STR grants: How one physician in rural Florida is trying to help

If the State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) grants are like an elephant — large, especially relative to funding for addiction treatment in general — they are also almost impossible to generalize about. But seeing one piece in context of the whole is essential in trying to find out where the money is actually going. The money goes to the single state authority (SSA) in charge of the Substance Abuse Prevention and Treatment (SAPT) block grant in each state, the person who knows most about what is needed in that state. The funding comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants added $2 billion‐plus to addiction treatment services for opioid use disorders for four years — and many expect this number to be doubled. For perspective, the entire SAPT block grant is under $2 billion and has been for decades.     

What does $8 billion for coronavirus say about opioid funding?

Last week, Congress gave $8 billion to the fight against coronavirus, seemingly overnight. Certainly, compared to the extra $2 billion a year for addressing the opioid epidemic, the money came much faster. It took years for the State Targeted Response to the Opioid Crisis (STR) grant to be included, as it was in the Cures Act passed by Congress in 2016 and signed into law by President Obama in December of that year. The State Opioid Response (SOR) grants continue. How did the coronavirus $8 billion — $6 billion more than the White House had asked for — materialize so quickly? We asked two Capitol Hill experts.     

Sign‐on letter for SAPT increase due March 20

Representatives Paul Tonko (D‐New York) and Brian Fitzpatrick (R‐Pennsylvania) need signatures for their letter to the House Appropriations Committee urging a $500 million increase for the Substance Abuse Prevention and Treatment (SAPT) block grant in fiscal year 2020. “This funding stream serves as the cornerstone of States' substance abuse treatment, prevention, and recovery systems,” states the letter. “SAPT Block Grant funds, which are distributed by formula to all States and Territories, provide lifesaving treatment services to approximately 1.5 million individuals per year. In some States, the SAPT investment accounts for 100 percent of substance use prevention dollars. Unfortunately, SAPT Block Grant funding has not kept up with inflation, resulting in a 24 percent—or $444 million—decrease in actual funding since 2009.” The block grant has been just over $2 billion for decades. The letter requests that legislators fund just over $2.358 million for the SAPT block grant, which is equal to what the House of Representatives approved in the FY2019 Labor‐Health and Human Services Appropriations legislation and a $500 million increase over current funding levels. To sign on to the letter, contact Jeff Morgan in Rep. Tonko's office at jeff.morgan@mail.house.gov or Joseph Knowles in Rep. Fitzpatrick's office at joseph.knowles@mail.house.gov .     

Shatterproof on its rating pilot for SUD treatment programs

Shatterproof launched its rating system for addiction treatment programs with a $5 million pilot, the company announced in December, with funding coming mainly from insurance companies and grants (see ADAW, Jan. 14). The project began a year ago (see ADAW, Jan. 15, 2018) but is now moving forward. ADAW caught up with Sam Arsenault, director of national treatment quality initiatives for Shatterproof, last week about the project.     

Transitioning SOR to the SAPT BG: Why not?

It's time to think about transitioning the State Opioid Response (SOR) grants to the Substance Abuse Prevention and Treatment (SAPT) block grant, Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), told the House Energy and Commerce Committee at its March 3 hearing on opioid legislation. The STR and SOR grants went directly to single state authorities (SSAs) in charge of the SAPT block grants — NASADAD members — so this makes perfect sense. These are the officials who best know how funding should be spent in their states — on what substances, including alcohol. Instead of having a designated amount set up for opioids — although that was expanded to include stimulants as well (see “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” ADAW, Dec. 23, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ) — each SSA should just have this funding added permanently to the block grant.     

