Sunday, January 25, 2015
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Nancy Parker, Director at the Tewksbury
Treatment Center,
and State Rep. Tom Golden at the center. |
A Maze With No Way Out
Legislators look for solutions; treatment professionals look for commitment
By Todd Feathers
LOWELL — There is no silver bullet for the opiate epidemic, on that all experts and legislators agree.
During the past year the Legislature has passed one major law expanding care, and a new roster of elected officials — including Gov. Charlie Baker — promised to make opiates a top priority. And while treatment professionals are optimistic that the new attention will bring about positive changes, the problem is daunting and comes at a time when the state is facing a budget deficit in the hundreds of millions.
Addiction treatment is not cheap, and the kinds of changes experts say are necessary — in particular more treatment beds and a better culture of care — will take time to put in place. Addicts must often wait months to find an open bed in residential treatment programs and fight insurance companies to get coverage for the care.
“This is a tremendous public- health crisis that is devastating families and communities across the state,” Attorney General Maura Healey said.
“We’ve heard the governor talk about this, we’ve had a lot of elected officials talk about this, so I think there’s a real commitment,” she added.
Legislation passed in July was the first step in a renewed push against the epidemic. The law requires insurers to cover up to 14 days in a residential facility and earmarked $20 million for expanded detox care.
Legislators look for solutions; treatment professionals look for commitment
By Todd Feathers
LOWELL — There is no silver bullet for the opiate epidemic, on that all experts and legislators agree.
During the past year the Legislature has passed one major law expanding care, and a new roster of elected officials — including Gov. Charlie Baker — promised to make opiates a top priority. And while treatment professionals are optimistic that the new attention will bring about positive changes, the problem is daunting and comes at a time when the state is facing a budget deficit in the hundreds of millions.
Addiction treatment is not cheap, and the kinds of changes experts say are necessary — in particular more treatment beds and a better culture of care — will take time to put in place. Addicts must often wait months to find an open bed in residential treatment programs and fight insurance companies to get coverage for the care.
“This is a tremendous public- health crisis that is devastating families and communities across the state,” Attorney General Maura Healey said.
“We’ve heard the governor talk about this, we’ve had a lot of elected officials talk about this, so I think there’s a real commitment,” she added.
Legislation passed in July was the first step in a renewed push against the epidemic. The law requires insurers to cover up to 14 days in a residential facility and earmarked $20 million for expanded detox care.
But treatment professionals, like Bill Garr, CEO of Lowell
House, Inc., said the state’s addiction programs cannot rely on sporadic
earmarks from lawmakers. The real need, Garr said, is for a permanent and
substantial increase in the statutory reimbursement rates for the facilities.
During his campaign, Baker promised to implement rate increases for addiction programs, which the state has long delayed. But he also comes into office with a $765 million budget shortfall.
The heads of several national addiction treatment associations said Massachusetts has been ahead of the curve in some key areas, particularly in distributing the antioverdose drug naloxone, also known as Narcan, and the proliferation of methadone clinics.
But they pointed to several models from other states that could expand care without spending millions on state funded programs.
Florida, in particular, is a destination for opiate addicts, in part because the Sunshine State has a booming private addiction treatment industry.
Florida has licensed 144 private residential facilities in, compared to 20 in Massachusetts. The facilities can be expensive — around $20,000 per month — but they have open beds for those who can pay.
“If you’re got insurance you can get in,” said Mark Fontaine, director of the Florida Alcohol and Drug Abuse Association. “There’s a plethora of treatment facilities in (the Broward and Palm Beach counties) corridor.”
Florida’s state-funded outpatient counseling services have also developed symbiotic relationships with halfway houses that effectively render them residential treatment facilities, even though they are not licensed as such. Patients sleep in the sober homes, but spend their days in counseling programs.
Like those in Massachusetts, sober homes and halfway houses in Florida are not regulated, leading to questions of quality and efficacy.
But the Florida Legislature seems poised to pass a bill, Fontaine said, that would create a voluntary certification program for the homes and require outpatient counselors to partner only with the homes that receive certification.
Another common complaint from families of addicts is the lack of continuity in care. Some facilities offer case management services to help place patients in the next level of care, but the waiting periods and lack of a central information system make it hard for families and addicts to move smoothly from step to step.
In 2012, Vermont began a “hub-and-spoke” system. Patients go to a regional treatment center where they are assessed and in some cases receive medication-assisted treatment.
Clinicians and case managers at the hub then determine what other care the patient requires — residential, mental health, etc. — and coordinate future treatment.
