Ohio: Medicaid’s Role in Drug-Abuse Treatment Debated

medicaid“Ohio’s growing heroin and prescription drug problem has collided with the biggest issue facing the state legislature this fall: whether to expand Medicaid health care benefits to hundreds of thousands of low-income residents.

The Medicaid debate is set to be the top issue the General Assembly tackles when it returns to Columbus next month. An Oct. 1 deadline is looming over supporters of Republican Gov. John Kasich’s proposal to take federal money to expand Medicaid under the health care reform law, the Patient Protection and Affordable Care Act. After Jan. 1, Ohio will begin to lose out on more than $13 billion promised by the federal government.”

http://www.lancastereaglegazette.com/article/20130827/NEWS01/308270045/Medicaid-s-role-drug-abuse-treatment-debated?nclick_check=1

Source: LancasterEagleGazette.com – August 28, 2013

Rockefeller Urges Federal Agencies to Take Stronger Steps Against Prescription Drug Abuse

prescription drugsSen. Jay Rockefeller, D-W.Va., is asking three federal agencies to step up efforts to
counter prescription drug abuse, an increasing problem in West Virginia.

Rockefeller wrote to the Government Accountability Office, the Centers for Medicare
and Medicaid Services and the U.S. Food and Drug Administration (FDA).

He requested that the GAO study the neonatal abstinence syndrome. He asked the Centers for
Medicare and Medicaid Services for information about how the agency monitors prescription
drug abuse by people on Medicaid and Medicare. Rockefeller also asked the FDA about efforts
to improve education about methadone for both patients and those who prescribe it.

http://wvgazette.com/News/201302130117

The press release can be accessed at: http://www.rockefeller.senate.gov/public/index.cfm/
press-releases?ID=649103fe-024e-4edf-8435-df52251216cd

Source: WVGazette.com – February 12, 2013

Kentucky – Prescription Drug Abuse Bill Making Its Mark Just Days After Going Into Effect, Officials Say

prescription drugsDays after a landmark prescription drug abuse law took effect, the law appears to have already effected changes in the medical field and positioned Kentucky as a leader in battling prescription drug abuse.

“The enforcement of this bill began just a couple of days ago, and yet we already know that four ‘pain management clinics’ in Kentucky have waved the white flag and notified us they will shut their doors,” said Gov. Steve Beshear, who joined Attorney General Jack Conway, lawmakers and medical providers in hailing the law’s impact.

House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring. The bill included multiple elements to prevent the abuse and diversion  of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices.

“We know that more than 9,000 medical providers have signed up for electronic prescription monitoring just since this law passed in April – more than doubling the number registered.

http://www.kyforward.com/2012/07/prescription-drug-abuse-bill-making-its-mark-just-days-after-going-into-effect-officials-say/

Source: KYForward.com – July 25, 2012

Rockefeller, Manchin Applaud Senate’s Support of Prescription Drug Bill

The U.S. Senate on May 24 unanimously supported a measure to make getting painkillers more difficult. Now, Sens. Jay Rockefeller and Joe Manchin, both D-W.Va., are praising their Senate colleagues for working in a nonpartisan way to get that bill passed.

The amendment, which Manchin sponsored as part of the Food and Drug Administration Safety Act, would reclassify drugs containing hydrocodone as Schedule II substances. Because of the reclassification, patients would need an original prescription for refills, pills would be stored and transported more securely and traffickers would be subject to increased fines and penalties. Hydrocodone is found in drugs such as Vicodin and Lortab.

In addition, Rockefeller introduced a provision to the FDA bill that called for new study tools for health care providers, including doctors, nurses and pharmacists, to promote safe pain management in an effort to reduce the prescription drug epidemic.

http://www.statejournal.com/story/18625854/rockefeller-manchin-applaud-senates-support-of-prescription-drug-bill

Source:  State Journal.com – May 25, 2012

Denying Medication-Assisted Treatment (MAT) in the Criminal Justice System—Is It Legal?

