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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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4

Conclusions

Chapters 2 and 3 review information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) on activities engaged in by grantees. For the State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT) and Building Communities of Recovery (BCOR) programs, SAMHSA provided information on clients as reported via the Government Performance and Results Act (GPRA) reporting tool, as well as redacted progress reports submitted by grantees. The progress reports varied greatly in the provided information on many of the required activities of these programs, such as education, training, outreach, system building, and partnerships. For the Improving Access to Overdose Treatment (OD Treatment Access) and First Responders (FR-CARA) programs, SAMHSA provided some information on the use and distribution of naloxone, as well as efforts to refer those who received naloxone to treatment, in addition to activities such as training and partnership efforts. In the subsequent sections, the committee briefly reviews the limitations of the information received, comments on the potential impact of the COVID-19 pandemic, and presents its conclusions about the progress to date. The chapter ends with comments about possible approaches to Report 3.

DATA LIMITATIONS

As described in Chapters 2 and 3, the committee encountered several important limitations with the data sources that it received from SAMHSA for the preparation of this report. These limitations and their impact on the committee’s analysis are discussed in detail in the methodology sections of Chapters 2 and 3. Table 4-1 provides a summary for review.

A NOTE ON THE COVID-19 PANDEMIC

The committee understands that the COVID-19 pandemic has inevitably affected grantees’ ability to function as envisioned in their grant applications. A few grantees mentioned COVID-19 in the material received by the committee. Evidence shows that since the start of the pandemic, substance use and overdoses have increased (Ahmad et al., 2020; CDC, 2020a; Czeisler et al., 2020; Slavova et al., 2020; Stack et al., 2020). The committee acknowledges that the pandemic might slow progress, especially in implementation. SAMHSA has COVID-19–related guidance

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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TABLE 4-1 Limitations of Evidence Sources Used by the Committee

Cross-Cutting Limitations Impact on Analysis
Reporting tools not clearly linked to the requirements of the grant programs, per funding opportunity announcements Difficult to organize information received around program requirements
Absence of pre-program data Difficult to interpret data, particularly on program impact
Lack of information about each grantee’s local context Cannot account for policy context, cannot compare outcomes to expected outcomes/status in a given community
Lack of information on other programs in same area with similar features (whether funded by SAMHSA or others) Difficult to assign impact to SAMHSA programs
Sources of data, reliability, meaning of data in context not always clear Difficult to interpret data, particularly on program impact
Evidence Source Used by Committee Program with This Source Type Limitations of Evidence Source Impact on Analysis
CSAT Government Performance Results Act (GPRA) data reports PPW-PLT, BCOR Not all grantees submitted (25/27 BCOR grantees) Results only speak to progress of reporting grantees
Individual-level data Does not speak to community-level or systems-level change
Unclear whether clients were (a) enrolled in other programs simultaneously or (b) participating in the grantee programs prior to the reporting period Cannot isolate effect of SAMHSA grant funding on client outcomes
Potential bias in client outcomes data, due to (a) low follow-up rates or (b) characteristics of patients with follow-up data Client progress, in aggregate, may be overstated
Data aggregated across grantees (without pre–post data or comparison groups) Difficult to interpret effects of SAMHSA grant funding on client outcomes; redactions prevent interpretation of the context for client outcomes, either in terms of program features or community/population context or data
Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×
Evidence Source Used by Committee Program with This Source Type Limitations of Evidence Source Impact on Analysis
Grantee progress reports PPW-PLT, BCOR Not all grantees submitted (25/27 BCOR grantees) Results only speak to progress of reporting grantees
Redacted information (applies to 2/6 PPW-PLT grantees; 24/25 reporting BCOR grantees) Relevant activities undertaken may be misunderstood, misrepresented, or not included
Variation in the reporting periods covered by individual grantee reports Difficult to compare across grantees; some grantee activities may not be included
Variation in clarity, quality, completeness of information provided Difficult to compare across grantees
Summary Report from the CSAP Division of State Programs Management Reporting Tool (DSP-MRT) OD Treatment Access, FR-CARA Not all grantees submitted (4/6 for OD Treatment Access, 21/48 for FR-CARA), therefore not all grantees are reflected in the summaries Results only speak to progress of reporting grantees
Report from the OD Treatment Access Reporting Tool OD Treatment Access Unclear reporting period (OD Treatment Access) Unclear how much progress may have been accomplished before/after that may not be reflected in summary
Material summarized across grantees, redacted (some subsections of OD Treatment Access Reporting tool included disaggregated, verbatim responses; limitation does not apply for these few responses) Unclear how many grantees reported a given activity; aggregated quantitative data prevents analysis
Summaries created by funder (rather than independent evaluator) Difficult to confirm interpretation of data; unclear how SAMHSA determined which information would be included
Variation in grantee responses to prompts (likely due to unclear prompts) Inconsistent reporting of activities
No explanations are provided as to why some grantees left questions blank Unclear whether an unanswered questions indicated no progress, some progress, or simply a skipped question
Some material in the two report types for OD Treatment Access directly contradict one another Unclear which is correct; cannot interpret these data
Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×
Evidence Source Used by Committee Program with This Source Type Limitations of Evidence Source Impact on Analysis
SAMHSA Responses to National Academies Questions PPW-PLT, BCOR, OD Treatment Access, FR-CARA At times, the committee requested clarification on a point (e.g., reporting period for another reporting tool), and gaps remained in SAMHSA’s responses Did not always provide additional clarifications

