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SAMHSA: Updates and Initiatives Onaje Salim, EdD, LCPC, NCC
Director, CSAT, Division of State and Community Assistance
Maryland-DC ASAM ConferenceNovember 11, 2017
“Elevate Your Practice”
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SAMHSA’s Mission
• SAMHSA is organized around four interworking Centers and five Offices to accomplish its mission:
• To reduce the impact of substance abuse and mental illness on the American people, and promote behavioral health for individuals, families, and communities.
• SAMHSA’s reach is increasingly global in nature.
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Legislative & Regulatory Framework
• DATA 2000
• Affordable Care Act (ACA) 2010
• Mental Health Parity and Addiction Equity ACT (MHPAEA) of 2008
• Comprehensive Addiction and Recovery Act (CARA) 2016
• 21st Century Cures Act (2016)
• CFR 42, Part II Revised rule making activity 4
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New Leadership
• Eric D. Hargan – Acting Secretary, U.S. Department of Health and Human Services
• Eleanor McCance-Katz, MD, PhD -the first U.S. Assistant Secretary for Mental Health and Substance Use (2016 - 21st Century Cures Act).
• Kimberly Johnson, PhD – Director, SAMHSA Center for Substance Abuse Treatment
• Anita Everett, MD, Chief Medical Officer
• Federal Colleagues present today…5
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Public health, health promotion, & prevention measures reduce SUDs & their associated comorbidities.
Everyone who has a SUD is identified and connected to appropriate high quality care.
Everyone who has a SUD has equal access to high quality treatment.
Everyone is able to pursue their uniquely individual path to recovery and good health.
CSAT’S VISION
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U.S. PEOPLE AGED 12 OR OLDER WITH A PAST YEAR SUBSTANCE USE DISORDER
Note: Estimated numbers of people refer to people aged 12 or older in the civilian, noninstitutionalized population in the United
States. The numbers do not sum to the total population of the United States because the population for NSDUH does not include
people aged 11 years old or younger, people with no fixed household address (e.g., homeless or transient people not in
shelters), active-duty military personnel, and residents of institutional group quarters, such as correctional facilities, nursing
homes, mental institutions, and long-term care hospitals.
Note: The estimated numbers of people with substance use disorders are not mutually exclusive because people could have use
disorders for more than one substance. NSDUH 2015 DATA
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DRUG DEVASTATION IN THE U.S.
https://www.nytimes April 14, 2017
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U.S. OPIOID DEATHS, 1999-2015
https://www.washingtonpost.comCDC data
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17.5 MILLION ADULTS WITH AN SUD IN THE U.S. DID NOT RECEIVE TREATMENT
102015 NSDUH
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PREVENTION & RECOVERY CONTINUUM OF CARE
Prevention
Risk ReductionRecovery
Engagement
Recovery
Maintenance
TreatmentScreening
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WHAT ARE WE TRYING TO ACCOMPLISH?
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• Screening
• Treatment (pharmacotherapy and psychosocial interventions)
• Alcohol use disorder
• Opioid use disorder
• Cannabis use disorder
• Stimulant use disorder
• Promoting group mutual help (e.g. AA, NA, Smart Recovery)
• Address co-occurring mental health conditions and psychosocial problems
• Continuing care guided by ongoing assessment
• Stabilization & recovery
SUD Medications Psychosocial Intervention
Alcohol AcamprosateDisulfiramNaltrexoneTopiramateGabapentin*
Behavioral Couples TherapyCognitive Behavioral therapy (CBT)Community Reinforcement Approach (CRA)Motivation Enhancement Therapy (MET)Twelve Step Facilitation
Opioid BuprenorphineMethadoneER-InjectableNaltrexone*
Medical Management**Contingency Management (CM)/Individual Drug Counseling (IDC)**
Cannabis CBT/MET
Stimulant CBT/CRA/IDC +/- CM
*suggested **recommended only with medication
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SUD NEAR TERM GOALS: 90:90:90
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Identification Access Engagement Remission
Goal
Estimate
EMERGENT OUD 90:90:90 MODEL
http://healthaffairs.org/blog/2017/03/13/to-battle-the-opioid-overdose-epidemic-deploy-the-cascade-of-care-model/#one
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NEED
CAPACITY
PHYSICIAN GAP: U.S. BASELINE
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National
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Waiver Limits MD/DO NP PA Grand Total
30 26350 3352 866 30568
100 8929 8929
275 3706 3706
Grand Total 38985 3352 866 43203
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Maryland
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Waiver Limits MD/DO NP PA Grand Total
30 803 176 28 1007
100 307 307
275 106 106
Grand Total 1216 176 28 1420
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District of Columbia
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Waiver Limits MD/DO NP PA Grand Total
30 129 25 4 158
100 30 30
275 1 1
Grand Total 160 25 4 189
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LACK OF COVERAGE FOR ASAM LEVELS OF CARE
Adapted from: Colleen M. Grogan et al. Health Aff 2016;35:2289-2296©2016 by Project HOPE - The People-to-People Health Foundation, Inc.
