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FY 2011 Request for Application (RFA)

Cooperative Agreement for a Prescriber’s Clinical Support System for the Appropriate Use of Opioids in the Treatment of Pain and Opioid–related Addiction (Short Title: PCSS-Opioids)

Initial Announcement

Request for Applications (RFA) No. TI-11-007
Posting on Grants.gov: March 9, 2011
Original Receipt date: April 19, 2011

Catalogue of Federal Domestic Assistance (CFDA) No.: 93.243

Key Dates

Application Deadline Applications are due by April 19, 2011
Intergovernmental Review (E.O. 12372) Applicants must comply with E.O. 12372 if their State(s) participates.  Review process recommendations from the State Single Point of Contact (SPOC) are due no later than 60 days after application deadline.
Public Health System Impact Statement (PHSIS) / Single State Agency Coordination Applicants must send the PHSIS to appropriate State and local health agencies by application deadline. Comments from Single State Agency are due no later than 60 days after application deadline.

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) is announcing the availability for fiscal year (FY) 2011 funding for the Prescriber’s Clinical Support System for the Appropriate Use of Opioids in the Treatment of Pain and Opioid-related Addiction.

The purpose of this grant is to develop a free national mentoring network that will provide clinical support (e.g., clinical updates, consultations, evidence-based outcomes and training) to physicians, dentists and other medical professionals in the appropriate use of opioids for the treatment of chronic pain and opioid-related addiction.  This initiative will help SAMHSA address the Nation’s major concern about the morbidity and mortality that have been caused by misuse/abuse and fatal drug interactions involving opioids used in the treatment of addiction and chronic pain.

SAMHSA presently collaborates with the Office of National Drug Control Policy, Centers for Disease Control and Prevention, Drug Enforcement Administration, National Institute on Drug Abuse, and Food and Drug Administration, as well as with State agencies in addressing the rising methadone- and opioid-related mortality. The collaborative trainings of these agencies, coupled with an increase in requests for consultation and assistance from State authorities and practitioners in the field, have created a need for SAMHSA to evaluate and address the causes of the increase in abuse, morbidity, and mortality associated with the medical and non-medical use of methadone and other opioids.

While data strongly suggest that most of the increase in methadone-associated deaths is related to the rapid increase in the prescription of methadone for treatment of chronic pain, there is a widespread public perception that diversion of methadone from OTPs and OTP clients, and inappropriate client care in some OTPs, are major reasons for the rise of methadone-related mortality. This perception not only damages attitudes toward methadone maintenance treatment, which has been demonstrated scientifically in numerous studies to be the most effective treatment for opioid addiction, but also undermines public support for treatment generally.

Therefore, SAMHSA has a strong interest in and responsibility for helping ensure that methadone, whether prescribed for pain management or dispensed for the treatment of opioid dependence, is being used appropriately by physicians who have been trained in the latest evidence-based practices.

The target population for this initiative includes prescribers (physicians, dentists) and other health professionals working in SAMHSA-certified OTPs as well as those prescribers using opiate-based therapy for chronic pain.

While methadone abuse, morbidity, and mortality remain a major concern, SAMHSA is equally concerned about the use of opioids in general.  The results from recent SAMHSA national surveys (National Survey on Drug Use & Health, Drug Abuse Warning Network-Emergency Departments) suggest that other opioids, including oxycodone, hydrocodone, fentanyl, oxymorphone, and others are abused and misused at increasing rates.  Unlike methadone, these other opioids cannot be used for addiction treatment and are indicated for the treatment of pain.  In addition, these opioids are prescribed by a variety of practitioners – nurse practitioners, physician assistants, dentists, and others.  Finally, the number of prescriptions for opioids for chronic pain has increased dramatically over the last decade.

The training and clinical support provided under this initiative will address the specific complexities that are inherent in opioid-based therapy and the ways in which those complexities affect the appropriate care of individuals being treated for chronic pain and opioid-related addiction.

SAMHSA has demonstrated that prevention works, treatment is effective, and people recover from mental and substance use disorders.  Behavioral health is an essential part of health service systems and community-wide strategies that work to improve health status and lower costs for families, businesses, and governments.  Continued improvement in the delivery and financing of prevention, treatment, and recovery support services provides a cost effective opportunity to advance and protect the Nation’s health.  In order to achieve this goal, SAMHSA has identified eight Strategic Initiatives to focus the Agency’s work on improving lives and capitalizing on emerging opportunities.  The PCSS-Opioids program addresses the Prevention of Substance Abuse and Mental Illness Strategic Initiative.  One of the goals of this Initiative, which is consistent with the intent of PCSS-Opioids, is to reduce prescription drug misuse and abuse through the education of current and future prescribers regarding appropriate prescribing practices for pain and other medications subject to abuse and misuse.

