2023 List of Accomplishments: Biden-Harris Administration Marks Two Years of Advancements in HHS’ Overdose Prevention Strategy with New Actions to Treat Addiction and Save Lives

Today, the U.S. Department of Health and Human Services (HHS) marked two years of its Overdose Prevention Strategy (Strategy) by announcing bold new actions to combat overdoses. These actions include finalizing a rule that will dramatically expand access to life-saving medications for opioid use disorder, announcing that certain grant funds may now be used to purchase xylazine test strips (XTS), and releasing the Substance Abuse and Mental Health Services Administration’s (SAMHSA) updated Overdose Prevention and Response Toolkit. Actions announced today build on President Biden’s National Drug Control Strategy and his Unity Agenda call-to-action to address the overdose epidemic and save lives.

The following is a list of accomplishments in 2023:

Total Investment

In FY2023, the Administration invested nearly $8 billion in programs supporting the Overdose Prevention Strategy across the Department of Health and Human Services (HHS).

Prevention

• Chronic Pain Activities. The Centers for Medicare & Medicaid Services (CMS) finalized new payment codes in Medicare for monthly chronic pain management and treatment services that support behavioral health, effective January 1, 2023. CMS also finalized separate payment in the Ambulatory Surgical Center setting for five non-opioid pain management drugs that function as surgical supplies starting in 2023. CMS also issued guidance to states describing how states may increase coverage of non-opioid pain management treatments. CMS and the National Institutes of Health (NIH) partnered on a new web page for professionals for pain management assessment resources.
• SAMHSA’s Strategic Prevention Framework – Partnerships for Success grant program (SPF-PFS). The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $42.6 million in new funding to 17 states and 60 communities (located across 33 states) to focus on preventing substance use initiation and reducing the progression of substance use and related problems by supporting the development and delivery of state and community substance use prevention and mental health promotion strategies. In addition to this new funding, SAMHSA provided over $60 million in continuation funding to prior cohorts of the SPF-PFS program.
• Primary Prevention. Through the Substance Use Prevention, Treatment, and Recovery Support Services Block Grant prevention set-aside, SAMHSA provided nearly $400 million dollars to support primary prevention. With this funding, states are required to develop a comprehensive primary prevention program that includes activities and services provided in a variety of settings. The program must target both the general population and subgroups that are at high risk for substance use, including universal, selective, and indicated prevention strategies.
• Rx Awareness Campaign. This Centers for Disease Control and Prevention (CDC) campaign tells the stories of people whose lives have been impacted by prescription opioid misuse and overdose. The goals of the campaign are to increase awareness that prescription opioids can be addictive and dangerous, and to reinforce that help is available for those suffering from an opioid use disorder (OUD). In 2023, CDC captured more real stories to add to the campaign. The new stories focused on audiences hit especially hard by the opioid overdose epidemic, including pregnant women, veterans, younger adults (25-to-34-year-olds), older adults (45-to-54-year-olds), and American Indians/Alaska Natives.
• Stop Overdose Campaigns. In addition to Rx Awareness, CDC also amplified messages related to naloxone and fentanyl through its Stop Overdose campaigns. The campaign continued to reach intended audiences and educate them on substance-use related harms. Video-completion rates consistently exceeded government benchmarks. Website clicks increased during this same period. The campaign has received nearly 3 billion total impressions since its August 2021 launch. The media plan has delivered over 690 million impressions and nearly $20 million dollars in donated support. That equates to a return on investment of $78.83 for every dollar invested into media.
• Community Guide Review on Substance Use: Family-based Interventions to Prevent Substance Use Among Youth. CDC funded the Community Preventive Services Task Force (CPSTF) systematic review for family-based interventions to prevent substance use among youth. Evidence from this review of 60 studies showed interventions reduced initiation and use of cannabis, alcohol, tobacco, illicit substances, and misuse of prescription drugs among youth. Studies also reported reductions in sexual risk behaviors and improvements in mental health symptoms and school-related outcomes.
• DFC Application Increase. In 2023, the Drug-Free Communities (DFC) program saw an increase in the number of FY23 applicants (207) compared to FY22 (163). In fiscal year 2023 (September 2023 – September 2024), 750 DFC coalitions across the United States received funding. Coalitions implemented programs like Trumbull County’s Let’s Talk Mental Health, Trumbull initiative to encourage connection, provide support, and promote social/emotional health among Connecticut youth living in their community.
• Opioid Labeling Updates. The Food and Drug Administration (FDA) issued a Drug Safety Communication and a statement announcing several updates to the prescribing information for opioid analgesics. The updates also included a new warning about opioid-induced hyperalgesia, a condition where opioids cause an increase in pain (hyperalgesia) or an increased sensitivity to pain (allodynia).
• Stimulant Labeling Updates. FDA issued a Drug Safety Communication and a statement announcing updates for amphetamine and methylphenidate products, a class of stimulant medications used to treat attention deficit/hyperactivity disorder (ADHD) and other disorders, to standardize prescribing information. The updates were intended to inform patients, caregivers, and healthcare professionals of risks associated with their medications.
• Additional Opioid Analgesic Disposal Option. FDA announced the requirement for manufacturers of opioid analgesics dispensed in outpatient settings to make prepaid mail-back envelopes available to outpatient pharmacies and other dispensers as an additional opioid analgesic disposal option for patients. Additionally, as part of FDA’s comprehensive approach to expand impactful opioid disposal options, FDA participated in the National Academies of Sciences, Engineering, and Medicine’s public workshop on defining and evaluating in-home drug disposal systems for opioid analgesics.
• CDC MMWR – Counterfeit Pills. CDC released a September 2023 Morbidity and Mortality Weekly Report (MMWR) that shared information on overdose deaths associated with counterfeit pills. The MMWR called for overdose prevention messaging that highlights the dangers of pills obtained illicitly or without a prescription, and was tailored to persons most at risk.
• SAMHSA’s Youth Fentanyl Awareness Prize Challenge. In this Prize Challenge, SAMHSA sought the best ideas from U.S. youth, aged 14-18, on a community strategy to get the message out to other youth on raising awareness, education and prevention around the dangers of fentanyl, especially the hidden dangers with fake pills and other contaminants that can lead to drug overdose deaths. It is important that the dangers of illicit fentanyl in general and fake pills in particular be communicated with all youth to help prevent associated risks, and steps that can be taken to reduce risk (e.g., have naloxone and know how to use it). These messages will resonate with youth if they come from a trusted resource, like other youth. SAMHSA sought a video submission that pitched and demonstrated an idea which could include any innovative ways to reach youth like social media posts, vlogs, podcasts, video journals, etc.
• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain. Since initial publication in 2022, the Guideline website has been visited over half a million times, and CDC has developed a suite of eight new trainings and over 24 additional translation resources to help appropriately implement the Guideline, including an academic detailing guide. In addition, CDC released new publications related to chronic pain, including:
  • Prevalence of Pharmacologic and Nonpharmacologic Pain Management Therapies Among Adults with Chronic Pain – United States, 2020 | Annals of Internal Medicine (acpjournals.org)
  • Chronic Pain Among Adults – United States, 2019–2021 | MMWR (cdc.gov)
• Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders: A Study Supported by The National Institute on Drug Abuse (NIDA), SAMHSA and CDC. NIDA, SAMHSA and the CDC are supporting a National Academies of Science, Engineering, and Medicine consensus study to provide a roadmap of steps needed to develop and finance a sustainable prevention infrastructure at the national and/or state level for implementing evidence-based interventions for preventing psychiatric disorders like addiction.
• NIDA's Substance Use Prevention Services in Primary Care Challenge. In August 2023, NIDA selected three winners of a Primary Care Challenge to generate ideas for how primary care practices can more effectively identify people at risk for substance use or misuse and prevent substance use initiation and escalation of misuse to substance use disorders. Winning submissions included proposed models of substance use screening and prevention services (or referral to those services) for adults who have been incarcerated, in pediatric clinics, and for youth via peer-led mental healthcare.
• The NIH Helping to End Addiction Long-term (NIH HEAL) Prevention Initiative. Led by NIDA, the NIH HEAL Preventing Opioid Use Disorder (OUD) Research Program continued funding a variety of research projects in 2023 addressing four strategic areas: identifying risk; studying the role of social determinants and policy, particularly their impacts on health equity; developing effective interventions; and supporting research toward disseminating and implementing sustainable, scalable prevention services. Launched in 2019, research under this program focuses on underserved populations that experience health disparities.

Harm reduction

• New Overdose Reversal Agent Approvals. FDA approved the first-ever branded over-the-counter naloxone nasal spray and the first-ever generic over-the-counter naloxone nasal spray, and subsequently the second branded over-the-counter naloxone nasal spray.
  
