Access to addiction treatment restricted for middle class

Addiction does not discriminate – it wreaks havoc on individuals and families regardless of race, age, gender or socioeconomic status. But there’s a huge gap in access to treatment for a very large portion of the population: the middle-class.

The two primary socio-economic groups in this country with access to residential substance use disorder (SUD) treatment are the very wealthy and the very poor. When you are wealthy, you can pay out of pocket for yourself or a loved one, and if you are uninsured or underinsured you can qualify for Medicaid to access residential addiction treatment. That leaves out a large slice of the population — the teachers, firefighters, construction workers — who don’t qualify for state-funded programs and don’t have the wealth to cover the cost of a residential stay, which is an important component of the treatment spectrum. The middle class may have some money to pay for treatment, but their resources are stretched thin and the necessary care it takes for successful, long-term recovery is often out of reach.

Just as the disease of addiction is on a spectrum from mild to moderate to severe, the response to treating the disease must also be a full spectrum of services from residential services to intensive outpatient to outpatient. Included in the spectrum of services is the ability to access appropriate medications that, in conjunction with the appropriate level of treatment, can provide effective paths toward recovery.

Washington, D.C., and Maryland have among the country’s 11 lowest provider rates for addiction treatment, specifically when it comes to the ability to prescribe buprenorphine, a medication-assisted treatment that can stave withdrawal symptoms during opioid detox. This is a treatment that has proven to save lives but is still largely inaccessible.

The middle class relies on their insurance providers to help cover the cost of treatment, and that coverage is often lacking. Insurance providers often resist authorizing residential addiction treatment for people with severe diagnoses and instead authorize people into lower levels of care, usually to the detriment of the person in need.

There are three key questions the United States needs to answer if we want to effectively address the opioid epidemic:

  • How do we get to a place where we recognize that substance use disorder is a disease that needs widespread access to quality evidence-based treatments?
  • How do we raise awareness that addiction is a disease with evidence of recovery? (Just like people can recover from having heart disease or manage diabetes — it doesn’t mean the disorder goes away, it means it’s controllable. Just like other chronic recurring illnesses, SUD is a disease, and treatment is an effective strategy for initiation into recovery from that disease.)
  • The third question, and most important at the moment, is: How do we figure out a way to fund the treatment for this disease across all socioeconomic groups?

Maryland’s hospital emergency rooms have been overwhelmed by SUD patients; as reported by The Baltimore Sun, the number of patients with behavioral health problems admitted between 2013 and 2016 made up nearly a quarter of all E.R. visits in the state.

New Jersey and West Virginia, two states that bear some of the highest costs of the opioid crisis (alongside Washington D.C.), have taken steps to break down this insurance barrier of treating the opioid epidemic, requiring private insurers to cover a certain period of “medically necessary” inpatient treatment — no preauthorization, no waiting weeks or months to get help.

Why are there only two states that have made this requirement?

Patients and their advocates must work with insurance providers to ensure a full continuum of care is available and affordable for the middle class — for everyone suffering from substance abuse. People diagnosed with a severe SUD need access to therapeutic residential environments where they can detox and safely engage in a therapeutic process, where they can effectively be initiated into recovery. The cost of not treating addiction is much higher than the cost of putting a patient through a treatment program and starting their journey to recovery.

Adam Brickner is CEO of Recovery Centers of America's Maryland Center for Addiction Treatment; his email is abrickner@recoverycoa.com.

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