Fighting the Opioid Epidemic with Evidence and Innovation

How Congress and the Health and Human Services Department can reduce opioid-related deaths.

What will it take to tackle our nation’s opioid epidemic, with more than 140 Americans dying every day from overdoses of prescription opioids and heroin? Money is important—federal and state governments are spending billions through Medicaid, the Substance Abuse Block Grants, and the recent 21st Century Cures Act. But funding is only part of the challenge. We also need more effective treatments and better ways to deliver services to those in need. In other words, we need a learning and innovation strategy to accompany and hone a treatment strategy.

For example, the most promising opioid use disorder treatment is Medication-Assisted Treatment that combines medication with behavioral therapies. But MAT is not widely implemented, and the quality of evidence supporting it varies by the treatment type, context, and population served. We urgently need a better understanding of how best to use MAT.

Moreover, because the mix of opioids that are abused has changed in unexpected and deadly ways, any single (or previously established) treatment approach is less likely to be effective. That underscores the importance of developing new approaches to treatment.

And finally, many people with substance use disorders never receive treatment at all. That highlights the need to not only increase treatment availability, but to develop better ways to engage people and retain them in treatment.

To spur more evidence and innovation in addressing the opioid crisis, the Health and Human Services Department needs to play a central role. In particular, it should immediately launch an innovation fund for addressing opioid addiction. The Substance Abuse and Mental Health Services Administration is the agency best suited to lead such an effort, with support from research experts across HHS. SAMHSA has for years supported the implementation of new strategies aimed at addressing mental health and substance use disorders in the U.S.

The fund should use a so-called “tiered-evidence” design that allows for scaling up programs with strong evidence of effectiveness while simultaneously supporting field-generated innovations that can lead to even more effective interventions. The approach is similar to that of a venture capital fund, where investors (SAMHSA, in this case) place bigger bets on approaches with more evidence of success and use smaller bets to encourage new and innovative approaches. The tiered-evidence approach has bipartisan support, including from Speaker of the House Paul Ryan and House Republicans who called on Congress to require social programs to use a tiered-evidence model.

An innovation fund at SAMHSA—call it the Opioid Use Disorder Innovation and Research (OPIR) program—could be launched in one of two ways. First, Congress could develop legislation that directs SAMHSA to award competitive grants using a tiered framework. Alternatively, SAMHSA could use its existing authority to modify its solicitations for substance use disorder grants to incorporate tiered evidence criteria. Either way, Congress and HHS should work together to ensure adequate resources are provided to implement the program effectively.  

How exactly would OPIR work? HHS would make grants to states and other eligible entities to test or expand entrepreneurial and field-initiated innovations to address opioid use disorders. The grants could be implemented using the following tiered approach:

  • Early-phase grants (e.g., $50,000 to $300,000) to fund the development and feasibility testing of interventions with a record of promising prior evaluation results, for the purpose of determining whether the interventions can be successfully implemented in real-world settings, such as hospitals, jails, and community health clinics.
  • Mid-phase grants (e.g., $500,000 to $3 million) to fund the implementation and rigorous evaluation of interventions that have been successfully implemented in an early phase, in order to measure their impact on important outcomes, such as opioid use, mortality and criminal arrests.
  • Expansion grants (e.g., $3 million to $7 million) to fund the implementation and rigorous replication evaluation of interventions with strong evidence of sizable, important impacts, in order to deliver the interventions on a larger scale and determine whether their success can be reproduced and sustained over time.  

Likely the biggest barrier to the creation of an OPIR program is an understandable belief, given the scope of the crisis, that every dollar of opioid-related funding should be spent immediately on existing treatments, rather than carving out a portion of those dollars to develop and evaluate better treatment approaches.

It is important to recall, however, that the number of opioid-related deaths has been growing at 9 percent per year for almost 40 years: It is a crisis long in the making and one that will take time to remedy. That is especially true given the changing nature of the epidemic. Underinvesting in a learning and innovation strategy now would cost lives in the future.

Congress took an important step last year by providing significant new funding to address the opioid epidemic. Now Congress and HHS should take another crucial step to ensure that those additional funds—and future spending at the federal, state and local levels—go to the most effective strategies possible. Launching an innovation fund within SAMHSA to test and evaluate new approaches would be a useful step toward that goal.

Andrew Feldman is a director of results-driven government at the Laura and John Arnold Foundation.

Richard Frank is a professor of health economics at Harvard Medical School. He recently served as the assistant secretary for planning and evaluation at the Health and Human Services Department.

Christopher Spera is the division vice president for health and environment at Abt Associates and a professor of public policy and management at Carnegie Mellon University.    

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.