Year in Review: Addiction Policy in 2016
2016 was a historic year for addiction policy. In the face of a devastating opioid epidemic that shows little signs of abating, the federal government engaged in multiple efforts to change our national tone and approach toward addiction. There has been great progress in improving our collective understanding of addiction as a disease instead of a moral failing. This is reflected in the work of lawmakers who have adopted public health approaches in lieu of punitive criminal justice responses.
Much of Center on Addiction’s work on evidence-based prevention and treatment methods and data-informed policy recommendations is now memorialized in federal laws, regulations and guidance. Undoubtedly, we still face a tremendous amount of uncertainty regarding the incoming administration’s policy on addiction. But the progress that has been made this year sets a solid foundation and an encouraging path forward. It is also promising that these laws passed despite a deeply divided Congress. Addiction is one of very few issues with broad bipartisan support.
Below, we reflect on the work accomplished in the past year.
- In March, the U.S. Department of Health and Human Services increased the buprenorphine patient cap through regulation. Waivered physicians who have been prescribing buprenorphine for at least two years can now treat up to 275 patients at a time.
- The Comprehensive Addiction and Recovery Act (CARA) became law on July 22, 2016. Aptly named, the law takes a comprehensive public health approach to addiction by authorizing funding for a wide range of grant programs focused on prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. The law expands access to medication assisted treatment (MAT) by allowing appropriately trained nurse practitioners and physicians assistants to seek waivers to prescribe buprenorphine.
- In October, the White House Mental Health & Substance Use Disorder Task Force issued its report on parity implementation. The report contains several actions and recommendations to improve parity compliance and enforcement, including resources and support for health care consumers, regulators and health plans. The report acknowledges and addresses many of the challenges impeding full parity implementation.
- The Surgeon General’s Report on Alcohol, Drugs, and Health was released in November. The report shines a much needed spotlight on substance misuse and addiction and provides a long overdue call for significant changes to how we address this top public health problem. Center on Addiction was very gratified to see the Surgeon General elevate major findings and conclusions from our 2012 report, Addiction Medicine: Closing the Gap Between Science and Practice. The Surgeon General echoed our many recommendations for a more professional, integrated, and comprehensive approach to addiction that makes science-based prevention and treatment more accessible and uses research and advocacy to reduce the stigma and discrimination of this disease. This report lays a strong blueprint for the field of addiction to follow over the next four years and beyond.
- On December 10, 2016, the federal government approved $500 million in funding to help states respond to the opioid crisis.
- The second major piece of addiction legislation to pass Congress this year is 21st Century Cures. Signed into law on December 13, 2016, 21st Century Cures is a broad health law that builds on CARA by authorizing several grant programs to promote the use of evidence-based practices for addiction prevention and treatment. The law funds grants to address the opioid epidemic, strengthen the substance use disorder treatment workforce, improve the quality of addiction treatment and support integrated health care systems. Finally, the law contains several provisions to promote compliance with the Mental Health Parity and Addiction Equity Act.
Despite the solid foundation that was set this year, it is clear that much work remains to be done. Substance use and addiction rates are still unacceptably high and people are still dying from opioid overdoses at an unprecedented rate.
Here are some of the challenges we will face in 2017 and beyond.
- If Congress and the new administration repeal the Affordable Care Act (ACA) without an immediate and sufficient replacement plan, the resulting loss of health insurance coverage will create significant barriers for patients seeking evidence-based addiction treatment. While we have yet to fully measure the ACA’s impact on improving access to treatment, the ACA’s successes in greatly expanding insurance coverage are indisputable. Insurance coverage is now more essential than ever for people with addiction. Because it was expected that insurers would pay for treatment as a result of the ACA, there is less state and federal funding available for addiction treatment. If people lose insurance because of ACA repeal and state and federal funding for addiction treatment is not increased immediately and substantially, it will become even more difficult to obtain addiction treatment, more people will die, and more families and communities will suffer the terrible consequences.
- While insurance coverage of evidence-based treatment for addiction has improved, it is still inadequate. In June, Center on Addiction released a report, Uncovering Coverage Gaps: A Review of Addiction Benefits in ACA Plans, in which we detailed the poor coverage of critical benefits to treat and manage addiction in the health plans that establish the minimum benefits in each state. We continue to hear of high rates of denials for addiction treatment services, suggesting widespread non-compliance with federal law. Insurance plays a critical role in addressing addiction and insurers need to be doing more to help their members access evidence-based treatment.
- Financial resources to address addiction are woefully insufficient. Research, prevention, treatment, and recovery supports remain significantly underfunded despite the prevalence of the disease. Further, both CARA and 21st Century Cures are authorization bills that will need to be continually funded through Congressional appropriations. Unfortunately, without sufficient and sustained funding, these promising bills represent empty promises to vulnerable and suffering individuals and families who have been underserved for decades.
- Finally, there is a significant professional workforce shortage in addiction treatment. While there are many factors contributing to the staggering treatment gap, the lack of adequately trained providers to treat and manage addiction is significant. All providers need to be better trained in addiction, and be reimbursed appropriately for the medical care they provide. Incentives are also needed to attract highly skilled professionals into the field of addiction care.
In sum, 2016 brought significant progress in terms of federal policy that recognizes addiction as a disease that should be addressed with a public health approach. Many states and municipalities also undertook efforts to address addiction in their communities. But 2016 also brought heartbreak to countless families who continue to suffer from the devastation of addiction. Significant federal government action has occurred, with unprecedented bipartisan support, to help everyone know what needs to be done to reduce this unnecessary suffering. We look forward to building on the progress of 2016 and facing the many challenges that lie ahead.
Samuel A. Ball, PhD
Dr. Ball is President and CEO at Center on Addiction