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HRSA-SAMHSA 2016 PROJECTIONS FOR BH PROFESSIONS IN 2025
Barriers to Recruitment and retention of
SUD workforce
• Shortages of experienced staff
• Issues around staff training
• Staff burnout
• Licensing/credential
requirements
• Compensation
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PARTNERSHIPS WITH PROFESSIONAL ORGANIZATIONS
Credentialing and Licensing
• A key finding in a recent survey of all states found that one of the barriers to increasing the mobility of the behavioral health workforce was the inconsistent credentialing and licensure requirements between states.
• SAMHSA is working with professional organizations that set standards for credentialing and licensing to improve consistency across the country, and to explore strategies to support cross state movement.
o APA/NAADAC/NAMI/NBCC/IC&RC/MFT/NCPG/o AMHCA/ASTHO/NGA
SAMHSA’S EFFORTS TOADDRESS THE OPIOID CRISIS
$32.3MAmount SAMHSA awarded in
discretionary grants for Opioid
Prevention, Treatment or Recovery
in 2016-17
$485MAmount SAMHSA awarded in
formula grants through the State
Targeted Response to Opioid Crisis
$1.8BAmount of SAMHSA Substance Abuse
Prevention & Treatment Block Grant
(SABG) used for prevention, treatment &
recovery, including opioids
SAMHSA'S EFFORT TO FIGHT OPIOID MISUSE & ABUSE
Community awareness programs such as the Strategic Prevention Framework for Prescription Drugs (SPF-RX)
grant helps states and tribes create strategy to prevent overuse through education to schools, prescribers, patients
and parents Additionally, SAMHSA helps states to use the data from the Prescription Drug Monitoring Program
(PDMP) to create effective and strategic prescription drug prevention plans.
The impact of the opioid epidemic is increasing, with addictions to illegal drugs such as heroin and legal pain relievers, such
as oxycodone, hydrocodone, codeine, morphine, fentanyl, and many others. SAMHSA continues to provide information,
evidence-based practices, and treatment locators to prevent, treat, and promote recovery from opioid misuse and abuse.
THE OPIOID CRISIS NUMBERS
The SAMHSA Substance Abuse Prevention & Treatment Block Grant (SABG) and Prevent Prescription
Drug/Opioid Overdose Related Deaths (PDO) grants provide funding to help states, tribes and communities
purchase and distribute Naloxone. The PDO grant also trains first responders and other key
community workers on using Naloxone appropriately and safely.
The Cooperative Agreement for the Provider’s Clinical Support System - Medication Assisted Treatment
Supplement (PCSS-MAT), Medication Assisted Treatment-Prescription Drug & Opioid Addiction (MAT-PDOA)
grants help states & tribes improve access to evidence-based MAT services through education and training of
providers and strategic planning.
SAMHSA helps individuals find appropriate treatment through it's Buprenorphine Physician & Treatment
Program Locator & Opioid Treatment Program Directory found at www.samhsa.gov. SAMHSA regulates MAT to
ensure public safety through the PDMP, and Buprenorphine Final Rule.
