NASADAD has released an updated timeline of funding for the State Targeted Response to the Opioid Crisis (STR) and State Opioid Response (SOR) grant programs. The timeline outlines key dates, such as: when grants were authorized; when Congress appropriated funds; when funding opportunity announcements (FOAs) were released; funding award periods for States for each of the grant programs; and more.
Here are some highlights from the timeline:
- The timeline begins with passage of the 21st Century Cures Act of 2016, which created a $1 billion account in the Treasury to be used for grants to States to address the opioid crisis. This culminated in the STR grant program, for which the State alcohol and drug agencies were the eligible applicants.
- In FY 2018, Congress allocated an additional $1 billion to States to address opioid addiction and overdose through the SOR grants. The State alcohol and drug agencies were listed as the eligible applicants for SOR.
- The SUPPORT for Patients and Communities Act of 2018 reauthorized STR through FY 2021. However, Congress did not allocate funds to STR in FY 2019.
- Congress appropriated $1.5 billion for SOR in FY 2019.
The updated the timeline includes these recent developments:
- On March 11, 2019, the Administration released its proposed budget for FY 2020, and included a request of $1.5 billion for the SOR program.
- On March 20, 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced an additional $487 million to supplement first-year SOR funding.
- The next installment of $1 billion is expected to later this fiscal year.
NASADAD has released an updated fact sheet on the Substance Abuse Prevention and Treatment (SAPT) Block Grant. The updated version includes a new analysis of the lost purchasing power of the SAPT Block Grant over the past decade; the latest outcomes data from the 2018 Block Grant Report; recent data on primary substance of use and demographics of individuals at time of admission; an overview of the set-asides within the Block Grant; the important role of the State alcohol and drug agencies; and more.
Here are some highlights:
- The SAPT Block Grant is currently funded at $1.858 billion (FY 2019).
- Over the past decade, SAPT Block Grant funding has not kept up with health care inflation, resulting in a 24% decrease in the real value of funding since FY 2009.
- At discharge from Block Grant-funded programs, 76% of clients demonstrate abstinence from alcohol use, and 57% are abstinent from illicit drug use. Additionally, of clients discharged from treatment, 89% have stable housing, and 93% have had no arrests.
- On average, SAPT Block Grant funds make up 68% of primary prevention funding in States and Territories. In 20 States, the prevention set-aside represents 75% or more of the State agency’s substance use prevention budget.
- Pregnant women must be given priority in treatment admissions, and those that are referred to the State for treatment must be placed within a program or have interim arrangements (e.g., education on communicable diseases, counseling on effects of substance use on the fetus, referral to prenatal care, etc.) made within 48 hours.
- Over one-third (34.1%) of individuals admitted to treatment in the publicly-funded system cited heroin or prescription opioids as their primary substance of use in 2016.
On February 15, 2019 President Trump signed into law the Consolidated Appropriations Act of 2019, which funds those federal agencies that did not previously receive final FY 2019 appropriations. While the Department of Defense and the Departments of Labor, Health and Human Services (HHS), Education, and Related Agencies received final appropriations through a bill that was enacted in September 2018, other parts of the federal government, including the Department of Justice (DOJ) and the White House Office of National Drug Control Policy (ONDCP), were impacted by the partial government shutdown as they awaited funding.
NASADAD has updated its appropriations overview to reflect final funding for priority programs within DOJ and ONDCP.
NASADAD has released an overview of buprenorphine patient limits. The overview includes a history of the issue, beginning with the Drug Addiction Treatment Act (DATA) of 2000, which permits physicians who meet certain qualifications to treat opioid use disorders with FDA-approved medications in treatment settings other than opioid treatment programs (OTPs). The document reviews the 2016 final rule on MAT for Opioid Use Disorders, which allows eligible physicians to request approval to treat up to 275 patients after prescribing at the 100-patient limit for one year. The overview also describes the impact of the Comprehensive Addiction and Recovery Act of 2016 and the SUPPORT Act of 2018, which both expanded the definition of a “qualifying other practitioner” who can prescribe buprenorphine to include nurse practitioners and physician assistants (CARA), as well as clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives (SUPPORT).
The overview includes the current status of who can be considered a “qualifying practitioner”. If they meet certain criteria (e.g., 8 hours of training for physicians, 24 hours of training for NPs, Pas, CNSs, CRNAs, and CNMs), the following types of practitioners can apply for a DATA waiver in order to offer MAT:
- Physicians (including osteopathic and allopathic doctors)
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Certified nurse midwives
Additionally, the overview summarizes the current maximum patient limit for physicians: Qualifying physicians can treat 100 patients in the first year if they meet the criteria outlined in the SUPPORT Act, and 275 after one year of prescribing at the 100-patient limit. If a physician does not meet the criteria to treat 100 patients in the first year, they would have to prescribe at the 30-patient limit for one year before requesting an increase to 100 patients, and then treat at the 100-patient limit for one year before requesting an increase to 275 patients.
Over the past several months, NASADAD has received an increasing number of questions about the State Targeted Response to the Opioid Crisis (STR) and State Opioid Response (SOR) grant programs, which are administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). In response, we have created a timeline of STR and SOR that outlines key dates, such as: when grants were authorized; when Congress appropriated funds; when funding opportunity announcements (FOAs) were released; funding award periods for States for each of the grant programs; and more.
NASADAD has released a section-by-section summary of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271). The SUPPORT Act was signed into law on October 24, 2018, and contains several provisions related to Medicaid, Medicare, FDA, CDC, SAMHSA, ONDCP, and more.
On September 28, 2018, President Trump signed into law H.R. 6157, the FY 2019 appropriations bill for the Department of Defense and the Departments of Labor, Health and Human Services (HHS), Education, and Related Agencies. The enrolled bill provides full-year funding (October 1, 2018-September 30, 2019) for programs within HHS, including the Substance Abuse and Mental Health Services Administration (SAMHSA) and other NASADAD priority programs. NASADAD created an overview of final FY 2019 funding levels for our priority programs within HHS, comparing them to FY 2018 levels.
On April 11, 2018, NASADAD’s Executive Director, Robert Morrison, testified before the Senate Health, Education, Labor, and Pensions (HELP) Committee during its seventh bipartisan hearing focused on the opioid crisis. The Committee, which is led by Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA), released a discussion draft of the Opioid Crisis Response Act earlier in April, and during the hearing they sought input from witnesses on the bill, as well as other issues related to substance use disorders.
In addition to responding to certain provisions in the discussion draft, during his verbal testimony Mr. Morrison highlighted: the important role of the State alcohol and drug agencies; the critical role of the Substance Abuse Prevention and Treatment (SAPT) Block Grant as the cornerstone of the publicly funded system; and the use of State Targeted Response (STR) to the Opioid Crisis grant funds for comprehensive and innovative services.
Other witnesses who testified during the hearing were Jessica Hulsey Nickel, President and CEO of the Addiction Policy Forum (APF), and Jennifer Donahue, Child Abuse Investigation Coordinator for the Delaware Office of the Child Advocate.
Mr. Morrison’s written testimony, as well as the entire recording of the hearing, can be accessed here.