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Policy solutions are an impactful way to implement public health research and theory to improve the health of our community. Below we have outlined some current evidence-based legislation for substance use and mental health.
The examples below can serve as models or additional research for your own policy advocacy.
Measure 110 in Oregon: Otherwise known as the “Drug Addiction Treatment and Recovery Act”, Measure 110 was passed in November 2020.
The measure is broken into two major parts:
The first section became effective in February 2021 and reduced penalties for possession of controlled substances. Controlled substances are drugs or other substances that are regulated under federal law into one of five different levels called “schedules”.
For possession of small amounts of controlled substances, penalties were reduced from a criminal misdemeanor to a Class E violation that is punishable by a $100 fine or completion of a health assessment at an Addiction Recovery Center.
For possession of larger amounts of a controlled substance, penalties were reduced from a felony to a Class A misdemeanor that is punishable by a maximum of 364 days of imprisonment and a maximum fine of $6,250.
For comparison, the maximum term is 10 years for a Class B felony and 5 years for a Class C felony.
Second, the measure established the Addiction Recovery Center Grant Program to provide grants to support or create Addiction Recovery Centers. These centers must address short-term care needs, provide screening and assessment, assist with planning and case management, connect patients with services, provide peer support, and provide outreach services.
While it is too early to determine the success of Measure 110, there are some emerging strengths and weaknesses.
On one hand, based on the first round of data from the Oregon Health Authority, more than 16,000 people have accessed services and there has been an almost 60% decrease in the number of people arrested for controlled substance offenses.
On the other hand, there have been some noted issues with the implementation of Measure 110. Some of these issues include unclear roles and responsibilities for the Oversight and Accountability Council (OAC) and the Oregon Health Authority (OHA), lack of support from the Oregon Health Authority, and an inefficient grant process. Moving forward, it will be important for these issues to be addressed.
Overdose Prevention Centers (OPCs): Sometimes referred to as “supervised consumption services” (SCS) or “supervised injection facilities” (SIFs), Overdose Prevention Centers are safe spaces where individuals can use drugs or substances obtained elsewhere with access to sterile equipment, fentanyl test strips, and trained staff.
The purpose of Overdose Prevention Centers is to reduce harm, prevent overdose deaths, connect individuals to treatment or assistance services, and reduce public disorder.
There are more than 100 Overdose Prevention Centers worldwide and research has shown they are effective and do not increase substance use or crime in the area.
New York City Overdose Prevention Center Pilots: On the 30th of November 2021 two Overdose Prevention Centers began operating in Manhattan. The two sites had previously been needle exchanges and have now expanded their services. As of February 2024, the two Overdose Prevention Centers have reversed 1,339 overdoses and collected 2,000,000 units of hazardous waste.
Rhode Island Harm Reduction Centers (pdf): In July 2021, 2021-S 0016B was signed and authorized a two-year pilot program to establish Overdose Prevention Centers called “harm reduction centers”. In 2023, additional legislation was passed that extended the pilot program another 2 years until March of 2026. According to the legislation, each center will be a community-based resource that provides screening, disease prevention, recovery assistance, and a safe space to consume pre-obtained substances. Additionally, each center must have trained staff and provide referrals. Prior to opening, centers must receive authorization from the local governing body.
AgriStress Helpline Funding in Oregon: In July of 2023 Senate Bill 955 took effect in Oregon. The legislation provides $300,000 of funding to support the implementation and operation of the AgriStress Helpline in Oregon.
The AgriStress Helpline is a 24/7 crisis helpline for agricultural, forestry, and fishing communities that is now available in Connecticut, Missouri, Oregon, Pennsylvania, Texas, Virginia, and Wyoming. Crisis specialists with the hotline complete additional training focused on the unique stressors and lived experiences of agricultural, forestry, and fishing communities called FarmResponseSM. Crisis specialists can also use an Oregon-specific database or agricultural and health resources to connect callers with local resources.
Behavioral Health Administration in Colorado: At the end of May 2022 HB22-1278 signed into law in Colorado. The bill will create the behavioral health administration (BHA) within the department of human services.
The bill will require the behavioral health administration to establish a behavioral health complaint system, a monitoring system for behavioral health performance, a comprehensive safety net system for behavioral health, regionally based behavioral health administrative service organizations, make the behavioral health administration the licensing authority for behavioral health organizations or facilities, and create the behavioral health administration advisory council by July of 2024. In 2022 the BHA Advisory Council (BHAAC) was formed and began meeting quarterly, with its membership consisting of people with lived behavioral health experience. While it is too early for implementation data, up-to-date information about implementation efforts can be found on Colorado's Behavioral Health Administration Website.
Improving Mental Health and Wellness in Schools Act: In October 2021 the Improving Mental Health and Wellness in Schools Act (S. 2930) was introduced in the United States Senate.
This legislation would amend the Richard B. Russell National School Lunch Act to include mental health in local school wellness policies.
Additionally, it would permit registered dietitians and school-based mental health services providers to participate in the development, implementation, and review of local school wellness policies.
Finally, it would allow the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide technical assistance and identify best practices.
The Improving Mental Health and Wellness in Schools Act died in 2021 after never going to a vote, but was reintroduced in March 2023 (S.754).
Mental Health Parity and Addiction Equity Act (MHPAEA): In 2008 the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was passed in Congress. The final rules regarding the implementation of this Act were decided in 2013 and took effect starting in 2014.
The act requires certain insurance plans to provide equal treatment for mental health and substance use conditions as it would physical health conditions. Parity is required for non-Federal governmental plans and group health plans of private employers with more than 50 employees, plans purchased through the healthcare marketplace, Federal Employees Health Benefits Program, Medicaid Managed Care Plans (MCOs), and State Children’s Health Insurance Programs (S-CHIP). It is important to note that parity does not inherently reflect the quality of coverage. For example, if an insurance plan has a high deductible and limited coverage for physical health conditions, then the mental health coverage would also be limited and have a high deductible. While the passage and subsequent implementation of the parity act was heralded as a major success, there have been notable issues with enforcement.
Oregon Mental Health Parity: HB 3046 from the 2021 session added to the federal parity law by outlining treatments that must be provided by coordinated care organizations and covered by insurers while also. The legislation also updated review and reporting requirements with insurers and coordinated care organizations being required to send a report regarding compliance to parity laws to the Department of Consumer and Business Services and Oregon Health Authority respectively. You can view these reports on the OHA website Mental Health Parity Analysis page.
No Behavior Cost Sharing Act in New Mexico: In April of 2021 Senate Bill 317 was signed into law in New Mexico.
This legislation prohibits insurers from imposing cost-sharing measures (e.g., co-payments) when seeking behavioral health services.
The behavioral health services covered include prevention and identification of mental illnesses and substance use disorders, inpatient treatment, residential treatment, outpatient treatment, intensive outpatient therapy, detoxification, and all medications.
Moreover, Senate Bill 317 established the Health Care Affordability Fund to help decrease the cost of health care coverage for New Mexico residents and small businesses.
The legislation took effect in January of 2022 and is set to end at the start of 2027 if not renewed.