The holidays are often a tough time for people struggling with drug and alcohol addiction or mental illness. But Congress has provided an early present that may ease some of these struggles in years to come:
- Half a billion dollars in state grants to be awarded early in the new year to prevent and treat addiction to opioids, including heroin and pain pills, and a promise for another half a billion dollars in 2018
- Authorization of a 5 year, $50 million demonstration project to train more health professionals to provide mental health and substance use disorders services in underserved community-based settings that integrate these services with primary care
- Authorization of $25 million in grants to increase screening and treatment for post-partum depression, and separate support for early intervention and treatment of mental illness in children
- Small steps to improve oversight and enforcement of the parity law preventing health insurers from discriminating against people with mental illness or substance use disorders
- Allowing use of federal grants for programs that provide community-based services to divert people with substance use or mental illness from the criminal justice system prior to arrest or before they are “booked” for an alleged offense
These gifts come in a giant package called the 21 Century Cures Act that President Obama signed into law yesterday, and a separate law he signed on Saturday to fund the government through April. The Cures Act, approved in a rare bipartisan congressional vote, also includes many other provisions on cancer, research and other health issues. Unfortunately, the Cures package also includes a fair amount of coal:
- It robs the Prevention and Public Health Fund of $3.5 billion that was authorized in the Affordable Care Act for prevention services across the health spectrum.
- It weakens Food and Drug Administration rules designed to protect Americans from unsafe medicines.
- While it authorizes more funding to the National Institutes of Health, the money is vulnerable to cuts because it has to be voted on annually.
Like many gifts being received this season, this present needs some assembly.
The federal government just released the application for the $500 million in opioid state grants, which can be used for prevention, treatment, and recovery support services. All states are eligible to apply. Advocates and their partners need to weigh in with state officials to make sure they apply and that this money is put to the best use. We need to remind state officials who oversee substance use services of the importance of prevention, including verbal screening and early intervention for youth, as part of a holistic approach to substance use disorders.
In 2017, federal advocacy is also needed to secure an appropriation for other $500 million authorized for opioid services in the Cures Act. Similar advocacy is needed to shake loose the money to treat maternal depression and to train more people to treatment mental illness and substance use disorders.
Meanwhile, the portions of the law designed to reduce inequities in treatment for substance use disorders and mental illness also require the federal government to issue new regulations and develop an action plan to coordinate federal and state enforcement. While President Trump has said the nation needs to address the opioid epidemic, he has been more outspoken about reducing regulation and government “overreach.” Advocates must speak up loudly and clearly for more enforcement of the law requiring parity in mental health and substance use disorders treatment vis-à-vis treatment for physical illnesses.
New data last week highlights the continuing toll of the opioid epidemic: More than 33,000 deaths from overdoses last year. The new funding for state opioid grants and better enforcement of parity is critical to stopping this tremendous loss of life. But we also need to keep the expanded insurance coverage and access to services that 22 million people gained through the Affordable Care Act (ACA), or the death toll will only get worse. In addition to the opioid deaths last year, alcohol and non-opioid drugs contributed to more than 100,000 other deaths and untreated substance use costs the nation $400 billion annually in crime, health, and lost productivity.
The best holiday gift we could imagine would be for the Trump administration and Congress planning to give up their plans to repeal the Affordable Care Act.