“The setting in which mental healthcare is delivered has a significant impact on reimbursement for providers, even when the treatments are very similar, according to a new report that suggests mental health professionals and their patients are not getting a fair deal from healthcare insurers.
In addition to the payment disparities found in 46 out of 50 states, “out-of-network” use of addiction and mental health treatment providers is extremely high when compared with physical healthcare providers, the report found.
The report was prepared by Milliman and released by a coalition of mental health and addiction advocacy organizations. It was based on 3 years of insurer claims data, 2013-2015, covering 42 million Americans, including inpatient and outpatient services, primary care office visits, and specialist office visits, comparing in-network and out-of-network claims in all 50 states and D.C.”
Source: MedPageToday.com – December 10, 2017
By expanding the pool of applicants through waivers, the Army hopes to meet its goal of recruiting 80,000 new soldiers by September 2018.
The U.S. Army has expanded its pool of applicants—by allowing people with a history of self-injury, bipolar disorder, depression, and drug and alcohol misuse to seek waivers.
The decision to remove the ban on people with a history of certain mental health issues comes in an effort to increase the number of applicants and meet recruitment quotas, according to USA Today.”
Source: TheFix.com – November 14, 2017
“Lawmakers in several states are advancing proposals to force individuals who abuse opioids into treatment via involuntary commitment statutes as a means of coping with the rapid rise in overdose rates. Some experts say that the proposals, while commendable, so far are not perfect.
Bills have been offered in New Hampshire, Pennsylvania, and the state of Washington. The simplest proposal — Senate Bill 220-FN, in New Hampshire — would modify state involuntary commitment laws to change the definition of mental illness to include “ingestion of opioid substances.”
Andrew J. Saxon, MD, professor, Department of Psychiatry and Behavioral Sciences, University of Washington, in Seattle, told Medscape Medical News that adding substance use disorder to the mental illness statute is “a positive step in most ways,” because experts in the field already view such disorders as a mental illness.”
Read more at: http://www.medscape.com/viewarticle/877839
Source: Medscape.com – March 28, 2017
“While Democrats have been pounding the drum against proposed changes to Medicare, Republicans appear far more likely to pursue an overhaul of Medicaid, the healthcare program for the poor.
But Republicans warn of the program’s growing costs and have pushed to provide that money to states in the form of block grants — an idea President-elect Donald Trump endorsed during the campaign.”
Source: TheHill.com – December 29, 2016
See related article Obamacare Repeal Jeopardizes Mental Health, Addiction Coverage available at: http://www.usatoday.com/story/news/politics/2017/01/08/obamacare-repeal-jeopardizes-mental-health-addiction-coverage/96199628/
“A wide range of pre-existing psychiatric and behavioral conditions and the use of psychoactive drugs could be important risk factors leading to long-term use of opioid pain medications, reports a study in PAIN®, the official publication of the International Association for the Study of Pain (IASP).
Using a nationwide insurance database, the researchers identified 10.3 million patients who filed insurance claims for opioid prescriptions between 2004 and 2013. The study looked at whether pre-existing psychiatric and behavioral conditions and use of psychoactive medications were predictors of later opioid use.
“We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids,” write Patrick D. Quinn, PhD, of Indiana University, Bloomington, and colleagues. The association appears stronger for long-term opioid use, and especially for patients with a previous history of substance use disorders.”
Source: Eurekalert.org – December 29, 2016
“The federal government is enforcing parity and investigating violations, according to a report by The U.S. Department of Labor. “Improving Coverage for Mental Health and Substance Use Disorder Patients” presents information on mental health and substance abuse parity violations investigated among insurance carriers from October 2010 through the end of 2015.
“It’s one thing to hear the complaints, frustrations and difficulties of getting paid by carriers anecdotally and another to see where the Department of Labor is specifically finding problems,” says Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers (NAATP).
While there have been successes with the Mental Health Parity and Addiction Equity Act and progress has been made in terms of enforcing and implementing the law, the report found both quantitative (payment-oriented) and non-quantitative (access-oriented) violations. Among the 1,515 investigations carried out, 171 violations were found—58 percent of which were non-quantitative.”
Source: Behavioral.net – February 17, 2016
Despite widespread news coverage, extensive research, and effective treatments, opioid addiction is reaching new heights—not only in the U.S., but in many parts of the world.
According to data from the National Survey on Drug Use and Health, in 2014about 1.9 million people in the U.S. had substance use disorders related to opioid prescription pain relievers. This was up from about 1.4 million in 2004, but down slightly from the 2012 estimate of 2.1 million.
