This week, SAMHSA announced the availability of $22.6 million to public and private non-profit entities through its Medication-Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) grant. Applications are due Friday, April 29. More information about applying for the grant is available on SAMHSA’s website.
The National Council for Mental Wellbeing will host Overdose Prevention Across the Continuum of Care: Strategies from the Field, the first of a two-part series, from 3:30 pm–5:00 pm on Monday, March 21. You can register for the event here.
Presenters will discuss a range of evidence-based strategies that have been successfully implemented across the continuum of care to prevent overdose and improve the health of people who use drugs and have substance use disorders, including those with co-occurring serious mental illness.
The Senate Appropriations Committee will meet for a budget hearing with the Department of Drug and Alcohol Programs (DDAP) at 2:30 pm today, March 16. The budget hearing will be livestreamed. Please note that RCPA provider members received an email from RCPA earlier this week that incorrectly stated the hearing was at 10:00 am today.
For Fiscal Year 2022/2023, 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.
More details of DDAP’s budget are available in DDAP’s Bluebook. In addition, a previous communication from RCPA about DDAP’s budget ahead of its House Appropriations Committee provides additional detail about the $317 million budget.
The Office of Inspector General (OIG) within the U.S. Department of Health and Human Services (HHS) has issued a favorable advisory opinion regarding contingency management (CM), an evidence-based approach for treating substance use disorders (SUD) that uses financial incentives to reward healthy behavior, such as abstinence and treatment retention, according to the National Council for Mental Wellbeing.
CM has been shown to be an effective approach for those with SUD in more than 100 randomized controlled trials over 50 years. Evidence shows it can double abstinence rates across opioids, stimulants, alcohol, tobacco, and nicotine, compared to usual care alone. It is the most effective and most evidence-based treatment for stimulant use disorders. In 2021, the Biden Administration declared advancing CM among its drug policy priorities.
The advisory opinion clears the way for CM for routine use in publicly funded substance use treatment programs and healthcare facilities under federal reimbursement, including Medicaid.
The Senate Appropriations Committee will meet for a budget hearing with the Department of Human Services (DHS) at 10:00 am on Tuesday, March 8. The budget hearing will be livestreamed. Then, at 10:00 am Wednesday, March 9, the House Appropriations Committee will hold its hearing with DHS. That hearing will also be livestreamed.
DHS is budgeting more than $6 billion in capitation to pay for behavioral health services in Fiscal Year (FY) 2022/2023. Based on the current fiscal year’s spending, approximately 22 percent, or $1.6 billion, is budgeted to be spent for drug and alcohol, including administration fees paid to behavioral health managed care organizations, according to DHS. The $6 billion is an increase of 11 percent over the $5.4 billion budgeted for FY 2022.
The details of the budget are available in DHS’ 2022/2023 Executive Budget.
The $6 billion behavioral health budget (p. 105 of 399 in the Executive Budget) is comprised of:
The FY 2022/2023 budget also includes $57 million in state dollars for the Behavioral Health Services Initiative (BHSI). BHSI includes state funds to provide treatment services to Pennsylvanians who are uninsured, do not have insurance that covers the service they need, or cannot obtain Medical Assistance benefits. Single County Authorities distribute those dollars per the Pennsylvania Department of Drug and Alcohol’s Fiscal Manual, according to DHS.
The DHS Executive Budget also breaks out an $80 million line item in both FY 2021/2022 and FY 2022/2023 for the American Society of Addiction Medicine transition (See p. 101 of 399). This $80 million, $16 million of which is state dollars, is included in $6 billion behavioral health capitation budget.
RCPA will continue to update the membership on the budget as it moves toward passage in the coming months.
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:
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.
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.
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.
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.
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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