Opportunities and Limits of New Federal Funding for Stimulant Responses

    As the federal government pours billions of dollars into state-level responses to opioid use disorders and opioid-involved overdoses, the tide may be turning on the historic death toll. But the narrow focus on opioids has left many people who use cocaine and methamphetamine without stimulant-specific services and resources—and stimulant-involved deaths are rising.

    At the end of 2019, Congress approved a spending bill that allows federal dollars from the State Opioid Response (SOR) grant program—which provides $1.5 billion in funding for opioid use disorder prevention, treatment and recovery—to go towards stimulant-specific services as well.

    Mark Stringer, the director of Missouri’s Department of Mental Health, told the Associated Press that the addition will be a “game changer” for his state and for others in the West and Midwest, “where meth is much more prevalent than opioids.”

    The text of the bill does not specify the particular stimulant resources towards which SOR funds could be directed. One example could be using the grant money to close “gaps in training related to psychostimulants and polysubstance use” in West Virginia, as Christina Mullins, the commissioner of West Virginia’s Bureau for Behavioral Health, described in her January 14, 2020 testimony to a House committee on “state efforts to curb the opioid crisis.”

    But some of the main approaches to opioid-related harms supported by SOR funds, like medication-assisted treatment and distribution of the overdose-reversal medication naloxone, simply do not translate to stimulants.

    Stimulant use disorder treatments lag far behind those for opioids. The federal government has yet to approve a substitution therapy for methamphetamine, for example, while multiple medications, like methadone and buprenorphine, are available for opioid use disorders. Research in this area may close the gap, however. A number of medications, like the common anti-depressant wellbutrin, have already been identified as potential treatments for stimulant use disorder. Recently mirtazapine, another psychiatric medication, was reportedly found to help people reduce their meth use, as Filter reported.

    The spending bill recognizes the lack of available medications and “urges” the National Institute on Drug Abuse (NIDA) to continue its research in order to “expeditiously find and approve a medication-assisted treatment for methamphetamine,” stated a Congressional explanatory statement appending the bill.

    People using stimulants (assuming they aren’t adulterated with opioids) do not “overdose” in the sense of experiencing a stoppage in breathing. Rather, they risk “overamping,” which can include a variety of symptoms like psychosis, seizures, strokes and heart attacks. A medication that reverses overamping—an equivalent to naloxone, which has demonstrated “overwhelming” evidence of effectiveness in preventing opioid-involved overdose deaths—does not currently exist.

    The change to federal funding rules comes as researchers and advocates have called on the federal government to be attentive to the ever-changing landscape of drug use. “Congress and the administration should build flexibility into federal grants to allow state agencies to adapt to quickly changing conditions on the ground,” recommended the Bipartisan Policy Center think tank in a March 2019 review.

    State program directors have suggested that the federal government ought to entirely rethink how it funds responses to drug harms. “Over time, we hope that Congress would gradually transition from investments in drug-specific grants” to ones that offer greater flexibility, said Jennifer Smith, the secretary for Pennsylvania’s Department of Drug and Alcohol Programs, in her House testimony earlier this month.

    Daniel Raymond, Harm Reduction Coalition’s policy director, told Filter that “striking the balance between being prescriptive and flexible” is key. He agrees with Secretary Smith’s position, but also cautioned that “maximum flexibility” for states “carries the risk that some states will opt to invest in ineffective interventions, whether that’s treatment programs that don’t offer [medication for opioid use disorder] at all, more punitive or coercive policies, or naloxone distribution that fails to prioritize people who use drugs.”

    Photograph of meth pipe by Jlcoving via Wikimedia Commons/Creative Commons

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