Denying access to medication-assisted treatment (MAT) for opioid addiction has been a long-standing practice throughout the criminal justice system, with devastating consequences—unnecessary incarceration, increased spread of HIV, hepatitis, and other infectious diseases; drug overdose, sometimes fatal; and recidivism rather than recovery.

Many arrestees and inmates in U.S. facilities are addicted to opioids, yet a December 2011 report from the Legal Action Center says that the vast majority of jails and prisons fail to offer MAT as ongoing maintenance treatment, even when it’s recommended or prescribed by a treating physician. At an estimated cost of about $4,000 per year, MAT successfully reduces addiction and related criminal activity, allowing people to lead productive lives, support families, and pay taxes—rather than costing taxpayers as much as $40,000 annually for imprisonment.

But some probation and parole agencies prohibit MAT, and courts often require detoxification from methadone or buprenorphine before defendants can complete drug court requirements as an alternative to jail or prison.

The Legal Action Center report, Legality of Denying Access to Medication Assisted Treatment in the  Criminal Justice System, (see link) explains why withholding access to MAT at any level of the criminal justice system—correctional facilities, courts, and parole and probation boards—makes no sense, and can violate federal antidiscrimination laws and the United States Constitution.

For example, the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 prohibit discrimination on the basis of disability, and require that each individual’s ability to take part in specific activities be evaluated objectively. Denying access to MAT at any level of the criminal justice system violates these Acts, whether denial is based on a blanket policy or carried out on a case-by-case basis, but without the required objective, individualized evaluation.

Moreover, jails and prisons that force those receiving MAT to detoxify without proper medical supervision and treatment risk violating the Constitution’s EighthAmendment prohibition on cruel and unusual punishment, or the Fourteenth Amendment Due Process clause. Thus, medical best practices continue to elude the vast majority of those who have an opioid use disorder and are unfortunate enough to come up against the criminal justice system. They’re being forced to taper or go to jail.

Access Denied!

Despite advocates’ attempts to work with judges and probation and parole boards, denied access continues. Some examples:

  • Drug court judges who believe in MAT, but rarely refer people for treatment because they feel pressure from district attorneys.
  • District attorneys concerned with what they view as public safety risks in granting outpatient versus residential treatment, and who regard MAT as having the risk of abuse or diversion.
  • Defense attorneys who have little information about what’s appropriate or needed for their clients, or an understanding of best practices in treating opioid addiction, and aren’t prepared to advocate for medication-assisted treatment.
  • Judges and drug court staff who “have a rule: we just don’t let people stay on methadone and graduate from drug court.”
  • The Federal Bureau of Prisons guidelines for treating opioid addiction that call for medically supervised detoxification (including with methadone), cognitive behavioral therapy, and drug abuse education—but do not recommend methadone maintenance treatment, and prohibit treatment with buprenorphine as maintenance therapy.

AT Forum spoke with Sally Friedman, legal director of the Legal Action Center and author of the Center’s report. Written at the request of the American Association for the Treatment of Opioid Dependence (AATOD), the report is being distributed to government and criminal justice agencies, and to consumer groups and advocacy organizations.

Litigation

“The report has focused significant attention on these discriminatory policies, but litigation is another key strategy to bring about the necessary change,” said Ms. Friedman. “Even a few federal court decisions holding criminal justice agencies liable for denying access to MAT could make a big impact.”

“The Legal Action Center is prepared to bring litigation when we find the right case,” said Ms. Friedman—“someone who’s willing to challenge a criminal justice agency and willing to fight to the end of the litigation. We’d welcome hearing from people who’ve been forced off their addiction medications in order to take part in drug courts or other alternative sentencing programs, or by any other part of the criminal justice system.”

Potential cases may be a successful patient in an opioid treatment program (OTP) with a job and family who is picked up on an old warrant and told to taper or face jail; or one where a physician recommends MAT and the judge demurs. “MAT as a treatment option shouldn’t be off the table because of a judge’s misconception that it’s substituting one addiction for another, or because of overblown concerns about diversion,” Ms. Friedman said. “The point of the ADA and the Rehab Act is that the government should make decisions on the basis of objective medical evidence that applies to that individual, and not on the basis of stereotypes or broad generalizations. ADA case law is quite clear that people must be evaluated individually.”

