Substance Abuse And Mental Health Services Administration Research Articles

988 and crisis, suicide prevention, and substance use

Called the 988 Suicide and Crisis Lifeline, this three‐digit number was launched more than a year ago by the Substance Abuse and Mental Health Services Administration (SAMHSA) to great fanfare. It appeared to everyone to be mainly for suicide prevention. But it is in fact for every crisis, and substance use is included.

SAMHSA reinstates CSAP Prevention Fellowship program

One of the substance use disorder (SUD) workforce tools to die during the Trump administration was the CSAP (Center for Substance Abuse Prevention) Prevention Fellowship Program, run by the Substance Abuse and Mental Health Services Administration (SAMHSA).

988: It's not just for suicide, it's for substance use too

Called the 988 Suicide and Crisis Lifeline, this three‐digit number was launched more than a year ago by the Substance Abuse and Mental Health Services Administration (SAMHSA) to great fanfare. It appeared to everyone to be mainly for suicide prevention. But it is in fact for every crisis, and substance use is included.

ASAM features harm reduction, methadone, OTPs at conference

Not surprisingly, last week'k American Society of Addiction Medicine (ASAM) conference was sold out, with its big focus on moving methadone out of the opioid treatment program (OTP) system and into general office‐based care (preferably by only ASAM‐boarded physicians), and also considerable attention paid to the value of high‐quality treatment with methadone. A track called “Methadone in the Modern Era” included Ruth Potee, M.D., in an impassioned speech focused on the need for more access to methadone, and on the for‐profit OTPs that are out there. That track also featured Yngvild Olsen, M.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA) who talked about the other modern (aka, real world) era in which OTP regulations have been completely updated and revised. Aaron Ferguson, who said at a public conference last fall that he owed his life to diverted methadone (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33908) despite being a patient advocate, also presented at the conference, this time on harm reduction, which is beneficial to keeping people alive. Many OTPs, especially the large chain for‐profit OTPs, have been a target of ASAM members for years; most are also members of the American Association for the Treatment of Opioid Dependence, and some are members of the National Association for Behavioral Healthcare.

SAMHSA calls for “culture change” in methadone treatment

New regulations for opioid treatment programs (OTPs) create many new flexibilities for methadone practitioners and providers, and last month'h webinar for administrators focused on the key points. The Substance Abuse and Mental Health Services Administration (SAMHSA), which implements the 42 CFR Part 8 regulations, presented the information to about 800 attendees via a Zoom call on March 20 that was hosted by the American Association for the Treatment of Opioid Dependence (AATOD). Next week, ADAW will cover the March 27 webinar, which was for clinicians. For more on the new rule, see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023.

An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women.

Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.

Part 8 update: AATOD argues for removing more barriers to methadone treatment

Changes to the CFR 42 Part 8 regulations covering methadone treatment for opioid use disorder (OUD) have been welcomed by opioid treatment programs (OTPs) (see ADAW https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023), which are the only providers with experience using methadone for this condition. However, the devils are, as always, in the details. It's not just a matter of the Substance Abuse and Mental Health Services Administration (SAMHSA) changing its rules.

Self-help group (SHG) attendance and treatment outcomes among older adults in the US

BackgroundSubstance dependency is a global problem and significantly affects the geriatric population in the United States. This study aims to determine how self-help group (SHG) attendance affects substance use treatment outcomes among older adults in the US. MethodsThis cross-sectional study used the 2020 discharge treatment episodes data set (TEDS-D)fromthe Substance Abuse and Mental Health Services Administration (SAMHSA). Multivariable logistic regression was used to evaluate the relationship between self-help group attendance and treatment outcomes among older adults. ResultsWe included 3,424 older adults (19.2% female). The primary substance use was alcohol in more than two-thirds of the participants (67.9%), while heroin (17.1%), cocaine (5.8%), and other opiates/synthetics (3.3%) were the other common primary substance of abuse among other participants. In the multivariate logistic regression analysis, SHG attendance at discharge from treatment facility was significantly associated with reduced frequency of use of primary substance -FUPS (p-value = 0.013) and increased odds of treatment completion (p-value <0.001) but no significant association with arrests at discharge from treatment facility (p-value = 0.101). SHG attendance on admission into treatment facility was associated with reduced odds of treatment completion (p-value <0.001). Having a living arrangement at discharge was found to be associated with reduced FUPS (p-value <0.001) but with lower odds of treatment completion (p-value <0.001). ConclusionAssociation of SHG attendance with positive treatment outcomes indicates the need to enhance access to this service in the geriatric population.

