Amid the animus of the Supreme Court fight, the Senate voted nearly unanimously today to authorize another down payment on the massive investment needed to prevent addiction and build a comprehensive treatment and recovery system. The 660-page bipartisan compromise package is now on its way to President Trump, who is expected to sign it into law.
The package contains many of the elements that are needed – prevention, treatment, recovery services, housing and trauma services – to help prevent addiction and serve people with substance use disorders. But Congress seems focused on the short-term – stopping opioid deaths – rather than a long-term strategy of intervening to reduce all addiction. At a time when there is more recognition of substance use disorders as a chronic health condition, the bill also focuses a lot of time and money on law enforcement strategies, including stopping importation of synthetic opioids. Reducing deaths is important and incremental change is useful. But this package is like replacing windows and doors on an old house that needs a new foundation.
In addition, this bill authorizes new components to address addiction, but doesn’t write the check to pay for them.
Here are some of the elements that may have the most relevance for consumers:
- Youth-focused prevention grants and dissemination of best practices. ($10 million per year)
- New grants to set up Comprehensive Opioid Recovery Centers that provide a range of services including, residential and outpatient treatment, medication assisted treatment, peer recovery services, housing and employment support ($10 million per year)
- Several programs promoting trauma-informed care, including development of best practices, and grants to schools to expand services for children ($50 million per year)
- Reauthorizing state targeted response grants established by the 21st Century Cures Act, and expanding the scope of the grant program to include prevention, treatment and recovery supports ($500 million per year)
- Increase access to housing by allowing selected states to use Community Development Block Grants to help individuals with substance use disorders become stably housed
- Several initiatives to boost peer recovery services, including reauthorization of funding for community organizations providing peer recovery supports ($5 million per year) and establishment of a peer-run technical assistance center
- Expanding access to medication-assisted treatment (MAT) in Medicare, and allowing more types of clinicians to prescribe MAT
- Workforce development incentives, including student loan repayments for clinicians serving in provider shortage areas
- Reauthorizing the Drug-Free Communities Program, which supports local prevention coalitions
- Expanding residential treatment options by allowing Medicaid to pay for up to 30 days annually of treatment for substance use disorders in “institutions of mental disease”
Consumer advocacy helped to ensure some harmful provisions were excluded from the bill, including a provision that would have compromised privacy protections for people with substance use disorders.
Now, advocacy is needed on two levels. First, we need to ensure the programs in the bill are fully funded. This requires advocacy with members of Congress during consideration of appropriations. Congress just appropriated $3.9 billion for previously authorized addiction services and programs. Second, we need to engage Congress in discussions about the system change needed to integrate substance use services fully and equally into the health care system, provide prevention all along the lifespan and support the comprehensive social, economic and recovery services necessary for every person who has substance use disorders to be able to live a healthier life.