  The FDA also approved Opvee, the first nalmefene hydrochloride nasal spray, developed with funding from NIDA, for the emergency treatment of known or suspected opioid overdose in adults and pediatric patients 12 years of age and older.
• Xylazine Alerts and Communication. FDA issued an alert to healthcare professionals warning of possible xylazine inclusion in fentanyl, heroin, and other illicit drug overdoses; announced an action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the United States; and held a workshop on mitigating risks from human xylazine exposure. CDC released resources related to xylazine, including recent data as well as a Frequently Asked Questions page.
• CDC Xylazine Resources and Data. CDC published new data on xylazine-involved overdose deaths occurring among 21 jurisdictions, highlighting the need for routine toxicology testing for xylazine in suspected overdose cases and further investigation of xylazine’s potency and effects on humans. CDC also published additional resources to increase awareness of xylazine in the illicit drug supply as well as resources for care and treatment.
• Naloxone Saturation Plan Policy Academy and All-State Learning Collaboratives. SAMHSA received plans from all 50 States, the District of Columbia, Puerto Rico, and Guam for how they aimed to saturate their communities with naloxone. SAMSHA worked closely with states to help operationalize and adapt their Naloxone Saturation Plans in the context of the evolving overdose epidemic. As a part of this work, SAMHSA, in collaboration with NASADAD, held a 2-day virtual learning community with all 50 states in January 2023 to learn about naloxone saturation models and hear from their peers about innovative naloxone distribution efforts. In addition, SAMHSA, in coordination with CDC, NASADAD, and ASTHO, kicked off a policy academy with 10 states in July 2023 to dig deeper into their saturation plans.
  
  On November 6, SAMHSA held an all-state virtual convening to share information from other federal partners and exemplar states participating in the SAMHSA naloxone saturation policy academy, and to launch a new virtual learning collaborative. Under this learning collaborative SAMHSA will convene a virtual meeting every other month to create dedicated space and time for SAMHSA to engage with state leaders and other experts on specific topical challenges and successes related to expanding naloxone and other opioid overdose reversal medications, to identify emerging issues and technical assistance needs, and to provide for shared solutions and learning across states. 
• FDA/NIH leadership commentary on drug checking and screening. In a commentary in the New England Journal of Medicine, leaders at the NIH/NIDA and FDA highlighted the urgent need to address current gaps in the research, development, and implementation of fentanyl test strips and other rapid drug-detecting tools that could help prevent overdose deaths. These tools have the potential to save lives and to serve as an important part of harm reduction toolkits but often remain inaccessible because of gaps in research and various other barriers, including state or legal prohibitions.
• CDC Fentalog Study Dashboard. CDC leveraged Toxicology Investigators Consortium (ToxIC) data to provide provides estimates of substances detected in samples from patients experiencing a suspected opioid-involved overdose. These data can be used in combination with nonfatal drug overdose data from the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) system to improve understanding of drug use patterns in nonfatal overdoses.
• Fentanyl Test Strip Research. A major risk of drug use is the potential for overdose from adulterated drugs with fentanyl or other emerging synthetic drugs. Detecting fentanyl in drugs is difficult, and an individual may not know it is present in their drug supply. HHS has announced that funds from certain federal grants can now be used to purchase fentanyl test strips. Currently, NIH and FDA support research to investigate how fentanyl test strips may impact drug use behaviors.¹
• Toolkit for School Nurses. NIDA collaborated with the National Association of School Nurses to create a toolkit to help school nurses stock and use naloxone in schools to prevent fatalities from overdose.
• Integrating Harm Reduction Strategies into YA Services. ACF released a brief on integrating harm reduction strategies into services for young adults experiencing homelessness.
• Naloxone in Public Housing. To improve access to overdose reversal agents in public housing agencies (PHAs), HHS and the U.S. Department of Housing and Urban Development (HUD) worked together on a fact sheet and a joint letter. The fact sheet outlined the ways in which PHAs can make overdose reversal agents available to residents both on and off premises. The joint letter called upon the public health sector and HUD grantees to work together to make naloxone and other overdose reversal agents available.
• Addition of ORAs to AEDs.The Office of the Assistant Secretary for Health (OASH) and the General Services Administration (GSA) jointly issued the Federal Management Regulation (FMR) “Safety Station Program Guidelines in Federal Facilities” in the December 2023 Federal Register. This collaborative effort will result in the implementation of a comprehensive safety station program for all federal facilities (both GSA owned and leased) to add 1) hemorrhagic control equipment (Stop the Bleed Kits) and 2) opioid reversal agent supplies, along with existing AED units. These guidelines provided the first update to the “Guidelines for Public Access Defibrillation Programs in Federal Facilities” since 2009, which is when AEDs where originally added to federal facilities. This safety station program is an OASH design, currently being used in both the Rockville Tower Building and the Hubert H. Humphrey Building.
• Overdose Response Strategy (ORS) Pilot Projects. To build the evidence base for promising practices in opioid overdose prevention, CDC and the National Association of County and City Health Officials (NACCHO) awarded funding to 10 pilot sites in 2023 to develop and implement local projects designed to reduce overdoses. CDC provides technical support to these high need areas and works with High Intensity Drug Trafficking Areas (HIDTA) and Overdose Response Strategy (ORS) Public Health Analysts (PHAs) and Drug Intelligence Officers (DIOs) to ensure that the pilot projects are smoothly implemented and that their progress and impact are monitored effectively. The North Carolina Harm Reduction Coalition (NCHRC) received funding to continue, and expand upon, its jail-based overdose prevention education and naloxone distribution project.
• Grants
  • SAMHSA provided a second year of funding to its Harm Reduction Program grantees, and continues to provide intensive technical assistance to help advance the goals outlined in program.
  • SAMHSA also awarded new funding to support overdose prevention activities and expand access to naloxone and other overdose prevention strategies through three additional discretionary grant programs: FR-CARA, Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO) and Improving Access to Overdose Treatment (ODTA) program.
  • Harm Reduction Grants. Consistent with governing statutory authority, and applicable federal, state, and local law, CDC funded 65 harm reduction programs across 31 jurisdictions via the CDC-supported funding opportunity, Strengthening Syringe Service Programs. This opportunity was used to expand the reach of SSPs and harm reduction services across the United States to prevent infectious consequences of injection drug use and overdose. For example, the Illinois Department of Public Health (IDPH) used OD2A funding to support five harm reduction organizations and two county health departments in seven regions of the state with the highest opioid overdose death counts.
  • Flexibilities for Grantees. CDC Overdose Data to Action (OD2A) awardees were given flexibility to purchase naloxone in Year 4 of the program. Approximately 35% of awardees chose to leverage this flexibility over the last year, amounting to roughly $11 million. This helped fill an acute public health need to increase naloxone in high-burden communities, particularly through local community health departments.  
    
