SAMHSA updates guidance on MOUD and harm reduction

The Substance Abuse and Mental Health Services Administration (SAMHSA) issued two Dear Colleague letters — one warning against the use of medications for opioid use disorder (MOUD) without accompanying support services, and one outlining the administration’s curtailed list of allowable harm reduction services.

MOUD:

• This letter says that while SAMHSA “remains committed” to expanding access to treatment, including medications, it is “equally committed to ensuring that medications are part of the pathway to long-term recovery and sobriety, self-sufficiency, and thriving, not as a default sentence to life-long medication use.”
• The letter outlines core clinical tenets and provides new language that will be included in updated terms and conditions for grantees to ensure that “SAMHSA funding and training and technical assistance are advancing holistic care models that address the complex psychosocial needs of individuals with opioid use disorder, rather than medication-only models.” That includes having clinicians review continued use of medications at least annually.
• The main point: While the letter does not cast doubt on the effectiveness of MOUD, it appears to echo a trope that use of the medications does not constitute “true recovery.” While many clinicians may prefer to provide counseling alongside medication, current standards of care do not support withholding medication from patients who decline other services.

Harm Reduction:

• The other letter provides “updated guidance to grantees on the supplies and services previously defined under harm reduction that can be supported with SAMHSA funding.”
• Reminder: SAMHSA issued previous guidance on this in July, outlining the agency’s shift away from harm reduction, consistent with the Executive Order on Ending Crime and Disorder on America’s Streets.
• Supplies and services that can be supported with SAMHSA funding include opioid overdose reversal medications, distribution, and training; medication lock boxes and disposal kits; wound care supplies; home-testing kits, education, navigation services, and referrals to care for HIV and hepatitis; sharps disposal kits; and nicotine cessation therapies.
• Supplies and services not supported include purchasing/distributing syringes, pipes or other supplies for safer smoking kits, or fentanyl test strips or other substance test kits (though funds can be used for test strips to be used by law enforcement and health professionals); overdose hotlines that provide a companion to people while they are using drugs; purchasing/distributing sterile water, saline, or ascorbic acid; and purchasing/distributing any other drug paraphernalia or supplies not listed as acceptable.
• The main point: The letter is part of a broader administration move away from harm reduction. The opinion on harm reduction, and the test strip policy in particular, represent a major shift from the Biden administration, which pushed test-strip distribution enthusiastically.

Read more: Trump administration warns against using federal dollars on fentanyl test strips