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Authors Posts by Jason Snyder

Jason Snyder

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The online Exhibitor and Sponsor Portal for the 2025 AATOD Conference, set for October 4 – 8 in Philadelphia, is now open.

The 2025 AATOD Conference will attract more than 1,800 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. The registrants are decision-makers with purchasing power for their treatment centers and are looking for new products, services, and information to improve patient treatment.

Exhibit booth space, select sponsorship opportunities, and registration can be purchased directly through the portal. More information about exhibitor opportunities and benefits can be found on the conference website.

A full list of sponsorship items and exhibit details can also be found in the exhibitor brochure.

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For as long as I’ve been active in the recovery community and addiction treatment system, the prevailing mentality around people who couldn’t “get it” – with “it” mostly meaning compliance with a program and an outcome of sustained abstinence – was that they just weren’t ready, or they just didn’t have enough willingness to do the things that are necessary to stop using drugs and begin to recover. That attitude is much more pronounced in certain recovery communities, much more nuanced in the treatment environment, but it’s an accepted way of thinking in both. It’s a kind of thinking that blames the individual for failing, as opposed to the system failing the individual.

But what if a large subset of individuals with substance use disorder (SUD) really can’t get it, with “it” not only being abstinence or reduced use, but, more consequentially, the cognitive demands of treatment – alertness, attention, cognitive processing, memory, and executive functioning? What if these individuals are neurologically incapable – even if only temporarily – of engaging in treatment for their SUD the way the treatment system expects them to, because they have either an acquired or traumatic brain injury from or driving their SUD?

Such a recognition by the broad treatment system, the subsequent implications for improved individualized treatment and, most importantly, actual modifications to SUD treatment could be huge.

Earlier this month, I had the opportunity to participate in what for me was an eye-opening summit convened by the Pennsylvania Department of Health and the Brain Injury Association of Pennsylvania. It focused in part on recognizing the significance and prevalence of brain injury among those with SUD, especially opioid use disorder (OUD), and identifying ways to better treat this population. Much of what was shared and stimulated my thinking on this came courtesy of the Addiction Technology Transfer Center’s “Traumatic Brain Injury and Substance Use Disorders: Making the Connections” toolkit.

Most of the discussion focused on acquired brain injury (ABI). Internal factors, including lack of oxygen to the brain due to an opioid overdose, result in ABI. Traumatic brain injury (TBI), on the other hand, results from an external force, such as a blow to the head, including those that result from physical abuse. Both ABI and TBI have significant implications for those in SUD treatment. Often subtle yet significant changes in memory, attention, and social behavior, for example, make it difficult to participate in treatment, and many leave without completing. With historic numbers of overdoses over the past 10 years, the connection between SUD and brain injury, especially ABI, has not gotten the commensurate discussion it needs.

Since 2015, Pennsylvania advocates have rightly made the widespread distribution of naloxone a top priority. In fact, that is the year I began working for the Pennsylvania Department of Drug and Alcohol Programs, and getting naloxone into the hands of first responders, especially police, was our top priority. The mantra then, as it is now, was we can’t treat someone who is dead. From there, the natural progression from administration of naloxone was to warmly handing off that person to treatment or recovery support. One of the biggest challenges, and therefore areas of focus, with the warm hand-off process has been finding more effective ways to intervene at that critical moment to prevent the individual from simply walking away from a near-death experience and continuing on as if it hadn’t happened.

What has received little attention over those 10 years is the fact that for many, regardless of whether they agreed to treatment or walked away, life would never continue as if the overdose hadn’t happened, because many who overdose experience permanent brain damage.

It takes only four to six minutes of a lack of oxygen to the brain to cause permanent brain damage, which can forever affect a person’s ability to understand, retain and recall information, express themselves, think critically, or solve problems. Those who sustain a brain injury are at risk for future overdoses.

In North America, approximately 23 percent of all intravenous drug users will experience a non-fatal opioid overdose per year. Further, there are estimated to be as many as 40 non-fatal overdose events for every fatal overdose among people who inject drugs.

Sadly, I can’t tell you how many people I’ve met who have been reversed multiple times. In fact, research shows that people who have had at least one opioid overdose are more likely to have another, which can compound any impairment or injury.

