The state of mental health and substance use in the U.S.

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Jan 05, 2023 View in browser   By Daniel Payne and Krista Mahr Presented by With Megan R. Wilson Driving the Day About 1 in 4 adults reported having a mental illness in SAMHSA's 2021 survey. | Matt Rourke/AP Photo ONE IN THREE HAD MENTAL ILLNESS OR SUBSTANCE USE DISORDER IN 2021 — That's according to the latest data from the HHS' Substance Abuse and Mental Health Services Administration annual survey, which also found that more than 15 percent of the population had a substance use disorder. Some key figures from 2021 in the report include: — About 1 in 4 adults had a mental illness, with younger people in that group reporting higher levels, at 1 in 3 for those ages 18 to 25. — Over 16 percent of the population, more than 46 million people, met the criteria for substance use disorder. — Nearly 94 percent of people with substance use disorder didn't receive any treatment in 2021. Though the numbers are higher than last year's survey, officials said methodological changes caused by the pandemic mean the data can't be accurately compared. In the years leading up to the pandemic, the level of mental illness was rising, especially among younger adults. But it's not all bad news. Most adults — nearly 67 percent — who had ever had a mental illness considered themselves to be recovering or in recovery. For those who had ever had a substance use problem, the number who said they were recovering or in recovery was even higher, at more than 72 percent. Politics ahead: The survey highlights the breadth of mental health and drug use issues across the country, touching every state and congressional district — and explains the recent, growing political movement to address them. Lawmakers boasted about a new policy in the 2022 year-end omnibus package to address mental health and substance use needs. Overdose deaths were even mentioned in speeches this week about who should lead the House. The mental health and substance use package in the omnibus was heralded as one of the largest ever for the issue, but more could be on the way. Two issues still being eyed on the Hill: shortages of mental health workers and the impact of new telehealth rules on access to treatment. WELCOME TO THURSDAY PULSE. Do you know what mental health policies are on the horizon in the new year? We want to know, too — drop us a line at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, Lauren Gardner talks with Carmen Paun about the World Health Organization's warning that the new Omicron subvariant XBB.1.5 — which has become the dominant Covid-19 strain in the U.S. — could drive a new wave of cases. Listen to today's Pulse Check podcast   A message from PhRMA: In 2021, Insurers and their pharmacy benefit managers (PBMs) subjected patients to six times the out-of-pocket costs for brand medicines through the use of deductibles or coinsurance compared to patients with only copays — even when these middlemen received a discounted price. That's not fair. Learn more.   Some groups representing nursing homes, assisted-living facilities and other health care settings don't want OSHA to implement a new Covid-19 safety rule. | Nathan Howard/AP Photo NURSING HOMES AMONG GROUPS OPPOSING OSHA COVID RULE — The American Health Care Association and the National Center for Assisted Living, which represent nursing homes and assisted-living facilities, sent a letter to the Biden administration Wednesday in opposition to its attempt to finalize a rule aimed at protecting health care workers from Covid-19, Megan reports. The OSHA rule is currently sitting at the White House Office of Management and Budget for review, prompting groups — including AHCA/NCAL — to meet with officials and express their concerns. Mark Parkinson, the president and CEO of AHCA/NCAL, said in the letter to the Occupational Safety and Health Administration that new requirements are unnecessary and would be overly burdensome for providers. And the American Hospital Association, which also opposes the rule, is meeting with officials Thursday to discuss it. While the AHA declined to comment on the meeting, it has told OSHA that it favors following the guidance and recommendations from the CDC, which "have long been the national standard for safe operations and have been utilized by health care providers since the beginning of the Covid-19 public health emergency." — Meanwhile, unions representing health care workers support the rule. And other employers want to ensure the rule applies only to inpatient facilities, not outpatient ones. The text that outlines the final rules has not yet been released, leaving advocates in the dark about the details. OSHA did not immediately respond to a request for comment. At the Agencies NEW DETAILS ON ALZHEIMER'S DRUG TRIAL DEATH — A letter published Wednesday in The New England Journal of Medicine offered new information about a patient's death in a high-profile trial for an Alzheimer's drug, POLITICO's Katherine Ellen Foley reports. The details come two days before the FDA is set to decide whether to approve the drug. Clinicians at the Northwestern University Feinberg School of Medicine detail