    Similarly, 23 CDC OD2A awardees implemented activities involving fentanyl test strips over the past year, providing important information about fentanyl in the illicit drug supply so they can take steps to reduce overdose.
    
    CDC’s 2023 Overdose Data to Action program was launched in September 2023 and will fund 90 jurisdictions to improve surveillance and prevention efforts, including drug checking. This can advance the type of work done under The Massachusetts Drug Supply Data Stream, which was developed to learn more about the local illicit drug supply to better inform public health and public safety responses.
• NIDA Launched the Harm Reduction Research Network. With funding from the NIH HEAL initiative, the Harm Reduction Research Network was launched in late 2022 to address the U.S. overdose epidemic. The coordinated research network will build on existing research and test harm reduction strategies in different community settings that will inform efforts to help save lives. The network represents the largest pool of funding from NIH to date for research on harm reduction strategies to address overdose deaths.

Treatment

• Elimination of the X waiver. Section 1262 of the Consolidated Appropriations Act, 2023, eliminated the requirement for practitioners to submit a Notice of Intent (i.e., have a waiver) to prescribe medications, like buprenorphine, for the treatment of opioid use disorder. SAMHSA and DEA coordinated workplans and communications to resolve outstanding issues related to the elimination of the X waiver.   
  • The DEA sent a ‘Dear Prescriber Letter’ to all registrants.
  • SAMHSA and DEA coordinated on outreach regarding the passage of MAT and MATE (sections 1262 and 1263 of the Consolidated Appropriations Act, 2023).
    • SAMHSA and DEA hosted a webinar on the removal of the X waiver and SUD training requirements.
    • SAMHSA and DEA hosted more than 20 public presentations and/ stakeholder meetings on MAT/MATE.
    • SAMHSA participated in the American Academy of Addiction Psychiatrists podcast on MAT/MATE.
    • SAMHSA supported Provider Clinical Support System with $1.5 million dollars to provide training and technical assistance (TA).
  • SAMHSA developed new publicly facing information and FAQs to address this change.
• Tele-prescribing. Since March 2020, HHS and DEA have allowed practitioners to prescribe schedule II-V controlled substances (“controlled medications”) following a telemedicine visit without conducting an initial in-person medical evaluation. Additionally, DEA has waived the requirement for practitioners to obtain a DEA registration in the state where a patient is located, as long as the practitioner is authorized to prescribe controlled medications via telemedicine in both the state in which the practitioner is registered with DEA and the state in which the patient is located. Collectively, these are referred to as the “controlled medications telemedicine flexibilities.”
  
