An overlooked solution to the opioid epidemic

President Trump’s declaration of a public health emergency in the face of the opioid epidemic gripping the nation was a call to arms, but without the arms. Similar sentiments followed the release of the President’s Commission on Combating Drug Addiction and the Opioid Crisis final report.

The U.S. suffers the equivalent of a plane crash of overdose fatalities every day. In 2016 alone, a staggering 59,000 lives were lost. Put in context, we lost about that many soldiers in the entire Vietnam War. Meanwhile, only 10 percent of people with a substance use disorder get treatment for it in any given year.

{mosads}This gap in unmet need is unacceptable. The government must to do more. But neither the president nor his commission, chaired by Gov. Chris Christie (R-N.J.), called for the additional funding desperately needed to combat the epidemic.

As politicians, the medical community and the public argue over how to solve the opioid epidemic, one thing is clear: Tinkering around with the same old approaches won’t produce the change we need. If we want to see a dramatic reduction in opioid deaths, we must dramatically expand treatment, prevention and recovery resources in our communities. A brand new, but often overlooked, program that does just that is already in progress: the Excellence in Mental Health and Addiction Act demonstration, which took effect in eight states this year.

The law created certified community behavioral health clinics (CCBHCs), which provide a comprehensive array of addiction services integrated with mental health care, including 24/7 crisis care and partnerships with local hospitals and law enforcement for first response and care coordination. The law makes all this possible by establishing, for the first time, a sound fiscal footing for these clinics, building the national infrastructure needed — location by location.

Only six months into the demonstration, CCBHCs have made huge strides in addressing the opioid epidemic in their communities. Their dedicated payment model has enabled 47 clinics to hire more than 210 new addiction specialists — clinicians who are serving patients who previously went without care.

Three-quarters have used their funding to implement or expand medication-assisted treatment (MAT), an evidence-based practice shown to advance recovery for opioid use disorders. More than 60 percent have started training staff or community partners in the administration of naloxone, the overdose reversal drug.

And most have expanded their partnerships with hospitals and local law enforcement. As one clinic said, because of their CCBHC status and funding, they are now “working with local police, providing case management and working with local emergency departments to engage people who have been ‘reversed’ with [naloxone] into treatment.”

Congress made a bold statement when they created CCBHCs: We are no longer content with the old way of doing business — the way that has failed to adequately fund services for decades, contributing to today’s epidemic. The demonstration was specifically designed to address financing shortfalls by paying clinics a Medicaid rate that covers the costs of expanding their service lines and serving new consumers. Implementing a prospective payment system, successfully used by other safety-net providers for decades to expand access to services, CCBHCs are expanding access to addiction care through an increased service delivery, an enhanced workforce and enhanced patient outreach, education and engagement — all while meeting defined quality standards and reporting requirements.

CCBHCs work. But their reach is currently far too limited. To realize their full potential, the demonstration program must expand. The current program is limited to just two years across eight states; meanwhile, 11 additional states that applied to participate have been left without access to the benefits CCBHCs bring to their communities.

With CCBHCs, help is on the way in eight states. Eighty-seven percent of CCBHCs are seeing increased patient caseloads — and that means more people in our communities getting access to desperately needed services. As one clinic described the impact of the changes, they have “enabled people to get services for the first time. … We hear stories of people in tears when they realize they can get help.”

We urge Congress to expand the demonstration project into a nationwide effort to provide addiction and mental health services for a much broader swath of the population. The Senate and House should adopt legislation introduced by Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) and Reps. Leonard Lance (R-N.J.) and Doris Matsui (D-Calif.). It would ensure the eight states would be funded for another year and expand the program to 11 more states that already applied to participate in the program.

Too many lives have already been lost. Now is the time to end the epidemic. We remain committed to working with the administration and Congress to fight the opioid epidemic and are ready to start with what we know will work. 

Ingoglia is senior vice president of public policy and practice improvement at the National Council for Behavioral Health.