As the nation’s opioid epidemic rages on, the federal agency charged with leading the government’s response to substance abuse is changing the way it helps local communities. But critics say the move risks leaving programs with fewer resources until the new plan is in place.
The controversy began in January with an announcement by the Substance Abuse and Mental Health Services Administration. Rather than continue hiring contractors to pair experts with communities, as has been done for years, SAMHSA’s new approach will “utilize local expertise” to provide technical assistance and training.
This effort will “focus on the specific needs of states and local jurisdictions to address the opioid crisis in their areas,” according to the announcement, which mentioned the immediate release of $12 million in funding toward that.
Three months later, with the agency canceling or failing to renew more than a dozen long-standing contracts, some of the groups involved question the logic of severing the relationships and alliances they had forged with individual programs.
They also wonder if SAMHSA is motivated more by budget considerations than a goal of strengthening local support. The move will save $50 million, an agency spokesman acknowledged.
“In the middle of the opioid crisis, is this really the best approach and the best way to manage this?” asked one contractor, who spoke on the condition of anonymity because the company’s contract prohibits discussing SAMHSA operations. “Having done this work for 20 years, it takes at least a year, if not 18 months, to get things rolling.”
The force behind the change is SAMHSA Assistant Secretary Elinore McCance-Katz, an addiction psychiatrist who wrote in a recent blog post that she has treated “many patients whose lives are dependent on the types of services” her agency funds. And she was blunt about its “antiquated system,” saying “individuals, families, communities, and the nation at large deserve better than what they have been getting,”
In an interview with The Washington Post, McCance-Katz elaborated. “I want localized experts who know their communities,” she said. “We’re going directly to the source, essentially cutting out the middle man.”
Those experts will be members of the Rhode Island-based American Academy of Addiction Psychiatry. The nonprofit, which has been given a two-year, $24 million contract, includes more than 1,700 members across much of the nation — who McCance-Katz says will be well positioned to help needy communities in their area. SAMHSA also awarded some funding to 22 health-care organizations that will have members advise communities in areas not covered by AAAP.
The critics question whether McCance-Katz, a former academy president, may have used her influence to tip the scales toward the organization. She denies any involvement. “I had nothing to do with who got selected. In my role it’s not allowed,” she said.
SAMHSA has either canceled or failed to renew 19 of 34 contracts. Many of the people who implemented those contracts will lose their jobs.
Those opposing the change say they are worried that it will add confusion at a time when urgent problems require nimble solutions.
“If you don’t have contractors helping you figure things out, you've got nowhere to turn,” the one contractor said. Communities working to develop distribution plans for the drug that reverses an opioid overdose often have questions about how to set up a smooth system and provide training, she noted. Any delay until SAMHSA’s new system is fully in place “will have a direct effect on death rates,” she warned.
Those concerns are echoed by the Professional Services Council, a national trade association and advocacy group that tracks government policies and defends the role of contractors in implementing both. It includes approximately 400 members, including the SAMHSA contractors being eliminated.
Alan Chvotkin, the council’s executive vice president, recently asked to meet with agency officials to discuss their reasoning and to ensure that the new approach is not simply a cost-saving move. He said SAMHSA has agreed to a meeting, though no date has been set.
“If the transition [takes place] over a short period of time, what’s going to be the impact on those communities who have been dependent on the work these contractors have done?” Chvotkin said.
McCance-Katz disagrees that any communities will be left in the lurch. SAMHSA contractors often turned to AAAP's experts in the past, she said, adding, “I used to be one of the people they picked.”