Topics in Treatment: Treatment and Recovery Legislation, Part Three – The SUPPORT Act

In Parts One and Two of our series on treatment and recovery legislation, we discussed The Comprehensive Addiction and Recovery Act (CARA) and the 21^st Century Cures Act, respectively. We introduced the series by offering a brief description of the events that led to the opioid crisis, which led to the passage of three significant articles of legislation by Congress to address the crisis. CARA was the first of those three, and the 21 Century Cures Act was the second. In this third and final article in our series, we’ll discuss the third and most recent act passed by Congress in response to the opioid crisis, the SUPPORT Act.

Let’s get right to what’s inside the act.

What is the SUPPORT Act?

The SUPPORT Act was introduced by Representative Greg Walden of Oregon in June of 2018 and passed into law by Congress in October of 2018. The SUPPORT act followed the passage of CARA and the 21^st Century Cures Act. The Act reauthorizes and continues funding for many of the key elements of both preceding acts and introduces several new initiatives to ensure the programs started under CARA and 21^st Century Cures reach their full potential and benefit the lives of as many U.S. citizens as possible.

Here are the broad strokes of what the act does. The SUPPORT Act:

• Reauthorizes grants established by the 21^st Century Cures Act
• Expands first-responder training for the administration of Naloxone (a.k.a. Narcan, the fast-acting anti-overdose medication)
• Extends Naloxone training programs to include training on fentanyl safety. In case you’ve never heard of fentanyl, it’s a powerful opioid medication that plays a role in many accidental overdose deaths
• Establishes a grant program to establish comprehensive opioid recovery centers that include:
  • Holistic care
  • Medication-assisted treatment (MAT)
  • Counseling
  • Recovery housing
  • Job training
• Requires the Department of Health & Human Services to establish best practices for recovery housing, including processes for identifying fraudulent recovery housing operators

The overall goal of the act is to strengthen, extend, and expand the programs initiated by CARA and the 21^st Century Cures Act. However, the SUPPORT Act goes further. It doubles down on increasing education, standardizing federal treatment programs, and expanding access to treatment. It addresses remaining barriers to treatment access and recovery support by significantly increasing addiction coverage in federal health insurance programs such as Medicare and Medicaid.

We’ll now take a closer look at what’s in the act.

The SUPPORT Act: Key Provisions

The American Society of Addiction Medicine (ASAM) published a concise and helpful overview of the SUPPORT Act that highlights its most important elements. ASAM explains the act by dividing it into three core provisions: TEACH, STANDARDIZE, and COVER.

We’ll discuss those now, in that order, in the language ASAM uses.

The Support Act: Summary of Contents

1. Teach It. The SUPPORT act establishes:
   • Grant programs designed to encourage medical schools to increase training in addiction medicine and pain management.
   • An accelerated pathway for physicians to meet requirements established by the Drug Addiction Treatment Act of 2000 (DATA 2000).
   • Loan repayment programs for addiction physicians practicing in high-need areas
   • Provisions allowing qualified physicians and psychiatrists to treat up to 100 patients with buprenorphine. The previous limit was 30.
   • Authority for Nurse Practitioners (NPs) and Physician’s Assistants (Pas) to prescribe buprenorphine.
   • Authority for other members of the nursing profession – clinical nurse specialists, nurse anesthetists, and nurse midwives – to prescribe buprenorphine through October 2023.
2. Standardize It. The SUPPORT Act:
   • Encourages SAMHSA to share and provide information to help entities applying for grants that support the ongoing implementation and replication of evidence-based practices.
   • Authorizes federal grant money to assist hospitals in developing protocols for discharging patients who presented with opioid overdose.
   • Authorizes federal grant money to establish programs that connect people who overdose with peer support programs, access to Naloxone, and specialized substance use disorder treatment programs.
3. Cover It. The SUPPORT Act:
   • Establishes model outpatient opioid use disorder (OUD) treatment programs administered by Medicare. The model programs must:
     • Emphasize care coordination
     • Apply the biopsychosocial model of care
     • Enhance reimbursement programs for OUD treatment
   • Expands Medicare coverage of Opioid Treatment Programs (OTPs), which were previously not covered by Medicare.
   • Requires Centers for Medicare & Medicaid Services (CMS) to expand the use of telemedicine in substance use disorder treatment.
   • Changes the Controlled Substances Act to allow implantable or injectable medications for detoxification to be delivered by specialty pharmacies.

In the 1960s, observers noted that the Voting Rights Act gave teeth to the Civil Rights Act. It did this by establishing federal oversight over election processes and requiring states to get approval from the federal government before making changes to voting laws. It’s possible to look at the SUPPORT Act in a similar way. By requiring Medicare and Medicaid to cover life-saving treatments for people living with substance use disorders, extending prescribing authority to more medical professionals, and incentivizing medical schools to train students in addiction medicine and rewarding those students who do, it’s reasonable to say the SUPPORT Act gives teeth to both CARA and the 21^st Century Cures Act.

Advocacy in Action

We concluded Part Two of this series by pointing out that although the wheels of large bureaucracies like the federal government and the medical establishment turn very, very slowly most of the time, there are times when those same wheels turn rapidly.

When that happens, it’s almost never by accident.

The thing that gets those wheels to turn – the grease, as it were – is not a thing.

It’s people. It’s the advocates who work to raise awareness on behalf of our citizens in need. We owe our thanks to these advocates. We’re indebted to the concerned parents and the grieving families who spoke out. We can credit these changes to them, and the dedicated treatment professionals, first responders, physicians, and psychiatrists who saw the opioid crisis develop and understood that something had to be done to stop it.

We conclude this series by asking our readers to recognize something we think matters. While it appears that everything that has happened in Washington, D.C. these past few years has been hopelessly hamstrung by partisanship and characterized by a near-total absence of compromise and good-faith negotiation by our elected representatives, the passage of these three acts in Congress prove that we, as a nation, can still join together and enact laws that transcend our differences and work for the benefit of all.