Substance abuse remains personal crisis, challenge for public health

Substance abuse is both a personal crisis and a public health challenge. Resources to battle it need to be viewed in that light.

If a new study of how people purporting to be heroin users are treated by some health care providers is any guide, relatively minor federal policy changes could improve treatment of addicts substantially.

Researchers at the Havard University T.H. Chan School of Public Health wanted to know how heroin users who can pay cash for medical help are treated, in comparison to those relying on Medicaid coverage. Medicaid, of course, is relied upon by millions of low-income Americans.

Five states and the District of Columbia were chosen for the study, because of their high rates of drug abuse. West Virginia and Ohio, as well as Maryland, Massachusetts and New Hampshire, were included.

Callers posing as 30-year-old women using heroin — but seeking help — called health care providers. They sought appointments, allegedly because they wanted prescriptions for drugs (buprenorphine/naloxone) that might help them kick their habits.

Many times, the callers were unable to get appointments with health care providers, for a variety of reasons. Some had simply stopped taking new patients. But all too often, ability to pay out of one’s pocket was the problem.

Throughout the five states and the District of Columbia, 44 percent of those seeking appointments were refused them because of their “payer status.” The percentage was higher in Ohio (60 percent) but lower in West Virginia (32 percent).

Medicaid seems to have been much of the problem. Many health care providers complain the federal program is slow to pay and its reimbursement rates are not adequate.

Another challenge was refusal to schedule appointments quickly. Many times, the callers were told they would have to be placed on waitlists. That happened much more frequently in West Virginia than in other states — indicating clearly a need for more treatment options for drug addicts.

What about the Medicaid problem, however? Medicaid relies on both state and federal dollars. Limits on reimbursement for various health care needs must be set, or the money runs out.

But, again, drug addiction is not just a personal health crisis. For various reasons — including the impact on children and increased crime — it is a public health issue, too.

Why not consider increasing Medicaid reimbursement rates for services related to addiction treatment? That could persuade more providers to accept Medicaid patients, possibly saving many lives.

That — and more study of links between the drug crisis and the ability of some victims to pay for treatment — ought to be considered by federal officials.

By Josh Bovee

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