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.     

ONDCP issues first ‘treatment plan’: Not part of Strategy

Last week, in a surprise move, the Office of National Drug Control Policy (ONDCP) issued its first National Treatment Plan for Substance Use Disorder, along with its National Drug Control Strategy. If anyone was expecting an additional windfall like the $1 billion annual State Opioid Response grant program, it's not there.     

NASADAD releases updated timeline of STR and SOR funding

Last month, the National Association of State Alcohol and Drug Abuse Directors (NASADAD) released an updated timeline of the State Targeted Response to the Opioid Crisis (STR) and State Opioid Response (SOR) grant programs. The key dates, including when the grants were authorized, when Congress appropriated funds and when funding opportunity announcements were released by the Substance Abuse and Mental Health Services Administration, and funding award period for states are listed, as well as more information. The updated version reflects two recent developments.     

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.     

SAMHSA grantees can't use funds for medical cannabis

Some states are adjusting their contracts to the recent edict from the Substance Abuse and Mental Health Services Administration (SAMHSA) banning grantees, including Substance Abuse Prevention and Treatment (SAPT) and State Opioid Response (SOR) grantees, from.     

Using psychometric analysis to evaluate the construct validity and reliability of the Coping Response Indices

The Coping Response Indices developed by Billings and Moos (1984a) are frequently used in stress research in the social science and clinical fields. These indices were originally developed in a clinical setting using a conceptual process rather than psychometric methods. This study investigates the factorial structure of the Coping Response Indices scale using a nonclinical sample. Principal components analysis with varimax rotation yields three distinct dimensions within the scale. Considerable support is found for the conceptualization of the Coping Response Indices, as proposed by Billings and Moos. There is also some indication, however, that the conceptualization and measurement of the indices need further revision and testing, especially if they are to be used in social science research. Her research interests include economic strain, stress and coping, and child functioning in diverse family structures. She received her Ph.D. from Oregon State University. Her research focuses on vulnerable children and families, life-span caregiving issues, intergenerational relations, and prevention of child abuse and neglect. She received her Ph.D. from Oregon State University. Her research focuses on family resource management, work, stress, and families, and multiple role management. She received her Ed.D. from Utah State University.     

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.     

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.     

Texas pharmacist works with harm reduction on STR naloxone distribution

Legislatively, Texas may have its problems in addressing opioid overdoses and evidence‐based treatment, but the Texas Targeted Opioid Response (TTOR) grant, from the Opioid State Targeted Response (STR) from the Substance Abuse and Mental Health Services Administration (SAMHSA), is changing all of that. “We have amazing folks in the TTOR department at the Texas Health and Human Services department who are aggressively minded and are focused on trying to do the right things with the money,” said Lucas Hill, Pharm.D., clinical assistant professor in the University of Texas at Austin College of Pharmacy and director of Operation Naloxone, which is funded by TTOR.     

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.     

Supplemental SOR grants released to states

Last month, the federal Department of Health and Human Services (HHS) released an additional $487 million to states and territories in its State Opioid Response (SOR) grant program, bringing the 2019 total to $1.4 billion, including the $933 million in second‐year, continuation SOR grants to be provided later this year. The SOR grants increase access to medication‐assisted treatment (MAT), reduce unmet treatment need and reduce opioid‐related overdose deaths.     

Table of Contents

OSI Announces $10 Million RFP Seeking Ways to Close the Treatment Gap Grim Budget Proposal From President Bush Faces and Voices Campaign Mobilizes Voters on Several Fronts Analysis Indicates Genetic Factor Affects Naltrexone Response Topiramate Study Leads to Questions, Commentary from NIAAA Leader Briefly Noted State Watch Resources Coming up     

Table of Contents

FDA Takes First Step Toward Banning Caffeinated Alcoholic Beverages New Paradigms in Intervention: Closer Ties With Centers, Families Iowa Drug Policy Calls for Mandatory Rx Monitoring Organizing the Recovery Community SSA Indicates Changes to SA Determinations May Come in Future Legal Action Center/SAAS Response to SSA Briefly Noted State News Business News Coming up     

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.”     

Table of Contents

Block Grant Still Essential Under Health Reform, Report on Three States Shows Flexibility, Timely Response Crucial to Kaiser's Integrated Care Approach Hanley to Start Giving All Patients $600 SPECT Scans Parity Still Required in Grandfathered Plans SAMHSA/ONC: No Changes in 42 CFR Part 2 In New York, Providers Eye Cuts to Inpatient Detox Briefly Noted State News Resources Coming up     

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.     

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.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

‘Are we not [Civilized] Men?’: The Formation and Devolution of Community in Northern Mexico

Abstract The paper engages several of the issues raised by Cohn and Dirks’ statement on The Nation State, Colonialism and the Technologies of Power’ (“Beyond the Fringe’1988). It presents an account of the relationship between a community of armed peasants and the state in northern Mexico. The argument is that despite cyclic periods of coincidence and antagonism between the politico-ideological projects of state and community, an historical analysis of the experience of the people and town of Namiquipa, Chihuahua, reveals certain continuities in the forging of an alternative political-cultural space, regardless of the character of the community's relationship to the state at any time. In Mexico - as everywhere - the function of the State is the maintenance of the existing order, i.e. the maintenance of social inequality. A task for the social scientist is to document and analyse the regional strategies of the State, through the study of both the federal government and the actors who receive delegated power from it…. [T]he State apparatus is also in charge of distributing differential benefits among the population. The logic of this distribution transcends rural aspects and regional boundaries and refers to the historical dynamics of the Mexican nation, which manifests itself in the configuration of the State at different periods of time and is conditioned by the existing correlation among international forces. But from such macro-political panorama one must descend to its implications for regional development (Guillermo de la Pefia 1981: 259–260). Neither the peasants nor the State is an autonomous entity. Both are associated with other complex dependencies, with other forces and pressures. Both are stratified within and divided by interests that often contradict each other. The contradiction between the peasants and the State is not the only one in the country, and thanks to a coalition of many interests, it is not even the most apparent. However, it is the essential one in the sense that the changes that would radically and basically affect the entire situation can only be generated within it (Arturo Warman 1980:7).     

Social protection is a grassroots reality: Making the case for policy reflections on community‐based social protection actors and services in Africa

In Africa, the state is not the biggest responder to poverty and social vulnerability. While international attention has searched for State remedies to State shortfalls, the poor themselves have taken a different route. They have improvised, organized, delivered and governed their social protection (SP) services using grassroots mechanisms without State support. Based on empirical studies in 30 districts in six African countries, this article makes the case that the highly localized models may not be perfect, but are probably the best fit for implementing an all‐encompassing SP policy in Africa. The challenge for policy will be to harness this potential—not by trying to turn grassroots organizations into something they are not, but by supporting what they already are.