SAMHSA announces $6 million to promote integrating primary and behavioral health care

It's not just about integrating mental health and substance use (commonly referred to as “behavioral health”) anymore. The federal government for some time has been promoting merging these with primary care; in other words, giving primary care providers the job of treating mental illness and substance use disorders. Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the availability of $6 million, to be given to three awardees, for coming up with ways to integrate primary and behavioral health care. “The purpose of this program is to: (a) promote full integration and collaboration in clinical practices between physical and behavioral health care; (b) support the improvement of integrated care models for physical and behavioral health care to improve overall wellness and physical health status; and (c) promote the implementation and improvement of bidirectional integrated care services, including evidence‐based or evidence‐informed screening, assessment, diagnosis, prevention, treatment and recovery services for mental and substance use disorders and co‐occurring physical health conditions and chronic diseases through integrated care.” Applications are due May 20. For more information, go to https://www.samhsa.gov/sites/default/files/grants/pdf/fy‐2024‐pipbhc‐states‐sm‐24‐003.pdf.

Critical incidents in Colorado's opioid treatment programs: A comparison of the COVID-19 pandemic to previous years

IntroductionIn response to the COVID-19 pandemic, Substance Abuse and Mental Health Services Administration (SAMHSA) guidance allowed opioid treatment programs (OTPs) greater flexibility to provide take-home medication doses to patients. This study aims to characterize trends in the rates of critical incidents–safety events occurring in OTPs that are reportable to regulatory entities–across all Colorado OTPs during the COVID-19 pandemic. MethodsThis study is a retrospective review of critical incidents (CIs) for patients enrolled in Colorado OTPs between the years 2017 to 2022, as recorded in Colorado Behavioral Health Administration's (BHA) Opioid Treatment Program Critical Incident Repository Dataset. March 15, 2020 was considered the start of the COVID-19 pandemic in Colorado, so only incidents which occurred from March 15–December 31 of each year were included. CI rate per 100 patients was calculated by dividing CI annual count between March 15–December 31 by the census of enrolled patients at the calendar midpoint of this period, which is August 7. Means comparison tests assessed differences in CI rates. ResultsOTP patient enrollment in Colorado increased from 4377 in 2017 to 7327 in 2022. Overall, Medication Diversion accounted for 70 % of CIs, followed by Death (14 %), and Other (5 %). There was a significant increase in the overall rate of CIs from 2017 to 2022 (1.1 % to 3.4 %). The average post-COVID CI rate was higher than pre-COVID (4.0 % vs. 2.4 %). There was no difference, however, in the post-COVID rate of CIs when exclusively compared to 2019 (4.0 % vs. 4.1 %). Post-pandemic years had significantly more CIs per month than pre-pandemic years (27.6 ± 5.6 vs 15.8 ± 3.5). There was no difference in mean monthly CIs between 2019 and post-pandemic (28.5 ± 5.3 vs 27.6 ± 5.6). ConclusionsThere was no increase in the rate of reportable CIs in Colorado OTPs following the SAMHSA COVID-19 guidance increasing take-home doses when comparing 2019 to post-pandemic years. The notable increase in CI incidence occurred from 2018 to 2019, predating the pandemic. These data offer a measure of reassurance for the safety of increased take-home methadone doses. There should be further consideration of how a greater number of take-home doses might benefit both patients and OTPs.

