Substance Use Disorder Trends and State Efforts to Address Addiction - PowerPoint Presentation

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Substance Use Disorder Trends and State Efforts to Address Addiction Child Welfare League of America National Advocacy SummitWashington, DCApril 20, 2016

Robert Morrison, Executive Director/Director of Legislative & Regulatory AffairsNational Association of State Alcohol and Drug Abuse Directors (NASADAD)Slide2

Topics to CoverBackground on NASADAD – role of NASADAD membersScope of substance use disorder problemNASADAD Survey: State Actions on OpioidsAssociation initiatives of interestPublic policy prioritiesSlide3

Overview of NASADADMission: promote effective and efficient State substance use disorder prevention, treatment and recovery systems.Public Policy Department and Research/Program Applications DepartmentGoverned by Board of DirectorsCassandra Price (GA), PresidentSlide4

Role of State Substance Abuse AgenciesPlacement in State government – varies by StateDevelop annual State plans to provide prevention, treatment, and recovery services for safety net populationsEnsure service quality, accountability, service improvement, and service coordinationSubstance Abuse Prevention and Treatment (SAPT) Block GrantIncludes 20% set-aside for preventionSlide5

Use of Illicit Drugs, Alcohol, and TobaccoAccording to NSDUH 2014:27.0 million people used an illicit drug in the past month 139.7 million past month alcohol drinkers60.9 million who were binge users16.3 million who were heavy users66.9 million people were current users of a tobacco productSlide6

SUD TrendsApproximately 21.5 million people aged 12 or older had a substance use disorder (SUD) in the past year17.0 million people with an alcohol use disorder7.1 million with an illicit drug use disorder 2.6 million who had bothSlide7

Opioid Crisis5 million Americans used opioids during the past month 4.3 million misused prescription opioids435,000 used heroinShift from prescription opioids to heroinSlide8

Inquiry on Prescription Drugs and HeroinSSAs queried by NASADAD about recent public health initiatives Original 2012 inquiry focused on SSA efforts on prescription drug abuse.2014 inquiry was updated and expanded to include prescription drug abuse, heroin, and opioid overdose.Slide9

Inquiry MethodsWeb-based survey was conducted March-April 2014.Invited State Directors, Treatment Leads (NTNs), and Prevention Leads (NPNs) to participate.2014 analysis includes 46 States and the District of Columbia (N= 47 States, 92% of States).Slide10

Inquiry Results: Prescription Drug AbuseSlide11

State Strategic Plan Addressing Prescription Drugs and Heroin Abuse35 States reported that their strategic plan explicitly addresses prescription drug abuse. 12 of these States reported that their plan explicitly addresses heroin abuse. (All State prevention, treatment, and recovery systems include services for opioid and heroin abuse. However, during the past 2 years some States have identified prescription drug abuse and/or heroin abuse as requiring additional or reconfigured strategies in their State strategic plan.)Slide12

Educating the General Public on Prescription Drug Abuse

In 2012, 39 States provided education on prescription drug abuse. In 2014, the number increased

to 43 States. Slide13

Educational Activities for Physicians, Pharmacists, and PatientsPhysicians,Other

PrescribersPharmacist

s

Patients, Families

The number of States targeting their educational initiatives at each

of the following populations

increased

from 2012 to 2014.Slide14

Evaluating Prevention Programs or Education Initiatives21 States reported that they had (administered or funded) prescription drug abuse prevention programs or education initiatives with an evaluation component to assess their outcomes.Slide15

Usefulness of PDMP Data to SSAs (2012)2012 Data30 States said PDMP data is “very useful” or “useful.”Slide16

SSA Involvement with Prescription Drug Monitoring Program (PDMP)

2014

2012

As of 2014, most SSAs serve in an advisory capacity or have no involvement with the PDMP.Slide17

Inquiry Results:Heroin AbuseSlide18

State Trends for Heroin Abuse During the Past Two Years

37 States reported increases in treatment admissions for heroin.27 States reported increases in fatal overdose rates for heroin.Slide19

Medication-Assisted Treatment (MAT)Expansions26 States reported that they have expanded or made plans to expand MAT during the past 2 years.

49 States and DC have State opioid treatment programs (methadone maintenance).

All 50 States and DC have physicians who are waivered to prescribe buprenorphine.

