7 things we’ll remember about 2016

1. The election of Donald Trump as president of the United States

The incoming Trump administration presents an unpredictable atmosphere when it comes to health policy. Although he vowed to repeal the Affordable Care Act (ACA) on his first day in office, passing legislation to replace ACA is not so easy. Even tougher will be the transition plan to get the U.S. healthcare system from where it is today to where GOP leaders want it to be.

Many behavioral health executives were counting on Hillary Clinton being elected and her administration investing substantially in proposed health reforms, including $5 billion for Certified Community Behavioral Health Clinics and $10 billion to address substance use disorders.

What Trump will ultimately want to accomplish in the name of public health is yet to be determined.

2. The Comprehensive Addiction and Recovery Act (CARA) passing with overwhelming bipartisan support

In the divisive political climate of 2016, forward motion on any legislation seems like a miracle. The fact that a bill to address addiction received bipartisan support and was ultimately signed into law more than demonstrates the impact substance use disorders have in every jurisdiction. Congressional leaders not only endorsed CARA, some even used it as platform to gain re-election, as Sen. Rob Portman (R-Ohio) did.

Although CARA did not appropriate funding in its final language—a major sticking point for Democrats—it has thus far received $7 million of its authorized $181 million.

3. The surgeon general’s report on addiction

Surgeon General Vivek Murthy, MD, released a mammoth report in November, noting that there are more people with substance use disorders in this country than people with cancer. It’s a shocking statistic for many to digest.

With the onus on a federal official to gather such information, the document helps to extend the knowledge base about addiction outside of the traditional industry circles and into everyday America. The report not only aims to change the national dialog, it serves as a one-stop shop for framing addiction as a public health issue, collecting the evidence and making recommendations.

Among the more surprising suggestions, Murthy calls for research into the potential benefits of medicinal marijuana.

4. Marijuana legalization

Nine states, including the District of Columbia, now allow for recreational use of marijuana. Additionally, 28 states allow for medical use. Although pot is not legal as far as the federal government is concerned, states are looking at decriminalization as a way to reduce resources spent on law enforcement and to raise money through taxes on marijuana sales. Colorado, for example, realized $44 million in related tax revenue in 2014.

Many observers believe the legalization trend will continue, especially in light of California passing its ballot measure this year. However, industry advocates continue to warn that marijuana regulation must be thorough in order to avoid the type of marketing influence seen with “big tobacco” of the past.

5. The 21st Century Cures Act passes in a lame-duck session

Again in a bipartisan effort, Congress finalized new healthcare legislation that includes behavioral health provisions with the passage of the Cures Act. It authorizes $1 billion over two years to supplement existing grant programs for addiction treatment and prevention, prescription drug monitoring programs and workforce development. It also includes provisions of the Helping Families in Mental Health Crisis Act, a significant piece of mental health legislation that also calls for greater accountability for federal spending.

It will be interesting to see who is on the short list to fill the new assistant secretary and chief medical officer positions at SAMHSA.  

6. More providers prescribing buprenorphine

Not only did the Department of Health and Human Services bump up the maximum number of patients doctors can treat with buprenorphine in 2016, it also authorized nurse practitioners and physician assistants to prescribe the medication as well. Physicians now may treat up to 275 patients. The nurses, however, are only authorized to prescribe buprenorphine for a maximum of 30 patients so far.

There is evidence to suggest that these moves will not be the silver bullet that optimizes buprenorphine utilization. More support for prescribers and more connections to counseling for patients will be imperative.

7. President Obama’s record-setting $1.1 billion budget request to address the opioid crisis

An unprecedented request, the $1.1 billion in new funding Obama asked Congress to sign off on in February still would have fallen short of what industry leaders believe the country needs to make real progress on prevention and treatment of opioid addiction. However, the president’s focus on the issue was applauded by stakeholders and politicians alike. It’s impossible to say whether the administration prioritizing the opioid crisis influenced the movement on CARA or the Cures Act, but there’s no doubt 2016 was a record-setting year for behavioral health.

Your mission for 2017 is quite clear: Maintain the momentum at federal, state and local levels, regardless of party affiliation. Don’t let the progress of 2016 wither for lack of attention.