States' investment in recovery support services: An exploratory analysis

IntroductionRecovery support services (RSS), while not yet precisely defined, nevertheless have a longstanding role in managing chronic illnesses including substance use disorders (SUDs). This exploratory study is the first to identify the amounts of money that states invest from Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grants; SAMHSA discretionary grant and state-appropriated sources; the types of organizations from which RSS are purchased; and the non-financial supports states provide for RSS. MethodsThe study is a mixed method exploratory analysis, based on three data sources: content analysis of all 51 (Washington, D.C. included) Substance Abuse Block Grant (SABG) state applications; in-depth interviews with a purposive sample of ten states and one territory; and a structured electronic survey sent to all SABG recipients. Forty states and 2 territories returned a total of 42 questionnaires from 56 possible states and territories (75%). Thirty-two of the responding states provided complete FY2022 financial data. ResultsStates reporting financial data spent $412 million from SABG, SAMHSA discretionary grants, and state appropriations for RSS. An estimate based on extrapolating regionally grouped per capita spending averages to non-responding state populations projected $775 million spent from these sources for all states. The study also calculated per capita and SUD prevalent population expenditures from these sources for each state. States purchase services from recovery community organizations and SUD treatment organizations in equal proportions, as well as from statewide recovery support organizations, educational institutions, hospitals, community health centers, and justice system organizations. Purchased services are not uniformly defined, but include community centers, peer staff, housing, and other support services. States provide non-financial support in forms that include technical assistance, community engagement, practice guidelines, and regulatory frameworks. ConclusionsThis first report of states' investments establishes a baseline to serve as a reference point for future analysis of these expenditures, as well as a foundation to which other sources of RSS funding such as Medicaid and other state and federal (e.g. HRSA, CDC, DOJ) dollars may be added. Uniform definitions for RSS will be necessary to support future reporting, accountability, and research. Finally, newly formed peer-based provider organizations need particular attention in order to be sustainable.

SAMHSA overdose toolkit contradicts evidence on doses needed

A “toolkit” (federalese for a brochure) on overdose prevention and rescue from the Substance Abuse and Mental Health Services Administration (SAMHSA) issued last month has outdated recommendations for overdose rescue medications. The toolkit, which SAMHSA released at last month's annual CADCA conference, calls for giving one dose (4 mg) of naloxone initially, followed by a second dose two or three minutes later. It also says that studies show increased doses of naloxone are not necessary in the fentanyl era.

Attorney argues against SAMHSA overdose toolkit

In the February 26 issue, ADAW wrote about the “toolkit” on overdose prevention and rescue from the Substance Abuse and Mental Health Services Administration (SAMHSA) that calls for giving one dose (4 mg) of naloxone initially followed by a second dose two or three minutes later. The toolkit references studies that show increased doses of naloxone are not necessary in the fentanyl era. This is despite a study published in January from the U.S. Food and Drug Administration which found that 35% of overdose victims would die from that two‐to‐three‐minute wait for the second dose.

OTP leaders on Part 2: Tell patients what consent means

The confidentiality regulation governing substance use disorder (SUD) treatment records has been constantly weakened since 2010. Most recently, the final rule came out (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34035) which further weakens privacy, most importantly by allowing the first initial consent to release of patient information, signed by the patient, to be used forever, to go to almost anyone, except for law enforcement. When the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) jointly released that final rule, they did not comply with the requirement by Congress in the CARES Act that while sharing of information should be easier, anti‐discrimination provisions needed to be tightened. There was no addition of anti‐discrimination provisions.

Competence of teachers towards managing trauma among children with disabilities in Ghana.

Although trauma is one of the leading causes of behaviour problems among children with disabilities, there has been limited scholarly interest in trauma management within the discourse of implementation of inclusive education. The Substance Abuse and Mental Health Services Administration (SAMHSA) trauma management model was used to study teachers' awareness of trauma management among students with disabilities studying in regular classrooms. A total of 271 teachers were recruited from two municipalities in the central region of Ghana to complete the Teacher Trauma Management Scale developed for this study. The data were analysed using confirmatory factor analysis, mean scores, multivariate analysis of variances, and linear regression. The results showed teachers' uncertainty towards trauma management, and a positive correlation was also found between the tenets of the study framework. The study concluded with a recommendation for contextual development of the curriculum to guide teacher training in trauma management. Studies on trauma management within the discourse of implementation of inclusive education are scarce. This study extends the literature on inclusive education to teacher development to support trauma management among students with disabilities in regular schools.

SAMHSA overdose toolkit contradicts evidence on doses needed

A “toolkit” (federalese for a brochure) on overdose prevention and rescue from the Substance Abuse and Mental Health Services Administration (SAMHSA) issued last month has outdated recommendations for overdose rescue medications. The toolkit, which SAMHSA released at last month's annual CADCA conference, calls for giving one dose (4 mg) of naloxone initially, followed by a second dose two or three minutes later. It also says that studies show increased doses of naloxone are not necessary in the fentanyl era.