All three FDA-approved opioid treatment medications (methadone, buprenorphine, and naltrexone) are covered under the Medicaid Drug Rebate Program. The associated co-pays and authorization requirements vary from State to State.Slide20

Educating the General Public on the Transition from Prescription Drugs to Heroin Abuse

How?

21 States reported that they have taken steps to educate the general public on the

transition

from prescription drugs to heroin abuse.Slide21

Remaining Challenges/ TA Needs on Prescription Opioids and Heroin: Themes Across StatesLack of funding.Need for greater treatment capacity to meet the increasing need.Challenges with data (lack of data, data that doesn’t capture the entire story).Stigma associated with heroin abuse.Collaboration with primary care for referrals and prescriber education.Slide22

Legislative action related to SUDsOpioid use disorders continue to gain traction in CongressComprehensive Addiction and Recovery Act (S. 524/ H.R. 953)Passed the Senate in MarchSen. Shaheen’s (D-NH) Emergency Funding Bill to Address Opioid and Heroin Abuse EpidemicMental Health Reform Act of 2016Various hearings in House and Senate on opioidsCriminal justice reformInterest in parental substance use in families involved with child welfare systemSlide23

Substance Abuse Prevention & Treatment (SAPT) Block Grant$1.8 billion formula grant administered by SAMHSA.Provided treatment for 2.5 million Americans in 2015.20% prevention set-aside represents 68 percent of prevention funds for State substance abuse agencies.

Priority populations:Pregnant and Parenting WomenIntravenous Drug Users

Individuals with HIV/AIDS

Individuals with Tuberculosis

SAPT Block Grant funding has not kept up with costs of inflation over the past decade (2006-2016)

The result is a

26% decrease

in actual funding when adjusted for inflation over the past 10 years ($483 million)Slide24

Services for Pregnant & Postpartum WomenImproving Treatment for Pregnant and Postpartum Women Act (H.R. 3691; S. 2226)Reauthorizes SAMHSA’s Grant Program for Residential Treatment for Pregnant and Postpartum Women (PPW)Family-based servicesChildren can enter treatment with motherCreates pilot program to give States the flexibility to implement family-based services for PPW at various levels of care, not only residential settingsWould help State substance abuse agencies address gaps in services for PPW across the continuum of careSlide25

Comprehensive Addiction & Recovery ActAfter clearing Senate Judiciary Committee in February, the Comprehensive Addiction and Recovery Act (CARA) of 2016 moved to the Senate floor for consideration on February 29th First time a standalone addictions bill had been on the floor since the 1980s. CARA passed the Senate on March 10th with a vote of 94-1.

Provisions address: Prevention Treatment (including for PPW)

Recovery support

Law enforcement

Criminal justice reformSlide26

Funding for SUD ProgramsIn February the Administration proposed $1.1 billion in new funding over two years to address the opioid crisis:$920 million to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders. $50 million in National Health Service Corps funding to expand access to substance use treatment providers. $30 million to evaluate the effectiveness of treatment programs employing medication-assisted treatment under real-world conditions and help identify opportunities to improve treatment for patients with opioid use disorders.Additionally, Sen. Shaheen (D-NH) proposed $600 million in supplemental emergency funding for the opioid crisis

Initially introduced in December to provide additional funding for programs within DOJ (COPS, Byrne/JAG) and HHS (SAMHSA, CDC, NIH, Office of the Secretary)Would add $225,000,000 to SAPT Block GrantIn February the bill was introduced in the House by Rep. Courtney (D-CT)

Offered as amendment to CARASlide27

Reauthorization of RPGRegional Partnership Grants (RPG) support interagency collaborations to improve the permanency and the safety of children who are in, or at risk of, out-of-home placements as a result of a parental substance abuse.Varied evidence-based, trauma-informed interventions:family drug courtscomprehensive substance abuse treatmentin-home parenting support

child safety support for familiesOn February 23rd Senators Grassley (IA) and McConnell (KY) introduced legislation (S. 2565) that would reauthorize the RPG program and include language requiring the State child welfare agency to “

coordinate to a reasonable degree

” with the SSA in administering the grants Slide28

NASADAD ResourcesGuidance to States: Treatment Standards for Women With Substance Use Disorders Therapeutic Services for Children Whose Parents Receive Substance Use Disorder TreatmentState Adolescent Substance Use and Recovery Practice GuideSlide29

Thank youQuestions/Comments?Contact:Robert MorrisonNASADAD202 293 0090rmorrison@nasadad.orgwww.nasadad.org