The Substance Abuse and Mental Health Services Administration (SAMHSA) is in the middle of a Congressional move to change it. On May 6, Rep. Frank Pallone, Jr. (D–NJ) and Rep. Cathy McMorris Rodgers (R–Wash.), chairman and ranking member of the House Energy and Commerce Committee, released proposed legislation that would reauthorize the agency and revamp many of its programs. The Restoring Hope for Mental Health and Well-Being Act of 2022, was scheduled for two markups (member votes) in the early part of the month.
Among other things, the bill would, if passed in its initial form:
- Reauthorize critical public health programs to address the nation’s mental health needs, prevent suicide, and support substance use disorder (SUD) prevention, treatment, and recovery support service, including The Maternal Mental Health Screening and Treatment grant program to enhance maternal mental health and SUD treatment;
- Direct SAMHSA to assess flexibilities provided to opioid Treatment Programs during the COVID-19 public health emergency and increase access to treatment services.
Specifically, the Public Health Service Act would be reauthorized to award grants to states for screening and treatment for maternal SUDs for women who are postpartum, pregnant, or have given birth within the preceding 12 months. Already, pregnant women who have opioid use disorders (OUD) are prioritized for treatment. This section of the bill would authorize $24 million a year for FY 2023 to 2028, and an additional $10 million annually until 2028 for a national hotline.
The proposed bill incorporates that Summer Barrow prevention, treatment, and recovery grants, which would reauthorize SAMHSA programs for FY 2023 through FY 2027, including:
- Grants for reducing overdose deaths, authorized at $5 million each fiscal year;
- State pharmacy opioid overdose medication access and education grants, authorized at $5 million each fiscal year;
- State and local integrated comprehensive OUD response, authorized at $5 million each fiscal year; and
- Emergency department alternatives to opioid demonstration grants, authorized at $10 million each fiscal year.
Also under the bill, SAMHSA’s Substance Abuse Prevention and Treatment (SAPT) block grant would be renamed the Substance Use Prevention, Treatment, and Recovery Services block grant. This follows in the wake of Congress’ refusal to allow a set-aside for recovery services for the SAPT block grant. The purpose would be to provide states with funding to plan, carry out, and evaluate SUD prevention, treatment, and recovery support services, requiring that states “describe the recovery support services activities supported by block grant funds, including the number of individuals served, target populations, priority needs, and the amount of funds allocated to recovery support services,” according to the bill sponsors. The SAPT block grant is authorized at $1.908 billion a year (this is the current figure) with this as a contingency.
Patient safety concerns
The bill also eliminates the requirement that a patient be addicted to opioids for a year before being admitted to treatment by an opioid treatment program. This is a requirement imposed by SAMHSA and the Drug Enforcement Administration prior to giving a patient methadone for OUD. This requirement does not exist for buprenorphine. The bill would require SAMHSA to establish new criteria to allow patients to receive take-home methadone in either a 14-day or a one-month supply.
The opioid treatment provider (OTP) field is concerned about one aspect of the bill as originally proposed – the concern is that if OTP clinicians do not have discretion in who is admitted to treatment and who gets how many take-homes, there could be problems down the road, including threats to the integrity of treatment itself.
“If the clinician makes an error in judgment or if the patient does not accurately report what opioids they are using, then there is a risk of overdose,” Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), told AT Forum early this month. “In our judgment, the OTPs should have greater discretionary judgment.”
AATOD has supported H.R. 7238 “because it would provide additional clinical discretion when the OTP is deciding to admit a patient,” Parrino said. “It appears that the majority of new patient admissions are using fentanyl and OTP practitioners are concerned about not admitting such a patient and risking overdose by being denied access to care.”
Legislative text is available here: https://www.congress.gov/bill/117th-congress/house-bill/7666