A new report by the National Association of State Alcohol and Drug Abuse Directors has found that states are using grant money to address the opioid crisis in a wide variety of ways.
In April 2019, NASADAD surveyed state alcohol and drug service agencies to find out how they were using State Targeted Response (STR) and State Opioid Response (SOR) grants to tackle the opioid crisis in their states. All 50 states responded.
After separating the data into four categories (treatment initiatives, prevention initiatives, recovery support initiatives and overdose reversal initiatives), the group was able to present information on some of the benchmark programs, as well as an overview of what states are spending the grant money on.
Regarding prevention initiatives, the majority of primary prevention initiatives focused on educational programs and information dissemination. The survey found that 94 percent of the states reported that they provided education programs, while 92 percent of states used grant money to get information to the community through media campaigns, community health fairs, speaking engagements, or the distribution of materials.
“A few states also developed campaigns to reduce the stigma around opioid addiction,” the report said. “Prevention messages were tailored to target the general population or those with a higher risk of misuse such as youth, parents, older adults, veterans, tribes, and rural populations. The messages addressed issues such as chronic pain management without opioids; using prescribed medicine only as directed; safely storing and disposing of medicine; background on Good Samaritan laws; and naloxone availability and how to administer the opioid overdose reversal medication.”
Less than half of the states said they used the grant money on environmental strategies like prescription drug-monitoring programs, take-back events, and drug deactivation pouches. And only 38 percent said they used the money on identifying the problem or making referrals.
In terms of treatment initiatives, the majority of states increased the capacity and access to medical-assisted treatment (MAT) for individuals. The expansions included establishing or enhancing opioid treatment programs and office-based treatment programs, proving services in federally qualified health centers and opening medication units inside existing substance abuse disorder agencies and/or mental health agencies.
Increasing office-based MAT meant using grant money to increase the number of Drug Addiction Treatment Act (DATA) waiver training offered across the country. Additionally, states have expanded access to Food and Drug-approved medications for MAT – methadone, buprenorphine, naltrexone – and have reduced or, in some cases eliminated, treatment costs for uninsured and underinsured patients, the report said.
“Funding has also allowed states to expand access to MAT by utilizing telehealth technology. State telehealth efforts include implementing the Project ECHO (Extensions for Community Healthcare Outcomes) model across several university medical centers and community providers in SUD care,” the report said. “This collaborative model of medical education and care management has enhanced the delivery of evidence-based OUD care by linking a multi-disciplinary team of specialists with healthcare professionals in the substance use disorders field. Such joint efforts have given clinicians in rural and underserved communities the tools to provide specialty care to OUD and chronic pain patients in- house. Other telehealth efforts have involved providing ongoing clinical checkups and consultations via technology.”
Nearly 90 percent of the states said they used the grant money to invest in medication-assisted treatment expansions, while 64 percent used the money to address treatment in correctional settings.
In the recovery support arena, the majority of states used grant money to hire, train and certify peer support specialists and recovery coaches. Seventy-six percent said they used the money to hire support recovery specialists, while 50 percent said they used the money on recovery housing. Recovery housing can aid residents’ access to and use of MAT for opioid use disorder.
Only 32 percent of states said they invested in employment services and 30 percent of states said they used grant money to provide recovery support in emergency rooms in their state. Only 12 percent of states said they used the grant money to fund youth opioid recovery programs.
“Funding also allowed the delivery of recovery support in hospital emergency departments by having peer support specialists, recovery coaches, and patient navigators initiate MAT for patients that survived an opioid overdose and connect them to community-based substance use disorder treatment,” the report said. “Some emergency room programs also provided additional recovery supports, such as temporary housing, emergency food, childcare, education, and employment support for sustained community treatment.”
Finally, in overdose reversal initiatives, most of the states reported purchasing naloxone kits, developing programs to disseminate those kits as well as training those in community-based programs how to identify an overdose and administer naloxone.
Nearly all of the states – 94 percent – said they invested grant money into naloxone kits.
“As of April 2019, 851,327 naloxone kits have been distributed and 37,649 overdose reversals have been reported,” the report said. “State grantees also used STR/SOR funds to support strategic planning and capacity building in communities with high rates of overdose. Strategic planning initiatives included conducting community needs assessments and developing preparedness plans to better coordinate evidence-based practices and increase community involvement (e.g., naloxone distribution site planning, opioid overdose response planning).”
Only 10 percent of the states said they invested grant money into post-overdose programs for opioid use disorder patients.