To fight the opioid epidemic, cities and states tweak the standard toolkit of addiction treatment – with promising results
In the June issue of the Rosenthal Report, we explore innovative approaches to the use of medication-assisted treatment in Baltimore and Virginia, as well as Rhode Island’s pioneering prison treatment program that has significantly reduced overdose deaths. In news briefs, we look at a spike in overdose deaths among black drug users in Massachusetts, and the movement to decriminalize magic mushrooms.
Medication-assisted treatment, MAT, is fast becoming the core strategy in our nationwide anti-opioid battle. It is endorsed by the Rosenthal Center as an effective addiction treatment when combined with behavioral therapy as well as with peer-based counseling and long-term residential treatment for the most vulnerable patients. In inner cities and Rust Belt towns, as well as correctional facilities, where this epidemic is so relentless and widespread, some policymakers are now implementing broad based services systems for opioid users anchored by MAT programs.
Baltimore, for example, a city that recorded nearly 700 overdose deaths in 2016 compared to 167 in 2011, has launched a “levels of care” treatment program centered in hospital emergency rooms. Nearly all of the city’s 11 ERs now provide MAT “on demand” to addicts, in a program that includes overdose reversal drugs, drug screening, peer recovery specialists, support services and referrals to longer-term treatment. This “wrap-around” model integrates treatment into Baltimore’s existing healthcare system, and is designed to ensure that no patient “slips through the cracks,” according to Baltimore mayor Catherine E. Pugh.
Virginia is getting more patients into MAT through Medicaid. Although the state only this week approved Medicaid expansion under the Affordable Care Act, it initiated a program in 2017 called Addiction and Recovery Treatment Services (ARTS). This provides financial incentives through Medicaid, such as higher reimbursement rates to addiction treatment providers, rewarding them for expanding services. Initial results are encouraging: in the first nine months of the program, opioid prescriptions and emergency room visits were down, and more than 16,000 Medicaid members received treatment for addiction, a two-thirds increase over the previous year.
Rhode Island’s prison program, which began in 2016, is also attracting attention. It offers a full range of MAT services – screening for all inmates, medications and peer counseling – and is the first such program for correctional facilities, which do not generally provide comprehensive treatment. Equally important, it ensures critical follow-up care so that former inmates continue to receive medications and therapy during the difficult post-release period, when addicts are most susceptible to relapse. One year into the program, the number of overdose deaths among recently released prisoners in Rhode Island plunged 61 percent.
The Rosenthal Center applauds such innovations. Tweaking the basic tenets of the MAT model to meet specific patient needs, budgets and healthcare delivery systems can substantially increase its effectiveness. Moreover, by mobilizing the national resource of persons in recovery – as these programs do – it is possible to vastly expand treatment strength and capacity. We must keep experimenting and moving forward, as there’s no one-size-fits-all solution to this deadly crisis.
Black overdose deaths in Massachusetts defy statewide decline
Drug overdose deaths in Massachusetts fell in 2017, but not for every demographic: the death rate among whites dropped 13 percent and among Latinos 4 percent, but it surged 26 percent for blacks, a disturbing trend that mirrors a nationwide pattern in urban black populations. Researchers suspect the spike is due in part to increased use of cocaine that is laced (either intentionally or not) with the powerful synthetic opioid fentanyl.
Magic mushrooms on the menu
Micro-dosing LSD and other hallucinogens is a thing now, receiving widespread coverage in the New York Timesand a new book by acclaimed author Michael Pollan that explores “the new science of psychedelics.” But as these drugs are still illegal, advocates in Denver are trying to mount ballot initiatives to do away with felony charges for possession of magic mushrooms, citing studies showing purported mental health – as well as spiritual - benefits. Activists are using the playbook from the fight to legalize recreational marijuana in Colorado, which means they just might succeed.