The opioid epidemic is a public health disaster the likes of which our city and state have never seen before, even at the height of the AIDS crisis. We have an estimated 20,000 residents using heroin in Baltimore, and we had nearly 400 fatal overdoses just in the first half of last year. We will not see a decrease in these tragically high numbers in 2018 if we do not make serious changes at the state level.
I am a graduate student in social work, and I intern at an outpatient substance use disorder treatment program in Baltimore City for my school’s field placement requirement. I work under the close supervision of licensed, experienced professionals in an agency that provides individual and group therapy, substance use education, and medication-assisted treatment. This would be a great opportunity for me to learn firsthand about the field of addiction and to help stem the tide of opiate overdoses. Unfortunately, I am not able to work directly with patients because Medicaid will not reimburse for any substance use disorder services provided by students, even if they work under careful supervision of an experienced clinical social worker.
In 2014, the Maryland Department of Health enacted a regulation declaring that state certified addiction programs would not be able to bill Medicaid for services provided by student interns. In its memorandum, the department on the one hand stated that it encourages students to “perform in a learning environment to develop skills in the field of Substance Use Disorder,” but on the other hand it did not give any reasons for why students should not be able to provide billable services to patients.
By comparison, mental health services for problems like depression, anxiety or schizophrenia that are provided by students have been reimbursed by Medicaid since at least 2005. My peers are no more or less qualified to provide mental health services than I am to provide substance use disorder services, yet I have classmates working in mental health agencies who are able to provide direct services to patients because their work will be reimbursed. In an ostensibly integrated Public Behavioral Health System, we still see disparity between the recognition of and reimbursement for treatment of substance use and mental health disorders. These disparities should not exist and should be eliminated.
It is time to change the regulation and allow students to provide billable services to individuals with addictions. People with addictions face challenges that most of us cannot imagine: unemployment, homelessness, legal conflicts, poor health care and lack of access to resources that could improve their lives. We should not be making it any more difficult than it already is for our most vulnerable citizens to get treatment.
In the midst of an acute workforce crisis among substance use disorder providers, it is critically important that we do not turn away qualified help. The patients I see every day at my field placement would benefit from the services that I — and other students — could provide, especially considering that while we are gaining practical experience in the field, we are also completing masters-level academic coursework.
There is a shortage of professionals such as social workers who are choosing to enter the field of addiction treatment. Increased interest in this line of work will only occur if students have early, positive experiences with the substance use disorder field during their school training. A change on the state’s policy on this matter will lead to a more vibrant, skilled addiction treatment workforce.
Recently, social work students have made headlines by working in Baltimore libraries. We now need to be on the frontlines in the opioid epidemic, stanching the carnage caused by addiction and overdose. Social work students have enlisted to join the fight, but we are being prevented from receiving adequate training, and from providing life-saving treatment, due to an inconsistent Department of Health regulation. We need a surge of substance use disorder treatment and providers, and it would be easy for the state to make this happen.
Paris Bienert is a student at the University of Maryland School of Social Work and a candidate for the Baltimore City Democratic State Central Committee. Her email is bienertp@umaryland.edu.