By Alison Knopf
Of the $1 billion in federal grants going out to states in 2017 and 2018 to respond to the opioid epidemic, 80% must go to treatment. The grant money comes from the 21st Century Cures Act, signed by President Obama last December. Checks for the first year of the State Targeted Response to the Opioid Crisis grants (STR), administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), went out in late April.
Increasing Treatment Access
At that time, Tom Price, MD, secretary of the Department of Health and Human Services (HHS), SAMHSA’s parent agency, made it clear that he wanted a report on how the money was being spent—quite likely before the first year was even finished. “Opioids were responsible for over 33,000 deaths in 2015; this alarming statistic is unacceptable to me,” said Dr. Price, just before distributing the checks.
“These grants aim to increase access to treatment, reduce unmet need and reduce overdose-related deaths. I understand the urgency of this funding; however, I also want to ensure the resources and policies are properly aligned with and remain responsive to this evolving epidemic.
“Therefore, while I am releasing the funding for the first year immediately, my intention for the second year is to develop funding allocations and policies that are the most clinically sound, effective and efficient. To that end, in the coming weeks and months, I will seek your assistance to identify best practices, lessons learned, and key strategies that produce measurable results.”
States’ Plans Differ
States, in their applications for the grants, differ in their plans for using the money. Some, like California, have a strong opioid treatment program (OTP) component. Since medication-assisted treatment (MAT) is the most effective treatment for opioid use disorders, that makes sense, said Jason Kletter, PhD, president of the California Opioid Maintenance Providers and BayMark Health Services. “I don’t understand why every state isn’t using their money for MAT.”
That said, OTPs are supportive of the Department’s interest in evaluating how STR grants have been used, said Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). “Doctor Price is right to ensure that funds are being well spent to provide a comprehensive treatment response to combat the nation’s public health crisis of opioid addiction,” said Mr. Parrino, who is very interested in learning what states are doing with their funding in regard to OTPs.
“Additionally, it is important to understand how states are managing service integration as these STR grants are utilized,” he said. “Illustratively, once an individual is saved through the use of a naloxone overdose kit, does the individual get transported to an emergency room and does the ER have someone that is professionally trained to properly assess the needs of the individual, with regard to further treatment? Does the ER have the capability of referring the individual to treatment at an OTP, DATA 2000 practice, residential unit or other treatment intervention?
“We also know that a number of states are increasing the number of OTPs, including Indiana, Ohio and Mississippi,” said Mr. Parrino, adding, “A number of providers and states are also using the STR grants to expand access to mobile van units, which are connected to the OTP.”
The Evaluation Component
But SAMHSA built in broad flexibility to the grants, allowing states to move funding elsewhere. “I understand that some states are using the funding for initiatives that aren’t likely to have an immediate impact mitigating the opioid epidemic,” said Dr. Kletter. “What’s really important is that we have SAMHSA and HHS look closely at how states are spending that money,” he said. “The whole purpose is a rapid response. I support Dr. Price’s intent to review this closely.”
Dr. Kletter also thinks states should have some data by the midway point—the end of year one—of the grants. “We have already convened our first implementation meetings,” said Dr. Kletter of California, which is using the money to expand the hub-and-spoke model using OTPs. If states can’t demonstrate they are using the money for evidence-based treatment interventions to reduce overdose deaths, “then the money should be reallocated to other states that can,” he said.