With seven legislative days remaining in the Fiscal Year 2018 calendar, the U.S. Senate last night passed the Opioid Crisis Response Act in a nearly unanimous 99-1 vote. This action by the Senate comes almost exactly two months after the U.S. House of Representatives considered 70 opioid-related bills in an unprecedented effort.
Both votes signal what local leaders already know: The opioid crisis is hitting cities and towns across America, and Congress needs to do their part.
The bill passed by the Senate reauthorizes an additional $500 million per year from the 21st Century Cures Act for the State Targeted Opioid Response (STOR) Grants program to provide funding to tribes and give states additional flexibility for using the grants. The STOR program is designed to increase access to treatment, reduce unmet treatment need, and reduce opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids as well as illicit drugs such as heroin).
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In Fiscal Years 2017 and 2018, the Department of Health and Human Services (HHS) awarded more than $1 billion in grants to states and territories to help combat the opioid epidemic through the STOR program. Lack of clarity from Congress and the Administration on how States should use this money has left millions of dollars in federal spending on the table.
As such, at their Summer Leadership Meeting, the National League of Cities (NLC) Board passed a resolution enabling NLC staff to actively push for changes to the STOR program over the last three months. Theses proposed changes would have required the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within HHS, to either set aside up to 20 percent of the grants for competitive local grants or to require the states to pass through 80 percent of the STOR grants to local substance abuse, treatment, prevention and recovery programs.
While these changes did not make it in to the final bill that was passed this week, NLC will continue to fight for additional changes to the various opioid grant programs to ensure the money is getting down to the local level.. This bill, which will need to be conferenced with the previously-passed House bills before proceeding to the President’s desk for signature, is an important step but it falls short in many areas including ensuring sustained, systemic investments to local efforts to combat substance abuse disorders.
What Else is in the Senate Passed Opioid Bill?
You might be wondering what else is in the bill, aside from the critical funding to the STOR program. The bill also:
- Authorizes the Food and Drug Administration (FDA) to require drug manufacturers to package certain opioids to allow for a set treatment duration. For example, if prescribed a blister pack with a 3 or 7-day supply, patients would be given simple and safe options to dispose of unused opioids, such as safe disposal packaging or safe disposal systems for purposes of rendering unused drugs non-retrievable.
- Requires the FDA and the United States Customs and Border Protection (CBP) to improve detection and seizure of illegal drugs, such as fentanyl, by strengthening coordination efforts.
- Expands a grant program authorized by the Comprehensive Addiction and Recovery Act, which was designed to allow first responders to administer a drug or device, like naloxone, to treat an opioid overdose, and to include training on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs. NLC has long supported the need for additional resources such as naloxone to first responders and supports the expansion of the program to include training.
- Creates a grant program administered through SAMHSA to establish or operate comprehensive opioid recovery centers (CORC) that serve as a resource for the community. These entities may utilize the Extension for Community Healthcare Outcomes (ECHO) model, which supports care coordination and services delivery through technologyNLC believes access to long-term recovery services, especially by local residents in rural cities and towns, is essential to combating the opioid epidemic in rural communities.
- Requires HHS to issue best practices for emergency treatment of a known or suspected drug overdose, use of recovery coaches after a non-fatal overdose, coordination and continuation of care and treatment after an overdose, and provision of overdose reversal medication, as appropriate. HHS is also authorized to create a grant program for education on overdose prevention, the establishment or implementation of policies and procedures to treat and support recovery for individuals who have experienced a non-fatal overdoes.
- Reauthorizes and modifies the Building Communities of Recovery program to include peer support networks. This program provides funding to community organizations providing long-term recovery support services.
- Expands the types of physicians, who already meet the other training requirements to prescribe medication-assisted treatment (MAT), to obtain a waiver to prescribe MAT. Additionally, the bill creates a grant program to support development of curriculum that will help health care practitioners obtain a waiver to prescribe MAT.
- Requires HHS to identify or facilitate the development of common indicators that could be used to identify potentially fraudulent recovery housing operators. NLC believes this could be an important tool for local governments to ensure recovery housing operators in their cities are adhering to the standards set by HHS.
- Authorizes the Department of Labor to award dislocated worker grants to states through the Workforce Innovation and Opportunity Act. These grants will support local workforce boards and local partnerships tackling shortages in the substance use disorder and mental health treatment workforce and will provide coordinated job training and treatment services to individuals in affected communities with opioid or substance use disorders. This is critical to ensuring that individuals can be treated with wrap-around services to reenter the workforce.
