By Alison Knopf
How will the election of Donald Trump as president of the United States, with far-ranging changes in administration officials and policy, affect opioid treatment programs (OTPs)? There are many questions about the future, with Mr. Trump having said little in terms of concrete plans.
Drug policy reform may take a turn away from the “we can’t arrest our way out of the problem,” with a return to punishment instead of treatment for drug offenders. If Sen. Jeff Sessions (R-Alabama) becomes the new Attorney General, this may be the direction taken.
Increased access to medication-assisted treatment for opioid use disorders (OUDs) may be in the future, and there are indications that a Trump administration would favor the pharmaceutical industry. And Vivitrol may be getting more of a boost, especially as treatment in the criminal justice system takes a bigger role.
The fact that OTPs are highly regulated could be a plus in the eyes of a Trump administration.
What’s Next for Medicaid Expansion, the ACA, and OTPs?
But the biggest question in many people’s minds is what will happen with health insurance. Medicaid expansion, which made it possible for many more patients to get treatment, is now up in the air due to questions about the future of the Affordable Care Act (ACA). What Congress will do, now that the House of Representatives, the Senate, and the White House are Republican-controlled, is a question.
“To a large degree, we are all in the dark,” said Jerry Rhodes, former CEO of CRC Health Group, and now chairman of BayMark Health Services. “There has been scant discussion or indication of policy on behavioral health and addiction issues from President-elect Trump.
“Mr. Trump did attend an opioid abuse summit in New Hampshire, where he was confronted with the extent of the problem.” And the involvement of Rudolph Giuliani as a close advisor to Mr. Trump “certainly gives pause to folks who have been in the field a long time, as they remember that as Mayor, Mr. Giuliani proposed shutting down the OTP clinics in New York City.”
Still, drug abuse is a nonpartisan issue, and there has been broad agreement among Republicans and Democrats that the opioid crisis needs to be addressed.
Field groups were already aligned to work with either administration, and are working as usual to make sure treatment is accessible.
Mr. Rhodes is concerned about the ACA. “Everyone is clearly aware of the promise to repeal and replace the ACA,” he told AT Forum. There are several Republican plans floating around, he added, noting that a consistent theme of these plans has been to limit further Medicaid expansion, or to outright eliminate expanded Medicaid populations. Other plans include “bare bones plans” and developing high-risk pools, he said.
While OTPs have benefited from Medicaid expansion, this has been on a state-by-state basis, noted Mr. Rhodes. “There have been significant variances among states on the Medicaid commitment, including some states not offering any Medicaid reimbursement for OTPs.”
Factors to Keep in Mind
When thinking about the future of OTPs, Mr. Rhodes recommends weighing several factors:
- Fundamental demand. “We are in the midst of a pandemic of opioid abuse,” he told AT Forum. “This has devastated communities in the Midwest, the Northeast, and New England, and now is a plague across all the country.”
Despite Mr. Trump’s lack of policy specifics, drug abuse was an important topic in the elections. “The new administration cannot ignore the issue,” said Mr. Rhodes. “I think that the facts supporting OTPs, their proven efficacy, and the cost and the outcomes are compelling. These facts hopefully will continue to weigh strongly in favorable policy.”
- Mental Health Parity and Addiction Equity Act (MHPAEA). This Act had strong bipartisan support in Congress, and has helped OTPs in policy and regulation, said Mr. Rhodes. “Despite the imposition of mandates, I don’t think there is any appetite to repeal or modify MHPAEA.”
- Comprehensive Addiction and Recovery Act (CARA). This legislation is supportive of evidence-based and cost-effective treatment options—all options favoring OTPs, noted Mr. Rhodes. CARA also has strong bipartisan support in Congress.
- Block grants. “Some of Mr.Trump’s inclinations on policy favor the use of federal block grants for entitlements and other funding and allowing the states significant latitude to disseminate funding as they see fit outside of federal mandates,” said Mr. Rhodes. Whatever happens here, “there would continue to be variability among the states, with some that continue commitments to OTPs, and some that don’t,” he said.
- Fortunately, stigma is diminishing as a factor in policy and regulation, Mr. Rhodes commented. “Many in law enforcement now favor treatment, not incarceration, as the critical intervention.”
“Everyone involved with OTPs should have heightened vigilance,” he added. “However, given the factors above, I think there is some cause for optimism that we will continue to see support for expanded OTP services.”
As AT Forum went to press, Congress was considering adding $1 billion over two years to treat the opioid epidemic.