The Opioid Iceberg Dead Ahead In The Sea Of ACA Repeal

There's a moral imperative to address America's addiction crisis, but there's also a practical, financial case.

Our national conversation surrounding the repeal of the ACA has centered around recognizable chronic disease such as cancer, diabetes and heart disease. As the discourse reaches a raucous and almost unintelligible tenor, Congress passed a version of the bill that both cuts services for mental health and addiction and permits raising premiums for pre-existing conditions. This lays the legally sanctioned groundwork to make it harder for the 45 million Americans affected by the disease of addiction (23 million in need of immediate treatment and another 22 million in long-term recovery from addiction) to receive services that save taxpayers’ costs and countless lives. The elected officials crafting this health care bill are acutely aware that opioid overdose is the leading cause of death in the country. To not cover treatment would not just be short-sighted but a glaring financial catastrophe in the making as the problem continues to consume families, communities and the public. Let’s remember that opioid addiction is not just the hard health care provider costs of the patient’s hospitalizations, treatment, etc. – but also the societal and financial toll the ancillary effects of these patient’s families, children and employers continue to experience as a result of their disease.

It may make a popular sound bite to basically say that “these people” did this to themselves and therefore don’t deserve coverage, but that would be old school thinking. The November 2016 Surgeon General’s report on Alcohol, Drugs and Health clearly illustrated the pathology of addiction as a chronic and deadly disease as understood by conventional medicine maturing decades of scientific method leading to our present hard-earned understanding of the exact medical nature. Ironically, as described in the report and various court decisions of recent years, after declining for decades, the current national opioid epidemic was created in large part by our health care system as most patients are first exposed to opioids when they are legitimately prescribed by physicians. We now have more than 2.5 million heroin addicts nationwide – an estimated 80 percent of whom no prior addictive history or routine risk factors who got their very first opioid in a prescription bottle. I could dwell on the moral imperative incurred by a health care system to fix a problem it created through inefficiency and other obvious systemic flaws – but I’m not pleading a moral case, I’m pleading a practical and financial one.

In dealing with a national crisis, a logical approach is required ― not a politically expedient or an emotional approach. Think of it like steering a ship around the biggest and most obvious iceberg that is dead ahead ― we can exercise common sense navigation of this crisis that will have a positive effect on the entirety of the health insurance system. Or we could take a moral high ground and say we have every right to sail straight ahead ― to our own detriment. Like navigating an iceberg field, failure to steer our health care policy through the opioid crisis can absolutely bankrupt the system overall. We are taking on water, fast, due to the deleterious collisions we have had so far. The simple – and I argue hopeful ― reality is that efficient, cost effective outpatient treatment modalities now exist that can assist patients to end their dependence on opioids and the damage that this disease creates.

I have devoted my life to building the best approach to treating opioid addiction. The last 20 years have been devoted to medication assisted therapies to support behavioral health – methods lauded in the Surgeon General’s report as highly effective. I worked on a team developing depot naltrexone at the turn of the century. I was one of the founders of the team that developed and launched Suboxone in 2003, I have run networks of Methadone treatment providers. I currently run what many leading experts see as the best method for treating opiate treatment. We have developed a network of comprehensive treatment providers that includes integrated medication assisted therapy with on-site medications to treatment opioid dependence. I’ve learned several inconvenient and undeniable truths. Opioid dependence is a chronic disease. This is the position of all leading medical associations ― the AMA, ASAM, AAAP and the WHO to name a few. Historically, treatment has been delivered in brief disjointed treatment episodes. The current best thinking and measured results now shows that treatment delivered in a comprehensive treatment center combining a full set of behavioral health services matched with the best medical interventions delivered by one treatment team provides the best outcomes and thus the greatest cost savings for payors, communities and patients.

The current model of physician prescribing of Suboxone for patients was a lifesaver for patients in when we launched it 2003. I was a founder of the organization that launched the company and trained the first wave of physicians post approval to be DEA waivered to provide buprenorphine to their patients. Since then, we have seen the number of people struggling with opioid addiction continue to grow while access to the medication through certified physicians has grown almost tracking parallel. Per the leading manufacturer of buprenorphine, there are almost 3 billion mgs prescribed last year by over 38,000 trained and waivered physicians. But there remains a “treatment gap.” As the lead trainer would say at each physician training in the early days, “8 hours of training doesn’t teach a physician how to treat a dependent patient -it teaches them how to medicate a patient.” Removing the addiction specialist from equation for any patient prescribed buprenorphine in concert with behavioral health care given by one consistent treatment team has led to a gap in effective treatment for patients. The insidious nature of opioid addiction means no incentive to engage in behavioral health care guarantees disaster. Matched with insurance companies being led to believe that a prescription alone constitutes treatment and you have an insufficient care model evidenced by suffering, lost lives and skyrocketing costs. It would be unthinkable for a primary care doctor to administer chemotherapy with no oncologist in care continuum. As a result, buprenorphine is now reported as the 15th most prescribed medication in the U.S. ― but the fourth most diverted and abused pharmaceutical as reported in the journal Drug Alcohol Dependence in 2014. This model of care has compounded a solution into an additional problem.

The good news is that there are easy fixes, and if they are top of mind in health care policy, they can become status quo. If the ship is taking on water, we must plug the hole. An emphasis on long-term intensive outpatient treatment as essential to treating all addictions, particularly opioids, must become routine and required. An inseparable pairing of medication assisted treatments delivered with behavioral health services by one treatment team in a comprehensive treatment center must also be routine and required. Like our approach to cancer, best practices must be duplicated, reproduced in specialized centers of excellence and eventually phased in as insurance policies. This will save money and lives.

When it comes to the evolving ACA Repeal and Replace, the most important provision that can be added as the bill travels its long journey into law is for effective addiction treatment to be defined, mandated and entitled for those in crisis, early and long term recovery. We are at a tipping point with the math and dollars involved. This transcends any political ideology and polices both insurers and payers from being uninformed with respect to treating our number one killer affecting 45 million Americans. Where the solemn obligation and moral imperative to treat people doesn’t seem to resonate, maybe the dollars and sense will prevail.

Chris Hassan is the CEO of Soft Landing Recovery Centers. He is a Senior Healthcare Executive with over 25 years of experience in the field of healthcare. Prior to coming to Soft Landing, Chris co-founded Reckitt Beckiser Pharmaceuticals creating the office based treatment model for opioid dependence and launching Suboxone[R]. Subsequently, he served as the Chief Executive Officer of Colonial Management Group- the largest chain of opioid addiction treatment centers in the US at that time. He also developed and patented a number of new opioid product combinations focused on preventing diversion and inadvertent benzodiazepine overdose in patients. He is a committed father working to ensure that his children never have to suffer from the lack of effective treatment should they ever fall prey to this disease.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.