  DEA and SAMHSA extended these telemedicine flexibilities through December 31, 2024, thus ensuring continued access to patients receiving medications for opioid use disorder (MOUD).
• CY 2023 Physician Fee Schedule. In the CY 2023 Medicare PFS, CMS finalized several policies aimed at expanding access to behavioral health services:
  • Increased Medicare payment rates to OTPs to better reflect costs of individual therapy and finalized changes to stabilize payments for treatment with methadone at OTPs. CMS also finalized that Medicare pay for buprenorphine initiation through telecommunications (rather than just in person) to improve access to care.
  • Clarified that, in line with DEA requirements, OTPs may bill Medicare for services performed by mobile units, such as vans, without obtaining a separate registration. This can improve treatment access for hard-to-reach populations, such as individuals who are homeless or who live in rural areas.
  • Finalized changes that strengthen the Medicare behavioral health workforce, so practitioners can practice to the full extent of their license. The finalized policy allows clinicians such as marriage and family therapists, licensed professional counselors, and others to furnish behavioral health services under “general,” rather than “direct” supervision when furnished “incident to” a physician or non-physician practitioner.
• CY24 Physician Fee Schedule. In 2023, CMS issued the 2024 Medicare PFS final rule, finalizing additional policies aimed at expanding access to behavioral health services:
  • New Medicare Benefit for Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC). For 2024, CMS is implementing Section 4121 of the Consolidated Appropriations Act, which provides for Medicare Part B coverage and payment under the Medicare PFS for the services of MFTs and MHCs when billed by these professionals. Additionally, CMS has finalized allowing addiction counselors that meet all of the applicable requirements to be a MHC to enroll in Medicare as MHCs. MFTs and MHCs are now able to bill Medicare for services starting January 1, 2024. CMS has also made corresponding changes to the Behavioral Health Integration codes paid under Medicare to allow MFTs and MHCs to provide integrated behavioral health care as part of primary care settings.
  • New Medicare Benefit for Intensive Outpatient Services. Medicare continues to cover inpatient psychiatric admissions, partial hospitalization programs, and outpatient therapy for behavioral health conditions and in the 2024 OPPS/ASC final rule, CMS closes this coverage gap, starting in 2024, for behavioral health by establishing payment for Intensive Outpatient Program services, which can be furnished in hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, and Rural Health Clinics, and Opioid Treatment Programs.
  • Paying More Accurately for Behavioral Health Services. Starting in 2024 CMS will apply payment adjustments topsychotherapy codes and health behavior assessment and intervention codes implemented over a 4-year transition to address potential distortions that may have occurred in valuing time-based behavioral health services in the past.
  • Services Addressing Health-Related Social Needs (Community Health Integration Services, Social Determinants of Health Risk Assessment, and Principal Illness Navigation Services). Also beginning in 2024, CMS has finalized changes to better account for resources involved in furnishing person-centered care involving a multidisciplinary team of clinical staff and other auxiliary personnel aligned with the HHS Social Determinants of Health Action Plan. These include paying for Community Health Integration, Social Determinants of Health Risk Assessment, and Principal Illness Navigation services when clinicians involve community health workers, care navigators, and peer support specialists in furnishing care.
• Expanding Access to BH providers. CMS’s 2024 Notice of Benefit and Payment Parameters final rule for the Marketplace expanded access to behavioral health by including two new provider categories: Substance Use Disorder Treatment Centers and Mental Health Facilities. CMS’ 2025 Proposed Medicare Advantage and Part D rule also proposed a new specialty type where network adequacy standards apply: “Outpatient Behavioral Health,” which will include Marriage and Family Therapists, Mental Health Counselors, Opioid Treatment Providers, and other providers who furnish behavioral health counseling or therapy services in Medicare today.
• Medicaid Program: Ensuring Access to Medicaid Services. This proposed rule takes a comprehensive approach to improving access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service (FFS), managed care delivery systems, and in-home and community-based services (HCBS) programs. These proposed improvements seek to increase transparency and accountability, standardize data and monitoring, and create opportunities for States to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care.
• Quality Core Set Reporting - Final Rule. CMS issued a final rule to require reporting starting in 2024 of standardized quality measures in Medicaid and the Children’s Health Insurance Program that finalizes requirements for three different quality measure sets, which all include behavioral health measures: 1) Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP, 2) Behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid; and 3) Core Sets of Health Home Quality Measures for Medicaid.
• Improving Treatment Access within the Criminal Legal System
  • 1115 Demonstration – Medicaid in Jails. In January 2023, CMS approved an 1115 demonstration amendment in California which allows Medicaid to cover a set of critical, pre-release SUD services to people returning home from jails and prisons. This is the first time in history Medicaid has provided coverage to justice-involved individuals before they’re released (CMS). It is a step forward in closing gaps in services this underserved community experiences, and HHS encourages other states to follow California’s lead. Washington’s section 1115 Reentry demonstration was approved in June 2023 as part of a renewal of the state’s Medicaid Transformation Project.
