FY 2022 Annual Performance Plan and Report - Goal 2 Objective 3

Fiscal Year 2022
Released June, 2021

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, including faith-based and community organizations, to help identify and address mental health problems and substance use disorders.

In the previous administration, the Office of the Secretary led this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, OCR, and SAMHSA.  HHS has determined that performance toward this objective is progressing.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 2.3 Table of Related Performance Measures

Reduce the age-adjusted annual rate of overdose deaths involving synthetic opioids other than methadone (e.g., fentanyl) among states funded through CDC's multi-state surveillance and prevention cooperative agreement (per 100,00 residents) (Lead Agency - CDC; Measure ID - 7.2.7b) ¹³

CDC tracks the rise of opioid overdose deaths and uses these data to inform prevention activities.  Over 450,000 people have died from overdoses involving opioids in the United States from 1999 through 2018.  In response to this growing public health crisis, CDC's Prescription Drug Overdose Prevention for States (PfS) program funded 29 state health departments to advance and evaluate comprehensive state-level interventions for preventing opioid-related overdose, misuse, and abuse.

The age-adjusted annual rate of opioid deaths involving synthetic opioids other than methadone (e.g., fentanyl) in FY 2018 was 11.2 per 100,000 residents among states funded for the PfS program, which did not meet the target of 8.7 per 100,000 residents.  The growing issue of polysubstance use means that an opioid-involved overdose often occurs in combination with exposure to other opioids and/or other non-opioid substances. The overdose epidemic has also grown increasingly complex by co-involvement of prescription and illicit drugs. To address this emerging trend, CDC will continue to strengthen surveillance activities, identify interventions, and implement prevention programs that address the evolving nature of the epidemic.  Surveillance components will continue to collect and disseminate timely morbidity and mortality data for all drug overdoses, including emerging threats, such as polysubstance use and stimulants.  CDC will also continue to fund innovative surveillance strategies to help drive action and inform more targeted prevention efforts.  Prevention activities will strengthen prescription drug monitoring programs, improve consumer awareness around the risks of prescription opioids, establish linkages to care, and improve provider and health system support to increase safer prescribing.

Reduce the age-adjusted rate of overdose deaths involving natural and semisynthetic opioids (T40.2) or methadone (T40.3) as a contributing cause of death among states funded through CDC's multi-state surveillance and prevention cooperative agreement(per 100,000 residents. (Lead Agency - CDC; Measure ID - 7.2.7c) ¹⁴

CDC monitors the reduction of overdose deaths involving all opioids among the states funded specifically for PfS awards made in FY 2016.  Since 2016, as the epidemic has evolved, CDC has scaled its programs from an initial cohort of states to a program with a national scope.  This performance measure reports outcomes based on the number of funded states and includes overdoses caused by methadone.  These data allow CDC to better guide prevention activities related to safer prescribing.

CDC has tailored its response as the epidemic continues to evolve and will continue to take action to further reduce overdose deaths.  In FY 2019, CDC released its new Notice of Funding Opportunity, Overdose Data to Action (OD2A).  This program funds 47 states, Washington, D.C., 16 localities, and two territories to advance the understanding of the opioid overdose epidemic and to scale-up prevention and response activities which builds on previous surveillance efforts to foster an interdisciplinary, comprehensive and cohesive public health approach to the complex and changing nature of the opioid overdose epidemic.  In FY 2022, CDC will continue to support recipients along the trajectory of moving from data to action, building upon work completed through the funding opportunity OD2A.

Increase the number of substance use treatment admissions with Medication-Assisted Treatment (MAT) planned as part of Opioid Use Disorder Treatment (Lead Agency - SAMHSA; Measure ID - 2.3.19K) ¹⁵

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 use treatment for opioid use disorders, which includes tracking the planned use of MAT at admission.¹⁶  In CY 2015, 196,704 treatment admissions had MAT as a planned part of the treatment plan.  In CY 2016, 191,817 admissions had MAT planned and 241,675 opioid admissions had MAT planned in CY 2017, and 255,464 opioid admissions had MAT planned in CY 2018.  MAT data for CY 2019 will be available in 2021.  SAMHSA will continue to monitor the use of MAT in CY 2021 and 2022.

Increase the availability of electronic clinical decision support tools related to safe pain management and opioid prescribing (Lead Agency - AHRQ; Measure ID - 2.3.8)

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.¹⁷

In FY 2020, the two new contracts began designing and developing the CDS for chronic pain management, including meeting with end-users (e.g., patients, clinicians) and planning for integration with their pilot sites' electronic health records.  One contract built on the pain management dashboard developed by the AHRQ CDS Connect project in 2018, and the other contract built brand new applications to help with opioid tapering.  Each contract has been developing both clinician- and patient-facing CDS applications.  Information about the contracts has been disseminated through project profiles at https://digital.ahrq.gov, and abstracts have been submitted for presentation at research conferences.  One project's evaluation approach has received OMB approval for compliance with the Paperwork Reduction Act.

In FY 2021, both contracts will complete the design of the CDS applications, followed by testing and deployment at their pilot sites.  Each of the contracts will perform a self-evaluation of their CDS and will disseminate resources and lessons learned through AHRQ's CDS Connect platform.  This will include implementation guides and other materials for re-use by other health care systems.  Each project's self-evaluation is in addition to a separate evaluation of AHRQ's overall CDS initiative, which began in FY2020.

