SLP’s Top Ten Stories of 2023
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What follows, in no particular order, is SLP’s list of top ten stories of 2023 based on our observations, impressions and personal interests (and not on any sort of systematic content analysis).
One. Progress at the federal level
The year began on an encouraging note with the passage of the 2023 omnibus budget bill which included the Mainstreaming Addiction Treatment (MAT) and Medication Access and Training Expansion (MATE) Acts, aimed at removing barriers to buprenorphine used to treat opioid use disorders (OUD) and normalizing substance use disorder (SUD) care across healthcare settings, including annual addiction training requirements for doctors prescribing controlled substances. Other encouraging actions at the federal level included:
The FDA expanded access to lifesaving overdose reversing medication by making naloxone available over-the-counter.
In December, the House reauthorized the SUPPORT Act which would reauthorize key programs for patients with SUD and permanently extend required Medicaid coverage for medication for SUD treatment.
The Modernizing Opioid Treatment Access (MOTA) Act which would expand access to methadone gained traction in 2023.
Biden Administration allowed states to use Medicaid funds to treat incarcerated individuals for drug addiction with medication.
Two. Matthew Perry’s Death
“Friends” television star Matthew Perry’s death garnered a lot of media attention and came less than a year after the publication of his memoir chronicling his journey with addiction and recovery. Much has been said by others, so I will just say his book and his experiences illustrate to me how hard it can be to recover from addiction and how much more difficult it can be for someone in the public spotlight.
Three. Xylazine in the drug supply
Xylazine, an animal sedative approved for veterinary use but not for humans, has been increasingly found in illegal drug supplies across the U.S., particularly in urban areas. Because xylazine isn’t an opioid, naloxone can’t reverse its effects. As a vasoconstrictor, xylazine prevents wounds from healing and can lead to serious infections and even amputations. At a presentation I attended in D.C. last Spring, a harm reduction worker from the Kensington neighborhood of Philadelphia reported her organization now spends more time on wound care than on overdose prevention and treatment.
Four. Kratom
Speaking of substances many of us know very little about, kratom appears to have received more attention in the media in 2023 than in previous years. Kratom comes from a tree native to Southeast Asia and is generally sold (legally in most states) in capsule or powder forms at gas stations and tobacco shops. The National Institute on Drug Abuse (NIDA) describes kratom as an herbal substance that can produce opioid- and stimulant-like effects. Some users self-medicate with kratom to treat opioid addiction. More research is needed, but kratom is considered addictive. The Tampa Bay Times recently published a 3-part investigative series called Deadly Dose that’s worth a read for anyone interested in learning more. SLP recently re-posted an article examining the current legal and regulatory landscape for kratom. That article was originally published on KratomSobriety.com, a great source for news and personal stories related to kratom.
Five. Alcohol is bad for health
Even though this shouldn’t be new news to any of us living in the 21st century, the headline of a recent GQ article dubbed 2023 “the year we learned any amount of alcohol is bad for you.” Research findings have been telling us this for years. What’s new in 2023 is that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) considered following Canada’s lead by recommending Americans limit their alcohol consumption to no more than two drinks per week.
Six. Addiction is prevalent and widespread
A Kaiser Family Foundation (KFF) poll released in August received significant media attention. Among its findings: (1) Two-thirds of adults in the U.S. say they have been impacted by addition either personally or through a family member; (2) nearly 1 in 10 adults in the U.S. has lost a family member to drug overdose; and (3) the majority of people experiencing addiction don’t receive treatment. An excellent New York Times article published in December noted in the headline that 48 million people in the U.S. (8 million more than the population of California!) experience addiction. The article highlights potential strategies to expand access to treatment.
Seven. LA County’s “Reaching the 95% (R95)” initiative
Kudos to the Los Angeles County Public Health Department and their Substance Abuse Prevention and Control team for launching their Reaching the 95% (R95) initiative. Research finds only about 5% of people with SUD access treatment. The fact that this low penetration rate persists year after year indicates that what we are doing currently isn’t working. Hats off to LA County for turning this figure into a slogan and an initiative to keep the attention focused on the need for innovation to reach more people with treatment. Here’s to hoping the momentum, and the slogan, spread beyond Southern California.
Eight. The Sacklers still suck
The U.S. Supreme Court heard oral arguments in December on the Sackler bankruptcy $8 billion settlement agreement. At issue for many is that the deal shields members of the Sackler family from personal liability. SLP will be watching in 2024 to see how SOTUS weighs in on the arguments they heard recently.
Nine. Demographic disparities in access to medications for opioid use disorder (OUD)
The focus of recent federal efforts to increase access to medications for OUD has been aimed at reducing barriers such as who can prescribe, how the medications can be prescribed (e.g., telehealth vs. in-person), and where the medications can be dispensed (e.g., for pick up at a pharmacy vs. a methadone clinic). Recent research highlights the need to also address persistent demographic disparities in access to lifesaving medications like methadone and buprenorphine. The CDC reports that overdose deaths are rising faster among Black people than any other ethnic group, but that they are far less likely to be prescribed medication for OUD. A study in the Journal of the American Medical Association this year found that adolescents, another high risk group for overdoses, are far less likely than adults to receive medication for OUD.
Ten. Waste, fraud and abuse in the SUD treatment industry
Unfortunately, a weekly scan of addiction-related news items almost always yields stories about patient brokering, Medicaid fraud, the “Florida Shuffle” and a variety of other unethical and/or illegal practices in the SUD treatment industry. It’s unfortunate not only because bad actors prey on some of the most vulnerable patients in our health care system, but also because the attention threatens to tarnish the reputation of an industry in which most practitioners are ethical rule-followers motivated by a genuine desire to help people in need of care. I’ve been recommending a New Hampshire Public Radio produced podcast called The 13th Step, which began as an investigation into claims of sexual harassment at a treatment facility and broadened into a story that examines the industry as a whole.
