Three Things to Know About the SUPPORT Act Reauthorization

Addiction in the United States has a far reach, and recent polling shows the severity of the country’s crisis. Nearly 30% of Americans say that they or a family member have been addicted to opioids, but only half of people with addiction sought treatment. This crisis has taken a deadly toll on the U.S. — in 2022, nearly 110,000 people died from an overdose.

To reverse these trends, the Global Health Advocacy Incubator’s Overdose Prevention Initiative advocates to ensure that evidence-based treatment and harm reduction services that help save lives from drug overdose are within reach. By advancing federal policies that address the disparities, inequities and stigma in the addiction treatment system, we can make a difference in the lives of people across the U.S. and prevent needless overdose deaths.

In 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act — the largest Congressional investment in overdose prevention at the time. The original SUPPORT Act contained important funding for community-based treatment and recovery programs and enacted key policy changes. Notably, it required state Medicaid programs to cover all three FDA-approved medications for opioid use disorder (MOUD) — buprenorphine, methadone and naltrexone.

This year, Congress is set to reauthorize the SUPPORT Act against the backdrop of a worsening overdose crisis, spurred by the rise of fentanyl, xylazine, and other adulterants in the drug supply that lead to overdose and death. Because many of the policy provisions in the 2018 bill have five-year lifespans, the SUPPORT Act reauthorization is considered a must-pass bill before September 30, 2023.

When the original SUPPORT Act passed in 2018, approximately 70,000 Americans lost their lives to drug overdose — the highest-ever annual death toll at the time. Five years later, that number has ballooned to nearly 110,000, and Office of National Drug Control Policy (ONDCP) Director Dr. Rahul Gupta recently stated that without major policy change, the U.S. could see 165,000 overdose deaths each year by 2025. This stark reality makes the reauthorization — and expansion — of the SUPPORT Act even more urgent and critical.

What is in the SUPPORT Act reauthorization?

In July 2023, the House Committee on Energy and Commerce (House E&C) passed a version of the legislation (H.R. 4531) out of committee, sending the bill to the a floor vote in the House. The Senate version of the bill was released at the end of July. This is an important step in the process of reauthorizing and expanding the SUPPORT Act, and it gives advocates for overdose prevention an idea of what Congress intends to include in — and leave out of — the final version of the SUPPORT Act reauthorization.

1. The House E&C version of the SUPPORT Act reauthorization increases funding for community solutions to the overdose crisis.

Community-based organizations are on the frontlines of the overdose crisis, and the SUPPORT Act delivers crucial funding and resources, allowing them to continue providing hands-on overdose prevention care. Some of the original provisions in the 2018 SUPPORT Act saw modest increases, while others saw sizeable expansion of funding. Highlights include:

• Funding for communities of recovery was raised by $11 million each year (from $5 million to $16 million for each of the fiscal years 2024 through 2028). Through this funding, the Substance Abuse and Mental Health Services Administration (SAMHSA) allots grants for recovery services provided by people in recovery and/or peer support specialists.
• Residential treatment programs for pregnant and postpartum people saw an increase in funding of $9 million yearly (from $29,931,000 to $38,931,000 for each of the fiscal years 2024 through 2028).

2. Policy changes in the House E&C version of the SUPPORT Act reauthorization could make MOUD more accessible.

MOUD are effective treatments for addiction that prevent overdoses and help people maintain recovery and avoid return-to-use. Notably, when people are treated with methadone or buprenorphine, the risk of dying from an overdose dropped by 76% at three months. Despite their success, MOUD are greatly underused as a treatment for opioid use disorder in the United States.

The House E&C version of the SUPPORT Act reauthorization contains policies that would improve Americans’ access to MOUD, such as:

• Making permanent the 2018 requirement that state Medicaid programs cover MOUD.
• Directing the U.S. Department of Health and Human Services and the Food and Drug Administration to re-evaluate scheduling of buprenorphine-naloxone combo products, such as Suboxone and Subutex. Currently, all buprenorphine-naloxone products are Schedule III drugs, which can restrict the settings in which people can access the medication. “Down-scheduling” buprenorphine-naloxone products could make it more accessible through telehealth.

Other policy changes in the House E&C version of the SUPPORT Act reauthorization would increase access to MOUD for certain justice-involved individuals by making changes to the rule that people who are incarcerated are not eligible for Medicaid, even if they have not yet been convicted. These policy changes include:

• Maintaining Medicaid coverage for pregnant people pre-trial.
• Requiring states to suspend and not terminate Medicaid benefits after arrest. This prevents incarcerated individuals from having to re-enroll in Medicaid before release and prevents discontinuity of care.

3. Advocates are pushing for Congress to advance far-reaching policies that prevent overdoses.

Despite dedicated funding increases and policy improvements that will increase access to MOUD, many advocates are left wanting more from the SUPPORT Act reauthorization. The SUPPORT Act reauthorization presents a missed opportunity to advance major policy change that could transform the way the U.S. responds to the overdose crisis, including:

• Reentry Act (H.R. 2400/S.1165). This bill allows Medicaid-eligible individuals to resume receiving Medicaid benefits thirty days prior to their release from jail or prison. People who are leaving incarceration are 40 times more likely to die from an overdose than the average American, but extending Medicaid benefits to the thirty days before release can promote use of MOUD behind bars. This has been shown to prevent overdose deaths post-release and reduce recidivism. The Reentry Act is supported by more than 125 organizations.
• Due Process Continuity of Care Act (H.R.3074/S.971). This legislation would permit incarcerated individuals to remain eligible for Medicaid until they are convicted. The Due Process Continuity of Care Act is supported by more than 65 organizations.
• Methadone reform. The SUPPORT Act reauthorization fails to include any major changes to methadone, despite available legislation that would ease restrictions on the medication. Congress can use the reauthorization to rethink the current restrictions that inhibit access to methadone, which is often called the “gold standard” of care for opioid use disorder.

What’s next for the SUPPORT Act reauthorization?

With the threat of a government shutdown looming, the likelihood of a SUPPORT Act reauthorization package being finalized in both Houses of Congress before the September 30 expiration is increasingly unlikely. Congress is currently in recess until after Labor Day, leaving only a few weeks to pass a slate of must-pass legislation before the end of the fiscal year at the end of September.

Though its fate is uncertain, an increasingly likely scenario is that the SUPPORT Act provisions set to expire will simply be extended – kicking the can until FY 2024 funding is resolved. Given the critical importance of advancing overdose prevention policy, the SUPPORT Act reauthorization contain the transformative, far-reaching policies we need to properly address and end the overdose crisis.

This post originally appeared on Johns Hopkins University’s Opioid Litigation Principles site.