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By Alex Ruoff
Nearly 12 million Americans misused an opioid last year, underscoring the size of the epidemic that killed 64,000 people in 2016, according to a government survey.
The findings show the government should do more to ensure people who need treatment for addiction can find it, addiction specialists told Bloomberg BNA. While the federal government has spent billions of dollars trying to stop overdose deaths, the response remains inadequate to curb the problem of addiction.
“There’s still a massive gap in the need for services,” Rebecca Farley, vice president of policy and advocacy for the National Council for Behavioral Health, told Bloomberg BNA Sept. 11. “We’re talking about a range of services people need that’s not available.”
Less than a quarter of Americans addicted to an opioid received treatment, the survey found. An even smaller percentage of prescription drug abusers, 17.5 percent, received treatment for addiction.
The vast majority of people who misused opioids—meaning they took drugs without a prescription or doctor’s orders—took pain relievers like Vicodin or OxyContin rather than heroin, according to the survey.
The problem of access to treatment goes beyond having enough drug rehab or other inpatient facilities, Farley said. Many private insurers don’t cover a variety of drug addiction treatments or include many addiction specialists in their networks, behavioral health groups said.
The survey was released Sept. 7 by the Substance Abuse and Mental Health Services Administration, an agency within the Department of Health and Human Services. Following the release, health officials promised to promote treatment programs nationwide in the hope of curbing the rise in opioid use. They also lauded efforts to discourage the prescribing of opioids.
“We need to do everything possible to assure that those in need of treatment and recovery services can access them and we look forward to continuing work with federal and state partners on this goal,” Elinore McCance-Katz, assistant secretary for mental health and substance use for the HHS, said in a statement.
The HHS wants to ensure people can get both inpatient addiction treatment like rehab centers and ongoing services like drug counseling and community-based services, she said.
However, the Medicaid and private insurance reimbursement rate for addiction specialists and their services remains relatively low, meaning there’s little incentive for health-care providers to offer specialized drug treatment, Tom Britton, CEO of the nonprofit Gateway Foundation, which runs treatment facilities in Illinois, told Bloomberg BNA.
“The margins aren’t there for many to invest in science-based treatments,” he said. “They can’t afford to offer effective treatments, so they offer what they can.”
This means rural areas that already don’t have many doctors are unlikely to have addiction specialists or treatment facilities, Britton said. Most of these areas rely on safety-net hospitals to fill this gap, he said.
Private insurers often require beneficiaries to first seek cheaper, often less-effective, treatments like counseling or therapy before they’re authorized for other treatments, like medication, Britton said.
Some insurers also have prior authorization requirements—where doctors must obtain approval from the insurer to prescribe a certain medication—for drugs like buprenorphine but not for drugs considered to pose similar safety risks or have similar risk for misuse, according to a White House report. Buprenorphine is a drug meant to aid opioid addicts.
Some have called for improving enforcement of health insurance parity laws, which require health insurance companies to cover mental health and substance abuse services with the same lifetime limits, treatment limitations, financial requirements (including copays) and covered benefits as medical and surgical services. Advocates for parity laws include the National Council for Behavioral Health and Rep. Joe Kennedy III (D-Mass.).
President Donald Trump in August announced he would declare the opioid epidemic a national emergency, a procedure that would make it easier for the federal government to gather resources and funds to respond to the issue.
However, the emergency hasn’t yet been officially declared because White House and HHS attorneys are still reviewing the issue, a White House spokesman told Bloomberg BNA Aug. 30. At question is what resources can be marshaled for this effort.
Congress is debating how much money should go toward fighting opioid abuse in 2018.
Lawmakers in December will authorize the second half of the $970 million in state grants for drug treatment programs approved in late 2016 under the 21st Century Cures Act. This money was included in both the House and Senate 2018 federal spending bills for the HHS.
Senate Republicans and Democrats agreed to increase federal spending on opioid programs by $665 million in 2018, which combined with the Cures funding means the federal government will spend more than $1 billion next year to support treatment programs for opioid addiction. House Republicans agreed to a similar increase for treatment programs.
Democrats want to authorize another $1 billion for opioid addiction programs in 2018, Sen. Patty Murray (D-Wash.) said during a Sept. 7 hearing of the Senate Appropriations Committee. Republican leaders said the money wasn’t included in the budget because it would require cuts to other parts of the Labor-HHS spending bill.
“We had to stay within our spending guidelines,” Sen. Roy Blunt (R-Mo.), chairman of the Senate Labor-HHS appropriations subcommittee, said.
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