Category Archives: News


NASADAD Recommends Strategies to Address the Workforce Shortage to the Senate Committee on Health, Education, Labor and Pensions

On Monday, March 20, NASADAD responded to a stakeholder request for information from the Senate Committee on Health, Education, Labor, and Pensions on potential legislative solutions to alleviate the health care workforce shortage.


NASADAD’s response underscored the importance of working with the State alcohol and drug agency to ensure a coordinated approach across all levels of government. Additionally, our recommendations to strengthen federal workforce initiatives included:

  • Amend current statute to make clear that States may allocate Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant funds to support certain substance use disorder workforce initiatives;
  • Establish a discretionary grant in SAMHSA/CSAP to bolster the substance use disorder prevention workforce;
  • Reinstate SAMHSA/CSAT’s Women’s Addiction Services Leadership Institute (WASLI);
  • The importance of a report to be developed by the SAMHSA/CSAP on the state of substance use disorder prevention workforce; and
  • Continue to support the SAMHSA/CSAP Fellowship program.


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NASADAD Comments on NPRM 42 CFR Part 8

On December 13, 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a Notice of Proposed Rule Making (NPRM) to revise the regulations governing the accreditation and operation of opioid treatment programs (OTPs), clinics that are specially authorized to use methadone as a treatment for opioid use disorder (OUD). These are the most significant revisions to these regulations since 2016, and reflect experience gained from waivers and exceptions granted during the Public Health Emergency, as well as a need to expand access to medication for opioid use disorders (MOUD) due to the ongoing rising epidemic of opioid overdose deaths. The proposed regulations underscore support for the provision of comprehensive individualized treatment services for individuals receiving treatment in OTPs.

To understand the potential impact of the NPRM, NASADAD worked with State Directors and the Opioid Treatment Network (OTN), a NASADAD component group of State Opioid Treatment Authorities (SOTAs). NASADAD staff hosted meetings with the OTN Executive Committee and the Board of Directors Policy Committee to develop a response to the proposed rule on behalf of the Association. The response was submitted on February 14, 2023.

Below are highlights of the proposed regulations and NASADAD’s corresponding comments to the rule:

  • NPRM proposal regarding take-home medications. Under the Public Health Emergency, SAMHSA issued guidance allowing states to permit considerable flexibility to OTPs in providing take-home medication to patients to reduce patient and staff exposure to COVID-19. These flexibilities allow less stable patients to take home up to 14 days of medication and more stable patients to take home up to 28 days of medication. The proposed regulations would allow up to seven days of take-home medication during the first 14 days of treatment, up to 14 days of take-home medication after the 15th day of treatment, and after 31 days of treatment, the patient could be allowed to take-home medication for 28 days.


NASADAD comments. NASADAD noted that the proposed schedule for take home medications is more liberal than the schedule permitted during the Public Health Emergency (PHE), and while the PHE flexibilities were evaluated regarding safety and efficacy, the proposed schedule has not been evaluated. NASADAD recommended, therefore, that each patient be evaluated for their ability to safely manage take home medications and that this evaluation be documented in the patient’s clinical record.


  • NPRM proposal regarding admission restrictions. The proposed regulations would remove both the requirement that a person be addicted at least one year before admission, and the prohibition against treating individuals under the age of 18 without two documented unsuccessful attempts at short-term detoxification or drug-free treatment within a twelve-month period. The proposed regulations would replace these restrictions with requirements that are focused on medical assessments, and in the case of a person younger than 18 years of age, the proposed rule would require approval by a parent, guardian, or relevant state authority unless state law specifies that their approval is not needed.


NASADAD Comments. NASADAD strongly supported these changes, as they focus on specific needs of individual patients during a time of unprecedented risk of addiction or overdose.


  • NPRM proposal regarding initiation of medication, screening and assessment. Under the proposed regulations, patients could begin utilizing medication for opioid use disorder (MOUD) after a screening (before the assessment is completed), and both the screening and the assessment could be provided by a non-OTP practitioner, provided that the OTP practitioner verified the screening and assessment. The proposed regulations describe the elements that must be included in a screening or assessment, and under certain conditions, these could be provided by audio-visual telemedicine or by audio device.


