We commend Maryland officials for highlighting the serious health crisis that heroin use poses for all Marylanders and promising immediate action to respond to our state's overdose epidemic. Now is the time to invest wisely in the health care strategies that will prevent and treat opiate and other substance use disorders, even in a time of budget constraints.
While the state's investment in substance use treatment has never met the need for care, Maryland is building a solid public health and health care financing system that can be mobilized to address our overdose epidemic. The state, through its implementation of health care reform, requires private health insurance carriers to offer a comprehensive substance use disorder benefit that covers all levels of care from outpatient to residential treatment. With the state's Medicaid expansion, over 1.2 million children and adults have access to a wide range of substance use and other health services. The state has also implemented harm reduction strategies that allow trained individuals to administer naloxone to reverse an opioid overdose. Counties across the state are making the medication available to families and friends of those at risk of overdose, and police officers who carry the medication are playing a critical role in saving the lives of individuals.
The state can turn the corner on the tragic loss of life by taking full advantage of its health care system. By enforcing laws that are already on the books and protecting our current infrastructure, we can improve access to treatment and reduce overdose deaths. We recommend that Governor Hogan’s Heroin and Opioid Emergency Task Force and the Inter-Agency Coordinating Council take immediate action on the following three policy initiatives to make substance use treatment more readily available.
First, ensure state grant funds are available to provide care to all individuals who seek treatment but have lost insurance coverage, are under-insured or fall through the cracks. Any reduction in grant funds will prevent adults from accessing residential treatment, which is not covered by Medicaid, and will prevent our senior citizens from continuing outpatient methadone treatment and other cost-effective, community-based treatments not covered by Medicare. Grant funds provide the safety net for those who need immediate services to prevent overdose deaths.
Second, enroll incarcerated individuals in health insurance before they leave jail or prison and connect them to a health care provider. The state's data show that the risk of overdose for persons leaving prisons and jails is over eight times greater in the first week following release compared to the period of three months to a year after release. The departments of public safety and correctional services and health and mental hygiene must implement a plan to ensure that individuals leaving jails and prisons are enrolled in both Medicaid and linked to a health care provider on the date of their release and that reentry planning provides an immediate path to substance use treatment. County jails and detention centers can enroll individuals at the time of booking so that persons with substance use problems can be diverted immediately to treatment as an alternative to incarceration. Many other states have tackled this problem, and Maryland's citizens can wait no longer for the implementation of this humane and fiscally sound policy.
Finally, ensure that consumers with private insurance policies get the substance use treatment they are paying for. Benefit coverage is meaningless if carriers deny care that is recommended by the patient's clinician or limit access by offering inadequate networks of substance use providers. The Mental Health Parity and Addiction Equity Act requires carriers to sell policies that meet non-discrimination standards for care coverage and provider networks, but consumers have no way of knowing which plans are actually delivering on that promise. The Maryland Insurance Administration, which should be a member of the Governor’s Inter-Agency Coordinating Council, must do what other state insurance departments have begun to do — review all plans for compliance with the Parity Act and allow only those that can demonstrate equitable coverage and reimbursement of substance use and mental health services to be sold in the state.
History has demonstrated that policies that punish people for their drug use will do little more than increase the state's criminal justice costs. Luckily for its citizens, Maryland has put all the right health care pieces in place to address this epidemic as the public health crisis it is. Our political, business and health leaders can save lives by maximizing public and private resources at their disposal.
Ellen Weber is a professor at the University of Maryland Carey School of Law; her email is firstname.lastname@example.org. Dr. Nancy Rosen-Cohen is executive director of the National Council on Alcoholism and Drug Dependence; her email is email@example.com.