  • OTPs in BOP Facilities. SAMHSA partnered with DEA and the Federal Bureau of Prisons (BOP) on expanding treatment. The Federal Bureau of Prisons worked to ensure that each of their facilities are equipped and trained to provide in-house medication-assisted treatment (MAT) (White House, SOTU). In addition to an original 7 full OTPs certified within the BOP at the beginning of 2023, DEA and SAMHSA worked to convert 87 of 89 BOP medication units to full, independent OTPs.
  • NIDA's Justice Community Opioid Innovation Network (JCOIN). Funded through the NIH HEAL Initiative, JCOIN is a multisite study in 141 counties across 39 states that supports training, research capacity building, community resources, and research to expand effective opioid use disorder treatment in justice settings in partnership with local and state justice systems and community-based treatment providers. Through JCOIN, NIDA continues to study and discover approaches to improve access to high-quality, evidence-based addiction treatment in justice settings.
• Strengthening Parity (MHPAEA NPRM). The Departments of Labor, Health and Human Services, and Treasury announced an important step in addressing the nation’s mental health crisis by proposing rules to better ensure that people seeking coverage for mental health and substance use disorder care can access treatment as easily as people seeking coverage for medical treatments. These proposed rules are designed to achieve MHPAEA's purpose to ensure that participants, beneficiaries, and enrollees will not face greater restrictions on access to obtaining mental health and substance use disorder benefits than those for medical/surgical benefits.
• CDC’s Overdose Data to Action Linkage to Care Indicators. CDC’s Overdose Data to Action: LCOAL program funded city and county health departments to continue expanding innovative data efforts focused on better understanding the current and emerging drivers of stimulant overdoses. To lay the groundwork for the first linkage to care (LTC) surveillance system for SUD in the U.S., CDC funded a cohort of local health departments via OD2A: LOCAL to collect and analyze data on LTC indicators and disseminate findings to local partners. Part of this work will determine feasibility of collecting these LTC indicators and identify any essential refinements.
• The Opioid Rapid Response Program (ORRP). ORRP is an interagency, coordinated federal effort to help mitigate overdose risks among patients who lose access to a prescriber of opioids, medications for opioid use disorder, or other controlled substances, such as benzodiazepines. In FY23, the program alerted health departments about 75 actions across 30 states, with the aim of bridging access to care continuity and risk reduction for patients.
• Addiction Medicine Toolkit. CDC and the American Society of Addiction medicine created a toolkit designed to provide an introductory overview of addiction medicine for clinicians to integrate strategies into clinician practices.
• Actions to Address Stimulant-Involved Overdoses
  • Report to Congress on Contingency Management for the Treatment of SUDs. Contingency management (CM) is an evidence-based psychosocial therapy for the treatment of stimulant use disorder, as well as a variety of other substance use disorders (SUDs), that is supported by three decades of research. Despite CM’s great potential and demonstrated effectiveness in improving the health and well-being of many people with SUDs, this proven treatment remains underutilized. Expanding access to high-quality CM services for the treatment of SUDs represents an important opportunity to accelerate efforts to address the overdose epidemic, as well as the other substantial public health harms and costs related to untreated SUDs. In recognition of this opportunity, and to guide efforts by federal, state, local governments and other stakeholders, Section 4127 of the Consolidated Appropriations Act, 2023 (42 U.S.C. § 1320a-7d(a)(3)(B)), included a requirement for the Secretary of Health and Human Services and the Inspector General to “submit to Congress recommendations... for improving access to evidence-based contingency management interventions while ensuring quality of care, ensuring fidelity to evidence-based practices, and including strong program integrity safeguards that prevent increased waste, fraud, and abuse and prevent medically unnecessary or inappropriate items or services reimbursed in whole or in part by a federal health care program.” To respond to this provision, the HHS Workgroup on Implementation Strategies for Contingency Management prepared and transmitted a Report to Congress, which discusses opportunities and considerations for entities overseeing CM implementation, including regulators at the federal, state, Tribal, local and territorial levels; funders (e.g., grant making agencies, insurance companies); health care organizations; and health care providers.
  • SAMHSA’s Convening of Educational Experts in Contingency Management. Recognizing a need to promote robust education in evidence-based CM across clinical settings, SAMHSA’s Addiction Technology Transfer Center (ATTC), National Coordinating Office convened a meeting of experts in CM education and curriculum development in April 2023. This multipart convening resulted in a recommended curriculum that promotes evidence-based and sustainable CM programs across clinical settings. The curriculum will be rolled-out across ATTC regions. The ATTC hosted 239 trainings in 2023. A total of 1,299 people has attended the trainings since 2020.
  • OD2A Stimulant Funding. To monitor the changing nature of the stimulant-involved overdose, last summer, CDC’s Overdose Data to Action in States program provided $200M in funding to state health departments to continue expanding innovative data efforts focused on better understanding the current and emerging drivers of stimulant overdoses. CDC’s Overdose to Action: Limiting Overdose through Collaborative Actions in Localities grant program will provide an additional $80M in direct funding to local communities to use data to drive action to reduce stimulant overdose morbidity and mortality.
