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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Progress of four programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. https://doi.org/10.17226/26060.

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COMMITTEE ON THE REVIEW OF SPECIFIC PROGRAMS IN THE COMPREHENSIVE ADDICTION AND RECOVERY ACT

KENNETH B. WELLS (Chair), Director, Center for Health Services and Society, Semel Institute, University of California, Los Angeles

HORTENSIA AMARO (Vice Chair), Distinguished University Professor and Senior Scholar on Community Health, Florida International University

GINA BRYAN, Director and Clinical Professor, Post Graduate Psych-Mental Health Program, University of Wisconsin–Madison

KAREN CROPSEY, Conaster Turner Endowed Professor of Psychiatry, The University of Alabama at Birmingham

JOAN DUWVE, Public Health Specialist, Kansas Department of Health and Environment

RAHUL GUPTA, Senior Vice President and Chief Medical and Health Officer, March of Dimes

DAVID H. GUSTAFSON, Director, Center for Health Enhancement Systems Studies, University of Wisconsin–Madison (resigned August 2020)

MARCELA HORVITZ-LENNON, Senior Physician Scientist, RAND Corporation

RAYMOND C. LOVE, Professor and Director, Mental Health Program, School of Pharmacy, University of Maryland

YNGVILD OLSEN, Medical Director, REACH Health Services, Institutes for Behavior Resources, Inc.

SHARON REIF, Professor, Heller School for Social Policy and Management, Brandeis University

Study Staff

KATHLEEN STRATTON, Study Director

ANDREW MERLUZZI, Program Officer (until August 2020)

KELLY McHUGH, Research Associate (from October 2020)

MISRAK DABI, Financial Business Partner

CRYSTI PARK, Administrative Assistant

ROSE MARIE MARTINEZ, Senior Board Director

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by JOSIAH “JODY” RICH, Brown University and the Miriam Hospital, and JACK C. EBELER, Health Policy Alternatives, Inc. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Acknowledgments

The committee of this study thanks Dr. David Gustafson for his service in the early phases of this report. The committee also thanks both the Substance Abuse and Mental Health Services Administration and the Comprehensive Addiction and Recovery Act grantees for their work, and for providing information to the National Academies for this study.

Preface

At a time in our nation’s history when we are dealing with a major public health crisis from a viral pandemic, while also working to address a longer standing public health crisis from overdose and death from opioid use disorder (OUD), we are pleased as a committee to provide some guidance in this, our second of three reports, on specific initiatives funded by Congress through the Substance Abuse and Mental Health Services Administration (SAMHSA) to address the opioid crisis. The programs included in this report address a number of crucial facets of a public health response to the crisis, spanning prevention of overdose and death, treatment of OUD and co-occurring substance use disorder, and a pilot in the underdeveloped area of supporting pregnant and postpartum women. With some evidence that the incidence of OUD and overdose deaths involving synthetic opioids has increased with the coronavirus disease 2019 (COVID-19) pandemic, it is now perhaps of even greater importance to determine what we can learn from the implementation of these programs. Data to inform policy would be helpful across these areas. As chairs of this effort, we are grateful for the support of the National Academies and our outstanding colleagues on the committee to “take the journey” to understand the programs, consider what data are available, and comment on “progress.” Progress of the programs is the main theme of this report, and we have two main considerations of progress. The first is whether and how the programs started up and implemented the activities specified by SAMHSA. The second consideration is about the progress made in the collection of data that would be necessary to understand the impact of the programs. The committee considered the meaning and interpretability of the data provided by SAMHSA and the grantees for this report, and how these may or may not set the stage for impact evaluation—the focus of Report 3. What follows is our committee’s effort to describe that progress and the journey of the programs. May it help us get to clear lessons learned for Report 3, and for our efforts to improve the health of the public in a key area of need—OUD and its consequences.

Kenneth B. Wells (Chair)
Hortensia Amaro (Vice Chair)
Committee on the Review of Specific Programs in the Comprehensive Addiction and Recovery Act

Contents

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION AND BACKGROUND

Comprehensive Addiction and Recovery Act

Statement of Task and Report Methodology

Organization of the Report

2 PPW-PLT AND BCOR PROGRAMS

Introduction

PPW-PLT Program Description

BCOR Program Description

Methodology

Government Performance Reports Act (GPRA) Data Reports

Grantee Progress Reports

Cross-Cutting Data Limitations

Findings: PPW-PLT

Required Activity 1

Required Activity 2

Required Activity 3

Allowable Activity 1

Allowable Activity 2

Allowable Activity 3

Summary of PPW-PLT Program Progress

Findings: BCOR

Required Activity

Allowable Activity 1

Boxes and Tables

BOXES

1-1 Statement of Task

2-1 Recovery Support Services

3-1 First Responders and Members of Other Key Community Sectors

3-2 Connecting Overdose Survivors to Treatment

3-3 Examples of Workforce Development

3-4 Policy Context: Good Samaritan and Naloxone Access Laws

3-5 Additional Material Highlighted in the DSP-MRT for FR-CARA

A-1 PPW-PLT Grantees

A-2 BCOR Grantees

A-3 CSAT GPRA Reporting Tool

A-4 OD Treatment Access Grantees

A-5 FR-CARA Grantees

A-6 CSAP Division of State Programs Management Reporting Tool

A-7 OD Treatment Access Reporting Form

TABLES

S-1 Limitations of Data Sources Used by the Committee

S-2 Summary of the PPW-PLT and BCOR Programs

S-3 Summary of the OD Treatment Access and FR-CARA Programs

2-1 Summary of the PPW-PLT and BCOR Programs

2-2 Limitations of Evidence Sources Used by the Committee for the PPW-PLT and BCOR Programs

Acronyms and Abbreviations