As 2022 draws to a close, states across the country passed legislation in response to increasing rates of overdose deaths. Legislation focusing on expanded access to medications for opioid use disorder, Medicaid reimbursement rates, and oversight of state opioid litigation funds have all passed this year.

Opioid Litigation Expenditures 

With global settlements reaching upwards of $50 billion, states are creating the infrastructure to govern the expenditure of these funds.

Connecticut (HB5044), Delaware (SB166), Florida (HB5013), Illinois (HR296), Iowa (HF2573), Kentucky (SB56), Maine (LD 1722 and HP1277), Maryland (HB0794), Missouri (HB2162), New Hampshire (SB275), New York (S07870 and A08757), Oklahoma (SB1275), Oregon (HB4098), South Carolina (H5182), South Dakota (HB1038), Vermont (H711), and Michigan (SB0094) created opioid settlement funds and advisory committees.

Treatment in Correctional Settings

The Colorado governor signed HB22-1326 into law, which increases criminal penalties for fentanyl possession. This legislation also mandates community corrections programs to assess individuals for substance use withdrawal symptoms and to develop protocols for withdrawal management care, such as medical withdrawal and medication for opioid use disorder (OUD) treatment. The law mandates jails to provide opiate antagonists (naloxone), prescribe medication, and assist with coordinating care for substance use disorder (SUD) to qualified persons upon release. No state funding is provided to the counties to pay for medication treatment. The legislation also requires that jails continue individuals on their medication for opioid use disorder if they were receiving it prior to incarceration.

Kentucky’s HB7 became law after the legislature overrode a veto by the governor. It was originally vetoed by the governor due to its provisions limiting access to public benefits for Kentuckians. The final bill includes use of state Medicaid funds for SUD treatment in state correctional facilities pending federal authorization, including peer support services and patient navigation provided by a licensed clinical social worker.

Connecticut, under SB448, is now requiring an advanced practice registered nurse with experience in SUD diagnosis and treatment to be present in the medical unit of every correctional facility at all times.

Maine’s LD 663 and HP490 allocated over $900,000 to establish a comprehensive SUD treatment pilot program in all state correctional facilities.

New York’s S07703 and A08843 established treatment programs for people who are incarcerated and have a SUD. These programs include medication for opioid use disorder, transitional services, and peer support. These laws will positively impact one of the most at risk populations, especially considering the increase of drug-related deaths in custody. This legislation is consistent with research supporting medication for opioid use disorder as the gold standard of treatment for this chronic condition.

Changes in State Medicaid Laws

New Hampshire signed HB503 into law this summer, removing certain in-person and physical location requirements for Medicaid reimbursement and allowing medication assisted treatment for SUD via telemedicine, including for people who are incarcerated.

Arkansas permanently authorized Medicaid reimbursement for certain behavioral and mental health services delivered via telemedicine, including counseling, crisis intervention services, substance use assessments, and mental health diagnostic exams, among others through HB1176.

Mississippi’s HB657 authorized Medicaid reimbursement for SUD and OUD treatment to eligible providers. This law will expand access to life-saving care, by continuing telemedicine exceptions due to the COVID-19 pandemic, and authorizing Medicaid reimbursement for substance use disorder treatment services.

Access to Medications for Opioid Use Disorder and Naloxone

Louisiana’s SB268 requires behavioral health providers treating pregnant women with OUD to provide on-site access to at least one form of FDA-approved opioid agonist treatment.

Washington state signed HB1761 into law, authorizing nurses to dispense opioid overdose reversal medications in hospital emergency departments, as well as prescribe and distribute prepackaged emergency medications upon discharge.

Tennessee also expanded authorization for who may prescribe opioid antagonists with HB2465 and SB2572.

With preliminary data reporting over 107,000 overdose deaths in 2021 — a 15% increase from the previous year — the state legislation passed this year can have a widespread and enduring impact on substance use disorder across the country. In ensuring quality SUD care in carceral settings, legislators are working to protect some of the most vulnerable populations. The establishment of advisory committees to steer opioid litigation monies will ensure that these funds have the most effective impact. Expansions in Medicaid reimbursement continue to widen the door to access critical care for substance use disorder.