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Federal Efforts to Improve Access to Treatment for Individuals with Substance Use Disorders

posted on Wed, Dec 7 2016 1:08 pm by Hector Hernandez-Delgado

In October of this year, President Obama appeared in an MTV documentary alongside American hip hop recording artist Macklemore to raise awareness of the U.S. opioid crisis. In the documentary, the President expressed that, “how we’ve dealt [in the past] with the reduction of addiction and drugs has been oftentimes counterproductive.” This statement exemplifies the federal government’s recent shift in efforts to combat the opioid epidemic from an emphasis on law enforcement to an increasing acknowledgement of the importance of public health-based, scientifically-sound interventions.

In recent months, the federal government has redoubled these efforts by expanding on initiatives that improve access to treatment for individuals with substance use disorders (SUD). A key component of these efforts focuses on implementing and enforcing the Mental Health Parity and Addiction Equity Act, which requires most health insurance plans to treat mental health and SUD benefits on equal footing with- medical and surgical benefits. Last month, the Mental Health & Substance Use Disorder Parity Task Force issued its final report, which discussed the improvements that have been achieved  and the challenges that remain.

These achievements include elimination of higher copayments for mental health and SUD services for Medicare beneficiaries, the ACA’s extension of the parity requirement to individual insurance coverage, and the requirement that small-group plans provide a minimum amount of mental health and SUD coverage. Also, in March of this year, CMS finalized a rule implementing the mental health and SUD parity requirement in Medicaid and CHIP; a move that expands access to SUD services for over 21 million people. While much still needs to be done to make sure that insurers are complying with the law, it is already estimated that, together, these policies have improved access to addiction treatment for approximately 174 million people.

The federal government has also worked to expand access to medication-assisted treatment (MAT) by expanding health care practitioners’ authority to prescribe buprenorphine. Along with methadone, buprenorphine is one of the most effective drugs used to treat SUDs. In July 2016, The Substance Abuse and Mental Health Services Administration (SAMHSA) announced a rule that expands the number of SUD patients that a practitioner can treat to 275 per year. Additionally, the agency recently announced a new rule that implements a provision of the Comprehensive Addiction and Recovery Act that enables nurse practitioners and physician assistants to prescribe buprenorphine for up to 30 patients.

President Obama has also proposed additional federal funding to increase access to treatment for SUDs. The President’s FY 2017 Budget proposal includes a total of $1.5 billion to address the opioid epidemic under a two-tier approach. First, the budget proposal allocates $1 billion in new mandatory funding to expand access to treatment for prescription drug abuse and heroin use. This $1 billion includes funding for expansion of access to MAT for people with SUDs and funding for evaluation of the effectiveness of treatment programs. Second, the proposed budget allocates $500 million to expand state-level prescription drug overdose prevention strategies. These strategies include increasing availability of MAT and improving access to the overdose-reversal drug naloxone at the state level.

In perhaps the most important acknowledgement of the federal government’s commitment to evidence-based approaches to reducing SUDs, the Surgeon General recently released a groundbreaking report calling SUD a “chronic condition that can be effectively managed with medications and other treatments that focus on behavior and lifestyle.” The report is notable in that it addresses SUD as a health condition, and in fact commended the criminal justice system’s effort to place non-violent drug offenders in treatment instead of jail. The report also emphasized the importance of early intervention and MAT for people with SUD and called for the integration of SUD and mental health treatment with the rest of the healthcare system.

The Surgeon General’s report stated that, “sound scientific knowledge about how to address SUDs effectively has outpaced society’s ability and […] willingness to implement that knowledge.” The federal government’s recent efforts represent an important step in the direction of closing that gap and in changing the way we think about and address the public health crisis that the opioid epidemic represents.

This guest post was prepared by Hector Hernandez-Delgado, a Legal Fellow with the National Health Law Program

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.

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