Our essential overview of the issues past, present and future related to legislation around addiction—with resources for our community
By Jason LangendorfOctober 27, 2020
Long before Richard Nixon declared drug abuse to be America’s “public enemy No. 1,” launching a full-scale, 50-years-and-counting War on Drugs, the United States had been dealing with widespread substance issues—usually poorly.
From the mischaracterization of marijuana in the Controlled Substances Act of 1971 to the disastrous effects of Prohibition in the 1920s and ’30s to the lack of understanding and absence of regulation around “remedies” containing opium, cocaine and other potent substances as far back as the 1700s, America has often missed the mark on drug policy. Even today, amid a rampant opioid crisis that in 2017 was declared a public health emergency, we struggle mightily to shape legislation and programs to successfully address substance use, addiction and recovery.
Here, TreatmentMagazine.com offers a one-stop overview of the defining issues to help the treatment community track addiction legislation and how it affects our field. We briefly outline the issues, provide resources for further investigation and direct you to stories on our site related to these topics. We invite you to bookmark this page and return often, as we will continue to update it with the latest news and insights about addiction legislation.
The Big Issues
Stigma: The implicit or overt judgment of substance users and those suffering from addiction is a defining source from which so many issues flow. That the United States has only recently begun to come to terms with marijuana legalization but had long held minimal bias toward alcohol and tobacco shows the power of public opinion. Experts across addiction and treatment recommend that substance and addiction policy be driven by evidence-based research and empathy, not false narratives or political agendas.
Cost: Because of the long-held stigma associated with substance use, many taxpayers have been loath to support government officials’ directing funding to addiction and recovery legislation and programs. But the tide slowly is shifting. The opioid epidemic, in particular, has recently convinced many Americans of the need for sweeping changes in our approach to drug policy.
Criminalization: The United States historically has treated individuals with mental health and substance use disorders as social outcasts, delinquents and threats to law and order. That sentiment came to a head in the 1980s and ’90s, but the criminal justice system has only ramped up its intensity around illicit substances as the public shows increasing support for decriminalization.
Race and immigration: These topics walk hand in hand with criminalization. People of color and immigrants have been historically falsely demonized as drivers of the U.S. drug culture, and thus have been disproportionately targeted and incarcerated by law enforcement and criminal prosecutors.
Pharma: Some experts point a finger at America’s pharmaceutical companies, which have helped to create the opioid crisis and much addiction damage while being held to the least account. The industry’s massive profits and muscular lobbying arm have granted it outsized influence on legislation and, too often, a free pass from regulation that could benefit the greater good.
The Last Decade of Addiction Legislation
Here 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 connected more people to substance treatment options while also making them more affordable. Subsequent amendments to 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 it 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 wasn’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 became 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 on-premises visits and allowed for the prescription of controlled substances based on telehealth visits.
There have been notable critics of the legislation: In June 2020, a letter signed by 27 mental health and substance use providers and patient advocacy organizations was sent to Department of Health and Human Services Deputy Secretary Eric Hargan outlining urgent concerns about addiction care facilities across the country being cut off from CARES Act relief. The group wrote that without “immediate support from the federal government, it is likely the nation’s behavioral health safety-net will fail.”
Addiction Legislation Resources
• The Substance Abuse and Mental Health Services Association (SAMHSA) maintains a page on its website detailing important federal laws and regulations related to substance use and mental health services, SAMHSA programs and similar topics. If you’re interested in the broad strokes of U.S. drug and addiction legislation, this is a great place to start.
• The United States Congress features a website that tracks current and settled legislative activities. You can view the precise path a bill followed to become a law, search the archived reports of the Library of Congress and contact your representatives to let your voice be heard. The volume and level of detail can be daunting, but it’s as comprehensive and transparent a publicly available legislative record as you’ll find.
• The National Institute on Drug Abuse (NIDA) is “the lead federal agency supporting scientific research on drug use and its consequences,” and therefore plays a central role in influencing federal drug policy. On NIDA’s website, you’ll find a page with budget information and a chronology of legislation, information about research, grants and funding, as well as addiction and recovery resources related to the COVID-19 pandemic.
• The Drug Policy Alliance declares that “it’s time for a new approach grounded in science, compassion, health and human rights.” The organization backs up this claim with facts and statistics about the War on Drugs, racial discrimination in drug policy, decriminalization and more. The site even provides visitors with practical options to take action themselves.
• The Criminal Justice Policy Foundation outlines a nuanced history of U.S. drug policy, calls out reformist allies and offers a guide on seeking state and federal clemency.
A Short History of Addiction Legislation (8/15/20)
Photo: Sebastian Pichler