The Health Resources and Services Administration’s (HRSA) Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program offers up to $250,000 in student loan repayment for eligible professionals who commit to six years of full-time work providing direct SUD treatment or recovery support at an approved facility. The program is open to a range of providers, including medical, behavioral health, and peer support professionals.
Applications are due July 10, 2025. Learn more and apply.
By Jason Snyder, Director, SUD Treatment Services, BH Division
June 2, 2025
In the latest legislative run at involuntary substance use disorder (SUD) treatment, two Pennsylvania senators co-sponsoring SB 716 are looking to amend Pennsylvania’s Mental Health Procedures Act to include SUD and alcohol use disorder (AUD) by themselves as mental illnesses. Doing so would, under the law, subject those with the disorders to involuntary commitment in the same way mental health is today; that is, individuals with an SUD can then be forced into treatment against their will, mainly through a court-petitioning process, just as an individual in a mental health crisis can be involuntarily committed to psychiatric care today.
As to whether SUD and AUD are in fact mental illnesses, Sens. Laughlin and Williams appear to be on solid ground. The most recognized and credible medical association in the country, the American Medical Association, includes SUD as a mental illness, and the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies it as such. In fact, 34 states allow involuntary commitment for SUD, whereas all 50 allow involuntary commitment for a mental health issue.
But beyond that, the senators’ rationale is debatable.
Although we absolutely are still dealing with a continually evolving SUD epidemic, as of today, I would not call the epidemic unprecedented. In 2017, Pennsylvania was in unprecedented times with the highest number of annual overdose deaths ever seen at 5,456. Earlier in May of this year, the Centers for Disease Control released preliminary data that showed overdose deaths down 31 percent to 3,358 in Pennsylvania in 2024 over 2023. Had it not been for the Covid years, we may well have seen a continual annual decline from 2020 through today.
Even as fentanyl has replaced heroin and adulterants like xylazine and medetomidine have exacerbated the crisis, naloxone and warm hand-off protocols – both instituted broadly around 2016 – along with improved access to evidence-based treatment including buprenorphine; increased integration of peers; and other harm-reduction strategies, including fentanyl test strips, have all over time contributed to decreasing deaths. Most experts on the ground would say we need to do more of this, as it has proven over time to save lives.
Many of those same experts also oppose any effort to force people into SUD treatment. Research evaluating its effectiveness is mixed. In one review of studies assessing the outcomes of involuntary treatment, evidence did not overall suggest improved outcomes, with some of those reviewed studies suggesting potential harms. However, other studies do suggest some benefit to involuntary treatment. For example, one study found significantly reduced emergency department visits and unplanned hospital admissions for people who received involuntary treatment. Another study found that, when interviewed six months later, the majority of involuntarily admitted patients acknowledged that they needed treatment and felt positively about having been mandated to attend.
Even so, practical considerations within Pennsylvania’s addiction treatment system remain a big hurdle, and most treatment providers agree that involuntary commitment to SUD treatment is not only ineffective; in actuality, it is a burden on the system, staff, and other patients. And at this point, there are more questions than answers. To my knowledge, the senators have not consulted the broad provider community about the bill, the immense challenges it brings, or their ideas for alternatives.
In Pennsylvania’s last legislative session, Sen. Laughlin introduced SB 962, which would have established a new involuntary commitment process for those with SUD, especially those who overdose. In opposing that bill on behalf of our SUD treatment providers, we wrote a brief position paper in 2023, highlighting our concerns: the enormous burden placed on providers to manage an unfunded, complex involuntary treatment process; the perpetuation of stigma toward the disease of addiction by introducing the complexity and trauma of the judicial system to the treatment of a disease – not the commission of a crime; and little evidence that this approach reduces overdoses and death, not to mention the lack of locked SUD treatment facilities in the commonwealth and the potential disruption to the milieu of patients who do want to be in treatment.
As a provider representative, RCPA and its members still have those concerns today and continue to oppose the senators’ current efforts.
Yet I understand the anguish of families who live the active addiction of a loved one, and the exasperation, helplessness, and hopelessness of watching a downward spiral often end in death. My family, hoping that we were going to somehow wake up from the nightmare we were living, watched it with both of my brothers, who eventually died of drug overdoses.
So with involuntary commitment a non-starter for providers because of the complexity, ambiguity, and debatable outcomes, what more can we do for those in most danger of death who seem least likely to proactively seek treatment?
