Sunday, June 13, 2021 | 2 a.m.
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America is in the middle of an opiate epidemic. We know this; data is readily available, including years of headlines, overdose numbers at all-time highs and rising, deaths rising, and substance use disorders rising.
It seems that while lawmakers encourage the “breaking of stigma” and “increasing awareness,” they have forgotten that it takes action and, most important, treatment — which needs funding and accessibility by all — to make an impact.
One of the main issues we see, and a topic I have discussed directly with Sen. Catherine Cortez Masto, D-Nev., is regarding Medicare and Medicaid. Neither of these programs recognizes or provides coverage for beneficiaries who have substance use disorders when delivered by an alcohol and drug treatment professional in our state, known as a Licensed Alcohol and Drug Counselor (LADC).
To be able to combat substance abuse and overdose deaths, we need to dramatically expand the provider base allowed by Medicare and Medicaid. Otherwise, the efforts resulting from the best of intentions will die on the vine. Additionally, mental health workers are being overworked with the addition of all sorts of pandemic-related health issues, not just addiction. Adding LADCs to coverage of treatment would help alleviate the burden placed on these professionals.
Medicaid covers clinical professional counselors, marriage and family therapists, nurse practitioners, physicians assistants, licensed clinical social workers (LCSWs), psychiatrists and psychologists. Medicare also covers nurse practitioners, physicians assistants, LCSWs and psychiatrists.
Not having coverage for LADCs, though, is a serious problem, but one that can be remedied.
The American Society of Addiction Medicine determined that residential treatment is the effective level of care to treat substance use disorders. Medicare and Medicaid do not cover care at the residential treatment center level even though it is the best medical treatment for people who are not safe to be left alone. It is a critical level of care for people with acute substance use disorders.
People with commercial insurance routinely get this coverage, but Americans with Medicare or Medicaid (disproportionately minorities) are left to suffer. It’s time to stop continuing the stigma and allowing these state and federal payer systems to shirk the responsibility of this medically necessary treatment.
This issue is not only one of coverage approval and professional reimbursement, but also of level-of-care exclusions. Medicaid and Medicare do not cover detoxification, and they severely limit partial hospitalization programs. These are key requirements for the correct treatment of substance use disorders. We know that good treatment can stop substance use and overdose rates. In fact, that’s the only thing that we know works. We also know that the longer the treatment provided, the higher efficacy rates for long-term recovery. So why block access to treatment that gives people the best chance at surviving their addiction?
The COVID-19 pandemic has been shown to increase the prevalence of substance use disorders dramatically. The stigma of addiction and mental health is one of the significant barriers to treatment, and our government’s failure to recognize licensed treatment professionals and levels of care adds to the stigma.
Unsurprisingly, there is a third arch to this issue. On top of all the above items, people of color experience longer wait times to receive treatment and shorter duration of treatment. This is something elected officials need to address, because while people can push for this themselves, we know that profit-driven insurance and providers won’t make the necessary changes unless they are forced to.
Numbers have been rising since before 2020, and these issues existed before COVID-19. Yet this pandemic has caused the addiction epidemic to become far more acute. We should be rushing to address the challenges faced for many years to provide our people with proper treatment for decent lengths of time.
Americans continue to need rescuing from this horrible disease. Part of President Joe Biden’s American Rescue Plan could be utilized to address this.
Dave Marlon is the CEO of CrossRoads of Southern Nevada, Nevada’s largest drug and alcohol addiction rehab center, as well as founder of Vegas Stronger, a nonprofit aimed at defeating addiction in Nevada.