for their grantees.1 The committee looks forward to hearing from SAMHSA and grantees about innovative steps taken to reach those with substance use disorders (SUDs), for example, by providing services through telehealth.

CONCLUSIONS

Chapters 2 and 3 present extensive documentation of the evidence supplied by SAMHSA related to each of the program’s required and allowable activities. The limitations of this evidence are summarized above. As discussed in Chapter 1, the committee assessed progress to date by reviewing and matching information received to each of the required and allowable activities specified in the funding opportunity announcements. The committee considered whether there was evidence regarding progress in terms of planning and implementation steps (e.g., hiring, training staff, relationship building) and outcomes (e.g., client-based substance use outcomes; naloxone distribution and use; public education; trainings conducted).

Summary of Evidence of Progress

The committee found evidence from both the Center for Substance Abuse Treatment (CSAT) GPRA data and from the progress reports that grantees in both BCOR and PPW-PLT programs were operational in a number of activities, including providing services to clients as well as conducting important community outreach, providing community education, and, to some extent, building systems and infrastructure. For example, the GPRA data indicate that, although they were below planned goals, intake interviews have been conducted for 839 clients in the PPW-PLT program and 2,022 in the BCOR program.

All PPW-PLT grantees were functioning, recruiting, and serving clients, but at varying levels. All programs lagged behind in the recruitment goals they had set, and most programs had lower follow-up interview rates than the 80 percent expected by SAMHSA. Some programs cited greatly delayed approval for first-year budgets as an early setback, as well as a lack of clarification on certain questions regarding client eligibility and permitted uses of SAMHSA funds. It seems that they would have benefited from greater support, technical assistance, and training on aspects of programming and evaluation. The information on integrated treatment and system change–related goals was sparse, and these aspects were not evaluated by any quantitative data but rather came from descriptions in the progress reports, when grantees provided them.

The BCOR program was funded by SAMHSA primarily to support the “development, expansion, enhancement, and delivery of” community and statewide recovery support services (RSS). Based on a review of redacted progress reports and GPRA data (which were not designed for activities beyond direct client service provision), the committee finds that the BCOR programs as a whole made progress toward this goal. The progress reports indicate a wide range of ways in which RSS were developed, expanded, and enhanced, and the GPRA data indicate that many clients directly received RSS, although the data do not allow for assessment of how effective those services were. Individual grantee programs, based on the progress reports, were more or less successful. Some of this depends on how well developed a grantee’s program had already been prior to receiving this funding, its ability

___________________

1 See https://www.samhsa.gov/coronavirus (accessed January 12, 2021).

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×

to hire staff and implement infrastructure needs, and the specifics of its own goals. Many programs addressed the additional allowable activities: “(1) build connections through infrastructure building between recovery networks, between recovery care organizations, and with other RSS; (2) reduce the stigma associated with drug and alcohol addiction; and (3) conduct public education and outreach on issues relating to drug and alcohol addiction and recovery” (SAMHSA, 2017a). Each of these is assessed only via the progress reports.

