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Authors Posts by Jason Snyder

Jason Snyder

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The House Appropriations Committee will meet for a budget hearing with the Department of Drug and Alcohol Programs (DDAP) at 10:00 am on Thursday, March 3. The budget hearing will be livestreamed.

For Fiscal Year 2022/23, the governor is budgeting a total of $317 million for DDAP, which is a 16 percent reduction over the current fiscal year’s budget of $379 million. The decrease is due to a $60 million reduction in federal State Opioid Response dollars.

Of the total amount budgeted from the General Fund for the upcoming fiscal year, $270 million is budgeted for grants and subsidies to drug and alcohol programs. Of those funds, 75 percent ($220 million) comes from federal grants, including:

  • SAMHSA’s Substance Abuse Prevention and Treatment Block Grant (SABG) ($80 million);
  • State Opioid Response (SOR) Grant ($118 million); and
  • Substance Abuse Special Projects Grants ($22 million).

The remaining $50 million earmarked for drug and alcohol programs in the General Fund come from the McKinsey opioid settlement ($5 million) and $45 million in state funding.

Other funds in DDAP’s budget include the Compulsive and Problem Gambling Treatment Fund ($13 million), the Medical Marijuana Program Fund ($6 million), and the State Stores Fund ($5 million).

DDAP’s budget also includes $23 million ($3 million of which is state money) earmarked for operation and administration of the department and its various grant programs. The federal grants allow for a percentage of the funds to be used for operations and administration. Operations and administration also includes the department’s complement, or staffing, and their salaries.

While most of the SABG and state funding earmarked for drug and alcohol programs are distributed through the Single County Authorities, SOR and other special grant projects are delivered typically through a grant process. Details of initiatives that these grants have funded can be found on DDAP’s Department Funding web page.

As the regulator of the state’s addiction treatment system, DDAP’s funding of drug and alcohol programs pales in comparison to the Department of Human Services’ budget for drug and alcohol services. The governor has budgeted $6 billion for behavioral health services for Medicaid capitation rates, $1.6 billion of which is earmarked for drug and alcohol.

More details of DDAP’s budget are available in DDAP’s Bluebook.

DDAP’s Senate Appropriations Hearing is set for 2:30 pm, Wednesday, March 16.

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Act 126 of 2020 amended the original 2012 Methadone Death and Incident Review (MDAIR) Act, which established the creation of a team to review methadone-related deaths or incidents, to go beyond methadone and include a review of death and incidents related to any Food and Drug Administration (FDA)-approved medication to treat opioid use disorder as a primary, secondary, or contributing factor to a death or incident.

As a result of the new law, the Pennsylvania Department of Drug and Alcohol Programs selected a new MDAIR team to review medication-related deaths, communicate concerns, and develop best practices to prevent future medication-related deaths and incidents.

A list of the new team members can be found here.

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In the years Pennsylvania has been earnestly battling the opioid overdose death epidemic, many ideas have been suggested or implemented for intervening with overdose survivors. From hard line proposals (go to treatment following an overdose reversal or face criminal charges) to logistically complex processes (embed peers in emergency rooms to facilitate the transfer of overdose survivors to a treatment facility), these strategies have yielded mixed results as judged against one grim fact: exacerbated by Covid, 5,063 Pennsylvanians died of a drug overdose in 2020 (the latest year for which overdose death totals are confirmed). That total is second only to the record set in 2017, with 5,403.

One of the newest initiatives to intervene with overdose survivors is currently under way in Pittsburgh. By addressing many of the shortcomings of other intervention efforts, this strategy employs an evidence-based harm-reduction approach.

In Pittsburgh, Emergency Medical Services (EMS) is eliminating barriers to treatment and connecting patients to recovery resources through its prehospital buprenorphine program, a Pennsylvania Department of Health-approved pilot program that complies with all state and federal laws and regulations. Joshua Schneider, an emergency medical technician and overdose prevention coordinator for the City of Pittsburgh, recently testified before the Center for Rural Pennsylvania about the program, which allows paramedics to administer buprenorphine to a patient experiencing opioid withdrawal, whether part of an overdose reversal or not, and connect that patient directly to a telemedicine clinic. The patient then can receive a buprenorphine prescription, typically within 24 hours. This program circumvents traditional barriers, because it offers medication at the point of EMS engagement, does not require transport to an emergency department, and offers low-threshold access to ongoing treatment through a simple phone call. To date, this pilot program has improved post-overdose withdrawal symptoms for all enrolled patients and has resulted in multiple patients continuing treatment.

EMS providers respond to a high number of opioid overdose calls and are a key access point to the health care system for people who use drugs. A large number of patients who engage with EMS following an overdose decline transport to the hospital, creating an access gap that leaves patients without any care beyond resuscitation with naloxone. In 2021, more than 30 percent of Pittsburgh EMS patients declined transport to the hospital after experiencing an opioid overdose, approximately double the transport refusal rate for other call types. While an emergency department is not always the optimal place for a person who has overdosed to receive care, it can act as a resource hub where patients can be connected to substance use treatment and social services. Patients who decline transport to the hospital cannot be connected to those resources. The majority of EMS agencies lack the ability to connect patients to other forms of care and patients who are not transported to the emergency department are often left at the scene with nothing more than a box of naloxone or a resource pamphlet.

