States Squander Opportunity of Billions of Dollars in Federal Treatment Grants

    The overdose crisis is claiming a historic number of lives almost every year in the US, while addiction medications remain financially and logistically inaccessible for those who need them most. In response, the federal government created in the State Opioid Response (SOR) grant in September 2018, providing $2 billion for states to expand their opioid addiction treatment services over the course of two years.

    Yet as of just one month before that two-year cycle came to a close in September, half of all SOR funds dedicated to growing the treatment infrastructure remained untapped, a federal watchdog has found.

    According to a December 14 report by the Government Accountability Office (GAO), $1.4 billion of SOR funds had still not been withdrawn from states’ grant account administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Alabama had utilized the highest proportion of its grant at 76 percent, while Michigan had squandered the most, using only around 33 percent.

    GAO studied seven states in-depth—Alabama, Kentucky, Michigan, New Hampshire, New Mexico, Ohio, and Utah—and identified five difficulties obstructing spending. States have laborious procedures for establishing contracts, and some providers were unable to contract due to confusion regarding reporting obligations, or they simply were not interested because of their own stigma and lack of education about MAT. A fourth issue, a scarcity of qualified treatment providers, was described by GAO as a “main barrier.”

    A fifth obstacle is one that’s aroused criticism within harm reduction circles: a myopic focus on opioid-specific resources, despite the widespread and growing prevalence of polysubstance use and the leading role stimulants are coming to play in the historic numbers of drug-involved fatalities. Limiting grant money to services for opioid use disorders delayed at least six states from using their funds to contract with service providers. Kentucky, Michigan, New Hampshire, New Mexico, Ohio and Utah all faced this challenge, according to state officials interviewed by GAO. Ohio failed to spend about half of its first-year SOR grant specifically because of the opioid delimitation.

    Hope was sparked in December 2019 when Congress approved fiscal-year 2020 SOR grants to be put toward evidence-based prevention, treatment and recovery services for stimulant use disorders. Those interventions include contingency management strategies, treatment programs, and hospitalizations.

    In regard to lengthy contracting procedures, the GAO report found that New Mexico punted the responsibility of establishing contracts with numerous service providers to a single administrative service organization, who can get the funds moving in less time. Ohio tapped organizations it already had contracts with, using the SOR funds to expand their work, in order to skip the contracting process entirely. Taking on the problem of an inadequate workforce, Michigan is using its SOR money to pay the student loan debt of providers already-authorized to prescribe buprenorphine who expand their practice to serve those in so-called “MAT deserts” in the state.

    These strategies may be further developed as the new initial round of SOR grants were released this past fall. Almost $3 billion will be granted over the next two years, though it’s unclear if that is brand new money or mostly the continued availability of already-extant funds.

    Photo of a New York methadone clinic by Helen Redmond

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