The opioid situation in the U.S. gets lots of ink in the popular press because its impact is now extended beyond health policy and into the day-to-day lives of Americans. Opioid-related deaths are up — a county-by-county study of deaths in the U.S. revealed a 200% or more increase in deaths related to substance abuse and mental health in 2,000-plus counties across the United States — and that includes the Appalachian regions of Ohio, Kentucky, and West Virginia, where fatalities went up by more than 1,000% between 1980 and 2014 (see Many U.S. Counties See Substance Abuse, Mental Health Death Rates Spike).
Almost every area of the country has the same story. The State of Massachusetts reports that in 2015, 1,574 state residents died of an unintentional opioid-related overdose, 20% more than the 1,316 confirmed opioid-related overdose deaths during 2014, and 71% more than the 918 opioid overdose deaths in 2013 (see Massachusetts Opioid-Related Deaths Up 20% In 2015 and Opioid Deaths In Massachusetts Skyrocket By 70 Percent In Two Years).
The impact, in addition to the increased death rates, have been substantial. At the national level there was a 64.1% cumulative increase in the rate of opioid-related inpatient stays between 2005 and 2014, from 136.8 per 100,000 in 2005 to 224.6 per 100,000 in 2014 (see Opioid-Related Hospitalizations Up 64% Nationwide From 2005 To 2014). This included a 99.4% cumulative increase in the rate of emergency department (ED) visits from 89.1 per 100,000 people in 2005 to 177.7 per 100,000 people in 2014. And at the local level we’ve seen many states report huge surges in utilization of addiction treatment services. For example, in Kentucky, the number of addiction treatment services for the Medicaid expansion population increased by 740% between January 2014 and mid-2016 (see Kentucky Addiction Treatment Services For Medicaid Expansion Up 740% From 2014 To Mid-2016). In addition, between 1997 and 2012, the number of children and adolescents in the United States who were hospitalized for opioid poisoning rose by 165% (see Youth Hospitalizations For Opioid Poisoning Rose 165% From 1997-2012).
Beyond health care, there is the additional costs to the child welfare system and the corrections system. In child welfare, the proportion of U.S. children entering foster care due to parental alcohol or drug use increased by about 19% between 2009 and 2015. In 2009, parental substance use was a factor in foster care entry for 29.4% of the 255,418 children who entered care that year (see Foster Care Entries Due To Parental Substance Abuse Rise 19% Since 2009). And In 2013, the Criminal justice costs of dependence and fatal overdose due to prescription opioids was estimated at $7.6 billion, including costs for police protection, adjudication, correctional facilities, and property loss due to crime committed by people with prescription opioid dependence.
The responses have been many. At the national level, we’ve had the recent passage of federal legislation – the Comprehensive Addiction Recovery Act (see Congress Approves ‘Comprehensive Addiction & Recovery Act’) and the 21st Century Cures Act (Congress Passes 21st Century Cures Act, With Major Provisions For Mental Health Reform & Addiction Treatment Funding).
At the state level, there are actions to change the Medicaid program and also to develop broader strategies. In December 2016, the West Virginia Bureau for Medicaid Services (BMS) submitted a section 1115 demonstration application to create a continuum of addiction treatment services that includes residential treatment, supportive housing arrangements, and peer services (see West Virginia Medicaid Submits 1115 Waiver To Expand Addiction Treatment Options). On the other side of the country, in October 2016, San Mateo County, California, became the first county to receive approval from the California Department of Health Care Services and the Centers for Medicare & Medicaid Services (CMS) to provide addiction treatment services in the Medicaid program as part of the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver implementation (see San Mateo First California County Approved To Deliver Medicaid Addiction Treatment As Part Of Organized Delivery System).
Beyond state Medicaid programs, governors are developing broader plans to combat opioid addiction. In December 2016 Virginia Governor Terry McAuliffe announced plans for amendments for the fiscal year 2016-2018 budget that include $37 million to strengthen the state’s behavioral health system (see Virginia Governor McAuliffe Proposes $37 Million Behavioral Health Overhaul). Specific to opioid treatment, the legislation includes: limit opioid prescriptions written in emergency departments to three days; mandate e-prescribing for all opioids; fund $5 million to provide MAT and supports to more than 700 people with opioid use disorder; and provide 78,000 to fund a position in DBHDS to oversee the opioid addiction treatment programs funded in this budget. And on January 24 in Maryland, Governor Larry Hogan announced the state’s new anti-heroin proposal, which includes limits on the practice of writing prescriptions for opioids (see Hogan Proposes Limits On Opioid Prescriptions To Tackle Heroin Crisis).
Unfortunately, I don’t think we have seen the high-water mark of the damage done by the opioid crisis. But, in any crisis is the opportunity for provider organizations to develop new “solutions” for consumers, for their families, for government, and for health plans.
Look for our continuing coverage of changes in the addiction treatment landscape and how new policy and financing models are reshaping your need to prepare – The Addiction Treatment Market: $36 Billion In Spending In 2015. And be sure to join me on June 6, 2017 at The OPEN MINDS Strategy & Innovation Institute for the session, “The Shift From Residential: Keeping Up With The Changing Addiction Treatment Landscape.” For more, follow our coverage on Twitter @openmindseditor.