Governor’s Advisory Commission on Opioids and Addiction Discusses Progress and Challenges

September 18, 2020

The Governor’s Advisory Commission on Opioids and Addiction met September 14 and received updates on progress in combating addiction through improved access to treatment through the Medicaid program, as well as community efforts to enhance prevention, education, treatment, family support, and recovery. Commission members also received a briefing on the emerging issue of use of illicit stimulants such as cocaine and methamphetamine.

Dr. Chethan Bachireddy and Ashley Harrell with the Department of Medical Assistance Services (DMAS) outlined progress in enhancing the availability of substance use disorder treatment for Medicaid recipients through the Addiction and Recovery Treatment Services (ARTS) program, which extended Medicaid coverage to certain additional services and improved payment rates for others. ARTS is now in its third year, and has significantly enhanced the number of providers offering services such as office-based opioid treatment and intensive outpatient programs. Similarly, there have been significant increases in the number of Medicaid members receiving substance use disorder treatment and a decline in emergency department usage among Medicaid members with substance use disorder. Additional flexibility in providing services via telehealth that was permitted as a result of the COVID-19 pandemic has also increased access to treatment. Moving forward, DMAS will be working to improve access to services for Medicaid-eligible individuals who are involved in the criminal justice system, including a reentry pilot program to link individuals to treatment in the community. Language included in the Governor’s budget in December 2019 and retained in the budget as passed by the General Assembly, but subsequently unallotted in April, would have directed DMAS to seek federal approval to provide care coordination services to Medicaid-eligible inmates for 30 days prior to release from incarceration; this concept may be revisited in the future as more resources become available. The DMAS presentation is available at this link.

Commission members received a presentation from community leaders in the Roanoke Valley, who have worked for two years with a large group of stakeholders to develop a “Blueprint for Action.” This plan for a three-year collective response to the problem of substance use disorder seeks to improve prevention, in addition to “ensuring that there are always pathways to healthy and sustainable living for those affected by addiction.” The Blueprint’s five priority areas were developed by working groups of experts and include prevention and education; treatment; crisis response and connection to care; child and family support; and recovery. Each priority includes several specific action steps. The group plans to continue to identify resources and needs, develop a financial model and secure funding sources, and use the Blueprint in advocacy efforts for policy changes to support these local efforts.

Dr. Jon Zibbell of RTI International provided information on the growing use of illicit stimulants and the particular dangers of use of these substances in tandem with opioids (such as fentanyl) or non-opioid depressants (such as alcohol). Dr. Zibbell pointed out that opioid-involved overdose deaths with co-occurring cocaine or methamphetamine use grew by 429 percent from 2015 to 2017; the specific combinations of drugs tend to vary by region, race, and socioeconomic status. There are also a growing number of deaths associated with the use of methamphetamine without opioids, possibly attributable to more potent methamphetamine circulating or to the use of the drug by individuals with underlying health conditions.

Commission members discussed the importance of reentry programming for individuals returning to the community from incarceration; the need for more access to inpatient treatment, which often has long wait lists; and the benefits of expanded telehealth options.

VACo Contact: Katie Boyle

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