Criminal justice agencies and courts who deny access to MAT despite a physician’s recommendation generally haven’t faced legal consequences. “Many courts have found that the ADA prohibits employment and zoning discrimination against people who need or receive MAT,” Ms. Friedman pointed out. “But courts have not yet addressed the question of whether the criminal justice system’s failure to provide or permit MAT violates the ADA or Rehabilitation Act. We think now is the time.”

Suggestions for OTPs

Helpful publications and audiovisual presentations from the Legal Action Center include Educating Courts, Other Government Agencies and Employers About Methadone (2009), a PDF explaining how people in MAT can advocate for their rights so they can get in or stay in treatment, without discrimination; and Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? Rights for Individuals on Medication-Assisted Treatment (see link).

If an OTP patient is forced off of methadone or prohibited from enrolling despite the recommendations of a physician, an OTP Director can contact the Legal Action Center (phone: 212-243-1313 or 1-800-223-4044; fax: 212-675-0286; email: lacinfo@lac.org).

About the Legal Action Center

The only nonprofit law and policy organization in the U.S. whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, or criminal records, the Legal Action Center has for nearly four decades worked to combat stigma and prejudice and to help people reclaim their lives.

Legal Action Center Resources

Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System.
http://www.lac.org/doc_library/lac/publications/MAT_Report_FINAL_12-1-2011.pdf.
Accessed February 20, 2012.

Know Your Rights: Are You in Recovery from Alcohol or Drug Problems? Rights for Individuals on Medication-Assisted Treatment.
http://www.lac.org/doc_library/lac/publications/Know_Your_Rts_-_MAT_final,_9.28.10.pdf.
Accessed February 20, 2012.

Webinar: Medication-Assisted Treatment: Special Anti-Discrimination Issues.
http://lac.org/index.php/lac/webinar_archive. Accessed February 20, 2012.

Memo on Driving and Psychomotor Studies.
http://www.lac.org/doc_library/lac/publications/mmt-memo_on_driving_and_psychomotor_studies.pdf. Accessed February 20, 2012.

National Association of Criminal Defense Lawyers. http://www.nacdl.org/. Accessed February 20, 2012.

Additional Resources

National Institutes of Health, U.S. Department of Health and Human Services. Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse. Revised January 2012. NIH Publication No. 06-5316.
http://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations. Accessed February 20, 2012.

Whitten L. Prison use of medications for opioid addiction remains low. NIDA Notes, Research Findings. 2011 (July);23(5). http://www.drugabuse.gov/NIDA_notes/NNvol23N5/Prison.html.
Accessed February 20, 2012.

Krantz MJ, Mehler PS. Treating opioid dependence: Growing implications for primary care. Arch Intern Med. 2004;164:277-288. http://archinte.ama-assn.org/cgi/content/abstract/164/3/277.
Accessed February 20, 2012.

New York Bill Introduced on Methadone Clinic Location Restrictions

On January 27 the state of New York introduced an ACT to amend the mental hygiene law, in relation to the location of methadone treatment centers. The ACT would prohibit the establishment or continued operation of a methadone clinic within five hundred feet of an educational institution at the secondary level or below, day care center, park, church, synagogue or other place of worship unless located within a hospital.

http://assembly.state.ny.us/leg/?sh=printbill&bn=A09145&term=2011

Source: State of New York Assembly – January 27, 2012

Congress O.K.’s Drug-Testing the Unemployed: Will It Fight Addiction?

Last week, in a deal to maintain the payroll tax cut and extended unemployment benefits, the United States Congress passed a law that allows states to drug-test people seeking unemployment benefits, if they were fired from their last job for drugs, and anyone seeking jobs that would ordinarily require a drug test.