Even patients who accept transport to the emergency department struggle to get connected with substance use treatment. While all Allegheny County emergency departments have the ability to administer buprenorphine and make a referral to community providers, most patients who present to the emergency department do not receive buprenorphine or linkage to longitudinal care.

Effective treatment, including medication, for opioid use disorder (OUD) exists today beyond what has been traditionally viewed as rehabilitation. For those individuals willing to accept buprenorphine treatment as a potential pathway to recovery from OUD, Pittsburgh’s prehospital buprenorphine program offers great promise.

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The National Council for Mental Wellbeing, with support from the Centers for Disease Control and Prevention, conducted an environmental scan to determine how overdose prevention and response efforts are currently implemented in community corrections. This effort included a literature review, 19 key informant interviews, and a roundtable discussion with a diverse group of individuals with experience in community corrections, overdose prevention, or harm reduction.

Key findings, along with the full report, are available on the National Council’s website.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) announced more than $15 million in grant funding for stabilization payments to substance use disorder (SUD) treatment providers to assist with pandemic-related expenses.

Through 108 grant agreements, 375 SUD treatment provider locations will receive funding. Grantees span across every Pennsylvania county, and all eligible applicants who applied were awarded funding. A list of grantees and awards are available on the DDAP website. However, funding amounts will not be finalized until all grant agreements are fully executed. This funding will aid in pandemic-related expenses, including but not limited to minimizing the spread of COVID-19 by ensuring the provision of testing and support of vaccines as appropriate and delivering quality, evidence-based treatment to individuals who are underinsured or uninsured.

The grants are part of $55 million in federal funding awarded to Pennsylvania through the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment Block Grant Program COVID-19 Supplemental Awards.

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DDAP Modifies ASAM Transition Web Page, Archives Addendums That Outlined IOP Ratio and Daily Therapeutic Hour “Expectations”

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has overhauled its ASAM Transition web page, removing previous references to “expectations for contractual compliance” in areas of ASAM Criteria where DDAP originally went beyond the Criteria as explicitly written. Newly revised information, including an updated “Guidance for the Application of The American Society of Addiction Medicine, 3rd Edition, 2013 in the Pennsylvania Substance Use Disorder Treatment System for Adults” and “ASAM Frequently Asked Questions” document, references the 1:15 intensive outpatient (IOP) counselor-to-patient ratio and the six to eight daily therapeutic hours at residential level of care as a DDAP “recommendation.”

The change is significant because, according to the Pennsylvania Department of Human Services (DHS) Office of Mental Health and Substance Abuses Services (OMHSAS), per its HealthChoices Behavioral Health Program Standards and Requirements for Primary Contractors document, “the Primary Contractor and its BHMCO must ensure that the SUD providers in the network comply with program standards in the ASAM Criteria, included but not limited to admission criteria, discharge criteria, interventions/types of services, hours of clinical care, and credentials of staff as set forth in the ASAM transition requirements found at https://www.ddap.pa.gov/Professionals/Pages/ASAM-Transition.aspx.” In other words, providers were expected to be in compliance with any information published as an expectation on that page.

For months following DDAP’s testimony in Commonwealth Court that the IOP and daily therapeutic overreaches were simply “guidelines,” the provider community remained unclear on whether they would be required to comply with the “guidelines” as part of their contracts with the BHMCOs. Still, providers have not yet seen the evaluation tool that will be used to audit their compliance with ASAM Criteria despite DDAP’s expectation that they be “substantially aligned” with those Criteria by Jan. 1, 2022.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is now offering “Co-Occurring Conditions: Promising Practices and Approaches.”

Co-occurring conditions are no longer the exception but the expectation, requiring treatment programs to design services that address the interrelationship among complex physical, psychiatric, and substance use conditions. This curriculum will review up-to-date principles, terminology, screening, assessment, treatment considerations, and programming guidelines, and the interactive program will engage participants through discussion and small group exercise. This six-hour virtual course is divided into two parts in DDAP’s Training Management System.

Participants of this course will:

  • Describe the foundations of integrated treatment;
  • Highlight key treatment considerations;
  • Employ screening and assessment for COD; and
  • Critique integrated treatment plans.

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The Pennsylvania Department of Human Services is extending the public comment period for the renewal of the Section 1115 Medicaid Demonstration titled “Medicaid Coverage for Former Foster Care Youth from a Different State and SUD Demonstration” (Project Number: 11-W-003083/3). The public comment period, which was originally slated to end on Feb. 15, 2022, is now extended to March 10, 2022, so the public can see the clarifications made in the Demonstration Extension page on the DHS website. The effective dates of the current approved demonstration are Oct. 1, 2017, through Sept. 30, 2022. The extension requested will be for an additional five years through Sept. 30, 2027.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) has added a third option to its list of approved ASAM Criteria education.

For more information on ASAM, visit DDAP’s website.

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Anthem Foundation is making up to $30 million available over the next three years to support substance use disorder programs that address an array of care and service options, including prevention and early intervention, crisis response and interventions, long-term intervention, and community resources and recovery supports.

Qualified nonprofit organizations with a history of proven, programmatic community initiatives are invited to apply for funding. Although Pennsylvania has not been specifically identified as a local area of focus, Pennsylvania providers can qualify under the National Programs of Emphasis category. More information about funding guidelines and eligibility is available. The deadline to submit applications is January 31, 2022.

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