For both FR-CARA and OD Treatment Access, the committee found evidence that some grantees had taken steps to address required activities. For the OD Treatment Access program, two of four grantees clearly established prescribing or co-prescribing services at their sites. All of the program’s grantees created curricula and delivered training on the prescribing of overdose drugs and devices, used SAMHSA’s Overdose Prevention toolkit as a guide, and described lessons learned and best practices. However, scant information was provided about the outcome of the trainings, and the quantitative data left ambiguity about the types of audiences that were reached. Additionally, the four grantees responding described their protocols for connecting overdose survivors to treatment, and reported that 139 overdose survivors were connected to treatment and that 76 of those initiated treatment. While all grantees described their mechanisms for referrals to treatment, only in the case of one grantee was the committee able to determine that the survivors were connected to treatments that were appropriate or evidence-based. All four grantees did directly distribute overdose reversal drugs and devices and formed partnerships across a range of sectors. The grantees identified major obstacles toward sustaining their programs after federal support ends. There was little available information about whether grantees had engaged in the three allowable activities to collaborate with health care providers and pharmacies, and to provide public education on Good Samaritan laws, though some pieces of the reports suggested that small steps had been taken.

The information received from SAMHSA about the FR-CARA program indicates that with regard to the primary goal of allowing first responders to administer a drug or device for emergency treatment of known or suspected opioid overdose, grantees distributed 14,509 nasal spray kits and 1,925 other kits. The information from SAMHSA suggests that 21 percent of the naloxone kits distributed were administered and 1,815 overdoses were reversed. Training sessions (n = 624) were conducted, with 15,581 individuals involved in these trainings. SAMHSA reported that, overall, grantees had developed 17 new strategies for referring overdose survivors to treatment and recovery services; at the time of reporting, grantees had distributed information about treatment options to 570 overdose survivors and families, and many reported that overdose survivors were receiving various types of treatment, including medications for opioid use disorder (MOUD), counseling, and more. Twenty grantees had held meetings with advisory councils that they had joined or that were newly established during the reporting period. Some, but not all, grantees engaged to varying degrees in the allowable activities to collaborate with health care providers and to provide public education on applicable Good Samaritan laws. No information was provided on the effectiveness of these trainings or communication campaigns.

In light of these findings, the committee presents the following overall conclusions:

The committee concludes, based on information provided by SAMHSA, that grantees providing data have shown at least some progress in planning and implementing the four Comprehensive Addiction and Recovery Act programs under review. The degree of implementation and progress and the nature of supporting data vary across programs, grantees, and specific activities; data were not provided on all grantees.

The committee concludes that it cannot determine whether these programs have had specific, identifiable impacts on people with substance use disorders. It is very possible that these programs have had a positive impact on people’s substance use and on their health and well-being, but the limitations of the information provided do not allow for confidence in such a determination.

The committee concludes that it cannot determine whether the Comprehensive Addiction and Recovery Act programs have had a positive impact on advancing systems change in substance use prevention and treatment or in advancing systematic interagency collaboration. The lack of systematic, quantifiable, or descriptive data does not allow for such a determination.

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×

In light of the limitations identified above and as reflected in the conclusions, the report continues with a discussion of several approaches, including information needs, that the committee can take in preparation of the third and final report of this series.