Opioid-related inpatient stays increased
64%, and opioid related ER visits
increased 99% between 2000 and 20142
Sources: (1) www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm#sudyr06; (2) http://kff.org/state-category/health-status/opioids; (3) https://www.hcup-
us.ahrq.gov/reports/statbriefs/sb219-Opioid-Hospital-Stays-ED-Visits-by-State.pdf
Overdose deaths nationwide3
nearly tripled from 2002 to 2015
Approximately 2.4 million people had
an opioid use disorder addiction and
~591,000 have a heroin use disorder
as of 20151
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov
As of March 2017, there are
~1,500 Opioid Treatment Programs
certified to operate nationally.
As of March 2017, the total number of DATA-Waivered physicians
who can prescribe buprenorphine are:
MDs with Patient Limit (PL) of 30
~25,300
MDs with PL of 100~9,300
MDs with PL of 275~3,010
NPs with PL of 30205
PAs with PL of 3055
POPULATION SPECIFIC OPIOID RELATED TECHNICAL ASSISTANCE
SAMHSA's Service Members, Veterans, and Their Families Technical Assistance Center
(SMVF TA Center): Works with states/territories to strenthen SMVF behavioral health systems.
www.samhsa.gov/smvf-ta-center
OPIOID TREATMENT PROGRAMS & PROVIDERS
National Center of Substance Abuse & Child Welfare: Works with alcohol and drug treatment
agencies, child welfare agencies and the courts to support the complex need of families affected
by substance abuse. www.ncsacw.samhsa.gov
ATTC Center of Excellence on Behavioral Health for Pregnant and Women and Their
Families (ATTC CoE-PPW): Help to develop a family-centered, national treatment curricula,
web-based toolkit, and provide support for national training efforts through the ATTC
Network. http://www.attcppwtools.org/
RESOURCES FOR OPIOID USE DISORDER
Tribal Technical Assistance and Training Center: Comprehensive broad, focused, and/or
intensive training and technical assistance (TTA) to federally‐recognized tribes and other
AI/AN communities. https://www.samhsa.gov/tribal-ttac
MATx Mobile App to Support
Medication-Assisted Treatment of
Opioid Use Disorder
This free app supports practitioners who
currently provide MAT, as well as those
who plan to do so in the future. Learn
more at
http://store.samhsa.gov/apps/mat/
A Collaborative Approach to the
Treatment of Pregnant Women with
Opioid Use Disorders
Learn more at
http://store.samhsa.gov/product/A-
Collaborative-Approach-to-the-
Treatment-of-Pregnant-Women-with-
Opioid-Use-Disorders/SMA16-4978
Decisions in Recovery: Treatment for
Opioid Use Disorder
A web-based, multimedia tool for
persons seeking recovery from an
opioid use disorder. Learn more at
http://archive.samhsa.gov/MAT-
Decisions-in-Recovery/Default.aspx
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov
TREATMENT RESOURCESFOR OPIOID USE DISORDER
SAMHSA RESOURCESSAMHSA resources help practitioners be better prepared to identify a need
for, and connect patients to, appropriate opioid use disorder treatment.
Opioid Overdose Prevention Toolkit
This publ ication equips heal th care providers, individuals,
communities, and local governments with ways to
prevent and respond to opioid overdose. It addresses
issues for first responders, treatment providers, and
those recover ing from opioid overdose. Learn more at
http://store.samhsa.gov/product /Opioid-Overdose-
Prevention-Toolkit-Updated-2016/SMA16-4742
Screening, Brief Intervention, andReferral toTreatment (SBIRT)
SBIRT is an approach that del ivers ear ly
inter vention and treatment for people
with substance use disorders.