Accompanying the slight drop in opioid pain reliever disorders has been a sharp increase in heroin use. About 586,000 people aged 12 or older had a heroin disorder in 2014. This was a slight rise over the 2013 total (517,000), but considerably higher than during 2002 to 2010, as the bar graph shows.
Mortality data in the U.S. for 2014 are not yet available, but in 2013,16,235 deaths were attributed to prescription pain relievers, according to a Morbidity and Mortality Weekly Report (MMWR). Heroin-related deaths in 2013 totaled 8,257, according to the Centers for Disease Control (CDC), amounting to a 286 percent increase over 2002.
People addicted to opioids face difficult challenges—medical, legal, and personal. What risks of disease and death do they face? What factors make it more—or less—likely that they’ll ever be able to quit? And what are their chances of ever remaining abstinent?
University of California Study
To answer these questions, a team at the University of California, Los Angeles, studied approximately 250 articles covering long-term patterns of stability and change across the life span of people with opioid dependence.
The authors restricted their search to studies of established addiction. They selected 28 studies from Australia, Asia, Western Europe, and North America. Among other criteria, studies had to include at least three years of follow-up data through February 2014, and had to define abstinence as abstinence from opioids. The authors published the results of their study, summarized below, in the March-April 2015 issue of Harvard Review of Psychiatry.
The authors covered a variety of topics related to opioid dependence, noting that mortality has been well studied, but that potential turning points and critical life events that shift opioid use—such as incarceration—have not.
Opioid addiction is a chronic disorder associated with frequent relapses and often devastating consequences: 25 percent to 50 percent of the study subjects had died within 20 years after study entry. Mortality rates were about 6 to 20 times greater than those in the general population, with overdose being the most common cause of death. Of those who lived 10 to 30 years after entry, fewer than 30 percent ever reached stable abstinence.
Recurring abstinence and relapse were common, with patients in many studies using opioids for six to 10 years before entering addiction treatment. Dropout rates from treatment were generally about 20 percent to 30 percent. As for recovery, the authors noted that “neither age nor the chronicity of use predicts recovery,” and that people addicted to opioids do not “mature out” with age. Instead, “what increases over time is the mortality.”
Users didn’t usually stop using opioids before 10 years had passed. Stable abstinence was unlikely, but if it did occur, and lasted five years, future stable cessation was more likely.
Cessation had a downside, however: many former opioid users continued—or even increased—their use of alcohol and other drugs.
Transitions, Turning Points, and Maintenance
The authors also found:
- Medication-assisted treatment (methadone, buprenorphine, or naltrexone) or abstinence-based rehabilitation was often associated with temporary reductions in opioid use and criminal behavior, but many patients needed repeated treatment episodes before they could quit
- Abstinence after release from imprisonment tended to be brief, but many aging users “burned out,” and never returned to drug use
- Rewarding nondrug activities—employment, vocational training, and relationships with family and friends—helped former users maintain abstinence, but those with a history of sexual or physical abuse, especially women, were less likely to ever recover
- Those who stayed longer in treatment were more likely to remain abstinent; those who had been incarcerated were less likely
Findings were inconsistent as to whether mental health problems tended to precede heroin use and influence its progression.
- About 20% percent to 30% of participants showed symptoms of depression at study entry
- In several studies, 10% to 20% had histories of psychiatric problems or psychiatric treatment
- Post-traumatic stress disorder was diagnosed in about 40% of veterans entering methadone treatment
- Women in some studies reported poorer mental health than men, especially regarding symptoms of suicidality and depression
- Except for those with depressive disorders, a consistent finding was improvement in mental health as time passed
About half the studies, most of them from the U.S., included information on participants’ criminal activities or legal-system involvement. Incarceration was more common and longer-lasting in the U.S. than elsewhere, perhaps due to laws relating to drug offenses.
Drug possession and other drug-law violations were the most common crimes heroin users committed, but violent offenses also occurred. Crime levels appeared to fall when heroin use dropped.
People in the U.S. addicted to opioids were incarcerated in higher percentages, and for longer periods, than those in Europe, reflecting the European custom of treating addiction as a public health issue.
Criminal activity often led to addiction treatment, followed by a drop in criminal offenses. But after repeated incarceration, many started using heroin again, resulting in a large number of deaths from overdose and suicide.
The authors call for reducing treatment barriers, expanding treatment capacity, taking a chronic-care model approach to treatment, implementing long-term care and management strategies, and distributing naloxone to reduce overdose deaths.