But it’s not only those who have overdosed who may have a cognitive impairment. Amount and duration of substance use can also result in neurologic and cognitive effects, meaning many people – perhaps the majority – who enter the treatment system have some level of difficulty with cognitive and behavioral function. Research suggests 80 percent of those seeking services for co-occurring mental health and SUD are living with the effects of brain injury.

Yet we as a treatment system often expect these same patients to sit quiet and still in hours-long group therapy sessions, pay attention, and not be disruptive. We expect them to be on time for group. We expect them not to miss their individual sessions. We expect them to follow through and comprehend. Those who don’t are often labeled as not ready for treatment. They haven’t reached their bottom yet.

Of course, there must be some measure of accountability on the patient’s part. But to set expectations for those with a brain injury in the same way we would for someone who does not have one is setting them up for failure.

To be fair, without assessing a person for a brain injury, clinicians may not even realize there is an issue. Without understanding the serious implications of brain injury on a person’s ability to engage in therapy, there may be no perceived need to change the way treatment is being provided. Instead, the lack of knowledge and understanding leads to incorrect assumptions about the patient as the reason the treatment isn’t working, not the reverse.

By beginning to effectively and comprehensively screen for brain injury; training clinicians, peers, regulators, and payers on the prevalence and implications of brain injury; and modifying the way treatment and recovery supports are provided for these individuals, the SUD treatment system can significantly improve treatment outcomes.

It will take collaboration with regulators, especially to remove regulatory barriers, as well as collaboration with payers to consider potential alternative payment models, to accommodate the therapeutic needs of those with a brain injury.

Quality individualized treatment should be more than rote alignment with ASAM criteria. It should effectively recognize neurologic limitations – both those acquired as a result of overdose and those caused by trauma – and appropriately modify treatment for those with such limitations. Otherwise, the behavioral health system will continue to misread and mislabel what arguably is a majority of its patients.

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In a presentation to the Medical Assistance Advisory Committee today, Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Secretary Jen Smith shared data that shows a significant increase over the past three years in behavioral health managed care organization (BH-MCO) decisions to deny services to their members or contracted providers.

In addition to denial data for calendar years 2022 through 2024, the report also provides data on grievances and complaints and defines what each of those is. Notably, the 2024 data does not include the fourth quarter of the year.

The most egregious service type denials are seen in two categories: 1) non-hospital residential withdrawal management, rehabilitation and halfway-house services for drug/alcohol abuse or substance use disorders; and 2) IBHS for children and adolescents with mental health or substance use disorders. Although the IBHS denials appear down slightly in 2024, when the fourth quarter data is added, the number is likely to increase. On the SUD side, even without fourth quarter data, denials for the non-hospital residential substance use disorder treatment services are up 45 percent over 2023.

The presentation breaks down the number of denials per year per BH-MCO since 2022.

The increases in denials in 2024 occurred at the same time OMHSAS acknowledged a significant miscalculation of capitation rates, resulting in underfunding of the behavioral health system, including primary contractors and BH-MCOs, by hundreds of millions of dollars.

Deputy Secretary Smith cautioned that there are multiple factors to consider when reviewing the data and increase in denials, including Pennsylvania’s SUD treatment system’s ongoing alignment with ASAM Criteria and the increased BH-MCO scrutiny on providers and individual BH-MCO interpretation of ASAM Criteria.

The full presentation is available here.

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Photo by Markus Winkler on Unsplash

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) notified single county authorities (SCA) that it will continue to distribute federal COVID-related grant funding to SCAs while the US District Court considers a 23-state lawsuit seeking an emergency temporary restraining order against US Health and Human Services Secretary Robert F. Kennedy Jr. for abruptly terminating COVID-grant funds that were appropriated for use for states until September 30, 2025. Those grant funds include a supplemental to the Substance Use Disorder Block Grant. The lawsuit was filed on April 1.

Though not confirmed, media reports suggest the termination of grants could cost the Pennsylvania Department of Health $301 million, along with an additional $28 million or more hit against DDAP.

DDAP had been using these grant funds to expand testing and provide resources for COVID; support providers and help meet local needs during the pandemic; and expand the substance use disorder prevention, intervention, treatment, and recovery support services continuum, including various evidence-based services and supports for individuals, families, and communities.