the case of a 65-year-old patient who died a few days after receiving treatment for a stroke. The patient's stroke occurred four days after receiving at least his third infusion of lecanemab, an Alzheimer's antibody treatment from Eisai and Biogen. The letter's authors wrote that the patient's brain bleeds would be an "unusual" complication of stroke treatment alone, though they couldn't definitively say that lecanemab was the primary cause of death. In a response letter to the clinicians from Northwestern, two authors of the Phase III trial data noted that the patient who died appeared to have a condition in which the amyloid proteins associated with Alzheimer's lined her brain's blood vessels. They also noted that the person was genetically predisposed to higher levels of amyloid protein and previously reported cases of severe brain bleeds have been associated with those conditions, so it's unclear whether lecanemab caused the patient's death. The FDA declined to comment on the matter. Global Health EU RESPONDS TO CHINA'S COVID WAVE — The European Union agreed Wednesday to take several actions in response to the wave of Covid infections in China — but none are mandatory, POLITICO's Helen Collis reports. The voluntary agreement "encouraged" or "strongly encouraged" measures like facemasks, pre-flight testing and wastewater surveillance. China warned that further travel restrictions would risk retaliation even as the country has already expanded its own travel protocols. WHO PLEADS WITH CHINA FOR MORE COVID INFO — The World Health Organization asked China's government to share more information about its surge in Covid-19 cases, POLITICO's Ashleigh Furlong reports. The Chinese government said no new variants have been detected in the recent wave of infections, but the WHO said the data shared isn't comprehensive enough. The country's data, shared in a closed-door meeting between China's CDC and the WHO, showed infections were predominantly from the Omicron strain of the virus, already circulating globally. But WHO leaders continue to ask for real-time viral sequencing and hospital data, saying it could not only help identify new variants but also predict which mutations could lead to different strains in the future. The move comes as several countries, including the U.S., have implemented new testing requirements for travelers coming from China.   A message from PhRMA:   Covid MOST VIRAL COVID STRAIN YET — New Omicron strain XBB.1.5 could drive a new wave of cases, POLITICO's Carmen Paun reports. WHO officials told reporters the new strain was the most transmissible version of the virus yet — with a significant growth advantage already being seen in parts of Europe and the U.S. Still, health officials aren't sure what that means for hospitalization and death rates because vaccines and infection have built up people's immunity. White House Covid-19 response coordinator Ashish Jha tweeted about the new strain Wednesday, saying it's probably more immune evasive than past strains but whether it's more dangerous is unknown. He urged more uptake of the updated booster, saying more details about how well vaccines work for XBB.1.5 will be available soon. Names in the News FIRST IN PULSE: Jon Heppen has joined Sen. Angus King's (I-Maine) office as a legislative assistant overseeing health policy. He previously worked for Rep. Cheri Bustos (D-Ill.), who didn't run for reelection in 2022. Ben Weingrod is now director of policy and advocacy at Management Sciences for Health. He most recently was senior director for policy at Foreign Policy for America. Molly Block was named communications director for Sen. Bill Cassidy (R-La.), and Joe Ramallo was promoted to press secretary in the office. Ty Bofferding was named communications director for the HELP Committee minority. Jonathan Frank is leaving the Better Medicare Alliance, where he was vice president of communications. He'll become director of news and public relations for Tennessee Tech University. Peter Fise has joined Tarplin, Downs & Young. He was most recently health counsel to Senate Finance Chair Ron Wyden (D-Ore.). What We're Reading After the collapse of the Buffalo Bill's Damar Hamlin, Covid misinformation spiked, The Washington Post reports. Social media use is linked to changing teen brains, The New York Times reports. GE's health care spinoff is complete, leading to a new $27-billion company, GE HealthCare, The Wall Street Journal reports. A New York Times Opinion video argues the health care system isn't equipped to treat children — partly because of the profit motive.   A message from PhRMA: Every day, patients at the pharmacy counter discover their commercial insurance coverage does not provide the level of access and affordability they need. New data from a study by IQVIA reveal the harmful practices of insurers and their pharmacy benefit managers (PBMs) can lead to significantly higher out-of-pocket costs for medicines — causing some patients to abandon their medicines completely. Learn more.     Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Megan R. Wilson @misswilson Daniel Payne @_daniel_payne Ruth Reader @RuthReader   Follow us

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