First, we must sustain and improve upon what is already demonstrating effectiveness at reducing deaths; namely, widespread distribution and availability of naloxone, improved access to evidence-based treatment (including buprenorphine and methadone), increased use of peers at multiple intercepts, and other harm-reduction strategies.
In opposing SB 962 during the last legislative session, RCPA proposed that finding the will to develop programs and policies that are proven to reduce overdose deaths and better engage those with SUD with the treatment system was preferable to a well-intended but misguided involuntary commitment law. Such policies and programs would include: enabling safe access to evidence-based medications to treat opioid use disorder including, for example, immediate buprenorphine induction by emergency medical personnel at the site or instance of overdose or access to low-barrier bridge clinics; providing meaningful, sustainable funding to specially train and embed certified recovery specialists at every potential touchpoint with overdose survivors; and reforming regulations and eliminating administrative burdens that act as barriers to treatment access.
As an example of what others are proposing as alternatives to forced treatment, APA, in its journal Psychiatric Services, recently suggested focusing on the highest-risk subpopulations for brief (72 hours or less) involuntary holds, as opposed to commitments, in hospitals to allow health care providers to engage them and begin to provide ongoing care management and peer support, as opposed to simply watching the individual walk away. Could something like this work?
Most in the treatment system and arguably all harm reductionists oppose involuntary commitment for SUD. With overdose deaths continuing to trend significantly downward, now seems like an even less opportune time for reintroduction of such a bill than in the past. But clearly, some in the legislature want to do more.
What alternatives to involuntary commitment would you suggest?
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is accepting presentation proposals for its 2025 Emerging Drug Trends Symposium, which will be held Tuesday, November 18, 2025, at the Penn Harris Hotel & Convention Center, 1150 Camp Hill Bypass, Camp Hill, PA.
The one-day event will feature a combination of plenary presentations and breakout sessions aimed at providing a comprehensive overview of the current drug landscape. Participants will gain deeper insights into overdose trends and explore best practices for addressing emerging drug threats.
DDAP encourages breakout session presentations for intermediate to advanced professionals, and is seeking content that addresses the evolving needs of professionals at various career stages, focuses on common challenges, and highlights evidence-based strategies to overcome them and ultimately enhance outcomes.
The submission deadline for presentations is 11:59 pm on Tuesday, July 15, 2025. Submission guidelines and the breakout session proposal form are both available online. Email Margaret Eckles-Ray at DDAP with any questions.
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) will kick off Recovery Month with “Recovery Out Loud,” from 12:00 pm – 3:00 pm on Saturday, September 6 on City Island, located along the Susquehanna River in Harrisburg.
DDAP will then close the month-long celebration with its Wellness & Resource Fair at Soldier’s Grove in Harrisburg from 10:00 am – 1:00 pm for wellness activities, helpful resources, and a celebration of support. Those interested in hosting a wellness activity or resource table can sign up by September 1.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), Recovery Month, which started in 1989, is a national observance held every September to promote and support new evidence-based treatment and recovery practices, the nation’s strong and proud recovery community, and the dedication of service providers and communities who make recovery in all its forms possible.
The online Exhibitor and Sponsor Portal for the 2025 AATOD Conference, set for October 4 – 8 in Philadelphia, is now open.
The 2025 AATOD Conference will attract more than 1,800 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. The registrants are decision-makers with purchasing power for their treatment centers and are looking for new products, services, and information to improve patient treatment.
Exhibit booth space, select sponsorship opportunities, and registration can be purchased directly through the portal. More information about exhibitor opportunities and benefits can be found on the conference website.
A full list of sponsorship items and exhibit details can also be found in the exhibitor brochure.
By Jason Snyder, Director, SUD Treatment Services, BH Division
For as long as I’ve been active in the recovery community and addiction treatment system, the prevailing mentality around people who couldn’t “get it” – with “it” mostly meaning compliance with a program and an outcome of sustained abstinence – was that they just weren’t ready, or they just didn’t have enough willingness to do the things that are necessary to stop using drugs and begin to recover. That attitude is much more pronounced in certain recovery communities, much more nuanced in the treatment environment, but it’s an accepted way of thinking in both. It’s a kind of thinking that blames the individual for failing, as opposed to the system failing the individual.
But what if a large subset of individuals with substance use disorder (SUD) really can’t get it, with “it” not only being abstinence or reduced use, but, more consequentially, the cognitive demands of treatment – alertness, attention, cognitive processing, memory, and executive functioning? What if these individuals are neurologically incapable – even if only temporarily – of engaging in treatment for their SUD the way the treatment system expects them to, because they have either an acquired or traumatic brain injury from or driving their SUD?
