Opiods

SAMHSA Strategies for Addressing the Opioid Epidemic

By Ina A. Ramos, Ph.D.
Senior Technical Associate, The MayaTech Corporation


Introduction

The opioid epidemic continues to be a growing public health concern in the United States, and it is often associated with prescription drug misuse, lack of addiction treatment options, and limited safe drug disposal options, among other important contributing factors. According to the SAMHSA National Survey on Drug Use and Health (NSDUH)1 , in 2017, an estimated 11.4 million people aged 12 or older misused opioids in the past year. This number represents 4.2 percent of the population aged group and includes 11.1 million pain reliever misusers and 886,000 heroin users. An estimated 769,000 (3.1 percent) adolescents aged 12 to 17, 2.5 million (7.3 percent) young adults aged 18 to 25, and 8.1 million (3.8 percent) adults aged 26 or older misused opioids in the past year. In addition, approximately 2.1 million people had an opioid use disorder, which includes 1.7 million people with a prescription pain reliever use disorder and 0.7 million people with a heroin use disorder.

These increased rates were fueled by several factors, particularly providers’ unchecked prescribing practices, which can lead to overuse and misuse of painkillers. The recent dramatic increase of opioid-use and pain reliever misuse has emphasized the need for comprehensive approaches to address the opioid epidemic. This article provides an overview of SAMHSA’s response to combat the opioid epidemic, which includes issuing funding opportunity announcements, developing the Opioid Response Network, and expanding its available tools and resources.

Funding to Combat the Opioid Crisis

The Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) is the primary federal agency that provides funding to address the opioid epidemic. The 2016 Cures Act authorized funding for states to be administered by SAMHSA. The two primary opioid grant programs that SAMHSA administers are the State Targeted Response (STR) and the State Opioid Response (SOR) grants.2

The goal of STR is to close the gap between those who seek treatment and those who receive it. STR grants require that no less than 80% of the awarded funds be use for treatment services. In fiscal year (FY) 2017, states received STR funding that represented 15% of total federal government appropriations to address the opioid epidemic. In FY2018, in addition to traditional STR funding, supplemental funding was awarded to three of the 10 states with the highest rate of overdose deaths. The SOR program, which builds upon the STR, requires programs to include prevention, treatment, and recovery, as well as making treatment medications available (i.e., methadone, naltrexone, buprenorphine). In FY2018, states were awarded SOR grant funding, with a 15% set-aside for states with the highest rate of drug overdose deaths. The combined STR and SOR programs represented 21% of total opioid-related appropriations in FY2018.

In addition to STR and SOR grants, the Substance Abuse Prevention and Treatment Block Grant (SABG) also provides funding to address the opioid epidemic. The SABG program addresses all forms of substance use, including opioid misuse, and is the largest discretionary program for treatment and prevention. The SABG represented 54% and 24% of total opioid funding in FY2017 and FY2018, respectively.

Also, of note, SAMHSA administers the Programs of Regional and National Significance (PRNS), which includes 19 additional programs that target opioid use disorder. Programs within PRNS include the Medication-Assisted Treatment (MAT) for Prescription Drug and Opioid Addiction program, which provides funding to states to expand their MAT systems, thereby increasing access to evidence-based treatment, and the Strategic Prevention Framework for Prescription Drugs program, which raises awareness within the medical community about the risks of overprescribing opioids and funds prescription drug misuse prevention activities. The total appropriations for all PRNS programs combined represented 12% and 7% of opioid funding in FY2017 and FY2018 respectively.

1 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.

2 Bipartisan Policy Center, “Report: Tracking Federal Funding to Combat the Opioid Crisis,” March 2019, https://bipartisanpolicy.org/report/tracking-federal-funding-to-combat-the-opioid-crisis/.

The Opioid Response Network (ORN) is led by the American Academy of Addiction Psychiatry with support from a large coalition of national professional organizations. In February 2018, the coalition was awarded the SAMHSA grant to lead the State Targeted Response Technical Assistance Consortium (STR-TA) to provide evidence-based practices in the prevention, treatment, and recovery of opioid use disorders. The goal of the STR-TA is to respond quickly and provide free local training, education, and resources, equipping communities to address the opioid crisis.

