Substance misuse is a national health concern which should be a priority for the nation, according to a Surgeon General report on alcohol, drugs and their impact on the nation’s health. The report notes that while, in recent years, some progress has been made, the scope of the problem is often unappreciated. Almost 21 million Americans suffer from substance abuse disorders—a number greater than the total of all those with cancer combined. Additionally, one in seven people in the U.S. is expected to develop a substance abuse disorder at some point in their lives, yet, only 1 out of every 10 people with a substance abuse disorder receive treatment.
Costs. Addiction is a problem for the nation because the costs of substance misuse stem beyond the individual to impact families and communities in substantial ways. The report warns of the direct and indirect costs of addiction, including: compromised physical and mental health, increased spread of infectious disease, loss of productivity, reduced quality of life, increased crime and violence, increased motor vehicle crashes, abuse and neglect of children, and health care costs.
Report. The report is the first of its kind—the Surgeon General has not previously dedicated a report to substance misuse and related disorders. The report focuses on alcohol, illicit drugs, and prescription drug misuse. The report’s chapters include discussions of neurobiology, prevention, treatment, recovery, health systems integration and recommendations to address addiction problems.
ACA. The report covers the current legal landscape surrounding opioid treatment, noting that legislative efforts like the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) improved access to preventative care, requiring plans to cover services to prevent and treat substance use disorders. Additionally, the report noted that the ACA has provided significant access to substance abuse treatment by expanding coverage for low-income individuals both through the exchanges and the expansion of state Medicaid programs.
Recommendations. The Surgeon General recommended a wide variety of steps to address the addiction problem, including the improvement of: patient education; public awareness; negative attitudes; capacity of health systems to treat substance abuse; the science base of effective prevention, treatment, and recovery; and staffing and training of the health care workforce.
MAT. HHS is already increasing efforts to address the substance misuse problem, with a specific focus on the opioid abuse crisis. HHS announced expansion of medication-assisted treatment (MAT) for opioid use disorders, which will allow more providers to prescribe the opioid use disorder treatment, buprenorphine. MAT is a Substance Abuse and Mental Health Services Administration (SAMHSA) treatment strategy, which includes opioid-treatment programs (OPT) and combines behavioral therapy and medications. Under new program changes, Nurse practitioners (NPs) and physician assistants (PAs) may immediately begin taking the 24 hours of required training to prescribe the opioid treatment drug. Previously only physicians had the authority to prescribe buprenorphine. The new program changes build on earlier measures to extend physician authority to prescribe the drug to additional patients.
Opioid Initiative. HHS is also focused on improving opioid treatment more broadly, through its Opioid Initiative. The initiative is premised on three key areas: improving opioid prescribing practices, supporting the use and further implementation of MAT, and expanding access to naloxone. However, the initiative requires additional funding to meet its goals. Under the President’s 2017 budget proposal, states would be eligible to receive up to $920 million over a two-year period to improve opioid treatment access. Congress has not fully funded the budget proposal (see HHS funding will expand care to underserved, fight growing areas of concern, February 24, 2016).
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