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like overdose or infections. We also must continue to maintain strong privacy protections for people with SUD as we reform treatment so people who need care will attend without fear of shame, nor social or legal repercussions. Research has shown that people avoided treatment over concerns that providers might turn them into law enforcement.230, 231 Pregnant people232 and parents may avoid seeking care and assistance out of fear of being reported to child welfare. 233 A. Utilize federal grant mechanisms to support people most in need of treatment to include reimbursing for wrap around services. (Agencies Involved: DOJ/OJP; HHS/CMS, NIH, SAMHSA; HUD; USDA) The Substance Abuse Prevention and Treatment Block Grant and other relatively new grant programs provide money to states to offer payment to certain non-profit treatment providers to care for the uninsured or under-insured, as well as to implement prevention services. But treatment needs often extend beyond simply provider reimbursement and should include support and reimburse for wrap around services. The Administration should examine ways existing grant mechanisms may be better utilized to best serve people most in need of treatment through the provision of safe, child-friendly housing or by widening access to cover care of people who are incarcerated. Use of federal grant dollars by for-profit treatment providers who have significant capacity to provide services also should be considered as a more widely utilized option. Changes should consider availability of state Medicaid dollars, opioid litigation settlement dollars, and the behavioral health infrastructure so economically vulnerable and people with stimulant, opioid, and cocaine use disorders always receive evidence-based treatment and wrap around social support services. B. Expand mobile units for MOUD including to prisons and jails. (Agencies Involved: DOJ/BOP, DEA, OJP; HHS/SAMHSA; VA/VHA; ONDCP) The DEA recently published a rule entitled “Registration Requirements for Narcotic Treatment Programs with Mobile Components”234 that enables OTPs to deliver MOUD treatment to clients who are unable to access brick and mortar OTPs nearby. States and federal agencies that have not been able to start their own OTPs should be encouraged to invest in these units so they may offer treatment with MOUD to incarcerated individuals and people with limited transportation options. ONDCP should encourage states to consider whether state laws concerning mobile units hamper clinic’s ability to use this service so they may determine if changes are needed in the state. « « « « « « NATIONAL DRUG CONTROL STRATEGY 55 C. Arrange for treatment funding for people who are incarcerated. (Agencies Involved: HHS/ASPE, CMS, SAMHSA; DOJ/BOP) Currently by law, states generally4 may not spend federal Medicaid dollars on health care for individuals who are incarcerated, under the “inmate exclusion.” The federal government could convene an interagency working group to identify the best way to provide SUD services for people in state prisons and jails, and then work to advance policies that address the lack of access for SUD services for incarcerated individuals. D. Expand evidence-based treatment in federal prison. (Agencies Involved: DOJ/BOP, DEA; ONDCP) The federal prison system needs to expand its treatment programming so evidence-based behavioral therapy and all medications to treat addiction are available to incarcerated persons who use drugs. Choice of treatment should be based on provider and patient agreement, and medication access should not be contingent on additional therapy participation (as medication alone may be lifesaving). The federal government should work to help coordinate treatment options so the Federal Bureau of Prisons (BOP) may offer all evidence-based treatments, including all MOUDs approved by the FDA. It also should work to support individuals in its custody so that they may participate meaningfully in treatment, which may include providing MOUD, individual psychotherapy or counseling appointments in lieu of group counseling, or implementing other measures to enhance their privacy and confidentiality. E. Pilot methadone programs in federal prisons to leverage telemedicine and bureau of prison pharmacists. (Agencies Involved: DOJ/BOP, DEA; HHS/NIH; ONDCP) The BOP is a unique treatment environment because patients reside in prisons, and much of the practice of medicine in these facilities involves dispensing chronically-needed medication to patients on the premises under close observation. The BOP permits pharmacists to perform duties that advanced practice nurses and physicians complete outside of federal prison. However, these pharmacists are not allowed to store and dispense methadone to treat addiction. The executive branch could explore options to allow BOP pharmacists to dispense methadone prescribed by BOP physicians using telemedicine visit induction as an exception to the Controlled Substances Act statute requiring dispensing in OTPs. F. Arrange for treatment for people leaving incarceration. (Agencies Involved: DOJ/BOP, OJP; HHS/ASPE, CMS, HRSA, SAMHSA; VA/VHA) The Department of Veterans Affairs (VA) allows reimbursement for transportation to treatment for eligible
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