New opioid law a start, but there's a lot more to do

By:  Katie Fairbanks
Source: The Daily News

U.S. Sen. Maria Cantwell joined local health and law enforcement officials Tuesday to tout a new bipartisan federal law they say will help treat substance abuse and crack down on illegal use of opioids, but the Washington Democrat also got an earful about what more should be done. 

President Donald Trump signed the bill into law on Wednesday. Among its provisions — some of them written by Cantwell — the bill will increase penalties on drug makers for illegal distribution of opioids, authorize more funding for the High-Intensity Drug Trafficking Area Program (HIDTA), increase funding and resources for opioid treatment, and support new research and treatment alternatives.

Leaders from St. John Medical Center, Cowlitz County Health and Human Services and the Cowlitz County Sheriff’s Office gathered at Cowlitz Family Health Center in Longview for the discussion with Cantwell.

“You gave us the ideas we fought for, so I wanted to come back and check in on the implementation,” said Cantwell, who is in an election race with Republican Susan Hutchinson to win a fourth, six-year term.

Cowlitz County had the third highest opioid-related death rate in the state between 2012 and 2016, according to the state Department of Health. A federal study released in April suggests the total cost of opioid-related deaths to the county was roughly $128 million.

The bill authorizes $280 million for the HIDTA program, which assists federal, state, local and tribal law enforcement agencies located in major drug-trafficking areas. Cowlitz County qualifies for the program, but it’s not guaranteed the money, Sheriff Mark Nelson said.

Nelson said one of the big challenges for law enforcement is stemming the flow of drugs coming into the community. The sheriff’s office has a drug task force, but it is only funded until the end of the year, he said. Nelson said he is working with HIDTA program officials to get funding.

However, Nelson said combating drug problems goes beyond law enforcement.

“Law enforcement can’t separate itself from the public health or mental health side,” Nelson said. “We have to do this as a community effort or it fails.”

Dian Cooper, Family Health Center CEO, said medical providers have reduced opioid prescriptions and overdoses in the community. Jim Coffee, chief operating officer and deputy director of Family Health Center, told Cantwell that making the overdose reversal drugs such as naloxone and Narcan can over-the-counter would help further cut overdoses and overdose deaths.

The Family Health Center hopes to prescribe those with opioids to not only make them available to opioid users in case of emergency, but to remind patients about how dangerous opioids are, Coffee said. And Health Center patient Nichole Brese said pairing naloxone with opioid prescriptions is an “awesome” idea.

“People don’t understand taking one or two extra pills could kill someone,” she said.

Cooper said some parts of the bill help alleviate problems facing local substance-abuse and behavioral health treatment providers, including allowing Medicaid to cover more substance abuse treatment beds for up to 30 days. Cooper said increasing the time people can stay in inpatient treatment would help even more.

Robert Axelrod, system medical director of behavioral health at PeaceHealth St. John, said the wait for inpatient beds in the community has decreased, but is still a problem. In the time between a patient receiving treatment at a hospital and getting into inpatient care, they can fall off the healthcare system’s radar, return to drug use, or die, he said.

“You can detox people from drugs, but you also have to detox them from the lifestyle,” said David McClay, Columbia Wellness CEO. “There has to be place for people to go when they get out of detox.”

This also applies to people in drug court, said Chris DesRosier, Cowlitz County Health and Human Services director. Many people get out of jail and are ready to go into treatment, but there is nowhere for them to go, she said.

It is also more expensive for people with substance abuse or behavioral health problems to stay in jail rather than get treatment, Cantwell said. But the senator said she needs numbers that show that in order to get funding for treatment programs.

Nelson said a problem with many people with substance and mental health problems being held in jail is that their Medicaid coverage gets suspended while they’re incarcerated. That means cost of their care falls on the county.

Cantwell said getting rid of Medicaid suspension for inmates faces opposition in the state Legislature because the cost of that care then shifts to the state. 

Restrictions on use of telehealth also is a barrier to care, McClay said. The new law lifts Medicare restrictions for telehealth services for substance abuse, but those barriers still apply to Medicaid patients. 

Access to medical records among different providers is another problem, said Tim Strickland, PeaceHealth system director of government affairs. He said, for example, a patient with substance abuse could be prescribed opioid pills post-surgery because a new doctor may not know the patient’s history. 

Another challenge Cowlitz behavioral health providers face is recruiting enough staff, Cooper said. Some behavioral health professionals who work in Cowlitz County can qualify for loan repayment because the county is an underserved rural area. That has helped recruit some professionals to the area, but not enough, she said. 

Cantwell pledged to address the shortage of treatment options and find ways for rural area to recruit more behavioral health professionals. 

“This is a second step,” Cantwell said of the new legislation, noting it was based on her meetings with local providers. “We need a third and fourth.”