Submitted by achenault on Wed, 11/25/2015 – 12:51pm
Every day it seems a new dimension of Ohio’s opiate crisis in Ohio appears. In September, a report released by the Ohio Department of Health showed a 17% jump in Ohio deaths due to unintentional drug overdose. Now we learn that the number of Ohio youths dying of drug overdoses has quadrupled in the past decade, putting us in the company of only four other states with such a leap (Kansas, Montana, Wisconsin and Wyoming). (See Reducing Teen Substance Misuse: What Really Works, Trust for America’s Health, November 2015.[1]) This study found that Ohioans age 12 to 25 died at a rate of 9.1 per 100,000 in 2013 compared to the national rate of 7.3.
And if one needs personal stories to bring these alarming statistics to life, look no further than the CBS Sixty Minutes Heroin in the Heartland episode aired on November 1st. Teens are experimenting with medications lifted from their parents’ medicine cabinets, or getting hooked on pain pills legitimately prescribed for them for an injury. When the expensive pills become unavailable, heroin becomes the drug of choice and is amazingly easy to get. Sixty Minutes interviewed recovering college student Hannah Morris from Worthington who said, “[i]t started with weed and it was fun, and I got to good weed. Went to– oh my gosh, I went to pills, and it was still fun. You know, Percocet, Xanax, Vicodin, all that kinda stuff. And then yeah, heroin. I started smoking it at first.” Hannah was 15 at the time, and went on to shooting up heroin in the school bathroom. Fortunately, Hannah survived. Many have not.
Prevent Use Before It Starts
“More than 90 percent of adults who develop a substance use disorder began using before they were 18,” said Jeffrey Levi, PhD, executive director of Trust for America’s Health. “Achieving any major reduction in substance misuse will require a reboot in our approach – starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”
That’s right. PREVENTION. We won’t treat or arrest our way out of this. One supplier will replace the next when the demand is great and there is lots of money to be made by providing heroin to our young people.
Fortunately, the Trust for America’s Health made some critical recommendations (quoted in part):
UHCAN Ohio has been working on the last recommendation for almost two years now. Screening, Brief Intervention and Referral to Treatment (SBIRT), which has the support of the American Academy of Pediatrics, is a preventive intervention in which a trained individual (it could be a school nurse) asks a person a few preliminary questions from a validated tool about alcohol and drug use. For adults, this is often done in the doctor’s office. For youth, a school may be a better place to capture a greater number of young people. The screening can be paired with other health screenings done in school. For those who screen positive, a few more questions are asked, and then a trained person will do a “motivational interview” with the young person. This is simply a structured conversation that provides important factual information, assesses a young person’s readiness to change behavior, and helps them devise some strategies. Where necessary a referral to treatment is made.
College-age students in recovery tell us they wished someone had asked them in middle or high school if they were using. Let’s listen to their wisdom and start asking all of our young people in schools.
The Trust for American’s Health says, “Each state should have an end-to-end network of experts and resources to support the effective community-based selection, adoption, implementation and evaluation of evidence-based programs.” We need to devote resources and we need effective community-based programs. Ohio can do this, but we need to demonstrate the political will.
Before Ohio loses more of our young people, state leaders must take a hard look at investing more resources into prevention.
[1] The study performed by Trust for American’s health was funded by the Conrad N. Hilton Foundation, who also funds UHCAN Ohio’s work on spreading youth SBIRT.
On March 29, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized the long-awaited rule applying mental health and substance use disorders parity to Medicaid and the Children’s Health Insurance Program (CHIP).
Mental health and substance abuse parity means that a health plan pays for treatment as it would if the patient was being treated for any physical disorder. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes, the health plan must offer unlimited visits for a mental health condition such as depression.
Community Catalyst’s Health Policy Hub blog post on April 7, 2016 highlights the important features of the rule.
These provisions of the rule were finalized as proposed:
All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) have to follow the new rules.
Medicaid programs can’t avoid the rules just because it costs more.
Managed Care Organizations must disclose how they decide if a treatment is medically necessary for substance use disorders or mental illness, and the MCOs must provide explanations when they deny coverage. States must also publicly post documentation of compliance with parity rules.
Learn more about the rules by reading the full Community Catalyst blog.
Although states have 18 months to come into compliance with the parity regulations, there are three things advocates can start to do now:
Get in touch with state health department and Medicaid officials. Advocates can highlight stories of Medicaid and CHIP consumers who aren’t getting the mental health and/or substance use disorders care they need and urge officials not to wait 18 months to bring the Medicaid program into compliance with parity rules. Consumers should not have to wait any longer for good care.
Continue advocacy for fuller implementation of Early, Periodic Screening, Diagnosis and Treatment (EPSDT). Given the establishment of the EPSDT benefit as a compliance standard for parity in CHIP and concerns about how EPSDT is implemented, advocates can continue to encourage state regulators to monitor EPSDT services. Advocates can also proactively engage providers about the importance of including age-appropriate substance use disorders and mental health screenings as a critical component of the EPSDT benefit.
Push for more data, reporting, and enforcement. Laws and regulations do not guarantee robust enforcement. Advocates can urge state officials to improve data collection and reporting systems about consumer experiences, including better tracking of parity complaints with state agencies. Most importantly, advocates can press state and federal officials to enforce parity in all Medicaid and CHIP programs.
Many thanks to Community Catalyst for the content of this article.
