmental Affairs in response to a January hearing entitled "Unintended Consequences: Medicaid and the Opioid Epidemic." That hearing and its accompanying report presented a slew of misinformation, misleading statistics, and poorly informed conclusions that attempted to blame the current opioid crisis on the expansion of Medicaid. The George Consortium members mobilized to respond with facts and real potential solutions.
Involuntary Treatment for Substance Use Disorder: A Misguided Response to the Opioid Crisis [from Harvard Health Blog]
by Elisabeth Ryan
Guns were never a part of my life. In the Massachusetts suburb where I grew up, my family did not go target shooting for sport and did not keep guns in the home for protection. The very idea of hunting was repugnant in our animal-loving household. In law school, my constitutional law classes never even mentioned the Second Amendment. My life was, in all tangible aspects, unaffected by guns. But when I worked as a public defender, I represented people who commonly faced rampant violence in their lives and neighborhoods. For them, guns were often just part of reality. When I worked as counsel in the Massachusetts Executive Office of Public Safety and Security, overseeing state gun laws, regulations and policies brought me into contact with a population of individuals for whom guns were a central part of their lives, both tangibly and symbolically.
Threats to Medicaid and Community Integration for People with Disabilities
PHLW's Leo Beletsky, Elisabeth Ryan, and Wendy Parmet authored a piece this week on the Harvard Health Blog about why involuntary commitment for substance use disorder should not be touted as a tool in the opioid crisis.
Recently, Massachusetts Governor Charlie Baker introduced “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” (CARE Act) as part of a larger legislative package to tackle the state’s opioid crisis. The proposal would expand on the state’s existing involuntary commitment law, building on an already deeply-troubled system. Baker’s proposal is part of a misguided national trend to use involuntary commitment or other coercive treatment mechanisms to address the country’s opioid crisis.
Center for Health Policy and Law Joins Amicus Brief in Correa v. Schoeck
By Mary Crossley
As we enter the second year of the Trump administration, Medicaid remains in the cross hairs of conservatives in Congress and the administration. The repeated efforts in 2017 to reduce the program’s funding and change its structure, however, revealed the breadth and depth of public support the program enjoys. People with disabilities protested, putting their bodies on the line to express their outrage over proposed cuts that would threaten their access to services that permit them to live in the community rather than institutions. Along with others’, their protests helped defeat Republican proposals in 2017, but similar battles likely lie ahead.
Immigration and Health Care Under the Trump Administration [from Health Affairs Blog]
Public Health Law Watch is part of the Northeastern University School of Law Center for Health Policy and Law. The Center has signed on to an amicus brief, in support of the appellant-plaintiff, in the Massachusetts Supreme Judicial Court case of Correa v. Schoeck and Walgreens.
The amicus brief is available here: Correa v. Schoeck, amicus brief
The issue in this case is "whether a pharmacy owes a duty of care to its customer to notify her physician that her insurer will not pay for her prescription medication without prior authorization."
Will Public Health Litigation Help to Solve the Opioid Crisis?
After a brief hiatus during the holidays, a Nor'easter, and the dawn of a new semester, PHLW is back with this post by our own Wendy E. Parmet on the Health Affairs Blog. The piece about the current state of immigration and health care comes out of her recent presentation at the Harvard Law School Petrie-Flom Center Sixth Annual Health Law Year in P/Review in December 2016.
Minor Access to Prophylaxes in Massachusetts: STI Consent, the Mature Minor Rule, and the Definition of "Treatment"
by Rebecca Haffajee
In this week’s issue of New England Journal of Medicine, Michelle Mello and I write about drug company liability for the opioid crisis. We analyze the history of litigation efforts against opioid manufacturers and distributors to hold these parties responsible, at least in part, for the epidemic. Early litigation brought by individuals harmed by prescription opioids against drug companies was minimally effective: most cases were dismissed early on and few settled. But these personal injury suits faced formidable company defenses -- such as that opioids were FDA-approved substances and that there were intervening causes (i.e., individuals not using the drugs as prescribed and doctors over-prescribing opioids) that contributed to the harm. However, in more recent years, mounting litigation lodged by governments may hold greater promise to succeed and reduce public health opioid-related harms, either through wins, settlements, or spillover effects. But let's be clear: litigation will not be a silver bullet to solving the crisis and shouldn't substitute for other public health-oriented policies and interventions. But lawsuits just might do some good here.
Read more in our Perspective, entitled "Drug Companies' Liability for the Opioid Epidemic."
Could repealing net neutrality be bad for our health? [From Health Cents, philly.com]
By Jason Potter
The Massachusetts Joint Committee on Public Health is currently considering House and Senate bills to amend the Commonwealth’s emergency consent statute (Section 12F), which allows certain minors to self-consent to general medical care, and allows all minors to self-consent STI diagnosis and treatment. The bills would add the term “prevention” to the Commonwealth’s STI consent statute, thus allowing minors in Massachusetts to consent to STI diagnosis, treatment, and preventive care. Known as the “PrEP Bill,” S.1186 and H.3249 are sponsored by Senator Julian Cyr and Representative Jack Lewis, respectively. The senators are seeking to expand the language of the portion of Section 12F pertaining to STI-related care so minors may consent to HIV Pre-Exposure Prophylaxis (PrEP) and the human papillomavirus (HPV) vaccine. In my 2016 article PrEP and Our Youth: Implications in Law & Policy, I proposed this very change. On June 27, 2017, I testified before the Joint Committee in support of the PrEP Bill.
The following post, from George Consortium member Robert I. Field, was originally published in Health Cents on philly.com.
By Robert I. Field
Repealing net neutrality could be bad for American health care.
The Federal Communications Commission plans to vote this week on a proposal to repeal Obama-era rules that require Internet Services Providers, companies that connect your computer to the Internet like Comcast and Verizon, to treat all websites equally. The rules prohibit ISPs from speeding up or slowing down traffic to a site for financial or other reasons.