FY 2021 Annual Performance Plan and Report - Goal 2 Objective 3
Goal 2. Objective 3: Reduce the impact of mental and substance use disorders through prevention, early intervention, treatment, and recovery support
Mental illness and substance abuse create health risks and place a heavy burden on affected individuals and their families. Substance use disorders arise from the recurring use of alcohol and/or drugs, which lead to clinically and functionally significant impairments. Mental disorders are health conditions that involve significant changes in thinking, emotion, and/or behavior and lead to distress and/or problems functioning in social, work, or family activities. Mental and substance use disorders are illnesses that impact people's ability to go about their daily lives in family, social, and professional settings and place individuals at risk of additional health problems. HHS works closely with federal, state, tribal, local, territorial, and community partners, including faith-based and community organizations, to help identify and address mental health problems and substance use disorders.
The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, IOS, OCR, and SAMHSA. In consultation with OMB, HHS has determined that performance toward this objective is progressing. The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.
Objective 2.3 Table of Related Performance Measures
Increase the number of substance abuse treatment admissions with Medication-Assisted Treatment (MAT) planned as part of Opioid Use Disorder Treatment (Lead Agency - SAMHSA; Measure ID - 2.3.19K) 21
|CY 2014||CY 2015||CY 2016||CY 2017||CY 2018||CY 2019||CY 2020||CY 2021|
SAMHSA expects the number of people receiving MAT and the number of admissions to substance abuse treatment with MAT to increase. States are continuing to develop their systems with increased resources from grant programs, such as the State Opioid Response grants, Tribal Opioid Response grants, and Targeted Capacity Expansion: Medication-Assisted Treatment Prescription-Drug and Opioid Addiction grants. Medicaid systems have increased their focus on opioid-related technical assistance, and outreach efforts from across HHS promote the use of MAT. SAMHSA uses data from the Treatment Episode Dataset (TEDS) to track the provision of substance abuse treatment for opioid use disorders, which includes tracking the planned use of MAT at admission.22 In CY 2015, 224,389 treatment admissions had MAT as a planned part of the treatment plan. In CY 2016, 218,092 admissions had MAT planned in CY 2016, and 263,600 opioid admissions had MAT planned in CY 2017. MAT data for CY 2018 will be available in 2020. SAMHSA will continue to monitor the use of MAT in CY 2018, 2019, and 2020.
Increase the availability of electronic clinical decision support tools related to safe pain management and opioid prescribing (Lead Agency - AHRQ; Measure ID - 2.3.8)
|FY 2018||Develop at least one new electronic clinical decision support tool related to safe pain management and opioid prescribing.||Developed and tested a dashboard that aggregates pain-related information into one consolidated view for clinicians. Information includes data such as pain medications, pain assessments, pain-related diagnoses, and relevant lab test results.||Target Met|
|FY 2019||1) Test, revise, and disseminate at least one new electronic clinical decision tool related to safe pain management and opioid prescribing and
2) Partner with stakeholders to identify additional evidence-based electronic clinical decision tools related to safe pain management and opioid prescribing and make them publicly available.
|Worked with CDC to test, revise, and disseminate two opioid clinical decision support (CDS) tools using the Connect web platform||Target Met|
|FY 2020||Develop, test, and disseminate at least one electronic clinical decision support tool related to opioids or safe chronic pain management.||09/30/20||In Progress|
|FY 2021||Evaluate electronic clinical decision support tools related to chronic pain management and disseminate the results of the evaluation||09/30/21||Not Started|
Addressing the nation's opioid epidemic is an ongoing focus of AHRQ's Health Services Research, Data, and Dissemination portfolio. In FY 2017, AHRQ launched a new initiative to ensure that health care professionals have access to evidence supporting safe pain management and opioid prescribing at the point of care through electronic CDS. CDS Connect is the infrastructure for developing and sharing these CDS tools.23
In FY 2018, AHRQ developed a dashboard that aggregates pain-related information from the Electronic Health Records (EHR) into one consolidated view for clinicians. The information includes data such as pain medications, pain assessments, relevant diagnoses, and lab test results. ARHQ tested the dashboard in partnership with Oregon Community Health Information Network, a network of community health centers. The dashboard uses the Health Level Seven Fast Healthcare Interoperability Resources standard, which allows for interoperability and implementation in different EHRs.
