Policy Platform / Questionnaire
Opioid Crisis Action Network Policy Platform
Over 72,000 Americans died of drug overdoses in 2017, up 7% from 2016 and double the total from a decade ago. The Opioid Crisis Action Network (OCAN) was founded in January, 2018, by Heather and Larry Arata after the overdose death of their 23-year-old son, Brendan, to research and lobby for solutions to this public health emergency.
The couple interviewed health care professionals who treat those suffering from substance use disorder and found a consensus that a continuum of long-term care and medication- assisted treatment regimens lead to a significant reduction in costly and often deadly relapses. Tragically, these best-practices are most often not covered by private health insurance companies, Medicaid or Medicare. This is in violation of a 2008 federal law, the Mental Health Parity and Addiction Equity Act, which mandated that insurers treat mental health conditions to the same extent they treat physical issues. No one in the medical community believes that a patient suffering from opioid substance use reaches recovery / remission after seven, fourteen, or even twenty-one days of treatment, but specialists at facilities must spend substantial time justifying the need for additional treatment through formalized, regular “seven-day review” sessions with insurers. Indeed, desperately needed treatment is often interrupted by insurance companies, Medicaid or Medicare after seven, fourteen or twenty-one days. Most who receive this brief level of care suffer costly or deadly relapses. This costly, stressful, unproductive, unnecessary and industry-wide practice, dictated by private health insurance companies and the government, must be eliminated. Instead, a continuum of long-term care of no less than thirty days of in-patient treatment, followed immediately no less than 30 days of intensive out-patient (IOP) treatment, followed immediately by placement and no less than 30 days of residence in a state-registered sober-living facility, must be covered by private health insurance companies, Medicaid and Medicare. This continuum of long-term care has been found to significantly reduce incidence of costly and deadly relapses. Treating those suffering from substance use disorder with best medical practices including a long-term continuum of care will save lives and money and must be covered by health insurance companies and our government.
Along with a continuum of long-term care, medication-assisted treatments also have been found to significantly reduce incidence of costly and deadly relapses. Again, these best practices are most-often not covered by private health insurance companies, Medicaid and Medicare. Vivitrol (naltrexone), a monthly injection that blocks neuro-receptors, as well as Suboxone and Subutex (buprenorphine), sub linguals achieve the same effect. Methadone treatments have proven to be the most successful prevention of relapse. Again, treating those suffering from substance use disorder with best medical practices including medication-assisted treatments will save lives and money and must be covered by health insurance companies and our government.
After undergoing treatment and remaining clean and sober for over 90 days, Brendan Arata suffered severe cravings to use heroin that drove him to report to the facility where he was first treated. The facility wanted to admit him but coverage was denied by his private health insurance company because he had no traces of drugs in his blood. The insurance company was willing to risk that Brendan suffer a deadly relapse before they granted him needed treatment. The insurance company insisted it was merely following ASAM (American Association of Addiction Medicine) protocol. This is a baffling common occurrence reported by many in recovery. When Larry Arata and two treatment specialists who volunteered to join him met with several high-level officials of Independence Blue Cross and Magellan in March, 2018, the specialists presented this oft-repeated scenario and explained that the insurance companies were turning the ASAM criteria on its head, misinterpreting and over-emphasizing the first layer, dictating that if a patient reports intoxicated to a treatment center, he or she must not be refused treatment. Instead, the specialists advised the insurance company officials that they should have agreed to admit Brendan (and others like him) for at least a few days of counseling and an injection of Vivitrol (naltrexone) or Suboxone (buprenorphine) to reduce his cravings. After a long silence, the officials from Magellan responded that they adhere to all ASAM protocols and PA Act 106 (1989) requirements. Federal and state laws must mandate that no patient suffering from effects of substance use disorder reporting to a treatment facility be refused coverage for treatment by private health insurance companies, Medicaid or Medicare, whether or not he or she is intoxicated or has trace amounts of illicit drugs in his or her blood.