  • CDC Stimulant Guide. CDC published a resource to answer common questions about stimulants, stimulant use, stimulant overdose, and stimulant overdose prevention strategies developed by harm reduction experts. 
  • NIDA Research. NIDA is funding research to support drug repurposing as well as the development of novel treatments for stimulant use disorder, including medications, behavioral therapies, and neuromodulatory approaches.
• Newly Approved MOUD Formulations. FDA approved new medication formulations for substance use disorder, including an extended-release buprenorphine injection to treat moderate to severe opioid use disorder and the first generic application for naltrexone extended-release injectable suspension to treat alcohol and opioid use disorder.
• Draft Guidance for Developing Stimulant Use Disorder Treatment. FDA published a new draft guidance to assist sponsors in developing treatments for stimulant use disorders. This is part of FDA’s continued efforts to encourage the development of treatments for stimulant use disorder and novel trial designs.
• Peer Support Video. NIDA offered several videos on the intersection of drug use, overdose, and other health issues like HIV. One recent video explored how peer support plays a critical role in reaching people where they are to save lives and help folks start treatment.
• Pregnancy and Postpartum Drug Overdose Deaths. NIDA recently published a research article in JAMA Psychiatry entitled "Pregnancy and postpartum drug overdose deaths in the US before and during the COVID-19 Pandemic: Comparison with obstetric deaths and non-pregnancy-associated overdose deaths." The authors examined characteristics of how pregnant and postpartum overdose decedents aged 10-44 compared with other obstetric decedents. The research will help public health experts better understand overdose among people who are pregnant or who were recently pregnant.
• SAMHSA Advisory: Evidence-Based, Whole-Person Care for Pregnant People Who Have Opioid Use Disorder. Released in May 2023, this Advisory product outlined how healthcare providers (i.e., obstetrician-gynecologists [OB-GYNs], primary care physicians, and other professionals who treat pregnant people) can take an active role in supporting the health of pregnant individuals who have OUD and their babies.
• Mobile Crisis Work. CMS is working with states to implement state plan amendments (SPAs) to qualify for temporary enhanced federal Medicaid funding for mobile crisis intervention services, and several states were approved in 2023. SPAs in CA, DC, IN, KY, MA, MT, NY WA, WI, and WV were approved in 2023. Foundational to these approvals is a State Health Official Letter specifying the requirements for the increased federal match and also describing a number of additional ways states may support availability of crisis services for Medicaid and CHIP beneficiaries. CMS is working with states to implement these options.
• Behavioral Health in Nursing Homes. CMS identified a need to improve nursing home surveyor guidance related to meeting the unique needs of residents living with mental health needs including SUD, and updated surveyor guidance, including that facility staff have knowledge of signs and symptoms of possible substance use, and be prepared to address emergencies, such as possible overdose and contacting emergency medical services. Nursing homes are responsible for meeting all residents’ behavioral health needs. CMS also partnered with SAMHSA to fund and operate a Center of Excellence to provide behavioral health technical assistance to nursing homes for caring for individuals with serious mental illness and substance use disorders.
• Reducing Patient Burden through Education. CMS published four Customer Service Engagement illustrations on substance use disorders and the treatment of chronic pain, to help interested parties better understand the experience of living with a range of health challenges in behavioral health.
• Better Integrating Care. CMS’s Multi-State Initiative to Strengthen Primary Care will enhance access and quality of primary care and improve the health system to address priorities specific to communities including care management for chronic conditions, behavioral health services, and health care access for rural residents.
• Emergency Department Pilot Projects. The IHS Pain and Addiction Care in the Emergency Department (PACED) pilot project resulted in national American College of Emergency Physicians (ACEP) PACED accreditation for five IHS Emergency Departments. The accreditation program promotes access to naloxone and opioid overdose reversal and stabilization, enhanced care coordination activities, and supports evidence-based practices.
• SAMHSA’s Low Barrier Models of Care Advisory. This advisory, released in December 2023, outlines the principles and components of low barrier care, a strategy and approach to overcoming substantial gaps in access to, and engagement in, substance use disorder treatment. The Advisory provides real world actionable examples to overcome stigma, expand access to the continuum of harm reduction, treatment, and recovery support services, and foster retention in care.
• Medicaid Coverage of Medications to Reverse Opioid Overdose and Treat Alcohol and Opioid Use Disorders. This report, published by SAMHSA this week, provides an update on the present state of coverage, availability of, and access to, medications for treating ongoing alcohol use disorder (AUD) and opioid use disorder (OUD) and reversing an opioid overdose within state Medicaid plans. It also includes examples of innovative efforts to increase access to medications for the treatment of SUDs.
• Improving the Workforce Pipeline. In September 2023, HRSA, through the Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP), provided $40 million in direct service awards to participants working in communities where the overdose rate is higher than the national average or is in a designated mental health professional shortage area.
  
