Clear hurdles to treatment
There is no simple cure for the opioid epidemic plaguing New York and the rest of the nation, but a new state audit demonstrates how simply following the rules could do some good.
The audit by Comptroller Thomas Dinapoli found a fairly maddening dilemma: Some individuals on Medicaid whose addiction treatment involves a prescription for an opioid — usually methadone — may still be using additional opioid drugs obtained from private physicians who, for example, may be treating them for pain. The physicians may be unaware that they’re giving extra drugs to someone with substance use disorder, because federal law prohibits treatment programs from directly contacting a patient’s physician to coordinate care — unless the patient has consented.
So it could be entirely up to people struggling with opioid abuse to decide whether to cut themselves off from a ready, cheap supply of the drugs.
That law, of course, should be changed. But as the audit also found, treatment providers aren’t entirely without options, if they’d use them.
Using a state database set up in 2013 to track prescriptions and thwart “doctor shopping” and duplicative prescriptions for narcotics and opioids, staff at treatment centers are required by law to first check whether a person being treated for an opioid use disorder already has an opioid prescription from a personal physician. The audit, however, found those checks did not happen consistently in the population it looked at — approximately 56,000 Medicaid recipients in state-certified treatment programs who were also receiving prescription opioids outside of their addiction treatment regimens. Of these, 3 percent ended up overdosing, including 12 who died.
Even if the rules are followed, the system is limited in what it can do. Treatment counselors can’t force anything; they can only urge addicts to authorize their physician to coordinate treatment. Some patients simply won’t do that.
Yet it’s worth making that effort in every instance. And it’s the law to check the prescription database.
While the state Health Department disputes some of the audit findings, and suggests the people being treated could also have been using drugs obtained illegally, it agrees with at least some of the audit’s recommendations. Still, it can do little about the federal law that limits contact between a treatment facility and the patient’s personal physician. We understand a patient’s wish for privacy in confronting substance use disorder, but the audit makes the self-defeating, dangerous results of that pursuit all too apparent.
There is some hope for change. Despite the political divide in Washington, both the House of Representatives and the Senate recently reached a rare bipartisan agreement on measures to address the opioid epidemic. Congress should build on that cooperation and remove this obstacle to letting professionals better coordinate treatment of those with an opioid use disorder. The system should be helping addicts, not enabling them.