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Governor Shapiro and Pennsylvania are listed along with 22 other plaintiffs in a lawsuit filed in US District Court in Rhode Island, requesting an emergency temporary restraining order against US Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. for abruptly terminating COVID-grant funds, including a supplemental to the Substance Use Disorder Block Grant, that were appropriated for use for states until September 30, 2025.

Though not confirmed, media reports suggest the termination of grants could cost the Pennsylvania Department of Health $301 million, along with an additional $28 million or more hit against the Pennsylvania Department of Drug and Alcohol Programs (DDAP).

DDAP had been using these grant funds to expand testing and provide resources for COVID; support providers and help meet local needs during the pandemic; and expand the substance use disorder prevention, intervention, treatment, and recovery support services continuum, including various evidence-based services and supports for individuals, families, and communities.

DDAP is examining its options to maintain the full array of services offered by single county authorities and their providers to ensure Pennsylvanians continue to receive the lifesaving supports they need.

The factual allegations and legal background in the lawsuit state that during the COVID-19 pandemic, Congress appropriated substantial funds to strengthen public health programs that were not tied to the duration of the public health emergency. HHS and Congress continued to make these public health funds available after the end of the pandemic.

On Monday, March 24, with no advance notice, HHS abruptly terminated $11 billion in grants and cooperation agreements funded by appropriations from COVID-related laws. States were notified through letters from the Substance Abuse and Mental Health Administration (SAMHSA). The letters indicated the grants were issued for a limited purpose: to ameliorate the effects of the pandemic. The end of the pandemic provides cause to terminate COVID-related grants. Now that the pandemic is over, the grants are no longer necessary.

The lawsuit goes on to state the terminations have caused and will continue to cause irreparable harm and asks the court to vacate and set aside the termination of the funding and any other further actions taken by US HHS to implement or enforce them, among other requests.

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There are many stakeholders in the broad substance use disorder (SUD) landscape who are nervous about how US Department of Health and Human Services Secretary Robert F. Kennedy Jr. will steer policy. But from a treatment perspective, given his beliefs and experiences, he could drive significant improvement in the way those Americans who suffer most severely from SUD are treated.

In January, after President Trump took office and nominated Kennedy to be secretary, many SUD treatment providers and advocates, along with several media outlets, immediately raised concerns. Pointing predominantly to the 45-minute documentary Kennedy made as part of his early campaign for the presidency, some advocates feared that if he was confirmed as secretary of HHS, he would use his personal experience and preferences to unduly influence the country’s SUD treatment policy away from evidence-based treatment, including the use of medications like methadone and buprenorphine.

In “Recovering America – A Film About Healing Our Addiction Crisis,” Kennedy, who is in long-term recovery from heroin addiction, featured “healing farms” – a form of therapeutic communities – as successful models for treating SUD. Therapeutic community is a treatment approach built on the premise that for recovery to occur, a change in lifestyle and social and personal identity is vital. He said that if he was elected president, he would open hundreds of healing farms across the country.

Of course, he did not become president, but he was confirmed as secretary of HHS in February.

Kennedy’s support of healing farms is not the only concern of some advocates. The pathway to his own recovery – a 12-step program – and his staunch support and continued participation in that program, which many criticize for its abstinence-only philosophy, including its rejection of medications to treat SUD, is also a red flag.

An Opportunity to Improve What Already Exists

But Kennedy actually has an opportunity to leverage his experience and philosophies in a way that improves the predominant residential treatment model in place today for those with the most severe and advanced disease. This does not mean a wholesale shift toward healing farms or even therapeutic communities (though in a world of individualized care and personal choice, there can be a place for these types of treatment models). It should, however, include policy that forces increased funding of residential treatment settings, in order to provide adequate lengths of stay and meaningful integrated mental and physical health and recovery support services throughout the continuum – including, when necessary, skilled nursing facilities that accept patients whose treatment includes narcotic medication, and appropriate, safe, and accessible recovery housing. A stronger continuum of care for those suffering the most severe SUD can enable social connectedness, sense of community, belongingness, and meaning and purpose. Not only are these foundational goals of therapeutic communities and values Kennedy holds in high regard; they are also key tenets of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) working definition of recovery. As HHS secretary, Kennedy oversees SAMHSA.