THE FORTHCOMING FINAL REPORT

The purpose of the third and final report for this committee, due in March 2023, is “to review the specified programs for their effectiveness in achieving their respective goals as measured by the metrics identified and to provide recommendations to Congress concerning the appropriate allocation of resources to such programs to ensure cost-effectiveness in the federal government’s response to the opioid addiction epidemic.” The committee addresses the feasibility of a more robust third and final report by discussing separately the two parts of the mandate: assessing effectiveness in achieving goals and offering recommendations to Congress.

Assessing Progress and the Effectiveness of Funded Programs

As illustrated in this second report and discussed extensively in Chapters 2 and 3 and briefly above, there are serious limitations with the material provided by SAMHSA, which might or might not be overcome in the next 2 years. The committee is concerned that its ability to draw firm conclusions on the specified CARA programs will very likely continue to be limited. Program evaluation designs appropriate to stated goals should be included from the outset of program planning, as attempts to evaluate programs after the fact present numerous challenges (e.g., evaluation design, and metrics that do not respond to program goals), as those noted in this document.

The committee uses these identified limitations, described in the previous sections of this chapter and throughout the report, to lay out a set of information needs that would allow it to design and perform a more rigorous evaluation of program effectiveness.

First, in order to consider the impact of the CARA programs, the evaluation design would need to capture person-level sociodemographic, clinical health care and social services utilization, and outcome information on clients served by the programs, as well as data permitting comparisons to control clients, either by way of pre–post data, or by identifying appropriate comparison groups, or both. Furthermore, those data must allow robust comparisons whereas aggregated data eliminate the ability to examine those who did and did not receive any or a sufficient dose of services. Comparisons also require the ability to distinguish individuals who are newly receiving services from those who were already engaged and are newly classified as receiving services under the SAMHSA grants. In addition, comparisons require the same data across programs, which was only available through the GPRA tool, but not the progress reports, which were the only way to capture efforts to reach goals that went beyond individual clients.

Pre–post data could include data from the same or similar programs during a previous time period, and/or longitudinal designs with three or more assessment time points (e.g., prior to program participation, immediate post program participation and follow-up time point after program completion). For example, for BCOR and PPW-PLT, data collected would need to include valid measures that may be used to assess change in key outcomes over time among enrolled clients. The evaluation methodology would need to include robust follow-up strategies to achieve high rates of client or participant follow-up for all measurement points. Similarly, for overdose prevention programs, the evaluation design would need to allow for systematic comparisons of data from various periods of time before the intervention to after program implementation. Data should also be collected to assess degree of program reach or penetration across targeted demographic groups and geographies. For example, for programs primarily relying on training of first responders and other key community members in overdose prevention, data would need to be collected on knowledge gained in the training and subsequent impact of the training on use of overdose prevention strategies and their impacts on overdose rates locally. For all programs with goals and required activities pertaining to systems integration and/or workforce preparation, data would need to be collected to assess program impact and progress in these domains, in addition to impact on clients.

Using other, similar programs over the same time as comparison groups would permit a more robust evaluation. Having these data would help the committee to evaluate the CARA programs relative to programs with

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×

similar goals. For client-specific outcomes data (such as received for BCOR and PPW-PLT), comparison to SUD rates could be made to other socio-demographically matched communities.

Next, an understanding of several elements of each grantee’s local context would be crucial for conducting an evaluation. For this reason, the committee would need access to program data linked to local context, either as unredacted or linked de-identified data with indicators of key program features to allow for interpretation of specific program effectiveness. For example, it would be important to have information on other programs with similar goals that may be operating in the same communities as grantees, particularly to consider whether broad regional indicators of outcome are likely attributable to SAMHSA program effects. It would also be necessary to have grantee-specific, person-level information on specific outcomes in order to be able to contextualize outcomes within the local regions/communities. Additionally, changes in policy factors affecting specific states or all programs (e.g., changes in buprenorphine waiver requirements) would also be important to clarify in relation to timing of program implementation and clients served. Such contextual data would assist the committee in considering reasonable expectations for grantee impact within a given (or varying) policy context.