Such a recognition by the broad treatment system, the subsequent implications for improved individualized treatment and, most importantly, actual modifications to SUD treatment could be huge.
Earlier this month, I had the opportunity to participate in what for me was an eye-opening summit convened by the Pennsylvania Department of Health and the Brain Injury Association of Pennsylvania. It focused in part on recognizing the significance and prevalence of brain injury among those with SUD, especially opioid use disorder (OUD), and identifying ways to better treat this population. Much of what was shared and stimulated my thinking on this came courtesy of the Addiction Technology Transfer Center’s “Traumatic Brain Injury and Substance Use Disorders: Making the Connections” toolkit.
Most of the discussion focused on acquired brain injury (ABI). Internal factors, including lack of oxygen to the brain due to an opioid overdose, result in ABI. Traumatic brain injury (TBI), on the other hand, results from an external force, such as a blow to the head, including those that result from physical abuse. Both ABI and TBI have significant implications for those in SUD treatment. Often subtle yet significant changes in memory, attention, and social behavior, for example, make it difficult to participate in treatment, and many leave without completing. With historic numbers of overdoses over the past 10 years, the connection between SUD and brain injury, especially ABI, has not gotten the commensurate discussion it needs.
Since 2015, Pennsylvania advocates have rightly made the widespread distribution of naloxone a top priority. In fact, that is the year I began working for the Pennsylvania Department of Drug and Alcohol Programs, and getting naloxone into the hands of first responders, especially police, was our top priority. The mantra then, as it is now, was we can’t treat someone who is dead. From there, the natural progression from administration of naloxone was to warmly handing off that person to treatment or recovery support. One of the biggest challenges, and therefore areas of focus, with the warm hand-off process has been finding more effective ways to intervene at that critical moment to prevent the individual from simply walking away from a near-death experience and continuing on as if it hadn’t happened.
What has received little attention over those 10 years is the fact that for many, regardless of whether they agreed to treatment or walked away, life would never continue as if the overdose hadn’t happened, because many who overdose experience permanent brain damage.
It takes only four to six minutes of a lack of oxygen to the brain to cause permanent brain damage, which can forever affect a person’s ability to understand, retain and recall information, express themselves, think critically, or solve problems. Those who sustain a brain injury are at risk for future overdoses.
In North America, approximately 23 percent of all intravenous drug users will experience a non-fatal opioid overdose per year. Further, there are estimated to be as many as 40 non-fatal overdose events for every fatal overdose among people who inject drugs.
Sadly, I can’t tell you how many people I’ve met who have been reversed multiple times. In fact, research shows that people who have had at least one opioid overdose are more likely to have another, which can compound any impairment or injury.
But it’s not only those who have overdosed who may have a cognitive impairment. Amount and duration of substance use can also result in neurologic and cognitive effects, meaning many people – perhaps the majority – who enter the treatment system have some level of difficulty with cognitive and behavioral function. Research suggests 80 percent of those seeking services for co-occurring mental health and SUD are living with the effects of brain injury.
Yet we as a treatment system often expect these same patients to sit quiet and still in hours-long group therapy sessions, pay attention, and not be disruptive. We expect them to be on time for group. We expect them not to miss their individual sessions. We expect them to follow through and comprehend. Those who don’t are often labeled as not ready for treatment. They haven’t reached their bottom yet.
Of course, there must be some measure of accountability on the patient’s part. But to set expectations for those with a brain injury in the same way we would for someone who does not have one is setting them up for failure.
To be fair, without assessing a person for a brain injury, clinicians may not even realize there is an issue. Without understanding the serious implications of brain injury on a person’s ability to engage in therapy, there may be no perceived need to change the way treatment is being provided. Instead, the lack of knowledge and understanding leads to incorrect assumptions about the patient as the reason the treatment isn’t working, not the reverse.
By beginning to effectively and comprehensively screen for brain injury; training clinicians, peers, regulators, and payers on the prevalence and implications of brain injury; and modifying the way treatment and recovery supports are provided for these individuals, the SUD treatment system can significantly improve treatment outcomes.
It will take collaboration with regulators, especially to remove regulatory barriers, as well as collaboration with payers to consider potential alternative payment models, to accommodate the therapeutic needs of those with a brain injury.
