While everyone hopes with “fingers crossed” that each iteration of the State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration will keep on coming, planners are not naïve, and are already looking for other funding sources to make sure the programs they have put in place are sustained.
Take Maryland. For example, the “safe stations” (see https://atforum.com/2022/10/aatod-report-maryland/) which the state has implemented have been a valuable way to funnel people to treatment, as well as to simply give them a few hours or days respite to “sober up,” for want of a better phrase, and to have healthy food and a shower and a place to sleep. But safe stations are expensive. Even though many are operated out of firehouses, they require peers who are paid for their work – not volunteers.
“I do think that if we are using SOR dollars, if a jurisdiction wants a safe station, they could submit a proposal,” said Darren McGregor, director of the Office of Crisis and Criminal Justice Services at the Maryland Behavioral Health Administration. Speaking to a packed pre-conference workshop at the American Association for the Treatment of Opioid Dependence (AATOD), McGregor called the process “a learning curve.” At the beginning – before there is funding – most people involved are volunteers.
For the safe house operations in firehouses, the Behavioral Health Administration pays for many peer support specialists, and also gives a small maintenance fee to the fire departments. Also, in some parts of the state, the fire departments are totally volunteer.
This is why, for SOR III, the state is trying to identify other funding sources, state officials said at the October 31 session.
“As a state we’re looking at what Medicaid can fund, and will move that along so that the reimbursement is there,” said one state official, leaving the rest of the sentence implicit: if SOR funding is no longer.
And every county in the state is different. For example, in Montgomery county there are county dollars to support crisis beds, said McGregor. But these beds are mainly for mental health crises and not for OUDs. So it’s not possible to use SOR dollars to fund those beds.
There is also a problem with procurement – getting the SOR funds pushed out from the counties to the providers. The investment is there, but the process is not always set up yet.
In Montgomery county, there is a push for the state to procure the OUD crisis services, and fund them directly, said McGregor.
Baltimore is already looking for other funding sources to keep the work which SOR has funded alive.
Many groups have been launched by SOR – non profits which may not exist without those federal funds. The same is true for some state jobs. Still, the job of advocacy, planning, managing public funds, local partnerships, public education, and in general system management have to be done by someone.
For treatment providers, especially OTPs, the takeaway is this: people receiving services experience crises or relapses. If there is no safety net for these patients, it’s up to the OTP to care for them. Maryland, and especially Baltimore, have a robust OTP network.
Some of the counties on the Eastern shore of the state are more conservative, less likely to have OTPs, and certainly less likely to welcome people in OUD crises into their volunteer-staffed firehouses. In Caroline County, however, the sheriff has been a powerful ally, working to break down barriers to safe stations there. Ultimately, rural areas need OTPs too, and safe places for people in crisis. The sheriff in Caroline County has made a business card with a QR code on it. Anyone who is pulled over for any reason gets one of those cards. The QR code can be scanned and will tell the person where there is a safe station and whether they need to go to court. In addition, in Caroline County, anyone in opioid crisis can walk into the police department and ask for the safe station.
Another safe station is the Whitsit Center in Kent County, on the Eastern Shore. This building, which had vacant space anyway, expanded from four crisis beds under the state’s MORR to 12 through SOR, with a total of 848 individuals served so far.
Many attendees of the Maryland SOR session were from other states, looking for advice. Negotiating for beds is, apparently, a top problem which SOR has helped solve, but states need to help with procurement.
This story ends the three-part feature on Maryland and SOR from AATOD’s 2022 conference. Stay tuned for more reports from the meeting.