The project that is providing safe pain management and opioid prescribing data is ending in FY 2021 and this measure will be retired.

By 2023, evaluate the efficacy of new or refined interventions to treat opioid use disorders (OUD) (Lead Agency - NIH; Measure ID - SRO-4.9)

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 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, such as 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 2020, NIH supported the pre-clinical development of a new implant that will deliver nalmefene, a drug that blocks opioid signaling, over a six-month period.  The goal is to advance this implant to be tested in humans for the prevention of relapse to opioid addiction in patients following opioid detoxification.  In addition, NIH supported a clinical trial to evaluate the safety and efficacy of GM0017, an implant that delivers the OUD medication naltrexone over six months.  This implant is being developed for prevention of opioid relapse in individuals with OUD who have been detoxified.  Naltrexone is currently delivered as an extended-release injection on a monthly basis.  Developing an implant that could deliver naltrexone over six months would allow individuals to stay on the medication without monthly doctor visits, and help individuals in recovery remain abstinent from opioids.

In FY 2021, NIH is funding clinical trials to study an anti-opioid vaccine and a new medication to treat OUD.  In FY 2022, NIH will fund a clinical trial to study a medication for relapse prevention of OUD or overdose.

Increase the percentage of youth ages 12-17 who experienced major depressive episodes with severe impairment in the past year receiving treatment for depression (Lead Agency - SAMHSA; Measure ID - 2.3.19O) ¹⁸

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 medical doctor or other professional, or 2) Using prescription medication for depression in the past year.  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.

The prevalence of receiving depression care among youth with major depressive episode and severe impairment in the past year remained stable between 2006 and 2018.  In CY 2019, the rate was 49.7 percent, which exceeds the target (48.5 percent) by 1.2 percent. 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.  SAMHSA will work to improve this result in CY 2020 and CY 2021 by providing technical assistance to grantees and by continuing to monitor major depressive episodes in youth ages 12-17.  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.

Increase the percentage of adults with Serious Mental Illness (SMI) receiving mental health services (Lead Agency - SAMHSA; Measure ID - 2.3.19L) ¹⁹

NSDUH defines the mental health services as inpatient treatment/counseling, outpatient treatment/counseling, or the use of prescription medication for mental health problems. In CY 2019, 65.5 percent of the adults aged 18 or older received the mental health services, which was less than the target (68.0 percent).  In CY 2021 and CY 2022, 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.

HHS FY 2020-2021 Agency Priority Goals

The HHS FY 2020-2021 APGs established by the previous administration supported multiple objectives across the HHS Strategic Plan.  For presentation purposes, the Department has chosen to display these APGs under their most closely aligned strategic objectives.

Reducing Opioid Morbidity and Mortality. Reduce opioid-related morbidity and mortality through: 1) improving access to prevention, treatment and recovery support services; 2) targeting the availability and distribution of overdose-reversing drugs; 3) strengthening public health data and reporting; 4) supporting cutting-edge research; and 5) advancing the practice of pain management.  Starting from the baseline of September 30, 2019, by September 30, 2021:

1. Treatment—Increase uptake of medications for the treatment of opioid use disorder:
   1. By 15 percent the number of unique patients receiving prescriptions for buprenorphine in U.S. outpatient retail pharmacies (excluding implantable or long-acting injection products).
   2. By 100 percent the number of prescriptions for long-acting injectable or implantable buprenorphine from retail, long-term care, and mail-order pharmacies in the United States.
   3. By 25 percent the number of prescriptions for extended-released naltrexone from retail, long-term care, and mail-order pharmacies in the United States.
   4. By 57 percent the number of providers with a DATA 2000 waiver authorizing buprenorphine prescribing for opioid use disorder treatment.
2. Overdose intervention—Increase availability and access to overdose-reversing drugs:
   1. By 50 percent the number of prescriptions dispensed for naloxone in U.S. outpatient retail and mail-order pharmacies.

¹³ CDC has PfS cooperative agreements with 29 states.

¹⁴ CDC has PfS cooperative agreements with 29 states.

¹⁵ TEDS Annual Report, which is based on calendar year data, can be found at:  https://www.samhsa.gov/data/data-we-collect/teds-treatment-episode-data-set.  CY 2015, CY 2016, and CY 2017 were updated; states are allowed to update and/or correct their data at any given time.

¹⁶ MAT consists of provision of methadone, buprenorphine or extended-release naltrexone, in combination with counseling and behavioral therapies.  TEDS is a compilation of client-level data routinely collected by the individual state administrative data systems to monitor their substance use treatment systems.  TEDS records do not represent individuals; rather, each record represents a treatment episode.  Thus, an individual admitted to treatment twice within a calendar year counts as two admissions.  TEDS does not include all substance use treatments.  It includes treatment admissions and discharges at facilities licensed or certified by a state substance abuse agency to provide care for people with a substance use disorder (or at facilities that are administratively tracked for other reasons).  In general, facilities reporting TEDS data are those that receive state alcohol and/or drug agency funds (including federal block grant funds) for the provision of alcohol and/or drug treatment services.

¹⁷ https://cds.ahrq.gov.

¹⁸ The latest full NSDUH report, the 2019 NSDUH full report, is available at https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases.

¹⁹ The latest full NSDUH report, the 2019 NSDUH full report, is available at https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases.  Ibid.

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