In Kennedy’s documentary, he walked the streets of San Francisco and showed footage of Philadelphia’s Kensington neighborhood. Living in the age of fentanyl and xylazine, the individuals from these streets who make it to treatment are typically homeless, have extreme physical comorbidities, and have suffered unimaginable trauma and mental illness. In other words, they are the most ill. Yet, in Pennsylvania, we often see an aggressive push by payers to quickly move them from the highest levels of care, where patients whose acute biomedical, emotional, behavioral, and cognitive problems are so severe that they require primary medical and nursing care, to lower levels of care well before their clinicians believe they are ready.

Many policymakers, pundits, and payers will point to the high cost and lack of evidence to support such lengths of stay in residential settings. But any argument that the research does not support long-term residential treatment should be carefully scrutinized, in particular because little research exists that examines outcomes for those with the most severe SUD. If Pennsylvania policymakers and payers have such data, they should bring it forward.

Ensuring and Improving Access to Medication

What is indisputable is the fact that medications to treat opioid use disorder not only reduce overdose deaths, but they also increase engagement and retention in treatment, increase abstinence from opioid use, and improve other quality-of-life metrics.

But Kennedy’s position on several other issues has advocates concerned about his position on medications like buprenorphine and methadone.

From within the mental health and SUD advocacy world, one of the strongest endorsements Kennedy received ahead of his confirmation was from his cousin Patrick Kennedy, a former US Congressman from Rhode Island and staunch SUD and mental health advocate who has been in recovery 14 years. Patrick Kennedy’s treatment and recovery path included the use of buprenorphine and naltrexone, as well as medications to address mental health.

In a 2016 story in the Seattle Times, Patrick Kennedy said, “We’re hogtied because many of those influencing addiction policy in this country come from the 12-step culture, which says abstinence is the only true form of recovery. We’re losing a lot of people on the altar of that type of rigid ideology.”

Even closer to home, Robert Kennedy experienced the death of his younger brother David, whom he described as his best friend. David Kennedy was 28 years old when he died in 1984. My younger brother Todd was 28 years old when he died in 2005 from a heroin overdose. Less than two years later in September 2007, my 25-year-old brother Josh, the youngest of my parents’ three children, died of a drug overdose. I have often said that my parents, both of whom I am grateful to still have today, would much rather have their two dead sons alive and using buprenorphine or methadone, with a chance to define their own lives and recovery, than lying side by side in a graveyard in Cambria County, PA. I can’t imagine that Robert Kennedy feels any different about David – that if there was something that could have been done to give him another day and a shot at recovery, he would have staunchly supported it. In preserving and enhancing access to medications, Kennedy has the opportunity to give to parents, siblings, and other family members and loved ones what he and I no longer have.

Walking the Tightrope

In my work, a key component of advocacy on behalf of SUD treatment and those who need it is an ability to put aside my own recovery path, and acknowledge and support other pathways that I might not choose but can nonetheless be effective. In fact, this is in large part what a professional peer does. And for Kennedy, as evidenced by his documentary, the peer is an indispensable, integral part of the recovery process; not just in the healing farm setting, but in justice-system diversion programs as well, for example.

Related to my recovery from SUD, if you want the type of life I am striving to live and want to know what I do, I am willing to show you. My professional role, however, does not include forced imposition of my personal philosophies on you. To find such a balance requires open-mindedness, which is also a bedrock principle of the Alcoholics Anonymous (AA) program Kennedy lives. The challenge with open-mindedness is applying it in all of life, not just within the parameters we choose to live. In doing so, we potentially attract others to that lifestyle.

Kennedy obviously is not simply an advocate or a well-known “old-timer” in a local area of AA meetings. He is the top policymaker for HHS and SAMHSA. From the highest, most influential platform he has ever had relative to his recovery, he can strike the right balance.

With a better funding approach, Kennedy can infuse aspects of a treatment modality and recovery support program that has worked for many, including himself, into the system we have in place today. In doing so, he can improve treatment broadly for those with the most severe SUD, and support and advance the integral, life-saving role medications play, all while serving as a role model for what recovery may look like for some.