http://samhsa.gov/sbir t
SAMHSA’s Technical Assistance Publ ication (TAP 33) describes core elements
of SBIRT programs for people with or at r isk for substance use disorders. It
describes SBIRT services implementation, covering challenges, barr iers, cost,
and sustainabil ity. Search TAP 33 at http://www.store.samhsa.gov. Additional
information on SBIRT is available at the SAMHSA/HRSA Center for Integrated Health
Solutions at http://www.integration.samhsa.gov/cl inical-practice/SBIRT
Earn 1.75 CME/CE credits by taking the FREE, case-based SBIRT training activity
provided by SAMHSA through Medscape Education at http://www.samhsa.gov/sbir t
Medication-AssistedTreatment Courses
SAMHSA provides continuing CME
courses on prescribing opioids for
chronic pain and medication-assisted
treatment (MAT). Most courses include
resources that address practice management, legal and regulator y issues,
opioid pharmacology, and strategies for managing chal lenging patient
situations. Learn more at http://samhsa.gov/medication-assisted- treatment /
tr aining-resources/opioid-courses
Providers’ Clinical Support System (PCSS)
PCSSis a national training and mentoring
project developed in response to the
national increase in opioid use disorders.
It provides CME/CE training related to
proper opioid prescribing and providing
MAT. Learn more at http://pcss-o.org/
(for effective use of opioids for treatment of chronic pain and safe and effective
treatment of opioid use disorder)and http://pcssmat.org/ (for MAT).
FINDHELPThese resources can be used to find
specialty treatment for substance
use disorders in your community.
ht tp://samhsa.gov/ find-help
Find treatment facil ities and programs
for mental and substance use disorders.
http:// findtreatment.samhsa.gov
Find physicians author ized to
treat opioid dependency.
http://samhsa.gov/medication-assisted-
treatment/physician-program-data/
treatment-physician-locator
Find treatment programs in your state
for addiction and dependence on opioids.
http://dpt2.samhsa.gov/ treatment
Get treatment refer ral s and other
information at this free, confidential
helpl ine, available 24/7, 365 days a year
1-800-662-HELP (4357)
TTY: 1-800-487-4889
ht tp://samhsa.gov/ find-help/
nat ional -helpl ine
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov
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Direct to Consumer TechnologiesSAMHSA’s Knowledge Network
Awards to states and peer-run organizations.
Dissemination activities include webinars, technical assistance, and an email listserv.
Sponsorship of national summits, expert panels, & other forums that bring recovery communities together to share knowledge and to translate this knowledge into practice.
Development of tools that expand and sustain models of shared decision making.
This site is for educational purposes. Consult your physician before beginning any treatment.
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New England
ATTC
Brown Univ.
Providence
Northeast &
Caribbean
ATTC
Nat. Develop.
& Res. Inst.
N.Y.
Central East
ATTC
Danya Inst.
Silver Spring
Southeast
ATTC
Morehouse
School Med.
Atlanta
South-
Southwest
ATTC
Univ. Texas
Austin
Great Lakes
ATTC
Univ.
Wisconsin
Madison
ATTC Nat.
Coordinating
Office
Univ. Missouri
Kansas City
Mountain
Plains ATTC
Univ. North
Dakota
Grand Forks
Northwest
ATTC
Univ.
Washington
Seattle
Pacific
Southwest
ATTC
Univ. Cal.
L.A.
Mid-America
ATTC
Truman Med.
Ctr. West
Kansas City
ATTC Network 2017-2022
South Africa ATTC
Brown University – CT
&
University of Cape
Town
Ukraine ATTC
Univ. California San Diego
&
Ukrainian Res. Inst. Social &
Forensic Psychiatry & Drug
Abuse
Southeast Asia ATTC
Univ. California LA
&
Chiang Mai University
Thailand
Vietnam ATTC
Univ. California LA
&
Hanoi Medical University
Ho Chi Minh School Medicine & Pharmacy
Vietnam University of Labor & Social Affairs
International ATTC Centers
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LEVERAGING TECHNOLOGY
For informational purposes only; endorsement not implied. SAMHSA sponsored Recovery App Challenge
Surgeon General’s Report Presentation to SAMHSA Staff
5600 Fishers Lane
Rockville, Maryland
Contents of the Report
Chapter 1: Introduction and Overview of the Report
Chapter 2: The Neurobiology of Substance Use, Misuse, and Addiction
Chapter 3: Prevention Programs and Policies
Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders
Chapter 5: Recovery: The Many Paths to Wellness
Chapter 6: Health Care Systems and Substance Use Disorders
Chapter 7: Vision for the Future: A Public Health Approach
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2018