- Authorizes the HHS to establish a grant program to support the transition of individuals in recovery from a substance use disorder to independent living and the workforce. NLC believes this is very important for long-term recovery, especially for those individuals suffering from opioid addiction.
- Requires the HHS, in consultation with the Department of Education, to disseminate best practices, establish a resource center to provide technical assistance, and issue grants for the prevention of and recovery from substance use disorder in children, adolescents and young adults.
- Expands telemedicine opportunities by clarifying the ability of the Drug Enforcement Administration (DEA) to develop a regulation allowing qualified providers to prescribe controlled substances in limited circumstances via telemedicine. This provision is especially important for residents in remote cities and towns that are unable to travel long distances to meet with a doctor in a health clinic or hospital.
- Authorizes the Center for Disease Control’s (CDC) work to combat the opioid crisis through the collection, analysis, and dissemination of data, including through grants for states, localities, and tribes. NLC believes data collection and analysis is crucial for local governments to help identify hot spots, trends and resources to properly combat the epidemic.
- Provides support for states and localities to improve their Prescription Drug Monitoring Programs (PDMPs) and implement other evidence-based prevention strategies, encourages data sharing between states, and supports other prevention and research activities related to controlled substances. This is one of the critical recommendations identified in the National City-County Task Force on the Opioid Epidemic’s report, which can be found at opioidaction.org.
- Reauthorizes this HHS grant program to allow states to develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology.
- Directs HHS to provide technical assistance to states to develop and coordinate housing-related supports and services under Medicaid, either through state plans or waivers, and care coordination services, for Medicaid enrollees with substance use disorders.
- Makes states eligible to receive funding to provide evidence-based substance abuse prevention and treatment services to families with children at risk of entering foster care (as a result ofthe Family First Prevention Services Act), beginning in FY 2020. This section authorizes $20 million in funding for HHS to award to states to develop, enhance, or evaluate family-focused treatment programs, with intention to increase the number of evidence-based programs that will later qualify for funding under Family First.
- Reauthorizes the Office of National Drug Control Policy (ONDCP) at the White House, which oversees all Executive Branch efforts on narcotics control, including the development of a national drug control strategy.
- Reauthorizes the Drug-Free Communities (DFC) Program through 2022. DFC is a grant program administered by ONDCP that works to prevent youth substance abuse and reduce the demand for illicit narcotics at a community level.
- Reauthorizes the ONDCP High-Intensity Drug Trafficking Area (HIDTA) Program. HIDTA provides funding for federal, state, and local law enforcement task forces operating in our nation’s most critical drug trafficking regions. The bill also improves upon the HIDTA by targeting funds for implementing a coordinated drug overdose response strategy, which includes:
- Coordinating multi-disciplinary efforts to prevent, reduce, and respond to drug overdose;
- Increasing data sharing among public safety and public health officials on drug-related abuse trends; and
- Enabling collaborative resources on substance use addiction and narcotics trafficking.
- Reauthorizes Department of Justice funding for drug courts through 2022.
- Provides supplemental grants to law enforcement agencies to protect law enforcement from accidental exposure to dangerous narcotics. Grants may be used for purchasing portable equipment to test for fentanyl and other substances, training law enforcement officers and first responders on best practices andpurchasing protective equipment.
- Authorizes COPS Anti-Meth Program and COPS anti-heroin task force program. The Anti-Meth grants support state law enforcement agencies with high seizures of precursor chemicals, methamphetamine, and laboratories for the purpose ofinvestigating illicit activities, such as diversion, laboratories, or methamphetamine trafficking. The competitive anti-heroin grants support state law enforcement agencies in states with high rates of treatment admissionsto further investigate illicit activities. This task force will function through statewide collaboration with the greater effort to dismantle the distribution of heroin, fentanyl, Carfentanil, or the unlawful distribution of prescription opioids.
- Allows HHS to award grants to states and local governments, and tribal governments to develop programs designed to keep pregnant women who have substance use disorder together with their newborns. In addition, the bill supports the attendance of children who have a family member with substance use disorder at therapeutic camps or programs aimed at addiction prevention education, coping strategies, and family support initiatives intended to keep families together.
- Authorizes SAMHSA to provide grants to establish Sobriety Treatment and Recovery Teams (START) to determine the effectiveness of pairing social workers and mentors with families that are struggling with substance use disorder and child abuse or neglect.
About the Authors: Yucel (“u-jel”) Ors is the program director of public safety and crime prevention at the National League of Cities. Follow Yucel on Twitter at @nlcpscp.
Stephanie Martinez-Ruckman is the Program Director for Human Development at the National League of Cities. Follow Stephanie on Twitter @martinezruckman.