Opioid Crisis

The Nation is in the midst of an unprecedented opioid epidemic. More than 130 people a day die from opioid-related drug overdoses.

Prevention and access to treatment for opioid addiction and overdose reversal drugs are critical to fighting this epidemic. Primary care settings have increasingly become a gateway to better care for individuals with both behavioral health (including substance use) and primary care needs.

The Health Resources and Services Administration (HRSA) supports its grantees with resources, technical assistance, and training to integrate behavioral health care services into practice settings and communities.

How HRSA is Addressing the Opioid Crisis

Expanding access through health centers and other primary care settings

In September 2018, HRSA awarded $352 million in new funding to expand access to substance use disorder and mental health services at community health centers across the nation.

Previously, HRSA awarded $200 million in 2017 to expand mental health services and substance use disorder treatment and $94 million in 2016 through Substance Abuse Services Expansion funding.
Since September 2018, HRSA has awarded over 300 grants and cooperative agreements, totaling around $173 million, as part of the Rural Communities Opioid Response (RCORP) initiative:

RCORP currently includes the following grant programs for rural communities and consortia:
It also includes cooperative agreements for:
- Technical Assistance;
- Evaluation; and
- three Rural Centers of Excellence on Substance Use Disorders
Additionally, HRSA expanded the 2017 Rural Health Opioid Program, adding over $6 million in September 2018 to fund a total of 26 rural health organizations.
HRSA supports testing evidence informed interventions for integrating behavioral health with primary medical care for people living with HIV; using an implementation science model to develop tools and resources for Ryan White HIV/AIDS Program provider sites.
HRSA's 340B Drug Pricing Program supports affordable medication-assisted treatment.
In August 2019, HRSA awarded more than $200 million to 1,208 health centers across the nation to increase access to high quality integrated behavioral health services through the Integrated Behavioral Health Services (IBHS) program.
Through the Medication-Assisted Treatment (MAT) Award Enhancement HRSA provides additional support to National Health Service Corps members who possess or obtain a DATA 2000 Waiver and provide MAT at a NHSC-approved site.
The National Health Service Corps Substance Use Disorder Workforce Loan Repayment Program expands access to evidence-based substance use disorder (SUD) treatment in underserved, high-need communities by offering health care clinicians the opportunity to have their qualifying student loans repaid in exchange for serving at an NHSC-approved SUD site.
The National Health Service Corps Rural Community Loan Repayment Program makes loan repayment awards to qualifying NHSC clinicians to provide evidence-based substance use treatment, assist in recovery, and to prevent overdose deaths in rural communities across the nation.

Using telehealth to treat opioid use disorder

The Substance Abuse Treatment Telehealth Network Grant Program provides $700,000 for evidence-based, telehealth programs and networks to improve access to substance use disorder treatment in rural, frontier and underserved communities.

Similarly, the Regional Telehealth Resource Center Program supports the development and advancement of telehealth programs in high-need communities.
HRSA supports a Substance Use Warmline so primary care providers can access expert clinical consultation to assist them in caring for patients with substance use disorders.
Roughly 150 health centers participate in a HRSA-funded Opioid Addiction Treatment (OAT) Extension for Community Healthcare Outcomes (ECHO). This Project ECHO model was a virtual, national technical assistance effort to enhance health center capacity to treat opioid use disorder. It included bi-weekly virtual sessions with didactic training and case reviews. The slides, audio recordings, and transcripts for the training sessions are available on our Substance Use Disorders and Primary Care Integration page.
HRSA’s Center of Excellence for Behavioral Health Technical Assistance offers health centers the opportunity to join a Community of Practice on telebehavioral health best practices and strategies once the health center has set up an account on the website.
HRSA is hosting a series of MCHB Grand Challenges to support innovative, technology-based solutions to improve health, including the Addressing Opioid Use Disorder in Pregnant Women and New Moms Challenge to improve access to quality health care services, such as substance use disorder treatment, recovery support, and other support services for women with OUD, their infants, and their families, especially those in rural and geographically isolated areas.
HRSA’s Center of Excellence for Behavioral Health Technical Assistance offers health centers the opportunity to join a Community of Practice on telebehavioral health best practices and strategies once the health center has set up an account on the website.

Connecting stakeholders to opioid-related resources

As part of the Federal Rural Interagency Working Group on Substance Use Disorder, HRSA’s Federal Office of Rural Health Policy contributed to create a new Rural Community Toolbox , a clearinghouse for funding, technical assistance, and other information to support local action against opioid use disorder (OUD) in rural America. The toolbox houses a Community Assessment Tool , which gives county-specific data about overdose deaths and factors that may make a community more vulnerable to OUD. The toolbox also includes a Rural Community Action Guide (PDF - 4 MB), which provides rural leaders with recommended action steps to address OUD in their communities.
HRSA supports training dissemination and information portals that provide resources on emerging public health issues including opioids. The Rural Health Information Hub has a number of opioid resources and toolkits targeted to rural providers.

