By Chris LaPage

 

For the first time in a long time, Congress passed, and the President signed into law a budget bill for the Department of Health and Human Services (HHS) prior to the start of the fiscal year (October 1). The HHS appropriations were packaged together in a minibus with three other primary federal agencies: the Department of Defense (DoD), the Department of Labor (DOL) and the Department of Education (Ed). Following, is a breakdown of key HHS funding lines that specifically target addressing the opioid epidemic, as well as implications for potential grant programs. Information was gathered directly from the minibus agreement (H.R. 6157), the accompanying conference report (115-952), and historical information about the funding sources and the grant programs that they fund.

 

Rural Communities Opioids Response — $150 million total [Health Resources & Services Administration (HRSA)]

 

The agreement provides $120,000,000 for a Rural Communities Opioids Response to support treatment for- and prevention of- substance use disorder, with a focus on the 220 counties identified by the Centers for Disease Control and Prevention as being at risk, as well as other rural communities at the highest risk for substance use disorder. This initiative would include improving access to- and recruitment of- new substance use disorder providers; building sustainable treatment resources, increasing use of telehealth; establishing cross-sector community partnerships, and implementing new models of care, including integrated behavioral health; and technical assistance. HRSA may also use funds for loan repayment through the National Health Service Corps. Activities should incorporate robust evidence-based interventions or promising practice models in community education and workforce training, capacity building and sustainability strategies and facilitate linkage of prevention, treatment, and recovery services. Within the funds provided to Health Workforce for the National Health Service Corps, the agreement directs up to $30,000,000 in addition to the funding in Rural Health for the Rural Communities Opioid Response initiative.

 

Funds Expiration: 2022

Anticipated 2019 Solicitation Release: May 2019

Anticipated 2019 Awards:  75

Target Applicants: Rural Health Providers

Focus Counties: https://www.hrsa.gov/sites/default/files/hrsa/about/news/cdc-at-risk-communities.pdf   [CL1] 

 

Infectious Diseases and the Opioid Epidemic - $5 million [Centers for Disease Control and Prevention (CDC)]

 

The minibus directs the CDC to focus efforts on improving surveillance, treatment, and education efforts around hepatitis B, hepatitis C, and HIV infections as it relates to the opioid epidemic. The CDC is further required to prioritize funding for those areas most at risk for outbreaks of HIV and hepatitis due to injection drug use. This a new program, and while it is currently not clear how funding will be disbursed, it may be through grants or cooperative agreements.

 

Opioid Prescription Drug Overdose (PDO) Prevention Activity - $475,579,000 [CDC]

 

The CDC shall use the provided funds to advance the understanding of the opioid overdose epidemic and scale-up prevention activities across all 50 States and Washington, D.C. The agreement expects that this will include the expansion of case-level syndromic surveillance data, improvements of interventions that monitor prescribing and dispensing practices, better timeliness and quality of morbidity and mortality data, as well as the enhancement of efforts with medical examiners and coroner offices.

 

The CDC shall promote the use of Prescription Drug Monitoring Programs (PDMPs), including implementation of activities described in the National All Schedules Prescription Electronic Reporting Act of 2005 as amended by the Comprehensive Addiction and Recovery Act of 2016. This shall include continuing to expand efforts to enhance the utility of PDMPs in States and communities, making information systems more interconnected, real-time, and usable for public health surveillance and clinical decision making.

 

The CDC shall also promote alternative surveillance programs for States and communities that do not have a PDMP. The CDC is encouraged to work with the Office of the National Coordinator for Health Information Technology in order to enhance the integration of PDMPs and electronic health records. Finally, the CDC shall use $10,000,000 of the funds provided to conduct an opioid nationwide awareness and education campaign.

 

Funds Expiration: 2020

Anticipated Solicitation(s): May result in several programs, some of which may be grants.

Targeted Applicants/Recipients: Likely to be state agencies.

 

Examples of Past CDC Programs in this Area:

·         Prevention for States: https://www.cdc.gov/drugoverdose/states/state_prevention.html

·         Enhanced State Opioid Overdose Surveillance: https://www.cdc.gov/drugoverdose/foa/state-opioid-mm.html

·         Data Driven Prevention Initiative: https://www.cdc.gov/drugoverdose/foa/ddpi.htm   [CL2] 

 

Opioids Research ($500 million) [National Institutes of Health (NIH)]

 

These funds will be used to support basic opioid research, such as clinical trials on medications and other treatment interventions. The funds will be evenly distributed between the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Drug Abuse (NIDA).