In FY 2019, AHRQ disseminated safe pain management and opioid-related CDS tools through CDS Connect. These tools included the pain management dashboard developed in FY 2018. AHRQ continued to present its work in CDS at national meetings of key organizations, such as the American Medical Informatics Association and the Healthcare Information and Management Systems Society.
In FY 2020, AHRQ will develop and test clinician and patient-facing CDS applications for chronic pain management. AHRQ will disseminate the new CDS through AHRQ's CDS Connect platform. In FY 2021, each of the CDS applications will undergo evaluations of their development and dissemination for chronic pain management. AHRQ will conduct a separate evaluation of the agency's overall CDS initiative.
By 2020, evaluate the efficacy of new or refined interventions to treat opioid use disorders (OUD) (Lead Agency - NIH; Measure ID - SRO-4.9)
|FY 2018||Initiate at least one study to improve identification of OUD or evaluate the comparative effectiveness of available pharmacotherapies for OUD treatment.||A Phase 3 clinical trial to test a non-opioid medication for managing symptoms of opioid withdrawal was completed.||Target Met|
|FY 2019||Conduct one preclinical study and one clinical trial to develop non-opioid based medications to treat OUD that may avoid the risks of opioid dependence and overdose.||A pre-clinical study of a novel opiate withdrawal therapy was conducted, and a clinical trial of a therapy for both opioid withdrawal and associated insomnia was also conducted.||Target Met|
|FY 2020||Conduct one pre-clinical and one clinical study of a longer acting formulation of a medication for the treatment of opioid use disorders or opioid overdose.||12/31/20||In Progress|
The misuse of and addiction to opioids such as heroin and prescription pain medicines is a serious national problem. This issue has become a public health epidemic with devastating consequences, which include increases in OUDs and related fatalities from overdoses; rising incidence of newborns who experience neonatal abstinence syndrome because their mothers used these substances during pregnancy; and increases in the spread of infectious diseases, such as HIV and hepatitis C. This measure highlights one facet of NIH-funded research in providing scientific evidence to inform the public health response to the opioid crisis.
In FY 2019, a research team established that a novel chemical compound, known as ITI-333, shows promise as an OUD medication with low abuse potential. The research team is now completing additional tests in order to secure FDA approval to begin evaluating ITI-333 in humans. Also in FY 2019, another research team began studying suvorexant as a treatment for opioid withdrawal and insomnia in OUD patients. Suvorexant is an approved drug for insomnia. Preliminary evidence also suggests that the type of brain cells targeted by suvorexant may play a role in addiction itself. Suvorexant has the potential to lessen withdrawal symptoms and sleep problems that occur during supervised opioid withdrawal (detoxification). These problems often lead OUD patients to drop out of addiction treatment programs. If proven effective, suvorexant is expected to increase the likelihood of OUD patients completing addiction treatment.
In FY 2020, NIH is supporting research on a longer-acting formulation of a medication for treating OUD or opioid overdose. Although this measure is scheduled to discontinue beginning in FY 2021, the search for new or improved strategies for treating OUD will remain a top priority for NIH.
Increase the percentage of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year receiving treatment for depression (Lead Agency - SAMHSA; Measure ID - 2.3.19O) 24
|CY 2014||CY 2015||CY 2016||CY 2017||CY 2018||CY 2019||CY 2020||CY 2021|
|Status||N/A||N/A||Actual||Actual||Target Not Met||Pending||Pending||Pending|
With states and the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) driving efforts to address the needs of children and youth with serious emotional disturbances, SAMHSA expects to see increases in the percentage of youth with a past year major depressive episode who receive mental health treatment. The National Survey on Drug Use and Health (NSDUH) defines treatment for depression as 1) Seeing or talking to a medical doctor or other professional, or 2) Using prescription medication for depression in the past year. In CY 2017, 47.5 percent of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year received mental health treatment. SAMHSA has funded a number of programs to increase access to treatment, which include Healthy Transitions continuation grants and contracts for technical assistance and evaluation. The prevalence of receiving depression care among youth with major depressive episode and severe impairment in the past year remained stable between 2006 and 2018. In 2018, the rate was 46.9 percent, narrowly not meeting the target. In FY 2018, in addition to supporting contracts for technical assistance and evaluation, SAMHSA continued support for 14 continuation grants and supported 4 new grants. SAMHSA will work to improve this result in CY 2020 and CY 2021 by providing technical assistance to grantees and by continuing to monitor major depressive episodes in youth ages 12-17. The agency anticipates that these efforts made to improve access to services will lead to identifying reductions in the percentage of youth who report major depressive episodes.