Similarly, TargetHIV helps providers caring for persons living with HIV/AIDS and includes a toolkit on integrating medication-assisted treatment in HIV primary care.

State public health professionals can use the MCH Navigator to access learning tools to help mothers with opioid use disorder and infants with neonatal abstinence syndrome.
HRSA’s Healthy Start and Maternal, Infant and Early Childhood Home Visiting (MIECHV) programs screen, educate and connect perinatal women and parents of young children to treatment and recovery support services.
Through its ten regional offices, HRSA shares information and connects stakeholders to opioid resources. Staff take part in local, state, and federal opioid workgroups, taskforces, and meetings with local and state health departments and tribal organizations.
As part of the Rural Opioid Federal Interagency Working Group, HRSA’s Federal Office of Rural Health Policy contributed to create a new Federal Resource Guide for Substance Use Disorder in Rural Communities (PDF - 1.6 MB).

This comprehensive guide organizes federal grant programs and resources specifically available to rural communities, in order to improve coordination and awareness of these federal resources.
The Rural Health Integration Models for Parents and Children to Thrive (IMPACT) program supports the implementation of evidence-based, two-generational strategies that promote the health and well-being of young rural children and create economic opportunities for their families, with a focus on children diagnosed with Neonatal Abstinence Syndrome (NAS), or with other prenatal substance exposures, and their families.
Since 1990, HRSA has supported the Children’s Safety Network (CSN) to provide content expertise and technical support to activate the translation of injury prevention research into practice at the state and local levels. CSN provides resources on a broad range of child safety-related issues, including prescription drug use and misuse.
HRSA’s Alliance for Innovation on Maternal Health (AIM) program is a quality improvement initiative focused on reducing maternal deaths and severe maternal morbidity by engaging provider organizations, state-based public health systems, consumer groups, and other stakeholders within a national partnership to assist state-based teams in implementing evidence-based bundles to improve maternal safety and outcomes in the United States. In August 2017, the AIM Program released the Obstetric Care for Women with Opioid Use Disorder maternal safety bundle.
HRSA funds Mothertobaby that provides fact sheets and resources on opioids for pregnant women and health professionals. Mothertobaby provides free, confidential and up-to-date information via phone, text or email.

Sharing best practices and regional approaches

Increasing opioid use disorder training in primary care

In September 2018, HRSA awarded $18.5 million to support Behavioral Health Workforce Education and Training (BHWET) and Enhancing Behavioral Health Workforce (EBHW). The Behavioral Health Workforce Education and Training Program seeks to develop and expand the behavioral health workforce serving populations across the lifespan, including in rural and medically underserved areas.
Through the Health Center Program, HRSA provides extensive training and technical assistance to potential and existing health center grantees nationwide, including opioid use disorder treatment and pain management.
Through the Primary Care Training and Enhancement: Integrating Behavioral Health and Primary Care Program HRSA funds innovative training programs that integrate behavioral health care into primary care, particularly in rural and underserved settings with a special emphasis on the treatment of opioid use disorder.
Through the Addiction Medicine Fellowship Program, HRSA seeks to expand the number of trained addiction medicine specialists who work in underserved, community-based settings that integrate primary care with mental health disorders and substance use disorder (SUD) prevention and treatment services.
The Opioid Workforce Expansion Program - Professionals trains behavioral health professionals in opioid and other substance use disorder prevention, treatment, and recovery services in high need and high demand areas, with a special focus on children, adolescents, and transitional-age youth.
The Opioid Workforce Expansion Program - Paraprofessional trains behavioral health paraprofessionals in opioid and other substance use disorder prevention, treatment, and recovery services in high need and high demand areas, with a special focus on children, adolescents, and transitional-age youth.
The Graduate Psychology Education Program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and opioid and other substance use disorder prevention and treatment services in high need and high demand areas.
The Opioid-Impacted Family Support Program seeks to expand the number of peer support specialists and other paraprofessionals to work in integrated, interprofessional teams providing services to children whose parents/guardians are impacted by opioid and other substance use disorders.
The Nurse Education, Practice, Quality and Retention Program: Behavioral Health Integration aims to increase the access to and quality of behavioral health services through behavioral health integrated team-based care models; and train the future nursing workforce to provide integrated behavioral health services in primary care settings through academic-practice partnerships