NASADAD Comments. NASADAD shared a concern that non-OTP practitioners may lack necessary knowledge to adequately assess opioid use disorders. In addition, the OTP practitioner may not have reviewed outside screenings and assessments before initiating the medication. We noted that many of our members are actively working to enhance the knowledge of community providers, such as Federally Qualified Health Centers and emergency room bridge programs. NASADAD recommended that the final regulation include a requirement that the OTP Medical Director, or his qualified proxy, document in the clinical record that the written patient evaluation conducted by a non-OTP practitioner has been reviewed and approved within a reasonable time period after initiating medication.

NASADAD also expressed that using audio-only devices to screen new patients for MOUD should be the exception, and only allowed in situations where there is a lack of access to in-person or telehealth assessment. NASADAD recommended that these situations should be documented in the patient record and examples should be provided in the final regulations. In addition, NASADAD recommended that the written assessment be verified by the OTP Medical Director within a reasonable time of initiating medication.


Several definitions were added, eliminated, or revised, including the following:

    • The proposed definition of Practitioner would include mid-level practitioners.
    • The term medication-assisted treatment would be replaced by the term medication for opioid use disorder.
    • The terms detoxification treatment, maintenance treatment, and opioid agonist treatment were eliminated.
    • New terms proposed to be added include behavioral health services, care plan, continuous treatment, and harm reduction.


NASADAD Comments. NASADAD concurred with the changes to the definitions, with the exception of the addition of the term “behavioral health services,” which was defined very generally with no to reference to substance use disorders or recovery support services in OTPs. NASADAD recommended that the final regulations include specific definitions for mental health services and substance use disorder services, and that recovery support services be included in these definitions.


In summary, NASADAD was pleased to provide input on these important proposed rule revisions and look forward to working with SAMHSA to implement the final rule.

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NASADAD Develops Resource Document Summarizing Fiscal Year 2023 Funding for Federal Substance Use Disorder Programs

NASADAD has developed and released a comprehensive resource that summarizes fiscal year (FY) 2023 funding for key federal programs related to substance use disorders (SUD). As you may recall, President Joe Biden signed the Consolidated Appropriations Act, 2023 (H.R. 2617) now, Public Law No: 117-328, on December 29, 2022. This large omnibus bill included FY 2023 appropriations and a number of provisions reauthorizing certain expiring SUD prevention, treatment, and recovery federal programs.

The document includes a chart that summarizes FY 2023 funding for SUD programs housed within the following federal agencies:

  • Department of Health and Human Services (HHS)
    • Substance Abuse and Mental Health Services Administration (SAMHSA)
      • Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant
      • Center for Substance Abuse Treatment (CSAT)
      • Center for Substance Abuse Prevention (CSAP)
      • Center for Mental Health Services (CMHS)
    • National Institute on Alcohol Abuse and Alcoholism (NIAAA)
    • National Institute on Drug Abuse (NIDA)
    • Centers for Disease Control and Prevention (CDC)
    • Health Resources and Services Administration (HRSA)
    • Administration for Children and Families (ACF)
  • Department of Justice (DOJ)
  • Office of National Drug Control Policy (ONDCP)


We wish to recognize Daniel Diana, Legislative Coordinator, and Lacy Adams, Policy Analyst, for their work to develop this comprehensive resource.


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Updated: Reauthorization of the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant

Today, NASADAD is releasing an updated fact sheet on the reauthorization of the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant (formerly the Substance Abuse Prevention and Treatment [SAPT] Block Grant), housed within the Substance Abuse and Mental Health Services Administration (SAMHSA).

On December 29, 2022, President Joe Biden signed the Consolidated Appropriations Act, 2023 (H.R. 2617) now Public Law No: 117-164. This large omnibus bill included fiscal year 2023 appropriations and provisions reauthorizing certain federal programs through fiscal year 2027, including the SUPTRS Block Grant. The reauthorization of the Block Grant included new reporting requirements, language changes, and more.

To see a side-by-side analysis of the Public Law compared to the legislation proposed in the House of Representatives and Senate, check out this new fact sheet.

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An Overview of the Synar Provision: History, Impact of Tobacco 21 Legislation, and Recommendations

This updated factsheet includes the federal revisions to guidance that occurred between 2020-2022 as a result of the COVID-19 pandemic.

Congress enacted the Alcohol, Drug Abuse, and Mental Administration Reorganization Act (Public Law No: 102-321) in 1992 that included a provision referred to as the Synar Amendment. The Amendment aims to decrease youth tobacco use by requiring States and Territories to enact and enforce laws prohibiting the sale or distribution of tobacco products to individuals under the age of 18.

