10 Ways That States Can Improve Substance Use Treatment

With drug overdose deaths in the U.S. reaching record numbers, people with substance use disorder (SUD) need greater access to care than ever—from prevention services to treatment and recovery support. Ensuring access to these critical services depends on states strengthening their SUD treatment systems. Policymakers can do that in three ways: leveraging existing federal funding streams and opioid settlement dollars intended to address the overdose crisis; addressing existing state policies that limit patient access to care; and providing incentives to health care providers to deliver quality care in under-resourced communities.

To ensure that states use funds in the most sustainable ways and that policies align with these priorities, The Pew Charitable Trusts, in partnership with the Center for Health Care Strategies (CHCS), developed a set of 10 principles designed to help states finance and support robust substance use treatment systems. The work of CHCS focuses on improving outcomes for people enrolled in Medicaid, the federal-state health care insurance program for low-income people and families as well as those with disabilities.

The principles outlined in the report were informed by stakeholders with expertise in SUD financing, including research and policy experts, health care providers, state officials, former federal officials, and people with lived experience in accessing treatment services.

Adopting even some of these principles would help states reduce barriers to and inequities in substance use treatment and connect more patients to lifesaving interventions. Therefore, policymakers can:

1. Use Medicaid funds strategically to expand and sustain access to evidence-based substance use prevention, treatment, and recovery support services. Federal legislation—including the Affordable Care Act—expanded coverage requirements for SUD benefits, so states should leverage Medicaid to increase access to care and the quality of treatment services.
2. Direct flexible federal funds—to the fullest extent allowable—toward boosting infrastructure, prevention, harm reduction, and recovery support services. Medicaid dollars already support direct treatment services, so states should use other federal funds to invest in other priorities such as workforce development and IT upgrades, as well as prevention and harm reduction services.
3. Conduct an inclusive decision-making process for allocating opioid settlement funds and prioritize funds for investments in services and infrastructure needs not covered by Medicaid or other state/federal funding streams. States should incorporate the perspectives of people who use drugs and people with lived experience in recovery to determine how these funds can best address the needs of the communities most affected by SUD.
4. Incentivize and support “no wrong door” approaches to substance use care, treatment, and support services. To increase access to care, states should support entryways to treatment through existing clinical practices as well as community-based organizations, homeless shelters, syringe service programs, and correctional settings.
5. Ensure that patients are placed in the most appropriate level of care, including nonresidential, community-based substance use treatment and recovery support services. Patients have traditionally been referred to residential treatment, but states should ensure that outpatient community-based care and support services—which may be easier for patients to access—are readily available.
6. Address substance use treatment disparities for historically marginalized groups and communities. Black, Latino, and Indigenous communities have experienced vast disparities in the ability to access substance use treatment compared with White patients, so states can use funds to promote quality care in these communities.
7. Advance equitable access and outcomes for substance use care, treatment, and recovery support services among populations with multiple system involvement. People with SUD interact more frequently with mental health and child welfare systems and the criminal legal system than the population as a whole. They also may experience housing issues more often, so states should focus on improving treatment access in these populations.
8. Use data to drive effective, equitable care and outcomes. Local, state, and federal data on treatment access and outcomes, including patient-reported outcomes, can help states make informed decisions about how best to manage and improve their treatment systems.
9. Require specialty substance use treatment providers to offer evidence-based treatments, particularly medications for opioid use disorder. Lifesaving medications exist for people with SUD, but they are often underutilized, so states should ensure that providers offer them to patients as standard care.
10. Bolster the substance use prevention, treatment, and recovery support service network for children and youth. Early substance use and family experience with SUD can adversely affect children, so states should invest in SUD treatment and recovery supports for these people.

Alongside the above principles, Pew and CHCS outline how states can advance them via potential policy options and detail examples from states that are leading the way in building more sustainable treatment systems.

Most people with SUD don’t receive any treatment, and rising overdose deaths reflect that reality. With funding increasingly available to states, it’s critical that policymakers invest these dollars strategically and build substance use treatment systems that can best address people’s needs and reduce harm.

Andrew Whitacre works on Pew’s substance use prevention and treatment initiative.