From Policy to Practice: The SUPPORT Act’s Quiet Revolution in Opioid Treatment

Across the country, families and communities are still mourning lives lost to the opioid crisis, lives that might have been saved if treatment had been easier to reach. For too many people living with opioid use disorder in the US, the hardest part isn’t finding the courage to seek help, it’s finding a provider who can offer it. The 2018 SUPPORT Act Section 1003 (SUPPORT Act) demonstration set out to change that. By helping states expand access to medications like buprenorphine and methadone, this initiative gave more doctors, nurses, and clinics the tools to treat addiction as the medical condition it is. The result has been more than policy progress, it’s been a quiet transformation in how care is delivered, how recovery is supported, and how hope finds its way back into people’s lives.

The SUPPORT Act demonstration has played a critical role in addressing the shortage of providers equipped to offer Medication for Opioid Use Disorder (MOUD). After the initial planning phase, all five participating states, Connecticut, Delaware, Illinois, Nevada, and West Virginia, reported increases in the number of providers authorized to administer buprenorphine and methadone. These medications are essential components of evidence-based treatment for opioid use disorder (OUD), and expanding access to them is one of the most effective strategies to reduce overdose deaths and support recovery.

By 2024, participating states implemented targeted initiatives such as office-based opioid treatment (OBOT) fellowships and MOUD-specific training programs. These not only increased credentialed providers but also embedded OUD treatment into primary care and emergency department workflows. For example, internal medicine residents in some states began prescribing MOUD in outpatient clinics, normalizing OUD treatment in general practice. States also attended national research forums to learn best practices for initiating MOUD in emergency settings, where many individuals first encounter healthcare during an overdose or crisis event¹.

Leveraging Interagency Collaboration and Funding Streams

A key outcome of the SUPPORT Act demonstration was enhanced collaboration between state agencies. Historically siloed systems became more coordinated, with Medicaid agencies, behavioral health departments, and public health authorities working together. These collaborations also helped states secure additional funding sources, such as the American Rescue Plan and State Opioid Response (SOR) grants, to continue initiatives without waiting for uncertain federal reimbursements².

Cross-agency synergy supported sustainable models for SUD treatment expansion. Interagency committees aligned Medicaid plans with SAMHSA’s evidence-based standards, while pooled technical expertise and administrative capacity proved crucial during the COVID-19 pandemic. Shared priorities and streamlined communication allowed agencies to respond swiftly and implement changes more efficiently.

Data Infrastructure and Performance Monitoring Enhancements

Another benefit of the demonstration was improved data collection and reporting capacity among state Medicaid agencies. Accurate, timely data is vital for evaluating program impact and making informed decisions. The demonstration encouraged states to build data infrastructure for real-time tracking of provider participation, patient outcomes, and service metrics³.

States invested in health IT systems integrating Medicaid claims, provider directories, and patient records. These systems improved monitoring of MOUD utilization and helped identify provider shortages by geography. Data sharing agreements between Medicaid and public health departments enabled more strategic, community-level interventions. Enhanced analytics also revealed disparities in treatment access, informing more equitable resource allocation.

Challenges Related to Funding Uncertainty and the COVID-19 Pandemic

Despite its successes, the demonstration faced significant challenges. Chief among these was uncertainty around federal reimbursement after the planning period, leading some states to delay or scale back implementation. This limited investments in workforce and infrastructure⁴.

The COVID-19 pandemic also disrupted the demonstration. State staff were reassigned to pandemic response, and training programs were canceled or postponed. Clinical providers faced burnout and staffing shortages, complicating MOUD expansion. Meanwhile, the demand for SUD treatment surged as overdose rates climbed. These challenges underscored the importance of building resilient systems that can maintain focus during public health emergencies. Investment in telehealth and flexible service delivery proved critical and remains essential moving forward⁵.

Practical Strategies for Local Governments and Health Departments

Local health departments and governments can apply lessons from the demonstration to improve their own SUD treatment systems. One strategy is to build local provider capacity through partnerships with medical schools and teaching hospitals. Residency training tracks that include MOUD certification help embed SUD treatment into routine care. Continuing education incentives can also encourage providers to become waivered to prescribe buprenorphine.

Forming local interagency workgroups with representatives from Medicaid, behavioral health, emergency services, and criminal justice systems helps align policies, share data, and coordinate funding. Leveraging opportunities such as SOR grants or HRSA’s Rural Communities Opioid Response Program enables local agencies to supplement budgets and sustain efforts. Even without federal demonstration projects, the collaborative, data-driven framework of the SUPPORT Act offers a model for local implementation. Partnerships with community-based organizations further strengthen networks and support culturally competent care.

Building a Sustainable and Equitable SUD Treatment Ecosystem

For long-term impact, governments must build a comprehensive treatment ecosystem integrating prevention, early intervention, treatment, and recovery services. This includes equitable access to MOUD in both urban and rural areas, addressing social determinants of health, and supporting peer recovery networks. Equity must remain a guiding principle, especially as underserved communities often face the highest overdose rates with the least access to care⁶.

Municipalities should consider incorporating community health workers and peer support specialists into SUD programs. These roles can bridge gaps between clinical providers and patients, improving engagement and follow-up. Local governments, in coordination with state agencies, can revise zoning and licensing policies to support treatment centers and harm reduction services like syringe exchange programs and naloxone distribution. When aligned with public education and stigma-reduction campaigns, these efforts can increase community acceptance and participation.

Conclusion and Policy Recommendations

The SUPPORT Act demonstration shows that targeted federal initiatives, combined with state innovation and interagency collaboration, can enhance Medicaid provider capacity for high-quality SUD treatment. While challenges around funding and workforce remain, the demonstration offers a replicable model for jurisdictions addressing the opioid crisis.

To maintain progress, stakeholders should advocate for stable federal funding, invest in provider education, and build integrated data systems. Collaboration across agencies and sectors will help create a more resilient public health infrastructure capable of addressing both the opioid epidemic and broader behavioral health challenges. Sustained focus on equity, sustainability, and community engagement is essential to improving health and mental wellness.

Bibliography

1. Centers for Medicare & Medicaid Services. "Section 1003 Demonstration Project to Increase Substance Use Provider Capacity." U.S. Department of Health and Human Services, 2023. https://www.medicaid.gov/medicaid/section-1003/index.html.

2. Substance Abuse and Mental Health Services Administration. "State Opioid Response Grants." U.S. Department of Health and Human Services, 2023. https://www.samhsa.gov/grants/grant-announcements/ti-23-015.

3. Agency for Healthcare Research and Quality. "Improving Data Infrastructure for Substance Use Disorder Treatment." U.S. Department of Health and Human Services, 2022. https://www.ahrq.gov/research/findings/factsheets/index.html.

4. National Academy for State Health Policy. "Lessons from the SUPPORT Act Section 1003 Demonstration." NASHP, 2022. https://www.nashp.org/support-act-section-1003-lessons/.

5. Centers for Disease Control and Prevention. "Impact of the COVID-19 Pandemic on the Opioid Crisis." CDC, 2022. https://www.cdc.gov/opioids/data/analysis.html.

6. National Institute on Drug Abuse. "Addressing Health Disparities in Substance Use Disorder Treatment." National Institutes of Health, 2023. https://www.drugabuse.gov/publications/research-reports/addressing-health-disparities-in-substance-use.