In 1996, the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS) issued a regulation giving further guidance to States related to Synar implementation and enforcement. The regulation required States to conduct annual, unannounced inspections of tobacco retailers that provide a probability sample of the accessibility of tobacco products to minors under the age of 18. States had to meet at least an 80 percent compliance rate of retailers refusing tobacco sales to minors. States that have a retail violation rate of more than 20 percent resulted in penalization of up to 40 percent of a State’s Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant (previously named the Substance Abuse Prevention and Treatment [SAPT] Block Grant).

Over time, Congress worked with the Administration to offer an alternative penalty that was significantly less that the 40 percent marker but required the State to generate funds to remedy the violation. No federal funding was ever provided to the managers of the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant – State alcohol and drug agencies – to specifically support Synar implementation and enforcement activities.

For questions or more information, please contact Lacy Adams (  

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In order to capture current patient census data for people being treated for opioid use disorder in OTPs, the National Association of State Alcohol and Drug Abuse Directors (NASADAD) in partnership with the American Association for the Treatment of Opioid Dependence (AATOD), developed a census survey of all patients enrolled in treatment as of January 1, 2021, in Substance Abuse and Mental Health Service Administration (SAMHSA) certified OTPs in the United States (U.S.). The project was supported by the SAMHSA-funded Opioid Response Network (ORN).

The purpose of the survey was to determine the number of patients receiving medications for opioid use disorders (MOUD) in OTPs, the types of federally approved medications being used by patients in treatment, and the specific formulations of medication used among the patient population.

This is the first time that such information is being made available to federal and state agencies that have jurisdiction in this area in addition to the general public.

At the time of the census, 1,826 OTPs were listed in the SAMHSA OTP directory. A total of 1,547 OTPs across the country completed the census survey, reflecting an 85% response rate. The full report indicates the medication breakdown for 512,224 patients. Of the 512,224 patients in OTPs who reported using MOUDs, 476,763 reported using methadone, 33,473 reported buprenorphine, and the remaining 1,988 reported using naltrexone. In addition to the most common MOUDs being used, the census captured formulation data from 510,557 patients including the most common formulation types, the number of patients using each formulation, and regional differences between formulation use.

Through this census, NASADAD and AATOD have captured crucial and actionable data to better understand treatment demand and demand for specific medications in OTPs. This report lays important groundwork to examine future demand and service issues in OTPs.

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Melanie Whitter
Deputy Executive Director and Director, Research and Program Applications
National Association of State Alcohol and Drug Abuse Directors, Inc.
(202) 292-4873

Mark W. Parrino
American Association for the Treatment of Opioid Dependence (AATOD)
(212) 566-5555 Ext: 200

Reauthorization of the State Opioid Response (SOR) Grant Program

The State Opioid Response (SOR) grant program, housed within the Substance Abuse and Mental Health Services (SAMHSA), is a federal grant program designed to address the “opioid overdose crisis by providing resources to states and territories for increasing access to FDA-approved medications for the treatment of opioid use disorder (MOUD), and for supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder (OUD) and other concurrent substance use disorders (SAMHSA, 2022).”

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) serves as the voice of State alcohol and drug agencies in Washington, D.C. NASADAD’s members are the State Single Agencies (SSAs) responsible for applying, receiving, and distributing SOR funds to programs and providers. The SOR  grant program is currently up for reauthorization. As a result, NASADAD has developed an overview of key provisions in legislation in the the House of Representatives and Senate to reauthorize the program.

For more information about how States are using SOR funds, please visit the IMPACT OF STATE TARGETED RESPONSE & STATE OPIOID RESPONSE GRANTS.

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This fact sheet is a “living document” and will continue to be updated as legislation progresses through Congress. Please reach out to Lacy Adams ( with any questions.

Frequently Asked Questions (FAQs) About President Joe Biden’s Proclamation to Pardon Simple Marijuana Offenses

On October 6, 2022, President Joe Biden issued A Proclamation on Granting Pardon for the Offense of Simple Possession of Marijuana. The Proclamation set in motion a pathway to pardon all individuals with simple possession of marijuana offenses in violation of the Controlled Substances Act (U.S.C.844) or in violation of D.C. Code 48–904.01(d)(1). In response, NASADAD developed a fact sheet for State alcohol and drug agencies, Frequently Asked Questions (FAQs) About President Joe Biden’s Proclamation to Pardon Simple Marijuana Offenses, that explores answers to common questions around the timeline for pardons, what does receiving a presidential pardon entail, who does this proclamation apply to, and more.

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