For considerations on cost-effectiveness, additional data will be needed on not only the program costs incurred by grantees, but also the costs of other relevant services provided in the community, as well as indicators of societal costs and other related impacts (e.g., client or trainee time, housing or employment status, criminal justice involvement such as arrests and incarceration). For overdose prevention grantees specifically, the committee would need to have information about the costs of implementation and cost benefits from overdoses prevented and survivors engaged in MOUD and SUD treatment. It would also need to have information about costs related to trainings provided on overdose prevention, and comparable costs of not providing such trainings. For BCOR and PPW-PLT, the committee would need to have information about the number and type of services delivered and their relative costs, and other related costs to clients and service agencies, as well as societal costs or offsets (e.g., service events such as emergency department visits avoided, or events such as arrests).

The committee did not find evidence that SAMHSA considered rigorous or independent evaluation of these four CARA programs from the outset. Of note, there are limitations on the amount of grant funds that grantees may use for purposes of data collection or evaluation (see Tables 2-1 and 3-1), which means that the programs likely were not structured to provide sufficient information for evaluations of this nature. SAMHSA has successfully funded cross-site evaluations of several of its programs (e.g., Bray et al., 2017; Brown et al., 2018; McHugo et al., 2005; SAMHSA, 2018c; Scharf et al., 2014; Steadman et al., 1999) despite limitations in funding, demonstrating that rigorous program evaluation is possible if it is prioritized by agency leadership. It is possible that the urgency of the opioid crisis and the imperative to fund these programs led to a focus on getting them up and running quickly, shortcutting some of the program-wide planning that would have allowed for a robust evaluation of the effect of these programs. At the same time, the committee notes that for these same reasons, collecting high-quality data to enable an evaluation design permitting valid interpretation of program impact is of key importance to policy (GAO, 2018), as well as to clients and communities, as a means to inform how practice improvements may strengthen responses to the opioid use disorder (OUD) crisis.

Importantly, there may be limited opportunities for SAMHSA to change the evaluation design or data collection instruments, at least as they apply to current grantees, since many programs are past the funding period and others will be in the last year of funding. Any such additional data or analyses provided by SAMHSA will likely be limited to data elements collected during administration of the programs. Therefore, the data needed by the committee to evaluate the effectiveness of the CARA programs will not be available to SAMHSA or the committee because data collection instruments utilized did not contain the information needed and/or the evaluation design elements are not conducive to drawing inferences about program impact and cost-effectiveness. Recognizing the current constraints posed by available data elements and evaluation design noted in the committee’s first report (NASEM, 2020b) and in the current report, the committee looks forward to working with SAMHSA and grantees to receive more comprehensive and accurate information on programs and system and community context over time. Furthermore, the committee suggests that in the future, as SAMHSA is developing funding announcements, that it create reporting tools that are specific to the activities in the announcement, rather than using a standardized progress report across multiple SAMHSA programs (e.g., GPRA and Division of State Programs Management Reporting Tool). SAMHSA has clearly laid out their expectations for these grant programs, but has not provided

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×

a means by which to collect systematic data that is appropriate to those expectations. For additional commentary on this issue, see Recommendation 3-11 from the committee’s first report in these series (presented in NASEM, 2020b; see Appendix C).

The committee sets forth the following ideas for what approach might be feasible for the upcoming report. One approach to enhancing the understanding of data available is for the committee to obtain information directly from grantees. SAMHSA could help the committee to clarify which data apply to which programs by providing the complete grant applications (to compare what has been proposed versus implemented), grantee progress and evaluation report submissions from all grantees (unredacted and not summarized by SAMHSA staff), and outcome analyses disaggregated by grantees. To complement this information, the committee could work with grantees directly (e.g., conduct independent interviews with key program staff) in order to obtain information from programs with missing data, including their lessons learned and impressions of impact and context. This would allow the committee to gain information that would help to provide an understanding of the context in which grantees operate, such as their relationships with other programs addressing SUD, and changes over time in policies affecting these programs. The committee will need to be able to obtain from SAMHSA and review, for comparison, baseline rates in local communities, or the literature on the effectiveness of other similar or contrasting OUD and SUD programs.