Sober living homes are an important component of a best practices continuum of care for those recovering from substance use disorder. In fact, these facilities represent one of the fastest growing sectors of the economy. However, they are largely unregulated; state and federal standards for the training of staffs, and inspections monitoring their safety and management are lacking. As a result, while many sober living homes provide excellent care, some are predatory, stealing money from and even selling drugs to residents. US HR 4684, the Ensuring Access to Quality Sober Living Act, is a bill that passed the US House in May, 2018 and awaits Senate approval. At the state level, we are happy to report that PA Senate Bill 446 was signed into law by Governor Wolf. These bills, if properly implemented and enforced, would effectively provide the foundation for the regulation of sober living facilities. An important element of regulation not encompassed in these bills is the requirement for all facilities that treat the addicted, not just sober living homes, to maintain a database of outcomes including days sober per patient and the number of total relapses and relapses per patient and overdose deaths of patients. We must require these facilities to link with primary care doctors of their patients so that a continuum of care is encouraged and outcome data can be tracked. Families comparing heart surgeons can obtain similar relevant data about doctors and facilities and the link from surgeon to primary care doctor is a prescribed best practice. We must require that families evaluating treatment for a loved one suffering from substance abuse disorder have the ability to make informed decisions about their care and are provided with the same continuum of care. Federal, state and local governments must enact and enforce legislation that insures treatment facilities and sober living homes provide quality care to those recovering from substance use disorder. The mandated collection of patient outcome data and provision of links to primary care doctors of patients will enable government regulators at all levels to hold treatment providers accountable.
In PA, the cornerstone of the delivery of local mental health services for the past 21 years to 2.9 million Pennsylvanians enrolled in Medicaid is a highly successful program called Behavioral Health Choices (BHC). Each county can choose to manage its own program or work with other counties to form collaborative partnerships between county leaders, treatment and recovery professionals and individuals and families in need of help. Given this record of success, it is hard to imagine why anyone would want to dismantle BHC but that is exactly what some representatives in Harrisburg are attempting to do through ill-advised bills that would replace it with a sweeping one size fits all system run by large, national insurance companies or for profit corporations. This effort to replace BHC with managed care organizations ignores the needs of key local policy stakeholders, mental healthcare professionals and the patients and their families. PA Lawmakers must reject these reckless proposals to dismantle BHC and re-commit themselves to strengthening this successful, medical best practices model.
Delaware County 2019 Election:
In 2017, Delco lost an average of four residents per week to overdoses and Brendan Arata, 23, was one of them. Delco families with a loved one suffering from substance use disorder often do not know where to turn for help and when they turn to the county, the services provided are limited. Best medical practices are not universally endorsed or promoted adequately by our county government. There is no easy way for a family in need to discern a good sober living facility from one that is predatory. The county must provide families guidance through the maze of treatment methods and facilities.
A new county health department must work with local hospitals, treatment facilities and doctors to insure that adequate levels of care are available to meet the needs of those suffering from mental health and substance use disorder. Our loved ones should never be told that a bed is not available to them or a doctor certified in an area of treatment is not locally available.
Brendan Arata, like most those suffering from substance use disorder, also was plagued by other mental illnesses. Sadly, there is a shortage of medical facilities and practitioners in Delaware County and our region at large that are equipped to address patients with dual diagnosis. A new county health department must insure that facilities are expanded and doctors are recruited to meet these local needs.
In order to address the terrible shortage of sober living homes that provide supervised medication assisted recovery regimes, owners of sober living facilities who apply for a license to open a second (or already own more than two facilities and are applying for an addition license), must be required to provide this level of care in the new facility.
The county must adopt a response to the overdose crisis that emphasizes the saving of lives and harm reduction instead of law enforcement and the criminal justice system.
The county must expand its drug, mental health and veterans’ courts and allow and support those in medication assisted recovery regimes to participate in these alternative courts.
There are over two million Americans in prison and most of the incarcerated are serving sentences related to their drug use. Yet, almost no prison facilities offer best medical practices for drug treatment. In fact, most, including the privately run Delaware County, PA prison, offer no treatment programs whatsoever. The federal and state government must implement drug treatment programs employing best medical practices in all prisons so that when these citizens are released, they are not craving drugs. This will reduce recidivism, save money and lives.
Those in prison due only to the violation of probation through failure of a drug test, belong in treatment, not prison.
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