Addiction treatment is not enough
The President’s Commission on Combating Drug Addiction and the Opioid Crisis heard a consistent message from families, advocates and experts at its first meeting on June 16: now is a terrible time to throw millions of people off of health coverage. That’s because coverage under the Affordable Care Act, including the Medicaid expansion, is essential for access to life saving addiction treatment. Republican Senators from hard hit states including Ohio and West Virginia are now trying to reconcile their party’s ideology with the health of millions of their constituents.
The obvious approach would be to protect the Medicaid expansion. An alternative approach is now emerging: Roll back Medicaid, but set aside $45 billion or more over 10 years in special funding for opioid addiction treatment.
I am a doctor who specializes in the care of patients with opioid addiction. Even though this alternative approach would assure funding for clinics like mine, I think it is a terrible idea.
First, it won't work to expand access to all who need care. According to the Surgeon General’s 2016 report, Facing Addiction in America, only about 1 in 10 people who need treatment get it. And the number of people who need treatment for opioid addiction keeps climbing, without an end in sight. Our country needs much more access to treatment, but who would invest to build and staff treatment programs for temporary funding?
Second, the proposal misunderstands the problems facing people with addiction. It's more than opioids. It is HIV, hepatitis C, skin and heart valve infections, cancer, high blood pressure, diabetes, chronic obstructive lung disease, schizophrenia, and depression. And those were just the challenges facing my patients last week.
Medicaid provides access to a range of essential services, from medications for psychiatric disorders to laboratory testing for infectious disease to surgery for hernias. When patients come to me, I take care of their addiction and work to assure these other needs are met. It’s part of what is necessary to get them back on their feet, and help them stay there.
The Congressional recess is starting soon. If a Republican Senator wants to appreciate the impact of this latest proposal, he or she is welcome to visit my clinic in Baltimore. What will be apparent on such a visit is that my patients suffer from opioid addiction, but they are not defined by it. They are real people, with families who love them and with futures they are reaching for. They want not only to be free of addiction but also to be healthy.
Throwing money at addiction treatment is no substitute for real access to care. I implore Senators concerned about opioid addiction to see the whole picture.