 

Funds Expiration: 2021

Target Applicants:  Academic Medical Centers

Examples of Grant Programs: https://www.drugabuse.gov/funding-app/rfa?search=opioids&r=1  [CL3] 

 

State Opioid Response Grants ($1.5 Billion) [Substance Abuse & Mental Health Services Administration (SAMHSA)]

 

The agreement provides $1,500,000,000 in new funding for grants to States to address the opioid crisis. This funding is in addition to the $2.5 billion previously allocated to this program through the 21^st Century CURES Act of 2016 and the 2018 appropriations legislation. Congress provides $50,000,000 for grants to Indian tribes or tribal organizations. In addition, the agreement provides a 15 percent set-aside for States with the highest age-adjusted mortality rate related to opioid use disorders. SAMHSA is encouraged to apply a weighted formula within the set-aside based on state ordinal ranking. The agreement urges SAMHSA to ensure the formula avoids a significant cliff between States with similar mortality rates. SAMHSA shall make allocations based on the workplan it submitted to the Committees on Appropriations of the House of Representatives and the Senate in April 2018.

 

Funds Expiration: 2021

Anticipated Solicitation(s): August 2019

Target Applicants:  States

Link to 2018 Program Page: https://www.samhsa.gov/grants/grant-announcements/ti-18-015 [CL4] 

 

Opioid Treatment Programs/Regulatory Activities ($8.724 Million) [SAMHSA]

 

This funding allocation will not likely result in any grant programs. This funding is for certification of opioid treatment programs: https://www.samhsa.gov/medication-assisted-treatment/opioid-treatment-programs   

 

Targeted Capacity Expansion (TCE) Medication-Assisted Treatment (MAT) for Prescription Drug and Opioid Addiction - $89 million [SAMHSA]

 

The purpose of this program is to expand and/or enhance access to medication-assisted treatment (MAT) services for persons with an opioid use disorder (OUD). This program’s focus is on funding organizations and tribes/tribal organizations within states identified as having the highest rates of primary treatment admissions for heroin and opioids per capita and includes those states with the most dramatic increases for heroin and opioids, based on SAMHSA’s 2015 Treatment Episode Data Set (TEDS). The desired outcomes include ensuring that there is an increase in the number of individuals with OUD receiving MAT, and a decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up.

 

Funds Expiration: 2021

Anticipated Solicitation: May 2019

Anticipated Awards: 160

Target Applicants: States, municipalities, public and non-profit treatment providers

Link to 2018 Grant Program Page: https://www.samhsa.gov/grants/grant-announcements/ti-18-009  [CL5] 

 

Grants to Prevent Prescription Drug/Opioid Overdose ($12 million) [SAMHSA)

 

The purpose of this program is to reduce the number of prescription drug/opioid overdose-related deaths as well as adverse events among individuals 18 years of age and older by training first responders and other key community sectors. These individuals will be educated on the prevention of prescription drug/opioid overdose-related deaths and implementation of secondary prevention strategies, including the purchase and distribution of naloxone to first responders. Unfortunately, the $12 million in allocated dollars are likely only enough to fun existing awardees in year 4 of the 2016 program: https://www.samhsa.gov/grants/grant-announcements/sp-16-005.

 

A Final Word

 

Please note that the aforementioned allocations include only those that were in the HHS budget and specifically referenced opioids. There are many other programs that hold the capacity to fund projects addressing the opioid crisis, but these may focus on substance abuse more generically, telemedicine, or mental health and wellness. For example, the U.S. Department of Agriculture’s Distance Learning and Telemedicine Grant Program (DLT) funds telemedicine initiatives across service lines but has previously prioritized projects that address opioid treatment. Furthermore, the Department of Justice (DOJ) was funded through a continuing resolution that will expire in December. The DOJ budget will likely have funding that specifically addresses the opioid epidemic from a public safety perspective. In conclusion, while the budget allocations addressed in this breakdown specifically target opioids, this is just the tip of the iceberg in terms of potential funding for these projects.