Ensuring Cost-Effectiveness in the Federal Government’s Response to the Opioid Epidemic

The committee is perhaps even more concerned about the second part of the task for Report 3 to provide recommendations to Congress on appropriate allocation of resources. The committee offers three possible approaches to making such recommendations, and in the following paragraphs, speaks to feasibility of each. The committee could approach this task by considering whether these four specific programs should be funded again or whether similar programs should be funded in the future. The task could also be approached with an assessment of whether these programs were cost-effective. Alternatively, this task could be approached as an opportunity to recommend strategies for how Congress can provide legislative direction when funding such programs in the future. Each of these is a worthy question, and each would present different data needs in preparation for Report 3.

The answer to whether these or similar programs should be funded again will emerge from the final assessment of progress and effectiveness. The data needed for this approach have been described in the previous section. The committee notes that SAMHSA awarded grants to additional BCOR and FR-CARA cohorts in 2019 (SAMHSA, 2019a,b), and that applications for new rounds of funding for PPW-PLT and BCOR were due in February 2021 (SAMHSA, 2020a,b).

The committee also notes that SAMHSA is the only agency that consistently offers funding to individual treatment programs to develop and expand their activities to improve and enhance the lives of individuals living with SUD and to conduct prevention activities. However, the answer to whether these programs have been a cost-effective use of scarce resources builds on an answer to the first question, and would need to include additional analysis of costs in ways that might or not be possible to capture in the next 2 years, given how the programs have been structured and reported. This has also been discussed in the previous section.

The answer to how Congress could legislate and oversee such programs requires a different strategy. An analysis of how, in the future, Congress can specify required evaluation methods and processes to assess program effectiveness and cost-benefit analysis, and how SAMHSA can improve program evaluation capacity and efforts in similar programs, would result in more robust evaluation assessment and information for decision makers responsible for guarding the public’s health and related expenditure decisions. Given the likely inability to gather sufficient information for a cost-effectiveness evaluation, the committee could instead focus on providing a literature review of key attributes of and lessons learned from successful programs and program evaluations, not from the four CARA programs under review but from extant and longer-established programs for substance use intervention. This could also include a robust assessment of SAMHSA’s budget and staffing history to assess whether it has been given adequate resources by Congress to effectively support cost-effective programs. Additional considerations could include the tension between congressional interest in, on one hand, quickly appropriating funds and standing up programs in response to a crisis and, on the other, ensuring effective and cost-effective programming.

The committee looks forward to conversations about how it can be most helpful to SAMHSA and to Congress in anticipation of the third and final report.

Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
×
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Suggested Citation:"4 Conclusions." National Academies of Sciences, Engineering, and Medicine. 2021. Progress of Four Programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. doi: 10.17226/26060.
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Substance use disorder (SUD) and opioid use disorder are significant public health threats that affect millions of Americans each year. To help address overdose deaths and lack of access to treatment, the Comprehensive Addiction and Recovery Act (CARA) was signed into law on July 22, 2016. CARA is extensive legislation intended to address many facets of the opioid epidemic, including prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. It authorizes more than $181 million each year in new funding to fight the opioid epidemic and it requires the implementation of programs and services across the United States to address SUD and recovery.

Following the passage of CARA, the Departments of Education, Health and Human Services (HHS), and Labor, along with the 2018 Related Agencies Appropriations Act, included appropriations for a study of the Substance Abuse and Mental Health Services Administration (SAMHSA) components in CARA, to be conducted by the National Academies of Sciences, Engineering, and Medicine. In response to this charge, the National Academies formed an ad hoc committee to review outcomes achieved by four programs funded by SAMHSA through CARA: State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT), Building Communities of Recovery (BCOR), Improving Access to Overdose Treatment (OD Treatment Access), and First Responders (FR-CARA). The committee's review is designed to result in three reports over 5 years. This report, the second in the series, reviews reported outcomes and metrics to assess progress toward achieving program goals.

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