Upon request, the ORN identifies individuals with training and experience within a community to aid in addressing prevention treatment and recovery needs and facilitate access to evidence-based resources. Each state/territory has a designated team led by a dedicated regional technology transfer specialist (TTS), who is qualified to implement evidence-based practices.

To provide further context and information on the ORN, we interviewed the network’s outreach and communications manager, Ms. Jane Goodger, who has worked with the program since its onset.

The ORN is a national network comprising a lead agency, six core team organizations, and 21 partner organizations. During its conception, the coalition worked to identify consultants, in the 50 states and nine territories, who could provide technical assistance (TA) for prevention, treatment, and recovery services and who were also connected within their community because issues vary by region.

The ORN partners identify and vet consultants who are currently working in communities and able to support the network efforts. In addition, some partners are also responsible for vetting the evidence-based practices used and also provide resources needed to address TA requests. For example, Columbia University vets treatment consultants, Community Anti-Drug Coalitions of America vets prevention consultants, and C4 Innovations vets recovery consultants.

The ORN accepts TA requests online. Anyone may submit a request form on the website, and a designated TTS for that state/territory will respond within 1 business day to collect additional details about the request. Jane shared, “Many times, people have a vague idea of what they think they need but after speaking with a TTS, they can fine tune their requests.” The team, TTS, and/or identified regional consultant will work with the requestor until they are able to resolve their needs. The ORN receives TA requests ranging from waiver training, to building a curriculum for a local middle school, to building a system across 10 counties in state that wanted one system for prevention, treatment, and recovery. Jane noted, “Some TA requests are resolved quickly, while others have lasted months, but it's all FREE and you can ask for just about anything as long as it's within the scope of the grant.!”

The ORN is ideal for fellows as they prepare to enter their careers. The network has a mentoring program where fellows can shadow a physician. The ORN can accept more intensive requests to provide fellows mentorship by seasoned physicians who are experts in the field. Jane closed by sharing, “This program is funded by SAMHSA, and it’s been pretty amazing to see how hard everyone is working for this common goal!”

SAMHSA works with federal partners, states, and community stakeholders to develop and coordinate a comprehensive response to the opioid epidemic and has developed tools that address opioid use and misuse. The Opioid Overdose Prevention TOOLKIT was developed to offer strategies to healthcare providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths.

There are numerous resources related to Medication-Assisted Treatment, which combines the use of Food and Drug Administration (FDA)-approved medications with counseling and behavioral therapies to treat substance use disorders. Resources include information about MAT; medications to treat opioid addiction; information and training resources; statutes, regulations, and guidelines; and certifications for opioid treatment programs.

The Medication-Assisted Treatment of Opioid Use Disorder Pocket Guide provides information on approved medications, screening and assessment tools, and best practices for patient care for physicians using MAT for patients with opioid use disorder. The MATx for Opioids mobile app is a free mobile app that provides easy access to treatment and prevention tools that empower physicians to employ evidence-based care for opioid use, abuse, and misuse. It includes FDA-approved treatment approaches and medications, medication prescribing guides, and clinical support tools and treatment guidelines. The Opioid Treatment Directory is a directory that can be used to locate programs within the 50 states and two territories.

The Treatment Improvement Protocol (TIP) 63: Medications for Opioid Use Disorder document reviews the use of the three FDA-approved medications (methadone, naltrexone, and buprenorphine) to treat opioid use disorder. The document titled Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings provides an overview of policies and evidence-based practices that focus on reducing the risk of overdose and relapse in jails and prisons and during the reentry process.

In addition to resources, training programs are available to medical providers. The Buprenorphine Training for Physicians is an 8-hour waiver training course required for physicians to prescribe and dispense buprenorphine under the Drug Addiction Treatment Act of 2000. This SAMHSA-supported continuing medical education course helps physicians qualify to prescribe buprenorphine in an office setting. Opioid Prescribing Courses for Health Care Providers are available through SAMHSA-supported continuing medical education courses offered by the American Academy of Addiction Psychiatry, the American Osteopathic Academy of Addiction Medicine, the American Society for Pain Management Nursing, the American Society of Addiction Medicine, OpioidPrescribing.com, and the Addiction Technology Transfer Center Network.