Abstract
Between January 2016 and June 2020, the Substance Abuse and Mental Health Services Administration rapidly distributed $7.5 billion in response to the U.S. opioid crisis. These funds are designed to increase access to medications for addiction treatment, reduce unmet treatment need, reduce overdose death rates, and provide and sustain effective prevention, treatment and recovery activities. It is unclear whether or not the services developed using these funds will be sustained beyond the start-up period. Based on 34 (64%) State Opioid Response (SOR) applications, we assessed the states’ sustainability plans focusing on potential funding sources, policies, and quality monitoring. We found variable commitment to sustainability across response plans with less than half the states adequately describing sustainability plans. States with higher proportions of opioid prescribing, opioid misuse, and poverty had somewhat higher scores on sustainment. A text mining/machine learning approach automatically rated sustainability in SOR applications with an 82% accuracy compared to human ratings. Because life saving evidence-based programs and services may be lost, intentional commitment to sustainment beyond the bolus of start-up funding is essential.
Highlights
The opioid crisis in the United States has continued to escalate
We examined this further with a p-p plot (Fig 1), which compares the observed ordered p-values against what one would obtain by simulation under a null distribution of 15 independent uniform random variables
Grant applications were requested from all 50 states in order to assess their sustainability commitments beyond federal funding; 34 states shared their application documents
Summary
The opioid crisis in the United States has continued to escalate. There were 46,802 total opioid related deaths in 2018, a historical high that continues to rise, with a provisional number of opioid related deaths exceeding 50,000 in 2019 [1]. An increasing number of individuals who die from opioids are using stimulants such as methamphetamine and cocaine [2]. From 2015 to 2019, the death toll per 100,000 in the US population increased from 16.3 deaths to 595 deaths attributable to opioid overdose [3]. Despite some states’ recent reductions in opioid.
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