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HARRISBURG – A federal agency sending billions of dollars to states to help them respond to the opioid crisis is rolling back part of a policy that caused widespread confusion in Pennsylvania and falsely preventing at least one person from doing the later died of an overdose, got access to addiction treatment.
The Drug Abuse and Mental Health Authority has removed wording prohibiting grant recipients from providing federal funding to “any person or organization that provides or permits the use of marijuana for the purpose of treating drug use or mental disorders.”
The Pennsylvania Department of Drug and Alcohol Programs highlighted the change in a public bulletin on Monday. A spokesman said the agency “has no insight into the rationale for the change, but we’re pleased that the updated term no longer includes the ban”.
The new policy removes “the more restrictive language that was really confusing,” said Michele Denk, executive director of the Pennsylvania Association of County Drug and Alcohol Administrators.
The federal agency previously told Spotlight PA that the language should not prevent providers from serving people who were using cannabis for substance use disorders as long as those patients were willing to work towards alternatives. Federal funds could still pay for addiction treatments, the agency said, but not for cannabis purchases.
But in Pennsylvania, the language has been widely interpreted as a ban on spending federal funds to treat those who used medical marijuana for that reason.
A recent investigation by Spotlight PA found that in at least one case, confusion and a failure by the state to clarify funding rules had serious consequences.
Tyler Cordeiro, a 24-year-old man from Bucks County, was Denial of funding for addiction treatment through a government program that promises to help everyone because he had a medical marijuana card, his family said. He died weeks later, in October 2020, of a drug overdose.
Cordeiro’s mother, Susan Ousterman, said her son was not offered alternative sources of funding for treatment, raising the question of whether some drug and alcohol authorities were mistakenly interpreting federal policies as a total ban on helping these patients.
Ousterman spent months reaching out to state officials earlier this year over concerns about local drug and alcohol authorities refusing to fund addiction treatments to others.
On Wednesday, she told Spotlight PA that she was glad the federal government had changed its policy. But she still doesn’t understand why anyone has ever interpreted the previous guidance to deny help to people seeking addiction treatment.
“I don’t have a lot of faith that if they make sure people get the money they are entitled to, things will really change,” Ousterman said.
The conflict revolves around Pennsylvania’s medical marijuana program, competing state and state policies, and the state’s system of funding addiction treatment.
Each year the Pennsylvania Department of Drug and Alcohol Programs sends a large portion of the hundreds of millions of dollars it receives in federal funds to a network of 47 drug and alcohol offices in the county. These offices in turn help to pay for addiction treatment for uninsured people.
This system got more complicated in late 2019. Under former President Donald Trump, the Federal Drug Abuse and Mental Health Agency said its grant money “cannot be used, directly or indirectly, to purchase, prescribe, supply, or treat marijuana”. The agency also warned that the money could not be made available to any person or organization that “allows marijuana use for the purpose of treating drug use or mental disorders.”
Pennsylvania is one of only a few states to list opioid use disorder as a separate qualifying condition for medical marijuana.
But the ban wasn’t as extensive as it seemed. In January 2020, SAMHSA sent clarification to the Department of Drug and Alcohol Programs and authorities in other states.
“I know many of you have asked for a written follow-up,” wrote a SAMHSA official in an email dated Jan. 1, 2020, received through a public inquiry. “I hope the enclosed questions help clarify the implementation.”
A government official forwarded this email to top division officials, documents that were made public through the request.
The 2020 guidelines state, among other things, that organizations could continue to support people who used medical marijuana for drug use or mental disorders, as long as the patient understood the risks of marijuana and was willing to work towards alternative treatments.
But many drug and alcohol bureaus in Pennsylvania continued to operate like they couldn’t spend federal money to service these cardholders, and it’s not clear how consistently these bureaus used other funds to fill in loopholes.
The state’s Department of Drug and Alcohol Programs has included the more restrictive language in its tax and operations manuals, which went into effect in July 2020 and which the county’s drug and alcohol authorities are following without the clarifying guidance. The state didn’t announce the milder rules through a public bulletin until June 2021, after Ousterman got in touch.
In response to questions from Spotlight PA, the department defended the delay in June, describing the January 2020 email from SAMHSA as “informal” – a characterization the federal agency denied. The department said it mailed the June 2021 bulletin after receiving information “on a formal SAMHSA letterhead.”
This latest federal government policy goes even further.
In an email to Spotlight PA, the federal agency declined to say what exactly had prompted the new guidelines. “From our recent press releases, you can see that SAMHSA’s priorities are to expand opportunities for people to see treatment and increase the number of behavioral medicine staff,” the agency said.
Denk, of the Pennsylvania Association of County Drug and Alcohol Administrators, said its members hadn’t had a chance to discuss the latest bulletin as a group. It expects its members and treatment providers to direct questions to the Drug and Alcohol Programs Department and that the agency will share their responses as much as possible. That kind of response, Denk said, could hopefully “avoid further confusion”.
Ousterman is still worried. “It is not taken seriously by some people that these are lives that are at stake,” she said.
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