They believe that the current situation is urgent, and calls for new approaches:
- Research— to profile opioid users, based on the opioid or opioids they use
- New medications—designed to treat patients in medical offices, not just in clinics
They note that recent treatment options (buprenorphine and naltrexone) include depot formulations that have a longer duration of action, but an unknown long-term impact.
The authors also suggest additional studies of opioid users and former users outside treatment settings to provide “a fuller understanding of the long-term course of opioid addiction.”
Limitations of the Study
Study limitations were minor. Definitions of abstinence differed among countries, and some definitions included measurable outcomes. Some studies used data reported by study participants, but unverified. Differences existed between incarceration rates in various countries, perhaps because of the traditional criminal justice approach of U.S. drug policies.
Hser Y, Evans E, Grella C, Ling W, Anglin D. Long-term course of opioid addiction.Harv Rev Psychiatry.2015; Mar-Apr;23(2):76-89. doi: 10.1097/HRP.0000000000000052. PMID:25747921.
Center for Behavioral Health Statistics and Quality. September 2015. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm. Accessed September 25, 2015.
Centers for Disease Control and Prevention (CDC). Morbidity and Mortality Weekly Report (MMWR). QuickStats: Rates of Deaths from Drug Poisoning and Drug Poisoning Involving Opioid Analgesics – United States, 1999-2013. January 16, 2015; 64(01);32.
Jones CM, Logan J, Gladden RM, Bohm MK. Vital Signs: Demographic and Substance Use Trends Among Heroin Users—United States, 2002-2013. July 10, 2015. MMWR 2015;64(26):719-725. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a3.htm. Accessed September 25, 2015.
Murphy J. Heroin Use Increasing at Alarming Rate; Health Care Providers Can Help. MDLinx. July 9, 2015. http://www.mdlinx.com/family-medicine/article/60. Accessed September 28, 2015.
National Institute on Drug Abuse: Abuse of Prescription Pain Medications Risks Heroin Use. http://www.drugabuse.gov/related-topics/trends-statistics/infographics/abuse-prescription-pain-medications-risks-heroin-use. Accessed September 24, 2015.
Opioid addiction disease 2015 facts and figures. American Society of Addiction Medicine. Chevy Chase, MD; 2015:1-2. http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. Accessed September 24, 2015.
Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. http://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf. Accessed September 24, 2015.
Volkow, N. Prescription Opioid and Heroin Abuse. A presentation to the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, April 29, 2014. http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse. Accessed September 24, 2015.
“A flood of patients who have become newly insured under the Affordable Care Act are visiting doctor’s offices and hospitals, causing some health workers to worry about how they can provide care to everyone in need. One group, however, isn’t lining up for care: People with mental health issues or substance use disorders.
Though Obamacare extends coverage to this group – collectively referred to as behavioral health – various loopholes in the health care law at this time have kept people from requesting mental health care. Some states haven’t expanded Medicaid, the government health insurance program for poor or disabled Americans, leaving about 5 million in a coverage gap, the majority of whom, experts believe, need mental health care. In other cases, patients aren’t even aware of the benefits they can get with their new health insurance.”
Source: USNews.com – October 30, 2014
People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don’t support insurance, housing, and employment policies that benefit those dependent on drugs, new Johns Hopkins Bloomberg School of Public Health research suggests.
A report on the findings, which appears in the October issue of the journal Psychiatric Services, suggests that society seems not to know whether to regard substance abuse as a treatable medical condition akin to diabetes or heart disease, or as a personal failing to be overcome.
“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal.”
Between Oct. 30 and Dec. 2, 2013, Barry and her colleagues surveyed a nationally representative sample of 709 participants about their attitudes toward either mental illness or drug addition. The questions centered on stigma, discrimination, treatment and public policy.
Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery.
Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness.
Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible.
The researchers say that the stories of drug addiction portrayed in the media are often of street drug users in bad economic conditions rather than of those in the suburbs who have become addicted to prescription painkillers after struggling with chronic pain. Drug addicts who fail treatment are seen as “falling off the wagon,” as opposed to people grappling with a chronic health condition that is hard to bring under control, they say. Missing, they say, are inspiring stories of people who, with effective treatment, are able to overcome addiction and live drug-free for many years.
Barry says once it would have been taboo for people to casually discuss the antidepressants they are taking, which is often the norm today. That kind of frank talk can do wonders in shaping public opinion, she says.
“The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need,” says another study author, Beth McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction.
See related article from the Fix Taking The Stigma Out Of Addiction available at: http://www.thefix.com/content/ending-cycle-shame-and-addiction
Source: Eurekalert.org Press Release – October 1, 2014