More information is available at the SAMHSA website: http://www.samhsa.gov/About/strategy.aspx.
The PCSS-Opioids grant is authorized under Section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 focus area 40 (Substance Abuse Topic Area). 

Eligibility

There is a serious public health issue involving the abuse, misuse, non-medical use and concomitant morbidity and mortality associated with the increased availability of opioids for the treatment of acute pain, chronic pain and opioid-related addiction. While these medications are obtained through theft and other forms of diversion, SAMHSA surveys indicate that opioids used non-medically are usually obtained through prescriptions.  The Federal Controlled Substance Act permits physicians (including specialties such as psychiatrists, osteopaths, family practice, etc.), mid-level practitioners (such as nurse practitioners and physicians assistants), dentists, and other health professionals, to register to prescribe and dispense controlled opioid medications for the treatment of pain, and in limited cases, dependence.  Collectively, the quantity of these controlled opioids prescribed by physicians, dentists, and others, has increased several-fold over the last decade.  There are concerns that opioid prescribing practices may be contributing to the availability of opioid analgesics in the illicit market.  In addition, SAMHSA recognizes the difficulty in assessing patients for appropriate opioid prescribing and the limited training that physicians, psychiatrists, and dentists may receive during their formal, specialized training.  Moreover, licensed physicians and dentists, who have completed their formal training, lack adequate mentoring, continuing medical education, and other resources to evaluate patients and prescribe opioid analgesics appropriately.  To address this public health problem in a timely manner, SAMHSA is limiting eligibility for this cooperative agreement to the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Psychiatric Association, and the American Dental Association. These organizations have extensive experience in providing educational and other support services to their members.  As such, SAMHSA believes they are uniquely qualified to meet the requirements outlined in this announcement because they have the experience, infrastructure and capacity in place to expeditiously begin program activities.

Any of these entities may apply individually; they may also apply as a consortium comprised of all or several of the eligible organizations.  If a consortium is formed for this purpose, a single organization in the consortium must be the legal applicant, the recipient of the award, and the entity legally responsible for satisfying the grant requirements.  If a consortium submits an application, the application must include a written agreement outlining the roles and responsibilities of each organization participating in the consortium.  This agreement must be signed by an authorized official of each member of the consortium and attached to the application in Attachment 3 of the RFA, “Roles and Responsibilities of Participating Consortium Organizations.”

Award Information

Funding Mechanism: Cooperative Agreement
Anticipated Total Available Funding: $500,000
Anticipated Number of Awards: 1
Anticipated Award Amount: $500,000
Length of Project Period: Up to 3 years

Proposed budgets cannot exceed $500,000 in total costs (direct and indirect) in any year of the proposed project.  Annual continuation awards will depend on the availability of funds, grantee progress in meeting project goals and objectives, timely submission of required data and reports, and compliance with all terms and conditions of award.

Available funding for this program is subject to the enactment of a final budget for FY 2011 or an annualized Continuing Resolution (CR) for FY 2011.  Funding estimates for this announcement are based on potential funding scenarios that reflect an annualized CR at the FY 2010 funding level but do not reflect final conference action on the 2011 budget.  Applicants should be aware that SAMHSA cannot guarantee that sufficient funds will be appropriated to fully fund this program.

Contact Information

For questions about program issues contact:

Anthony Campbell, RPH, D.O.
Project Officer
Division of Pharmacologic Therapies         
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Room 2 -1067
Rockville, Maryland 20857
(240) 276-2702
anthony.campbell@samhsa.hhs.gov      

For questions on grants management and budget issues contact:

Love Foster-Horton
Office of Financial Resources, Division of Grants Management      
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Room 7-1095
Rockville, Maryland 20857
(240) 276-1653
love.foster-horton@samhsa.hhs.gov

Documents Needed to Complete a Grant Application

1. REQUEST FOR APPLICATIONS (RFA)

YOU MUST RESPOND TO THE REQUIREMENTS IN THE RFA IN PREPARING YOUR APPLICATION.


2. GRANT Application Package

YOU MUST USE THE FORMS IN THE APPLICATION PACKAGE TO COMPLETE YOUR APPLICATION.

Additional Materials

For further information on the forms and the application process, see Useful Information for Applicants

Additional materials available on this website include:

Last updated: 3/4/2011