Addiction Care in Peril: The SUPPORT Act’s Unresolved Reauthorization

While Congress managed to avert a shutdown (at least for the time being), vital resources for addiction care have lapsed. Thanks to a lack of reauthorization by September 30, many programs authorized in the SUPPORT Act now sit unfunded. As a result, patient access to addiction care hangs in the balance. It’s time for policymakers to step in and act.

What is the SUPPORT Act?

The Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act changed the federal approach to treating addiction. This bipartisan law represents a comprehensive response to the opioid crisis public health emergency. It directed federal resources toward prevention, education, coverage, treatment, and law enforcement programs. Since being enacted, the SUPPORT Act has increased access to services by relaxing eligibility and enrollment for vulnerable populations, expanded authorization for new Medicaid demonstration programs, and enhanced prescription drug oversight. The act also allocated funding for critical community-based treatment and recovery programs while requiring expanded coverage for FDA-approved medications to treat opioid use disorder (MOUD).

How has the overdose crisis changed?

Since 2018 when the SUPPORT Act was initially passed and signed into law, the nature of the drug overdose crisis has changed considerably. Overdose deaths increased by around 30% during the first year of the COVID-19 pandemic. At that time, overdose deaths were driven by increases in prescription opioid pain medications. However, now these deaths are climbing because of increases in the supply of illicit fentanyl. What’s noteworthy is that this rise is no longer confined to individuals with diagnosable substance use disorders; it now extends to first-time and casual drug users as well. These evolving dynamics have led to stark inequities among people of color—overdose death rates rose by 81% between 2019 and 2021 in both Black and Native Americans, compared with just 40% among white Americans during that same timeframe.

What’s at stake?

With the nation once again exceeding 100,000 overdose deaths in 2022, it is crucial that policymakers reauthorize the SUPPORT Act and respond to the changing needs of the drug overdose crisis.

The SUPPORT Act of 2018 shifted the nation’s approach to the opioid crisis by addressing it as a public health issue and bringing a whole-of-government response to fill service gaps across the health care system and within the community. Despite the opioid crisis having the same federal designation—a public health emergency—as the COVID-19 pandemic, there is a weaker federal response. Congress now has the responsibility to remedy this by coordinating and assessing how those investments and policies have fared in the intervening five years, and evaluating what must be changed to meet the evolving nature of the crisis. In our 2022 report, Combating the Opioid Crisis: “Smarter Spending” to Enhance the Federal Response, BPC provided recommendations to optimize federal spending to fight the opioid crisis. Congress can use recommendations like these to determine how their investments can yield better outcomes and ultimately prevent more lives from being lost.

Long-term success requires longer-term investments across the continuum of care. Without reauthorizing the SUPPORT Act, the U.S. runs the risk of losing the progress that has been made over the past five years. For example, increased access to telehealth services for patients with diagnosed substance use disorder—first authorized through the SUPPORT Act—contributes to increased treatment retention and helps close the treatment gap. Outside of the SUPPORT Act, federal policy changes from Congress and the Biden administration have made it easier to administer lifesaving MOUD, naloxone, patient-centered treatment plans, and crisis response. Keeping policy progress from recent years in mind, we can continue laying the groundwork for federal resources to be used more effectively, both for health care services and services that target social risk factors, such as housing insecurity.

At BPC, the Health Program and the J. Ronald Terwilliger Center for Housing Policy are dedicated to policies that improve access to addiction care and address homelessness. In addition to BPC’s 2022 report on addressing the opioid crisis, Congress can gain valuable insights from BPC’s work on how to increase the capacity of primary care providers to deliver behavioral health services (including in rural communities), promote new types of behavioral health professionals, build a comprehensive crisis response system, and address health among housing insecure and homeless individuals.

What comes next?

Many of BPC’s previous recommendations can inform the reauthorized SUPPORT Act. BPC has organized recommendations for Congress to consider across four major policy domains:

• enhancing community-based programs;
• addressing Medicaid coverage for high needs patients;
• updating behavioral health metrics; and
• improving workforce capacity. 

The challenges related to accessing treatment for substance use demand thorough and systemic reform. Incorporating BPC’s proposals into the SUPPORT Act reauthorization could facilitate improved access to, and assessment of, treatment and recovery services. We support Congress’s dedication to addressing the overdose crisis and encourage policymakers to take these steps to prevent further loss of lives.

For more information on BPC’s recommendations, check out our recent SUPPORT Act brief.