GUEST VOICES: Small Steps in Opioid Epidemic

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2018 opioid legislation on right track, but CA still miles short of real care.

Ramon Castellblanch, Ph.D., President, Quality Healthcare Concepts, Inc.

This year, the California legislature and governor took small steps toward alleviating the opioid epidemic that is plaguing our state. Action on the epidemic is desperately needed. In the past three years, more Californians have died of opioid overdoses than were killed in the Viet Nam war and the death rate could still be rising. In 2016, roughly 350,000 Californians abused and/or were dependent on opioids, putting them at high risk of a fatal overdose. These latter Californians are said to suffer from opioid use disorder (OUD).

To save as many lives as possible, the top priority for fighting this epidemic is getting treatment to Californians with OUD. Treatment often starts with medication assisted treatment (MAT). The gold standard medicines for MAT are buprenorphine and methadone. It then usually goes on to non-medical recovery and treatment services.

Unfortunately, California only has enough buprenorphine or methadone for roughly one-third to one-half of residents with OUD. According to the Substance Abuse and Mental Health Services Agency, California has one of the most severe recovery and treatment services capacity shortfalls in the nation. We need more funds for MAT and recovery and treatment services. We need more healthcare professionals and facilities providing evidence-based OUD treatment.

In 2018, the governor and legislature made it a little less difficult for Medi-Cal to adequately fund MAT and recovery and treatment services, thanks to Sacramento Assemblyman Kevin McCarty’s AB 349. Unfortunately, the governor vetoed Fresno Assemblyman Juan Arambula’s AB 2384, a bill that would have banned certain private insurance obstacles to funding MAT.

The governor and legislature did take short steps toward promoting evidence-based OUD treatment. SB 992 by West Covina Senator Ed Hernandez will crack down on some of the more egregious practices of recovery and treatment facilities (RTFs). It would close a loophole that allows some unscrupulous RTF owners to avoid licensure and it would ban RTF discrimination against patients undergoing MAT or suffering relapse. SB 823 by San Mateo Senator Jerry Hill will require the state Department of Health Care Services (DHCS) to mandate RTFs to use evidence-based treatment standards by 2023.

These bills get us closer to protecting our residents. But compared to other states, California has a long way to go in getting sufficient treatment to Californians with OUD, let alone all the other steps states are taking against the opioid epidemic. We should make private insurers give MAT and recovery and treatment funding “parity” with medical and surgical treatments they routinely cover. Medi-Cal should fund MAT well enough that low Medi-Cal rates are no longer a barrier. Californians with OUD shouldn’t have to wait until 2023 for evidence-based care; if they do, the wait means some will die of an overdose first. MAT treatment needs to be fully integrated into jails and emergency departments, as these facilities see so many Californians with OUD. This treatment should not just be short-term. Jails and emergency departments should also be required to help get Californians who need it into OUD treatment. Hopefully, 2019 will see the legislature and new governor take these big steps.

READ MORE about 2018’s opioid legislation in California.