Briefly Noted

The National Institutes of Health (NIH) will award 12 grants to form the Justice Community Opioid Innovation Network (JCOIN) to support research on quality addiction treatment for opioid use disorder (OUD) in criminal justice settings nationwide, with a total of $155 million from the National Institute on Drug Abuse. One focus will be on finding new medications. There will be 10 research institutions and two centers. JCOIN is part of the NIH HEAL (Helping to End Addiction Long‐term) initiative launched last year. Funded institutions and the site locations are: the New York State Psychiatric Institute (New York), Baystate Medical Center (Massachusetts), Friends Research Institute Inc. (Maryland), Texas Christian University (Illinois, New Mexico, Texas), the New York University School of Medicine (Connecticut, Delaware, New Hampshire, New York, Oregon), Brown University (North Carolina, Pennsylvania, Rhode Island), the University of Chicago (Illinois), Chestnut Health Systems Inc. (Illinois), the University of Kentucky (Kentucky), and Yale University (Connecticut, Minnesota, New York, North Carolina, Puerto Rico). George Mason University in Fairfax, Virginia, will serve as the JCOIN coordination and translation center. For more information, go to https://www.nih.gov/research‐training/medical‐research‐initiatives/heal‐initiative/justice‐community‐opioid‐innovation‐network .     

State profiles on STR and SOR spending released by NASADAD

The Substance Abuse and Mental Health Services Administration (SAMHSA) is keeping its evaluations under wraps, but the National Association of State Alcohol and Drug Abuse Directors (NASADAD) has released a state‐specific list of how the State Targeted Response to the Opioid Crisis (STR) and State Opioid Response (SOR) grants are being spent.     

How STR and SOR grants helped ‘Dark Ages’ rural Iowa add MAT

The State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration have helped rural Iowa tremendously, by increasing the capacity for treatment with methadone and buprenorphine.     

Briefly Noted

By the time this issue of ADAW is published, the final figures will be out. At press time, some $400 million in a $2 trillion stimulus package designed to combat economic problems from the coronavirus pandemic is going to the Substance Abuse and Mental Health Services Administration, according to Andrew Kessler, principal with Slingshot Solutions. Both the Senate and House versions allocated $400 million. The Senate bill proposed $425 million, while the House proposed $435 million. In both bills, $15 million goes to the Indian Health Service and $50 million to suicide prevention. In the Senate bill, $250 million is allocated to certified community behavioral health clinics (CCBHCs), while that number is $200 million in the House version. These clinics currently exist in only eight states, Kessler pointed out. The CCBHC money will allow states to apply for grants and put forth their own behavioral health priorities, said Kessler. Watch next week's issue for details.     

The economic toll of intimate partner violence against women in the United States

This study provides estimates of the economic cost of intimate partner violence perpetrated against women in the US, including expenditures for medical care and mental health services, and lost productivity from injury and premature death. The analysis uses national survey data, including the National Violence Against Women Survey and the Medical Expenditure Panel Survey, to estimate costs for 1995. Intimate partner violence against women cost $5.8 billion dollars (95% confidence interval: $3.9 to $7.7 billion) in 1995, including $320 million ($136 to $503 million) for rapes, $4.2 billion ($2.4 to $6.1 billion) for physical assault, $342 million ($235 to $449 million) for stalking, and $893 million ($840 to $946 million) for murders. Updated to 2003 dollars, costs would total over $8.3 billion. Intimate partner violence is costly in the US. The potential savings from efforts to reduce this violence are substantial. More comprehensive data are needed to refine cost estimates and monitor costs over time.     

SAMHSA to write new application for new SOR with stimulants included

The addition of stimulants as an allowable use for State Opioid Response (SOR) grants will require a new application, which the Substance Abuse and Mental Health Services Administration (SAMHSA) is working on, ADAW has learned. The change was in the FY 2020 appropriations bill passed last month by Congress (see ADAW, Dec. 23, 2019; “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ), along with funding for other SAMHSA programs, including the Substance Abuse Prevention and Treatment block grant (SAPT BG). After the bill passed before Christmas, Washington went away for the holidays.     

Senators call for $2 billion in supplemental SAMHSA funding

As the fourth stimulus bill, the HEROES Act, awaits action by the Senate, 19 senators sent a letter last week to Senate and House leadership calling for increased investments in substance use disorder programs during the COVID‐19 pandemic. The letter, from Senators Tammy Baldwin (D‐Wisconsin) and Jeanne Shaheen (D‐New Hampshire), along with 17 other senators (all Democrats), calls for “$2 billion in funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) to administer supplemental grant allocations under the Substance Abuse Prevention and Treatment (SAPT) Block Grant program and the State Opioid Response (SOR) grant program.”     

FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion

Appropriations bills for FY 2020 released last week detail some good news for the field. In the State Opioid Response (SOR) grants, there would be more flexibility: specifically, these could be used for stimulants.     

NASADAD calls for nominations for annual SSA award

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) is requesting nominations for the annual Ramstad/Kennedy Award, presented to a single state agency (SSA) — the state director who is responsible for the Substance Abuse Prevention and Treatment block grant (and STR and SOR grants, now).     

HHS OIG doubles down on constraints against contingency management

Stimulant use disorders are on the rise resulting in exacerbation of the opioid epidemic, with stimulants often present in opioid overdoses.. Subcontractors are lining up to implement the new stimulant use disorder treatment provisions of the $1 billion annual State Opioid Response (SOR) federal grant program. And contingency management (CM), in which patients are given monetary rewards for not using drugs, is the best — by far — treatment for stimulant use disorder.     

White House budget request decimates substance use prevention

The White House budget request for fiscal year 2021 for the Substance Abuse and Mental Health Services Administration (SAMHSA) proposes to zero out a major prevention program — the Strategic Prevention Framework State Incentive Grant — Partnerships for Success program. This is a cut of $109 million. It recommends using the prevention set‐aside (20%) from the Substance Abuse Prevention and Treatment (SAPT) block grant instead. But it doesn't give any more money to the block grant.     

Impacts of Long-Range Increases in the Fuel Economy (CAFE) Standard

This work models the impact of higher CAFE standards on producer and consumer welfare, gasoline consumption, externalities from increased driving, and the emissions of traditional pollutants. In particular, a long-run 3.0 MPG increase in the CAFE standard is estimated to impose welfare losses of about $4 billion per year and save about 5.2 billion gallons of gasoline per year, for a hidden tax of $0.78 per gallon conserved. An 11-cent-per-gallon increase in the gasoline tax would save the same amount of fuel at a welfare cost of about $290 million per year, or about one-fourteenth the cost. (JEL L51 , Q30 )     

Analysis of Australian Research Council Grants Awarded for Social Work Projects 2008–2017

ABSTRACT

The quantity and quality of social work research is central to creating knowledge for the profession and maintaining social work’s presence and status in universities. This study examines Australian Research Council grants awarded for social work projects for the 10-year period 2008–2107. It investigates the quantum of grants and the topics addressed, and compares social work to related social sciences. The field of social work was awarded 84 research grants over the 10-year period, a total of $23 million and an average of 8.4 grants per year. However, this did not match the grant successes of the two comparator fields of criminology and social policy and administration. Having a clear picture of research achievements, including grants, is necessary to enable the discipline to plot a strategic way forward, addressing gaps and deficits, and building on strengths.

IMPLICATIONS

• Increasing research grant success is vital to the ongoing development of the social work knowledge base, and bolsters the standing of social work in universities.

• Maximising the use of social work Field of Research codes will increase the visibility of social work research, especially in multidisciplinary projects.

• Social work researchers should publicise competitive grant successes

     

More than a funder,the SSA needs community providers

The Single State Authority — SSA — is an office, but, in reality, is actually a person. This person is in charge of the ongoing Substance Abuse Prevention and Treatment (SAPT) block grant. There is one in every state. This person is also in charge of the STR and SOR grants for opioid use disorder treatment. For this story, we interviewed four longtime former SSAs about their lessons learned and their advice to new SSAs in a role that is in the spotlight both within state government and in the community, as billions of new dollars flow out to their systems. Each SSA is a member of the National Association of State Alcohol and Drug Abuse Directors (NASADAD).     

NASADAD: The view from SAMHSA,from a state and from CMS

Last week, state directors and other attendees of the annual meeting of the National Association of Alcohol and Drug Abuse Directors (NASADAD) were treated to a stunning opening reception by the delegation from Hawaii, including entertaining, dancing, music and delicious food. The next morning, they heard from federal and state officials about important issues they are dealing with — starting with how to use the STR and SOR grants.