“The hub-and-spoke model from Vermont was unique and innovative and we have tried to explain it to other states so that they can use it,” said Rick Harwood, director of research and programming application at the National Association of State Alcohol and Drug Abuse Directors.
The Department of Vermont Health Access estimated that the system will save the state $6.7 million this year, according to media reports. Skeptics point out no studies have been publicized showing “hub-and-spoke” works.
There is evidence of a similar push for centralized care in Massachusetts, but the state agency responsible for addiction treatment has not announced detailed plans.
The Bureau of Substance Abuse Services has allocated money for a central navigation system for patients and a pilot for regional addiction assessment centers all of which would in theory lead to a simpler and superior continuum of care.
BSAS did not respond to repeated requests for interviews during the final month of Gov. Deval Patrick’s administration. Several days into Baker’s administration a spokesman said the agency would reserve comment on its opiate programs until the new administration had more time to examine the problem.
But documents from the agency show that plans are also in the works to add about 150 more residential beds in the state, expanded hours at recovery support centers, and a new high school in Worcester dedicated to educating and rehabilitating addicts.
State Rep. Tom Golden, who represents Lowell and Chelmsford, filed legislation this month that would require insurers to cover substance abuse problems the same way they cover physical illness and pay for up to 30 days in a residential treatment program.
“I think in this area we’ve done well, but this is something where doing well isn’t good enough,” he said.
During his campaign, Baker promised to implement rate increases for addiction programs, which the state has long delayed. But he also comes into office with a $765 million budget shortfall.
The heads of several national addiction treatment associations said Massachusetts has been ahead of the curve in some key areas, particularly in distributing the antioverdose drug naloxone, also known as Narcan, and the proliferation of methadone clinics.
But they pointed to several models from other states that could expand care without spending millions on state funded programs.
Florida, in particular, is a destination for opiate addicts, in part because the Sunshine State has a booming private addiction treatment industry.
Florida has licensed 144 private residential facilities in, compared to 20 in Massachusetts. The facilities can be expensive — around $20,000 per month — but they have open beds for those who can pay.
“If you’re got insurance you can get in,” said Mark Fontaine, director of the Florida Alcohol and Drug Abuse Association. “There’s a plethora of treatment facilities in (the Broward and Palm Beach counties) corridor.”
Florida’s state-funded outpatient counseling services have also developed symbiotic relationships with halfway houses that effectively render them residential treatment facilities, even though they are not licensed as such. Patients sleep in the sober homes, but spend their days in counseling programs.
Like those in Massachusetts, sober homes and halfway houses in Florida are not regulated, leading to questions of quality and efficacy.
But the Florida Legislature seems poised to pass a bill, Fontaine said, that would create a voluntary certification program for the homes and require outpatient counselors to partner only with the homes that receive certification.
Another common complaint from families of addicts is the lack of continuity in care. Some facilities offer case management services to help place patients in the next level of care, but the waiting periods and lack of a central information system make it hard for families and addicts to move smoothly from step to step.
In 2012, Vermont began a “hub-and-spoke” system. Patients go to a regional treatment center where they are assessed and in some cases receive medication-assisted treatment.
Clinicians and case managers at the hub then determine what other care the patient requires — residential, mental health, etc. — and coordinate future treatment.
“The hub-and-spoke model from Vermont was unique and innovative and we have tried to explain it to other states so that they can use it,” said Rick Harwood, director of research and programming application at the National Association of State Alcohol and Drug Abuse Directors.
The Department of Vermont Health Access estimated that the system will save the state $6.7 million this year, according to media reports. Skeptics point out no studies have been publicized showing “hub-and-spoke” works.
There is evidence of a similar push for centralized care in Massachusetts, but the state agency responsible for addiction treatment has not announced detailed plans.
The Bureau of Substance Abuse Services has allocated money for a central navigation system for patients and a pilot for regional addiction assessment centers all of which would in theory lead to a simpler and superior continuum of care.
BSAS did not respond to repeated requests for interviews during the final month of Gov. Deval Patrick’s administration. Several days into Baker’s administration a spokesman said the agency would reserve comment on its opiate programs until the new administration had more time to examine the problem.
But documents from the agency show that plans are also in the works to add about 150 more residential beds in the state, expanded hours at recovery support centers, and a new high school in Worcester dedicated to educating and rehabilitating addicts.
State Rep. Tom Golden, who represents Lowell and Chelmsford, filed legislation this month that would require insurers to cover substance abuse problems the same way they cover physical illness and pay for up to 30 days in a residential treatment program.
“I think in this area we’ve done well, but this is something where doing well isn’t good enough,” he said.
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