FY 2020 Annual Performance Plan and Report - Goal 2 Objective 3

Topics on this page: Goal 2. Objective 3 | Objective 2.3 Table of Related Performance Measures

Goal 2. Objective 3: Reduce the impact of mental and substance use disorders through prevention, early intervention, treatment, and recovery support

Mental illness and substance abuse create health risks and place a heavy burden on affected individuals and their families. Substance use disorders arise from the recurring use of alcohol and/or drugs, which lead to clinically and functionally significant impairments. Mental disorders are health conditions that involve significant changes in thinking, emotion, and/or behavior and lead to distress and/or problems functioning in social, work, or family activities. Mental and substance use disorders are illnesses that impact people's ability to go about their daily lives in family, social, and professional settings and place individuals at risk of additional health problems. HHS works closely with federal, state, tribal, local, territorial, and community partners and stakeholders, including faith-based and community organizations, to help identify and address mental health problems and substance use disorders.

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, IOS, OCR, and SAMHSA.

Objective 2.3 Table of Related Performance Measures

CDC tracks the rise of opioid overdose deaths and uses the data to pivot to prevention activities to curb this alarming epidemic. Opioids were involved in over 42,249 deaths in 2016, and opioid overdoses were five times higher in 2016 than 1999. In response to this growing public health crisis, CDC has launched its Overdose Prevention in States (OPIS)²³ effort as means to equip states with resources and expertise needed to reverse this epidemic. As a part of OPIS, CDC's Prescription Drug Overdose Prevention for States (PfS) program funds 29 state health departments to advance and evaluate comprehensive state-level interventions for preventing opioid-related overdose, misuse, and abuse. This measure tracks progress in reducing overdose deaths involving all opioids among the 29 states funded specifically for PfS. In FY 2016 the baseline, age-adjusted annual rate of opioid overdoses was 15.0 per 100,000 residents among states funded for the PfS program. The PfS program will fund states through September 2019, at which point all the current OPIS programs will be replaced with one comprehensive new grant – Overdose Data to Action. Eligible entities include states, territories, and localities. CDC will continue to track the rise of opioid overdose deaths to monitor the impact of its prevention activities in FY 2020.

SAMHSA expects the number of people receiving MAT and the number of admissions to substance abuse treatment with MAT to increase. States are continuing to develop their systems with increased resources from grant programs, such as the State Opioid Response grants, Tribal Opioid Response grants, and Targeted Capacity Expansion: Medication-Assisted Treatment Prescription-Drug and Opioid Addiction grants. Medicaid systems have increased their focus on opioid-related technical assistance, and outreach efforts from across HHS promote the use of MAT. SAMHSA uses data from the Treatment Episode Dataset (TEDS) to track the provision of substance abuse treatment for opioid use disorders, which includes tracking the planned use of MAT at admission.²⁵ In CY 2015, 223,407 treatment admissions had MAT as a planned part of the treatment plan and 217,626 admissions had MAT planned in CY 2016. MAT data for CY 2017 will be made available in 2019. MAT data for CY 2018 will be available in CY 2020. SAMHSA will continue to monitor the use of MAT in CY 2019 and CY 2020.

Addressing the nation's opioid epidemic is an ongoing focus of AHRQ's Health Services Research, Data, and Dissemination portfolio. In FY 2017, AHRQ launched a new initiative to ensure that health care professionals have access to evidence supporting safe pain management and opioid prescribing at the point of care through electronic clinical decision support (CDS). CDS Connect is the infrastructure for developing and sharing these CDS tools.²⁶

In FY 2018, AHRQ developed a dashboard that aggregates pain-related information from the Electronic Health Records (EHR) into one consolidated view for clinicians. The information includes data such as pain medications, pain assessments, relevant diagnoses, and lab test results. The dashboard was tested in partnership with Oregon Community Health Information Network, a network of community health centers, and uses the Health Level Seven Fast Healthcare Interoperability Resources standard, which allows for interoperability and implementation in different EHRs.

In FY 2018 and continuing in FY 2019, AHRQ will disseminate safe pain management and opioid-related CDS through CDS Connect. This includes the pain management dashboard developed in FY 2018. In addition, AHRQ will continue to work with its partners to disseminate safe pain management and opioid CDS tools. For example, CDC uses AHRQ's CDS Connect web platform as a dissemination mechanism for two opioid CDS tools that were developed by CDC and ONC. In FY 2019 and continuing in FY 2020, AHRQ will develop, test, and disseminate another electronic clinical decision support tool related to opioids or safe chronic pain management. AHRQ will continue to work with its partners and stakeholders on dissemination.

The misuse of and addiction to opioids such as heroin and prescription pain medicines is a serious national problem. This issue has become a public health epidemic with devastating consequences, which include increases in opioid use disorders (OUDs) and related fatalities from overdoses; rising incidence of newborns who experience neonatal abstinence syndrome because their mothers used these substances during pregnancy; and increases in the spread of infectious diseases, which include HIV and hepatitis C. This measure highlights one facet of NIH-funded research in providing scientific evidence to inform the public health response to the opioid crisis. In FY 2018, an NIH-funded Phase 3 clinical trial of lofexidine was completed, and the results were submitted to FDA.

Lofexidine is the first non-opioid medication for managing symptoms of opioid withdrawal in the United States, and FDA approved its use in May 2018. The drug provides a new option to help patients manage the excruciating physical symptoms of opioid withdrawal, which can be a major cause of relapse for those undergoing detoxification. Although medications have been available to treat opioid addiction, none have been approved to treat the physical symptoms of withdrawal. Approval of lofexidine (Lucemyra) is expected to facilitate detoxification and improve the success of detoxification, which will make treatment and recovery possible for many patients with opioid use disorder. In FY 2019 and 2020, NIH will continue to support research that explores new strategies for treating opioid misuse and addiction.

With states and the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) driving efforts to address the needs of children and youth with serious emotional disturbances, SAMHSA expects to see increases in the percentage of youth with a past year major depressive episode who receive mental health treatment. The National Survey on Drug Use and Health (NSDUH) defines treatment for depression as 1) Seeing or talking to a health or alternative service professional, or 2) Using prescription medication for depression in the past year. The most recent data available show that in CY 2017, 47.5 percent of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year received mental health treatment. SAMHSA has funded a number of programs to increase access to treatment, which include Healthy Transitions continuation grants and contracts for technical assistance and evaluation. In FY 2018, in addition to supporting contracts for technical assistance and evaluation, SAMHSA continued support for 14 continuation grants and supported 4 new grants. In CY 2019 and 2020, SAMHSA will continue to monitor major depressive episodes in youth ages 12-17, and the agency anticipates that these efforts made to improve access to services will lead to identifying reductions in the percentage of youth who report major depressive episodes.

With states and ISMICC driving efforts to address the needs of individuals with serious mental illness (SMI), SAMHSA expects to see increases in the percentage of adults with SMI who receive mental health services.²⁹ The most recent NSDUH data available show that in CY 2017, 66.7 percent of adults with SMI received mental health services. In CY 2019 and 2020, SAMHSA will continue to provide guidance to agencies on how to administer mental health services to individuals with SMI. Federal efforts, including ISMICC, discretionary grant programs, and SAMHSA's Clinical Support Services for SMI Technical Assistance Center will enable agencies to provide coordinated efforts and resources to individuals with SMI.