The United States has set a grim record: More than 100,000 Americans died from a drug overdose in the 12 months starting April 2020, according to the Centers for Disease Control and Prevention. It marked the first year on record that overdose deaths exceeded 100,000, pushing the total since 1999 to 841,000.
Opioids were primarily responsible for these deaths, with more than 75,000 overdose deaths in 2021, up from 56,000 deaths the year before. Illicit fentanyl and other synthetic opioids drove the increase, figuring in 73% of the overdoses.
Compounding the situation, disruptions from the COVID-19 pandemic caused people who use drugs to purchase them from new and unfamiliar sources, reduced the availability of the opioid overdose reversal drug naloxone and created further barriers to treatment for substance use disorders.
Since 2019, NCSL has tracked state responses to the ongoing opioid epidemic and the measures taken to increase access to lifesaving care. Thirty-six states and the District of Columbia enacted 175 bills in the last three years.
The bulk of these laws have sought to improve access to medication assisted treatment, also known as medications for opioid use disorder, or MOUD. Medication assisted treatment is the use of medications approved by the Food and Drug Administration (including buprenorphine, methadone and naltrexone), in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.
NCSL tracked 72 bills in 27 states seeking to improve access to these medications. Alabama clarified guidelines for prescribing buprenorphine in nonresidential treatment programs. California enacted legislation that makes parolees eligible for a 30-day reduction in the period of parole for every six months of substance use disorder treatment completed. Tennessee removed prior authorization requirements for medication assisted treatment. Washington appropriated funding to improve access to medication assisted treatment among American Indians and Alaska Natives.
Expanding Access to Telehealth
As the COVID-19 pandemic made traditional, in-person treatment services more difficult or even impossible to provide safely, many states turned to telehealth to keep patients in care. Telehealth or telebehavioral health programs for substance use disorders allow health care professionals to provide evaluations, diagnoses and treatment, including prescriptions, remotely.
At least 20 states have enacted legislation addressing access to substance use disorder treatment services through telehealth. Arkansas ensured Medicaid reimbursement for telebehavioral health services provided in the state. Massachusetts required payment parity for telemental health and other health services. Vermont authorized certain health professionals to renew a patient’s existing buprenorphine prescription without requiring an office visit. Louisiana expanded the types of health providers who can perform telepsychiatric evaluations to include psychiatric mental health nurses if certain requirements are met, including that such examinations takes place over videoconferencing technology.
Other states have examined their parity laws to ensure private and public insurance covers the cost of substance use disorder treatment. Colorado mandated health insurance coverage for the treatment of behavioral, mental health and substance use disorders and established rights of people receiving these forms of care. Tennessee required that substance use disorders and opioid use disorders be insured in the same manner as physical diseases.
Long-Term Care and Settlement Funds
In addition to improving access to treatment services, many states have also enacted legislation to support people in long-term recovery. Recovery support services refers to the collection of services that provide emotional and practical support to individuals in recovery, including visits with recovery coaches and peer supports, participation in mutual aid groups, and the utilization of sober living facilities, recovery high schools and colleges and other forms of long-term recovery care.
Colorado provided vouchers for housing assistance to certain individuals in recovery. Maine established a program to provide rapid access to low-barrier treatment for substance use disorders and stable housing to support recovery for opioid users. Missouri enacted legislation to provide postpartum care for up to 12 months to mothers with substance use disorders.
States are also allocating funding from lawsuits against opioid manufacturers and distributors to support treatment and prevention programs. Minnesota established an opioid stewardship fund and an advisory council to direct how funding acquired from settlements can be spent in the state. Kentucky created an advisory commission and established an opioid abatement trust fund separate from the state’s general fund. Virginia established an agency to provide grants to organizations working to treat, prevent and reduce the misuse of opioids. Texas created an opioid abatement fund and prescribed specific uses related to increasing treatment options in the state for which the fund could be used.
States will continue to play a key role in improving access to substance use disorder treatment and preventing further drug overdose deaths.
Charlie Severance-Medaris is a senior policy specialist in NCSL’s Health Program.
This resource is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $767,749 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government.