The opioid epidemic, now several decades in the making, continues to cause pain and suffering for millions of Americans. Each year, thousands of individuals die from overdose, and thousands more grieve from these losses. Opioid use disorder (OUD) can lead to a complete interruption of day-to-day activities, including caring for one’s family, maintaining a job or career, or keeping track of basic necessities, such as health care and finances.
The government’s response to this epidemic is manifold. This report, an offshoot of that response, is the first of three reports requested by the U.S. Congress and commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA). This series of reports focuses on four of SAMHSA’s grant programs that help alleviate suffering due to opioids and improve treatment quality and access. Following directly from a 2016 law titled the Comprehensive Addiction and Recovery Act (CARA), two of these grant programs focus on preventing overdose: the First Responder Training (FR-CARA) and Improving Access to Overdose Treatment (OD Treatment Access) programs. An additional two grant programs focus on treatment: the Building Communities of Recovery (BCOR) and Pregnant and Postpartum Women Pilot (PPW-PLT).
In the text that follows, an expert committee convened by the National Academies of Sciences, Engineering, and Medicine provides recommendations to SAMHSA to improve the outcomes and metrics associated with these four grant programs. The committee offers recommendations about the existing reporting tools used by these programs, which includes the
Division of State Programs Management Reporting Tool, the Center for Substance Abuse Treatment Government Performance Results and Modernization Act (GPRA) tool, and tools unique to individual programs. The committee also proposes additional metrics and outcomes that should be considered. Recognizing that the grantees under each of these programs may be limited in resources or staff, it is the committee’s hope that the following recommendations represent practical, feasible steps toward reducing the harm associated with opioids and increasing engagement and retention in life-saving treatments.
The following outcomes and metrics may assist SAMHSA in achieving success with respect to the two prevention grant programs, FR-CARA and OD Treatment Access.
The following outcomes and metrics may assist SAMHSA in achieving success in the second set of grant programs (BCOR and PPW-PLT).
1 The committee notes that in the final stages of preparing this report, the GPRA tool underwent an update. Now, the revised tool includes a question specifically about medications for OUD, including methadone, buprenorphine, and naltrexone.
It is the committee’s hope that these recommendations, if implemented, could reduce overdose rates, increase access to and engagement in treatment, and reduce the individual and societal suffering stemming from OUD.
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