President Obama remains more determined than ever to make headway in the fight against opiate dependence and addiction that affects so many people in this country. He addressed current treatment options in a panel discussion that took place in Charleston, West Virginia, where statistics on opiate dependence are higher than anywhere else in the country.
The long-ago stereotype of an opiate addict does not fit today’s addict, he said. If you think of a heroin addict as a junkie bum, clammy-skinned, gaunt, and shifty-eyed, wreaking out a bare existence on the edge of homelessness, you are so wrong. Obama describes today’s addicted persons as victims, and they are the people who rub elbows with us during our everyday lives: They are our parents, our children, our brothers and sisters, and our coworkers and friends. They come from all socioeconomic backgrounds, races, ethnicities, and political persuasions. Opiate dependence is an equal-opportunity destroyer.
The president recognizes that an important barrier to getting the treatment needed is the stigma and shame that overwhelm people who realize that their misuse of pain pills has led to a dependence. People within communities, from radio talk shows to arguments at community events, debate angrily with one another whether a person suffering from opiate dependence should be given the option to receive treatment or should simply be put in jail. Is an opiate-dependent person an immoral, selfish criminal, or the victim of a medical disorder? The truth—that addiction is a medical diagnosis—needs to get out.
The Left and the Right: Ideas to Combat Opiate Dependence
Obama’s proposed increase in treatment funding to the tune of $133 million during Fiscal Year 2016 will do much to expand therapeutic options. While it remains a proposal at this point, the good news is that the proposal will most likely be approved by Congress, because candidates for the presidency in 2016 on both sides of the political aisle are supporting increased treatment for opiate dependence.
Both the president and Democratic candidate Hillary Clinton have proposed increased funding to train doctors in alternatives to opiates for treating pain management. Clinton wants to earmark $10 billion to establish a partnership between the federal government and the states. Her five-pronged plan supports prevention education for our nation’s teens and young adults; ensuring that those who become addicted have access to treatment; expanding the availability of naloxone to reverse opioid overdoses; requiring the afore-mentioned physicians to participate in training if they are going to prescribe opiates; and reforming the criminal justice system so that rehabilitation rather than incarceration becomes the priority. The states that integrate specific plans to fight opiate dependence will receive four dollars of federal funding for every one dollar that they spend.
Republican candidates Jeb Bush and Carly Fiorina have both gone public with stories of addiction affecting members of their own families. Bush’s daughter Noelle developed an opiate dependence a decade ago that was front and center in the news, and Fiorina lost her 34-year-old stepdaughter Lori to a fatal overdose.
Reluctant Insurance Companies
The Affordable Care Act promised wider access to substance abuse treatment, but the insurance companies have squirmed from Day One against covering the costs of such care. Just about all insurance companies state that substance abuse treatment is a covered benefit these days, but just try to hold them to it. Rather than pay out money for actual care they set standards that are impossible to meet, especially for the patient who is too overwhelmed by the symptoms of opiate dependence to challenge his health care insurance provider.
One health insurance provider publishes on its website that substance abuse treatment is a covered benefit, and then told this writer that it is only covered if the person opts for treatment in an outpatient program that is run by an inpatient facility and also meets specific demands set by an obscure accrediting agency other than CARF or JCAHO.
Insurances typically avoid paying for residential treatment by first stating that it is a covered benefit as long as it is preauthorized and then, through the preauthorization process, recommending outpatient treatment. The decision can be appealed if the residential program provides the treatment and then at the time of discharge sends in the patient’s chart. That leaves the residential program in the position of providing 90 days of care for which it will subsequently be refused payment.
Gradually, however, some insurance companies are coming around and paying increasing amounts of money for substance abuse treatment. For the person who seeks treatment for opiate dependence using methadone or buprenorphine, many insurances will not pay for the actual medication, but they will pay for the outpatient counseling that is such an important part of a person’s treatment plan.
Dr. Howard Koh, writing for the Journal of the American Medical Association (JAMA) in September 2015, summarized current community efforts to fight opiate dependence:
- Doctors and other prescribers may not yet be required to participate in training in order to retain their prescribing privileges, but professional specialty societies are giving them the message loud and clear in policy statements issued to their members. When opiates must be prescribed, low doses over a short term are recommended.
- Communities are encouraged to integrate medication disposal days. Most often carried out by local hospitals or health departments or even municipal fire departments, people can take unused drugs of all types from their medicine cabinets to central locations for disposal. That decreases the quantities of opiate pain pills available for the taking by someone who wants to self-treat a back-ache, for example.
- Prescription drug monitoring programs have been instituted in all states except Missouri and in the District of Columbia. Doctors can check on their patients seeking opiate dependence to ensure, if they are enrolled in therapy using methadone or buprenorphine, that they are not also filling prescriptions for other opiates or benzodiazepines. In fact, getting back to the insurance companies, they are spot-checking their clients’ prescription records to ensure that those seeking benefits for opiate dependence are not also filling such prescriptions.
- Naloxone availability, as mentioned above, is fast becoming a reality instead of a hope. Just a few short years ago we heard stories about mothers who bought it on the black market in order to protect their grown children who were addicted to opiates. Today, naloxone distribution programs are expanding in many states. Naloxone kits are free to the people who cannot stop using and also to their family members.
With so many prominent people sharing their stories of addiction within their own families, the public has gained an awareness that persons affected by addiction are all around us, the people we know and love. Increasing numbers of obituaries for those who have lost the battle are citing opiate or heroin addiction as the cause of death just to bring attention to our need to keep battling it.
Experts recognize that access to treatment requires a three-pronged approach that is best provided by community opioid treatment programs (OTPs). Michael Botticelli, the head of the White House Office of National Drug Policy, admits that he is a recovering alcoholic and he understands that methadone or buprenorphine treatment alone is not enough to treat opiate dependence. It takes a continuum of care that integrates medication management with counseling and behavioral therapy. People cannot achieve recovery if they do not understand addiction. Case management that offers help with social, financial, legal, vocational, and other issues is required by the Commission on Accreditation of Rehabilitation Facilities (CARF), the leading organization that accredits opiate treatment programs. Education for families is also a priority to understand opiate dependence and help their loved ones in recovery.
If you’re ready for substance abuse treatment for opiate dependence, pick up the phone and call your local OTP. Make sure to choose a place that employs licensed, certified counselors and offers accreditation by CARF. Recovery is not easy, but it is possible. By exploring your options and being a partner in your treatment, your chances of success will skyrocket.