The Addiction Crisis: What We Need to Do in 2019

I ended last year advocating that we needed to Do More in 2018 to end the addiction crisis. I am pleased to report that we are making progress. Just over a year ago, I testified before the House Subcommittee on Oversight and Investigations which was looking into patient brokering and addiction treatment fraud, a topic that I had been speaking about for some time. Since then, we’ve seen a number of significant reforms, improvements, enactments, and action.

Florida continued to be a national leader on the state legislative front, tackling ethics issues in treatment as it enforced its new anti-patient brokering statute. LegitScript and Google are now weeding fraudulent providers out of Google AdWords. The National Association of Addiction Treatment Providers (NAATP) launched the Quality Assurance Initiative—standardizing treatment best practice guidance-- and its Code of Ethics 2.0 — which provides enforcement mechanisms to deal with unethical behavior. At Caron, we created a Patients Bill of Rights to refocus the treatment sector on the needs of patients and their families. And last month, Congress passed the SUPPORT Act, which contains numerous reforms and improves access to care.

While we are still not where we need to be, we are moving closer. One of the most important elements to overcoming this public health crisis is quality treatment and improved access to it. But all treatment is not created equal, and that is why I am so grateful for the standardizations and best practice-setting that groups like American Society of Addiction Medicine, NAATP, Office of National Drug Control Policy, Facing Addiction, Shatterproof, Congress, Caron itself, and others, set about doing this year. That work will ensure that those who access help are, in fact, actually receiving help.

What Do We Need to Do in 2019?

Enforce, Enforce, Enforce

Some of the most promising provisions of the SUPPORT Act involve new regulatory authorities for agencies like the FTC and HHS. Those the provisions must be enforced. During our meeting yesterday, we discussed with Conway the need to involve providers and input from the frontlines of addiction treatment when implementing the SUPPORT Act.

Enforcement and legislation can do much more to expand treatment access. Parity enforcement still has a long way to go. More states need to apply for the Section 1115 demonstration project waivers of the Institution of Mental Diseases (IMD) exclusion or press their legislators to call for elimination of the IMD exclusion for substance use disorders. The IMD exclusion is a federal rule that prohibits federal Medicaid reimbursement to states for adult patients receiving mental health or substance abuse care in a psychiatric or substance abuse treatment facility with more than 16 beds. Eliminating the IMD Exclusion would address a major barrier to SUD treatment. We must take these critical steps to eradicate barriers to treatment.

Expand Treatment Access

Finally, at the risk of sounding like a broken record, more Americans need to have access to quality, evidence-based treatment for adequate duration of care. “Detox” with medication-assisted treatment without treatment is not actually treatment. We need to look for ways to adopt innovative new payment models, like the Addiction Recovery Medical Home that Caron contributed to through the Alliance for Recovery-Centered Addiction Health Services earlier this year.

In all, 2018 brought us closer and marked a much-needed turning point to our national response to the addiction crisis. If we’re going to reverse the course of the crisis, we need to get working on the biggest and hardest tasks now, from prevention to getting people the lifesaving treatment they need and deserve.

During our meeting in December at the White House with Special Counselor to the President Kellyanne Conway and her team, it was encouraging to see the Administration’s high-level of engagement and commitment on this issue. We discussed our mutual shock at the lack of urgency we find around the issue. Addiction does not discriminate -- it affects 1 in 3 American families. Thousands of Americans are dying from overdose and alcohol-related deaths. Yet, with the signing of the SUPPORT Act last month, the First Lady’s focus on those affected by the opioid crisis, the growing acceptance that addiction is a chronic disease, and the ongoing commitment of so many in the field, 2019 has the potential to be a year we make a difference.