Republicans initially wanted to drug-test all people applying for unemployment benefits — a measure Democrats opposed. It’s not clear how many states will start testing under the new compromise law, or what percentage of the unemployed will end up having to pee in cups, but if the intent of the policy is to reduce addiction rates, the research suggests it isn’t going to work. In fact, the new law might even increase certain types of drug use.

http://healthland.time.com/2012/02/21/congress-o-k-s-drug-testing-the-unemployed-will-it-fight-addiction/#ixzz1n6W37MoQ

Source: Healthland.time.com – January 21, 2012

NIMBY: Stack, Boyle Bills Toughen Regulations for Proposed Methadone Clinics in Pennsylvania

Standing outside the site of a controversial, proposed methadone treatment facility in the Holmesburg community of Northeast Philadelphia, state Sen. Mike Stack and state Rep. Kevin Boyle announced October 13th their legislation that would tighten loose regulations currently in place for these facilities.

“We as a community were recently blindsided by the Healing Way’s plans to open a methadone clinic here. Fortunately, we have very active citizens who took action when we learned the truth,” said Stack (D-5th dist.). “The public deserves adequate notice and a chance to respond when a drug treatment center wants to open a facility in their community, and our legislation gives residents a voice in the approval process.”

“The proposed facility in my district would have a significant impact on the neighborhood. Many community leaders and residents have come together to fight against the proposed clinic,” said Boyle (D-172nd dist.). “This legislation would provide the tools necessary to fight back against such a situation happening elsewhere in Philadelphia and across the state.”

Stack’s legislation (Senate Bill 1277) and Boyle’s identical legislation (House Bill 1885) include four key provisions that the lawmakers say will ensure community involvement when a clinic is proposed:

  • They would require a public hearing for all proposed narcotics treatment facilities. Written notices would be given out 30 days prior to the hearing to all property owners or lessees located within 500 feet of the proposed facility.
  • The owner of the proposed facility would be required to receive approval from the local district attorney.
  • The proposed facility would be required to have adequate parking before it could be approved by the Department of Health.
  • The Department of Health would provide written notice to all locally elected public officials at the city, state and federal level of the location immediately upon receipt of the application. Notice would also be given to the Single County Authorities, which is the agency responsible for providing drug and alcohol addiction treatment to Pennsylvanians who have government-sponsored health coverage.

The bills were drafted in response to a recent dispute between the community and the Healing Way, which wants to open a methadone treatment facility at 7900 Frankford Ave.

Residents and nearby businesses claim they were told Healing Way was opening a doctor’s office or medical facility, not a methadone treatment center. They claim there was insufficient notice to file a petition opposing it to the Zoning Board of Adjustment.

Philadelphia Councilwoman Joan L. Krajewski (D-6th dist.) said her office investigated the property and found that a permit was obtained through the Department of Licenses and Inspections “over the counter,” meaning the applicant applied for it in person at L&I headquarters in downtown Philadelphia and received it without having to post a zoning notice or make the surrounding residents aware.

Krajewski hired an attorney and appealed the permit, funding both the appeals court fee and rented buses for community members to attend the hearing in opposition.

Krajewski applauded the Holmesburg Civic Association and surrounding residents for jumping into action when word of a proposed methadone clinic circulated the neighborhoods.

“A methadone clinic does not belong in such a heavy populated area, it should not operate so close to houses and local retail businesses that make up our Frankford Avenue corridor,” said Krajewski. “Our constituents of Mayfair and Holmesburg and any other residential neighborhood for that matter do not want this in their backyard. It belongs in a hospital facility setting.”

“The community has legitimate concerns with the Healing Way, including its proximity to an elementary school, daycare and church and the lack of parking. They were most concerned, however, that the Healing Way did not reveal its true intensions,” Stack said. “The community should have direct input. Our legislation accomplishes that.”

“When you look at the facts, it is clear that 7900 Frankford Avenue is not a good location for a methadone clinic, and the public should have been given the opportunity to address those concerns,” Boyle said.

http://www.senatorstack.com/media/releases/2011/Oct13.htm

Source: Pennsylvania State Senator Mike Stack – October 13, 2011

Higgins, Kennedy Take Action to Stop Prescription Drug Abuse in Western New York

Congressman Brian Higgins (NY-27) and N.Y. State Senator Timothy M. Kennedy (58th District) announced actions they are taking to address the growing epidemic of prescription drug abuse.

