SUPPORT Act Reauthorization

By: Allen Pinn, Policy Coordinator

Since the early 2000s, the United States has seen a growing epidemic surrounding opioid use disorder and overdoses. Attention to mitigating the opioid epidemic has remained a bipartisan effort. Enacted in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act aims to increase substance use disorder treatment services through Medicaid providers. The legislation includes planning grants awarded to 15 states and requirements that state Medicaid providers cover all major FDA-approved opioid use disorder medications including buprenorphine, methadone, and naltrexone, as well as test strips to detect fentanyl and other harmful additives to drugs. Although passage of the SUPPORT Act was a significant milestone in substance use disorder legislation, challenges addressing the opioid epidemic have persisted.

According to the National Institute of Drug Abuse, drug-involved overdose deaths have risen sharply since 2019. When the SUPPORT Act was first signed into law, overdose deaths involving opioids were just under 50,000 in 2018. However, in 2020, this statistic rose to 68,630 deaths and to 80,411 deaths in 2021. Of the 106,000 total overdose deaths in 2021, 70,601 could be attributed to fentanyl. This escalation in the crisis, especially around fentanyl has drawn considerable congressional attention in how to remedy this ongoing epidemic. In July 2023, the House of Representatives’ Energy and Commerce Committee unanimously approved a package to reauthorize and strengthen the SUPPORT Act.

Significant new measures in the Energy and Commerce’s reauthorization include:

  • Amending the 21st Century Cures Act to clarify the legality of drugs, devices and/or test strips to detect fentanyl and xylazine
  • Permitting pregnant people in pretrial detention to maintain Medicaid coverage;
  • Prohibiting states from disenrolling individuals from Medicaid when incarcerated; and
  • Permanently requiring that Medications for Opioid Use Disorder (MOUD) are covered by Medicaid.

Although the Energy and Commerce Committee’s package aims to strengthen the SUPPORT Act, some advocates believe more should be done. Despite widespread bipartisanship, the SUPPORT Act failed to be reauthorized before its September 30 expiration date. Prior to missing the reauthorization deadline, the SUPPORT Act was placed on the Suspension Calendar (a process to fast-track legislation that can receive supportive votes from three quarters of the chamber) before the House became unable to act until choosing a new Speaker, highlighting its bipartisan support and strong likelihood of passage. As another continuing resolution deadline approaches to fund the government, substance abuse disorder advocates maintain their enthusiasm that action will be taken.

As negotiations continue, the NHC will continue monitoring any new developments surrounding SUPPORT Act reauthorization.