  In September 2023, HRSA, through the Behavioral Health Workforce Education and Training (BHWET) Program for Paraprofessionals, provided $14.9 million in awards to 42 organizations. This activity helps increase access to the behavioral health workforce.
• Relevant Grants
  • Demonstrations to Improve capacity of Medicaid Providers. CMS, AHRQ, and SAMHSA supported five states which launched three-year demonstrations to increase the capacity of Medicaid providers to increase access to substance use disorder (SUD) treatment and recovery services and receive reimbursement for increases in SUD services.
  • Rural Communities Opioid Response Program. In late August 2023, HRSA, through the Rural Communities Opioid Response Program, provided more than $80 million in awards to rural communities in 39 states and two territories to support key strategies to respond to the overdose risk from fentanyl and other opioids. The awards assist with expanding access to medications to treat opioid use disorder, supporting rural communities in preventing and responding to overdoses, meeting the behavioral health needs of young people, preventing and addressing neonatal exposure, and investing in and disseminating best practices. To date, RCORP has supported prevention, treatment, and recovery services in more than 1,900 rural counties across 47 states and two territories.
  • Preventing Youth Overdose: Treatment, Recovery, Education, Awareness and Training. In September 2023, SAMHSA provided $2 million to four awardees to improve local awareness among youth of risks associated with fentanyl, increase access to medications for opioid use disorder for adolescents and young adults screened for and diagnosed with opioid use disorder, and train healthcare providers, families, and school personnel on best practices for supporting children, adolescents, and young adults with OUD and those taking MOUD.
  • Portable Clinic Pilot Program. HHS, through SAMHSA, awarded $2 million through the Portable Clinical Care Pilot Project in FY23. In this program, SAMHSA aims to improve healthcare for people experiencing unsheltered homelessness while learning, through the experience of funded grant recipients, best practices for HIV, HCV, SUD, and mental health service delivery using portable clinical care. These best practices and lessons learned will be disseminated to the public following the pilot project.