Quality individualized treatment should be more than rote alignment with ASAM criteria. It should effectively recognize neurologic limitations – both those acquired as a result of overdose and those caused by trauma – and appropriately modify treatment for those with such limitations. Otherwise, the behavioral health system will continue to misread and mislabel what arguably is a majority of its patients.
In a presentation to the Medical Assistance Advisory Committee today, Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Secretary Jen Smith shared data that shows a significant increase over the past three years in behavioral health managed care organization (BH-MCO) decisions to deny services to their members or contracted providers.
In addition to denial data for calendar years 2022 through 2024, the report also provides data on grievances and complaints and defines what each of those is. Notably, the 2024 data does not include the fourth quarter of the year.
The most egregious service type denials are seen in two categories: 1) non-hospital residential withdrawal management, rehabilitation and halfway-house services for drug/alcohol abuse or substance use disorders; and 2) IBHS for children and adolescents with mental health or substance use disorders. Although the IBHS denials appear down slightly in 2024, when the fourth quarter data is added, the number is likely to increase. On the SUD side, even without fourth quarter data, denials for the non-hospital residential substance use disorder treatment services are up 45 percent over 2023.
The presentation breaks down the number of denials per year per BH-MCO since 2022.
The increases in denials in 2024 occurred at the same time OMHSAS acknowledged a significant miscalculation of capitation rates, resulting in underfunding of the behavioral health system, including primary contractors and BH-MCOs, by hundreds of millions of dollars.
Deputy Secretary Smith cautioned that there are multiple factors to consider when reviewing the data and increase in denials, including Pennsylvania’s SUD treatment system’s ongoing alignment with ASAM Criteria and the increased BH-MCO scrutiny on providers and individual BH-MCO interpretation of ASAM Criteria.
The Pennsylvania Department of Drug and Alcohol Programs (DDAP) notified single county authorities (SCA) that it will continue to distribute federal COVID-related grant funding to SCAs while the US District Court considers a 23-state lawsuit seeking an emergency temporary restraining order against US Health and Human Services Secretary Robert F. Kennedy Jr. for abruptly terminating COVID-grant funds that were appropriated for use for states until September 30, 2025. Those grant funds include a supplemental to the Substance Use Disorder Block Grant. The lawsuit was filed on April 1.
Though not confirmed, media reports suggest the termination of grants could cost the Pennsylvania Department of Health $301 million, along with an additional $28 million or more hit against DDAP.
DDAP had been using these grant funds to expand testing and provide resources for COVID; support providers and help meet local needs during the pandemic; and expand the substance use disorder prevention, intervention, treatment, and recovery support services continuum, including various evidence-based services and supports for individuals, families, and communities.
Governor Shapiro and Pennsylvania are listed along with 22 other plaintiffs in a lawsuit filed in US District Court in Rhode Island, requesting an emergency temporary restraining order against US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. for abruptly terminating COVID-grant funds, including a supplemental to the Substance Use Disorder Block Grant, that were appropriated for use for states until September 30, 2025.
Though not confirmed, media reports suggest the termination of grants could cost the Pennsylvania Department of Health $301 million, along with an additional $28 million or more hit against the Pennsylvania Department of Drug and Alcohol Programs (DDAP).
DDAP had been using these grant funds to expand testing and provide resources for COVID; support providers and help meet local needs during the pandemic; and expand the substance use disorder prevention, intervention, treatment, and recovery support services continuum, including various evidence-based services and supports for individuals, families, and communities.
DDAP is examining its options to maintain the full array of services offered by single county authorities and their providers to ensure Pennsylvanians continue to receive the lifesaving supports they need.
The factual allegations and legal background in the lawsuit state that during the COVID-19 pandemic, Congress appropriated substantial funds to strengthen public health programs that were not tied to the duration of the public health emergency. HHS and Congress continued to make these public health funds available after the end of the pandemic.
On Monday, March 24, with no advance notice, HHS abruptly terminated $11 billion in grants and cooperation agreements funded by appropriations from COVID-related laws. States were notified through letters from the Substance Abuse and Mental Health Administration (SAMHSA). The letters indicated the grants were issued for a limited purpose: to ameliorate the effects of the pandemic. The end of the pandemic provides cause to terminate COVID-related grants. Now that the pandemic is over, the grants are no longer necessary.
The lawsuit goes on to state the terminations have caused and will continue to cause irreparable harm and asks the court to vacate and set aside the termination of the funding and any other further actions taken by US HHS to implement or enforce them, among other requests.
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