Increase the percentage of adults with Serious Mental Illness (SMI) receiving mental health services (Lead Agency - SAMHSA; Measure ID - 2.3.19L) 25
|CY 2014||CY 2015||CY 2016||CY 2017||CY 2018||CY 2019||CY 2020||CY 2021|
With states and ISMICC driving efforts to address the needs of individuals with serious mental illness (SMI), SAMHSA expects to see increases in the percentage of adults with SMI who receive mental health services.26 The most recent NSDUH data available show that in CY 2017, 66.7 percent of adults aged 18 or older with SMI received mental health services in the past year. For this measure, SAMHSA defines mental health services as inpatient treatment/counseling, outpatient treatment/counseling, or the use of prescription medication for mental health problems. In CY 2020 and CY 2021, SAMHSA will continue to provide guidance to agencies on how to administer mental health services to individuals with SMI. Federal efforts, including ISMICC, discretionary grant programs, and SAMHSA's Clinical Support Services for SMI Technical Assistance Center will enable agencies to provide coordinated efforts and resources to individuals with SMI.
HHS FY 2020-2021 Agency Priority Goals
The HHS FY 2020-2021 APGs support multiple objectives across the HHS Strategic Plan. For presentation purposes, the Department has chosen to display these APGs under their most closely aligned strategic objectives. For more information on this goal, go to Performance.gov.
Reducing Opioid Morbidity and Mortality. Reduce opioid-related morbidity and mortality through: 1) improving access to prevention, treatment and recovery support services; 2) targeting the availability and distribution of overdose-reversing drugs; 3) strengthening public health data and reporting; 4) supporting cutting-edge research; and 5) advancing the practice of pain management. Starting from the baseline of September 30, 2019, by September 30, 2021:
- Treatment—Increase uptake of medications for the treatment of opioid use disorder:
- By 15 percent the number of unique patients receiving prescriptions for buprenorphine in U.S. outpatient retail pharmacies (excluding implantable or long-acting injection products).
- By 100 percent the number of prescriptions for long-acting injectable or implantable buprenorphine from retail, long-term care, and mail-order pharmacies in the U.S.
- By 25 percent the number of prescriptions for extended-released naltrexone from retail, long-term care, and mail-order pharmacies in the U.S.
- By 57 percent the number of providers with a DATA 2000 waiver authorizing buprenorphine prescribing for opioid use disorder treatment.
- Overdose intervention—Increase availability and access to overdose-reversing drugs:
- By 50 percent the number of prescriptions dispensed for naloxone in U.S. outpatient retail and mail-order pharmacies.
21 TEDS Annual Report, which is based on calendar year data, can be found at: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/TEDS-2017.pdf
22 MAT consists of provision of methadone, buprenorphine or extended-release naltrexone, in combination with counseling and behavioral therapies. TEDS is a compilation of client-level data routinely collected by the individual state administrative data systems to monitor their substance use treatment systems. TEDS records do not represent individuals; rather, each record represents a treatment episode. Thus, an individual admitted to treatment twice within a calendar year counts as two admissions. TEDS does not include all substance use treatments. It includes treatment admissions and discharges at facilities licensed or certified by a state substance abuse agency to provide care for people with a substance use disorder (or at facilities that are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including federal block grant funds) for the provision of alcohol and/or drug treatment services.
24 NSDUH full 2017 report available at https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH.
26 In NSDUH, SMI is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. SMI was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition—Research Version—Axis I Disorders (MHSS-SCID) which is based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). These mental illness estimates are based on a predictive model. Additionally, 'Mental Health Services' in the NSDUH is defined as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.