At a press conference on October 24th Higgins pinpointed to the need for additional advancements in health information technology as critical step in this fight. Kennedy outlined a series of prescription drug reforms he introduced called the “Michael David Israel Laws” – named for a young Western New Yorker who lost his life after his battle with prescription drug addiction.

Senator Kennedy has introduced the Michael David Israel Laws as four separate bills which together represent a comprehensive approach to addressing the prescription drug abuse epidemic. The new bills target training for health practitioners, patient access to information, addiction transition and reform to the controlled substance abuse registry.

  • Doctor’s Training Law – Doctors, nurse practitioners and pharmacists would be required to complete three hours of continuing education each year on the impacts and warning signs of addiction, as well as methods to migrate patients from addictive drugs to lower-risk solutions.
  • Patient Information Act – Before prescribing any opiate analgesics or psychotropic drugs, doctors and pharmacists would be required to make patients aware of the dangers and risks of addiction and to provide them with information about coping with addiction and local resources available for help.
  • Addiction Transition Law – The Department of Health (DOH) would be required to promulgate recommendations for prescribers to transition patients from highly addictive pharmaceuticals to lower-risk pain management solutions.
  • Controlled Substance Registry Reform Act – DOH will be required to develop a “real-time” reporting system for the controlled substance registry. Both doctors and pharmacists will be granted access to the controlled substance registry, and they will be required to check the registry for indicators of abuse or addiction prior to writing or filling a prescription. DOH will also develop a system of penalties for failing to check the registry.

Congressman Higgins has been an avid supporter of electronic medical record implementation as a means for health professionals to better exchange patient information, avoid medical errors and generally encourage better outcomes.  In a 2009 survey of 11 countries only 46% of U.S. doctors use electronic medical records compared to over 90% in Australia, Italy, the Netherlands, New Zealand, Norway, Sweden & the UK.  Higgins says this nation should take swift action toward comprehensive health IT implementation.

http://higgins.house.gov/2011/10/higgins-kennedy-take-action-to-stop-prescription-drug-abuse.shtml

Source: Congressman Brian Higgins – October 24, 2011

New York Methadone Clinic Blocked

The director of a methadone treatment trade organization drew a sharp rebuke when he hinted at the possibility of legal action if Glens Falls, New York officials attempt to prevent a methadone treatment center from opening in the city.

Henry Bartlett, executive director of the Committee of Methadone Program Administrators, told the Glens Falls Common Council on Tuesday evening that the city’s lawyers should review previous legal decisions involving the cities of Baltimore, MD, and Reading, PA.

Mr. Bartlett said both decisions centered on the Americans with Disabilities Act and the 14th Amendment to the U.S. Constitution, which addresses equal rights for black people.

http://poststar.com/news/local/methadone-clinic-blocked/article_16113c12-f48b-11e0-850c-001cc4c002e0.html

Source:Glens Falls Post Star – October 12, 2011

New Illinois Parity Law Recognizes State Funded Addiction Treatment Providers

In a move that raises the bar for addiction treatment advocates and legislators in other states, state-funded addiction treatment providers were specifically codified in to law as covered providers when Illinois Governor Pat Quinn signed the Illinois Mental Health Parity bill August 18, 2011.

HB 1530 establishes parity for addiction treatment services among health insurance policies, but exceeds the recently enacted Federal law in several ways. The Illinois law specifically recognizes those community-based providers that the state contracts with for services. Additionally, the law sets forth a definition for substance use disorders and requires medical necessity determinations to be made in accordance with appropriate patient placement criteria established by the American Society of Addiction Medicine (ASAM).

http://behavioralhealthtoday.com/2011/08/29/new-illinois-parity-law-recognizes-state-funded-addiction-treatment-providers/

Source: AHP Healthcare SolutionsAugust 29, 2011

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