As overdoses rise, federal aid targets more access to treatment, medications
WASHINGTON — As federal officials spend big to shepherd the country through the COVID-19 pandemic, a different, longer-running public health crisis — the opioid epidemic — is resurgent, prompting federal officials to seize the wave of federal aid and direct it into drug treatment and prevention programs to fight a rise in overdose deaths.
Pennsylvania recently has seen an influx of money, with fewer strings attached, authorized by Congress to treat substance abuse by broadening access to medications and treatment, helping people re-enter the workforce, training health care workers to recognize signs of drug disorders and boosting quality at drug and alcohol recovery houses.
The Biden administration, tapping a former Obama administration drug policy official, will oversee funding that allows states to widen their investments in these areas. Yet state and local governments face a tough task: addressing an evolving crisis amid a pandemic with a shortage of trained health care workers, while also cracking down on fentanyl, the powerful synthetic opioid, and stimulants like cocaine and methamphetamine, which have contributed to the rise in overdoses.
“The amount of money going out to states is certainly unprecedented,” Regina LaBelle, acting director of the White House Office of
National Drug Control Policy, said in an interview last week.
“The number of people who are receiving quality treatment in this country is still pretty abysmal, and that’s an area where we have a very large room to grow,” Ms. LaBelle said. “The access to care is really limitedin most of the country.”
A complex problem
Pennsylvania officials believe the state is poised to finally have the right kind of federal resources to address the full scale of the opioid epidemic — a complex public health crisis that has ravaged the Pittsburgh region for several years. Statewide overdose deaths peaked at 5,396 in 2017, with 1,518 deaths in the Pittsburgh region and 825 deaths in Allegheny County alone.
The problem, public health experts said, demands policies that span government programs: quick-response mental health treatment, workforce development, housing, education, criminal justice reform, data collection, pain management techniques and doctors’ prescribing practices. Add to that the geopolitical ties with China, blamed for producing fentanyl, and Mexico, blamed for funneling it into the U.S.
The state government response was launched in January 2018, when Gov. Tom Wolf, a Democrat, issued an opioid disaster declaration, shortly after a federal public health emergency signed by former President Donald Trump three months prior. That year, statewide overdose deaths fell by 18% — led by a 39% drop in the Pittsburgh region.
But the state’s response has at times been stymied by administrative burdens placed on federal funding.
Jen Smith, secretary of the Pennsylvania Department of Drug and Alcohol Programs, told Congress in January 2020 that $230 million in federal funding had helped the state create addiction programs that reached thousands of people. But she asked for funding to be flexible — in the form of a block grant — to address the rise of stimulant use and the full picture of the addiction crisis.
The state also has been shortchanged on federal funding when considering overdose deaths, according to a 2019 study.
In 2019, overdose deaths in the region, state and country edged up, and they are on pace to be higher once again in 2020. In February, Mr. Wolf signed the 13th extension of the opioid disaster declaration.
Flush with funds
In an interview last week, Ms. Smith was pleased; lawmakers “did listen to us and that has been wonderful,” she said.
That’s because the American Rescue Plan, approved by Congress and signed by President Joe Biden last Thursday, included $1.5 billion in block grants for substance abuse services, and tens of millions for other programs that improve addiction care. That comes on top of $1.65 billion allocated in December’s COVID-19 relief bill, of which Pennsylvania was awarded $55 million last week.
The state will have a longer period of time — as much as five years — to spend the funds, allowing the proper time to get the cash to the right places, Ms. Smith said.
Last August, Pennsylvania was awarded nearly $80 million as part of the ongoing State Opioid Response grant program administered by the U.S. Department of Health and Human Services, which has doled out about $1.8 billion annually. For the first time, those grants could be used to address stimulants, Ms. Smith said.
Flush with funds, the state will continue many of its priorities, spending $9 million in the next year on free distribution of naloxone, an overdose-reversing drug, directly to the doorsteps of anyone who requests it online, Ms. Smith said.
But it will evaluate its methods for reaching people and improving quality of care.
For one, the department is working on its first-ever licensing regulations for drug and alcohol recovery houses that want to continue working with public funds. It expects at least 50 facilities statewide to seek licensure, with “several hundred” possible, which will be bound by a set of standards by December. Some federal funds will go to grants that help those facilities meet those standards, Ms. Smith said.
The state is also launching an online portal, developed by the nonprofit Shatterproof called ATLAS, that uses short surveys to direct individuals to treatment centers that best fit their needs.
‘Missing pieces’
Federal aid is attempting to address long-standing problems that were “exacerbated” by the pandemic, said Ms. LaBelle, the White House acting director.
Ms. LaBelle, who previously served as chief of staff and a senior policy adviser from 2009 to 2017, said the challenge is to “look at things with a fresh eye, to make sure that one’s not kind of stuck in where we were in 2015 or 2016.”
The pandemic shuttered treatment services just as people lost their jobs and saw family and friends get sick or die.
In the pandemic’s early weeks, one study found 43% of community-based syringe service programs closed or reduced hours, curtailing a key point of access to treatment and stemming the spread of dirty needles.
“If you think of a place where someone who is at risk of an overdose is going to go, that’s a place,” Ms. LaBelle said.
Training doctors across disciplines to spot signs of substance use disorder is another “missing piece” that will take time for states to fix, she said.
The American Rescue Plan includes $80 million for mental and behavioral health training for health care workers. Another $40 million will go to health care providers to promote mental and behavioral health among their own employees — a recognition of the pandemic’s toll on front-line health workers.
The bill includes $30 million syringe services programs and other harm reduction interventions.
“If we recognize that the vast majority of people who are in need of treatment are not receiving treatment, we can’t just give up on them,” Ms. LaBelle said. “We have to meet them where they are and provide them with the services they need.”
Easing access
Simple changes in federal policy could bring relief, health experts said.
Physicians and other practitioners currently must complete additional training and get federal approval to prescribe buprenorphine, a popular and effective medication, to patients for substance abuse disorder. The Trump administration, in its final days, moved to eliminate those certifications. The Biden administration is still reviewing that move.
Federal officials also should allow mobile clinics to administer methadone, a controlled substance that is currently limited to brickand-mortar facilities, said Coleman Drake, an assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health. The Drug Enforcement Administration is currently reviewing that ban.
Mr. Drake said the benefits of easing access to treatment have been evident during the pandemic, such as curbside pickup of methadone at clinics.
“I’ve met patients who are trying to hold down full-time jobs, often in construction and manufacturing, and they have to wake up at 3 a.m. to go to the clinic before they go to work,” Mr. Drake said.
“I suspect we’ll find that these changes have some positive effects, and I hope the administration doesn’t close the spigot,” he said.
Ms. Smith said that telephone-only visits to treatment providers and larger take-home doses of methadone have been “immensely helpful.”
Government funding can take time to make an impact.
Otis Pitts, deputy director of the Allegheny County Health Department, said in a written statement that more is needed to be done to address racial disparities in treating substance abuse. These include more targeted distribution of naloxone and community partnerships that “address economic and social conditions” that lead to drug use.
A $5.2 million federal grant awarded in 2019 has sped up collection of overdose data so officials can better target funds, Mr. Pitts said, and link more people with opioid use disorder to treatment. A number of reports in coming months, he said, will help officials to better understand the epidemic in local communities.