Recovery

• Building Communities of Recovery Program. HHS, through SAMHSA, awarded $5.54 million to recovery community organizations under the Building Communities of Recovery program to mobilize and connect a broad base of community-based resources to increase the prevalence and quality of long-term recovery support for people with substance use disorders and co-occurring substance use and mental health issues. These grants support the development, enhancement, expansion, and delivery of recovery support services as well as the promotion of and education about recovery. These grant activities are administered and implemented by individuals with lived experience who are in recovery from SUD and co-occurring SUD and mental health issues and reflect the needs and population of the community being served.
• Workplace Supported Recovery Program. CDC’s National Institute for Occupational Safety and Health (NIOSH) published a webpage with information for employers to consider when creating a Workplace Supported Recovery (WSR) Program. They will continue to build upon that webpage with additional content and resources.  
• Recovery Support and Housing: Block Grant Guidance. SAMHSA published valuable guidance on what recovery support services may be covered via the Substance Use Block Grants. The guidance outlines several housing-related services and supports – including temporary housing assistance, deposits and costs of setting up power – which can be covered by grant funds to recovery housing organizations.
• The NIH HEAL Initiative Research Recovery Network: Through the NIH HEAL-funded Research Recovery Network, the NIH continued to support researchers, payors, providers, and people in recovery to develop infrastructure to advance the science of long-term recovery. To date, NIH has contributed $13.9 million to fund nine awards to this network. Further, NIH is conducting research to identify evidence-based best practices for recovery support services and strategies to sustain these services in communities and justice settings.

Endotes

¹  https://www.hhs.gov/overdose-prevention/harm-reduction