Substance Abuse Laws, Acts, and Legislation in the United States

Substance Abuse Insurance Laws

Insurance regulations treat mental health and substance abuse services as essential health benefits.

• Affordable Care Act (ACA): The ACA, also referred to as Obamacare, made affordable health insurance available to people through tax credits that lower the cost of premiums for people within 100%–400% of the federal poverty level.¹ The ACA also expanded Medicaid benefits to millions of Americans in many states who didn’t previously qualify for coverage.¹ Thus, more people have the means to fund substance abuse treatment since insurance typically covers at least part of the cost of rehab.
• The Mental Health Parity and Addiction Equity Act (MHPAEA): Established in 2008, the MHPAEA, a federal law, prevents group health insurance plans that provide mental health and substance use disorder coverage from creating benefit limitations for those seeking treatment for these conditions. Instead, coverage must be on par with other medical and surgical procedures, such as annual or lifetime dollar limits and number of days covered for inpatient rehab.² The MHPAEA was amended in 2010, to include individual health insurance as well.²

Substance Abuse Immunity Laws

Some laws protect individuals from arrest, charge, or persecution for drug- or alcohol-related offenses in an emergency.

• Good Samaritan Laws: Good Samaritan laws were enacted to reduce drug use and overdose by expanding access to addiction treatment, modifying penalties to those seeking help, and expanding access to naloxone, an FDA-approved “rescue drug” that reverses the effects of an opioid overdose.³ Often, family and friends are in the best position to assist someone who is overdosing, and legislation enacted now allows nonmedical professionals to administer naloxone without a prescription.³ Good Samaritan or 911 immunity laws are now in place in 40 states, plus the District of Columbia. Good Samaritan laws generally provide immunity from arrest when a person, who is experiencing an opioid overdose or witnessing one, calls 911 for medical assistance.³
• Medical Amnesty Policies (MAPs): Medical amnesty policies at colleges and universities are designed to encourage students to seek medical attention for themselves or friends in alcohol-related emergencies.⁴ These policies provide students with the promise of reducing or pardoning any resulting disciplinary action. Studies indicate that schools where medical amnesty policies exist in conjunction with alcohol education strategies (to teach about the warning signs of life-threatening alcohol poisoning) emergency services are called more often.⁴
• Veterans Services: Existing laws provide benefits for military veterans through Veterans Affairs (VA). The VA offers treatment options for people with substance use disorders, as well as medication-assisted treatment options for alcohol and opioid addictions to help manage cravings and prevent relapse.⁵ Some veterans may be eligible for disability benefits through the VA as well. While the VA does not recognize SUDs as a disability, they recognize that substance misuse may stem from another service-related physical or mental health condition, like post-traumatic stress disorder (PTSD) and offer disability benefits to eligible individuals.^6,7

Substance Abuse Workplace and Confidentiality Laws

There are several federal laws and regulations that protect employees with substance use disorders.

• Workplace ADA and FMLA: The Family Medical Leave Act (FMLA) allows eligible employees to take 12 weeks of unpaid, job-protected leave (in a 12-month period) for family and medical reasons, including rehab for a substance use disorder, while maintaining group health insurance coverage.⁸ Additionally, the Americans with Disabilities Act (ADA) protects individuals in recovery and those who have sought treatment for addiction from discrimination.⁹ The ADA protects individuals by prohibiting employers from participating in discriminating behaviors, including refusing to hire or promote an individual because they attended rehab or have sought help for a SUD or AUD in the past, firing an individual for going to addiction treatment, or firing or refusing to hire or promote an individual with a history of addiction or substance misuse.⁹
• Confidentiality and HIPAA Laws: The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that created national standards to protect sensitive patient health information from being disclosed without the patient’s consent. It also protects any identifiable personal or health information from being shared without a person’s consent.¹⁰ Additionally, Title 42 of the Code of Federal Regulations (CFR), Part 2, prohibits disclosing any information that identifies an individual as having a substance use disorder unless the patient provides written consent.¹¹

Federal Drug Regulations and Statutes

Controlled substance laws and regulations aim to reduce the availability of illicit controlled substances in the United States.

• Controlled Substances Act: The Controlled Substances ACT (CSA) categorizes all substances that were regulated under existing federal law into 1 of 5 schedules. A drug’s placement is based on several factors, including the substance’s medical use, potential for abuse, and safety or dependence liability.¹² Schedule I drugs, for instance, have high rates of abuse and the ability to create severe psychological or physical dependence and include substances such as heroin, marijuana, and ecstasy. As the drug schedule changes, so too does the potential for abuse. Schedule V drugs, on the other hand, represent the least potential for abuse and include substances like cough syrup with small amounts of codeine.¹³ The CSA also allows for substances to be transferred between schedules or removed from them altogether, based, in part, on a drug’s history and current pattern of use and its public health implications.¹²
• Possession Laws: Federal drug statutes outline mandatory drug sentences for the distribution, manufacturing, and possession with the intent to distribute for a variety of substances.¹⁴ For example, there is a 5-year mandatory minimum and a 40-year maximum sentence for possessing (with the intent to distribute) 5 grams of meth, 100 grams of heroin, or 500 grams of cocaine.¹⁴ The mandatory sentences increase with larger quantities of illicit substances. Penalties may be increased if the person has prior drug charges or is a repeat offender.¹⁴
• Trafficking and Distribution Laws: Drug trafficking refers to the illegal cultivation, manufacture, transportation, and sale of controlled substances.¹⁵ In 2018, heroin, meth, crack cocaine, powder cocaine, marijuana, fentanyl, and oxycodone accounted for more than 90% of all drug trafficking offenses.¹⁶ In that same year, over 95% of drug traffickers were sentenced to prison.¹⁶ Sentencing lengths vary depending on the substance and quantity, but the average amount of prison time is 76 months.¹⁶
• Manufacturing Laws: Except by registered companies, organizations, and entities, the manufacturing of controlled substances is prohibited. Under Chapter 21 of US Code Section 841 (21 USC 841), it is a crime to manufacture controlled substances knowingly or intentionally, or to create a counterfeit substance.¹⁷ Punishment for violating 21 USC 841 varies but typically carries a sentence of at least 10 years and hefty fines, too.¹⁷