For the sake of all of those who are still suffering from this disease, including families, I hope he can do it.

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The U.S. Department of Health and Human Services (HHS) announced yesterday that the public health emergency declaration addressing the nation’s opioid crisis has been renewed, allowing sustained federal coordination efforts and preserving key flexibilities that enable HHS to continue leveraging expanded authorities to conduct certain activities in response to the opioid overdose crisis.

The public health emergency, first declared under President Trump in 2017, was set to expire on March 21, 2025. The renewal extends the emergency for 90 days.

More information about the declaration is available on the Substance Abuse and Mental Health Administration’s (SAMHSA) website.

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The 2025 American Association for the Treatment of Opioid Dependence (AATOD) Conference will be held October 4 – 8 in Philadelphia at the Philadelphia Marriott Downtown. The 2025 conference theme is “The Evolving Field of Opioid Treatment.”

Early registration is open now through June 30. Register here.

The aim of the conference is to educate and promote acceptance and integration of medication-assisted treatment options by patients, families, clinicians, the medical system, judicial systems, government, policymakers, social service administrations, and the general public. Presenters will disseminate innovative, evidence-based initiatives and treatment techniques to better serve patients and providers, improve program development and administration, promote integration across the continuum of care, and enhance patient outcomes to assist communities in developing an effective response to this crisis.

The Pennsylvania Association for the Treatment of Opioid Dependence (PATOD), the state chapter of AATOD, is a member of RCPA. RCPA member Josh Nirella, Regional Director for Acadia’s Comprehensive Treatment Centers, is Conference Chair. RCPA member Pam Gehlmann, Regional Director for Pinnacle Treatment Centers, is Host Committee Chair.

More information is available on the 2025 AATOD Conference website.

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The Pennsylvania Department of Drug and Alcohol Programs (DDAP) today issued Licensing Alert 01-2025 to update statewide exceptions granted to narcotic treatment programs (NTP) in September 2024 to expand access to medication for the treatment of opioid use disorder (MOUD). Specifically, this alert expands the exceptions to allow expanded use of telehealth in initial screening and physical examinations consistent with medical practice regulations of the State Board of Medicine.

Effective December 21, 2024, the State Board of Medicine amended its regulation regarding prescribing, administering, and dispensing controlled substances. The updated regulation mirrors federal regulations by allowing regulated practitioners in NTPs to conduct initial physical examinations by telehealth and initiate treatment with buprenorphine or methadone in compliance with federal requirements and requires an in-person physical examination to be completed within 14 days after admission. Therefore, DDAP is also granting an exception to 28 Pa. Code § 715.9(a)(4), which is the rule that requires a face-to-face determination be made as to whether a person has been dependent on a narcotic drug for at least one year prior to starting MOUD, provided that the NTP has a trained person to diagnose the client using medical criteria in accordance with 42 CFR § 8.12(e)(1) and documents the reason for admission for MOUD treatment in the record. DDAP will allow telehealth for the initial screening and medical examination provided that the clinician determines that they can complete an adequate examination through that method, that the mode of telehealth is permissible for the MOUD to be used in accordance with 42 CFR 8.12(f)(2)(v), and that the NTP completes a full in-person physical examination within 14 days of admission in accordance with 42 CFR 8.12(f)(2)(iii).

DDAP first granted statewide exceptions based on 42 CFR part 8 through Licensing Alert 07-2024. Today’s Licensing Alert 01-2025 rescinds and replaces Licensing Alert 07-2024.

Federal regulations continue to require NTPs and clinicians to comply with pertinent state laws and regulations.

To review all of the exceptions DDAP is granting NTPs, read Licensing Alert 01-2025.

There is no need for NTPs to submit exception requests or to inform the DDAP if they are using these exceptions.

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Pennsylvania’s single county authorities (SCA), in collaboration with the Department of Drug and Alcohol Programs (DDAP), developed a new rate-setting package (i.e., XYZ Package) for residential providers to submit cost-based rate requests for Fiscal Year 2025/26.

The deadline to submit the rate package has been extended to Monday, March 24. This change is reflected in the package itself, which, along with a training video for how to complete the new package, is available on the PACDAA website.

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