A Short History of Addiction and Drug Legislation

drug policy and legislation

The last decade has brought important strides in improving prevention and access to treatment

By Jason Langendorf

September 4, 2020

More than 21 million Americans 12 or older were estimated to be in need of substance use treatment in 2018, according to findings from the Substance Abuse and Mental Health Services Administration (SAMHSA). The same definitive study determined that only 3.7 million people in the United States received treatment the previous year. In other words, fewer than 1 in 5 Americans are getting the addiction care they need, according to the most recent data from one of the addiction field’s foremost agencies found, in keeping with a continuing trend.

It’s a stark truth that caregivers, health officials and government power brokers face. Substance use disorder is a dangerous Gordian knot that, due to a tangle of chemical, societal and financial factors, often resists the efforts of individuals struggling with addiction—even those who want to get help. The staggering shortfall to meet the needs of this population, nearly 50 years after Richard Nixon launched in 1971 our ongoing “War on Drugs,” makes clear the depth of America’s substance problem.

For at least as long as substance addiction has been labeled an epidemic in this country, one of the primary barriers to care has been payment—or at least concern about cost. Lack of health coverage or the perception that treatment would not be affordable was the top reason cited by those in need of care for not receiving it, as recently as 2013, according to SAMHSA. That figure has since decreased slightly, but the most recent data shows that even today cost is identified by 1 in 3 people who need treatment as a reason for not getting help.

Yet resources and funding should be one of the components of care that is mostly readily addressed. The White House Office of National Drug Control Policy found that “every dollar spent on substance abuse treatment saves $4 in healthcare costs and $7 in law enforcement and other criminal justice costs,” in a key 2012 study.

In the last 10 years, as concerns about the opioid epidemic approached critical mass—and as the benefits of decriminalizing substance use have risen into sharp relief—public opinion has begun to shift from punishment to treatment.

Legislators are taking note—and action. A series of bipartisan laws, both broad and hyper-focused, have allocated significant resources to caregiver systems, researchers, educators and individuals in the past 10 years.

Substance use disorder is a dangerous Gordian knot that, due to a tangle of chemical, societal and financial factors, often resists the efforts of individuals struggling with addiction—even those who want to get help.”

Below is a timeline of federal legislation on substance use and treatment in the last decade.

The Patient Protection and Affordable Care Act (March 2010): Also known as Obamacare, the Affordable Care Act (ACA) was one of the most significant pieces of legislation in U.S. history. In addition to expanding healthcare coverage (in particular to low-income citizens), the ACA helped bolster funds and access through Medicare and Medicaid, and connects more people to substance treatment options while also making them more affordable. Subsequent amendments of the ACA have improved access to treatment, and in 2014 the U.S. Department of Health and Human Services (HHS) devoted $50 million to supporting substance use recovery programs.

Comprehensive Addiction and Recovery Act (July 2016): The first major legislation around addiction the country had seen in decades, CARA authorized $181 million annually to address the prevention and treatment of substance abuse (with an emphasis on opioids) and instituted a number of harm-reducing strategies – many of them focused on filling the gaps in services for rural communities. Bolstering education, research and monitoring, loosening regulations handcuffing caregivers and ensuring proper access to and administration of the overdose-reversal drug naloxone all represented encouraging strides.

21st Century Cures Act (December 2016): The Cures Act was considered problematic by some for its perceived regulations-loosening of the drug and medical device industry, but it has had an undeniably positive effect on America’s substance abuse crisis. The law helped codify much-needed clinical leadership and evidence-based programs as part of a comprehensive government response. It also authorized $1 billion in funding over a two-year period specifically to address the opioid abuse crisis. The Cures Act has helped fund state block grants dedicated to prevention, treatment evaluation, caregiver training and improved treatment access, as well as requiring regular study of data trends in order to optimize distribution of those funds.

SUPPORT for Patients and Communities Act (October 2018): The SUPPORT Act represented sweeping legislation with a variety of provisions but specifically targeted the U.S. opioid overdose crisis. Outcomes included expanded and improved opioid use disorder holistic care, first-responders training and State Targeted Response (STR) grants that reauthorized and modified resources under the Cures Act to improve allocation flexibility for states and provide funding to underserved Native American communities.

MISSION Act Community Care Program (June 2019): The MISSION Act essentially replaced the Veterans Choice Program (VCP), which helped open community healthcare services to qualifying veterans. If a Veterans Affairs (VA) facility isn’t located nearby (and in certain other cases), qualifying veterans were newly allowed to receive local community care services. The MISSION Act continued these services, expanded benefits to caregivers and augmented the distance and wait-time parameters, improving resources and casting a wider net to assist more vets.

CARES Act (March 2020): Also known as the Coronavirus Aid, Relief and Economic Security Act, the CARES Act was created not only to deliver financial aid to individuals and businesses affected by the COVID-19 crisis but also to aid and expand access to telehealth services—including addiction treatment—during a period when face-to-face caregiver visits have been problematic or impossible. In addition to expediting telehealth policy in general during the pandemic, this legislation ensured coverage of certain audio-only physician and hospital consultations, aligned rates for telehealth services with those of in-premises visits and allowed for the prescription of controlled substances based on telehealth visits.

Photo: Bill Oxford