SAMHSA expands technology services partnership

The Substance Abuse and Men‐tal Health Services Administration (SAMHSA) has expanded its long‐standing partnership with ICF, a global consulting and technology services provider, with five new subcontracts to support mental health programs, including evaluation and communications support for the agency's 988 Suicide &amp; Crisis Lifeline. The agreements have a combined value of $24 million, an ICF news release stated. “These new agreements expand our long‐standing partnership with SAMHSA to help the agency better evaluate the impact of and raise awareness for mental health programs that change and save lives,” said Jennifer Welham, ICF senior vice president for health, people and human services. For three of the five service agreements, ICF will deliver a variety of behavioral health and technology‐based support services, totaling $16.1 million. Each has a term of five years, including a one‐year base and four one‐year options. Services will help address the nation's suicide crisis and include communications and data visualization support for the 988 Lifeline program (which was awarded in the second quarter of 2023) and the evaluation of the Zero Suicide Program, including building a large cloud‐based data collection and reporting system for both on Amazon Web Services.

Confidentiality for SUD records: Final rule issued

A week after the federal Department of Health and Human Services (HHS) issued a final rule liberalizing treatment for opioid use disorder (OUD) in opioid treatment programs, it issued a less patient‐friendly rule. ADAW has written about 400 articles on confidentiality and substance use disorder treatment, an area that has seen continued erosion since 2010 when the government started acceding to claims that requiring a patient to consent to the release of his or her substance use disorder (SUD) treatment information in a digital age (think “Electronic Health Record”) would be just too inconvenient. The most recent step came in the Federal Register issued Feb. 8, which changes the confidentiality rules to align with those of HIPAA. The rule, through the HHS Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), finalized modifications to the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR part 2 (“Part 2”), which protect the privacy of patients' SUD treatment records. In a press release about the rule, HHS said this: “Specifically, today's final rule increases coordination among providers treating patients for SUDs, strengthens confidentiality protections through civil enforcement, and enhances integration of behavioral health information with other medical records to improve patient health outcomes.”

OTPs gladly plan to implement new methadone rules

On Feb. 2 the Substance Abuse and Mental Health Services Administration (SAMHSA) released its final rule for opioid treatment programs and methadone, just as ADAW went to press (see SAMHSA issues final rule updating OTP methadone rules, ADAW Feb. 5; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023). The American Association for the Treatment of Opioid Dependence (AATOD), which represents more than 1,300 opioid treatment programs (OTPs) in the United States, last week commended SAMHSA for the guidance, which it called “enlightened and thoughtful.” In a Feb. 5 press statement, AATOD president Mark Parrino noted that the regulations have been reviewed by the Drug Enforcement Administration (DEA). For the final rule, go to https://www.federalregister.gov/documents/2024/02/02/2024‐01693/medications‐for‐the‐treatment‐of‐opioid‐use‐disorder.

Trend and geo-availability of somatic therapies for treatment resistant depression in the US

BackgroundHaving failed at least two pharmacotherapies, treatment-resistant depression (TRD) constitutes a major burden to healthcare in the US and globally, affecting close to a third of people diagnosed with depression in the US. Several studies have demonstrated the higher economic burden associated with TRD. This study sought to investigate changes in the availability of TRD somatic treatment options (Electroconvulsive therapy [ECT], Ketamine infusion therapy (KIT), and Transcranial Magnetic Stimulation [TMS]) in the US between 2014 and 2020 and the geographic variations in availability of TRD treatment options in the US as of 2020. MethodThis study is a cross-sectional study of US mental health facilities providing TRD treatment options between 2014 and 2020. We used the 2014 to 2020 National Mental Health Services Survey (N-MHSS) data from the Substance Abuse and Mental Health Service Administration (SAMHSA). We estimated service availability per 100,000 US adults, both nationally and regionally, and computed a random-effect logistic regression to calculate the changes in the availability of the services over the study period. ResultOverall, availability of any one of ECT, KIT, or TMS in US mental health facilities declined between 2014 and 2019 (0.23 vs. 0.18 per 100,000 US adults) but increased to 0.24 in 2020. While availability of ECT consistently declined between 2014 and 2020, ketamine and TMS reportedly became available only in 2020. North Dakota, Wyoming, and Utah had the highest availability per 100,000 US adults (0.86, 0.67, and 0.65) while Nevada, Oregon and Georgia had the lowest availability (0.04, 0.06, and 0.06) regionally. ConclusionThe US had less than one mental health facility offering somatic treatment options for TRD per 100,000 US adults as of 2020. Also, the observed increase in the availability of somatic treatment options for TRD across the US between 2014 and 2020 did not reflect the increasing need for more treatment options for the treatment of TRD.