White House Commission misses recovery support

The first report produced by the federal Commission on Combating Drug Addiction and the Opioid Crisis begins its recommendations by calling for the president to declare a national state of emergency. The declaration would bring about a more urgent level of coordinated actions between state and federal authorities to address the opioid crisis, say experts, but it’s not clear whether President Trump will follow through.

“The first piece would be raising the bar on the attention that this crisis would get, and the second piece would be funding,” Tom Coderre, senior advisor with Altarum Institute and former SAMHSA official, tells Behavioral Healthcare Executive.

Tom Coderre

For example, the Department of Health and Human Services might be able to fast-track grant money or innovation waivers for Medicare and Medicaid programs.

The commission presents 20 recommendations in its interim report, which was released Monday, and a final report is due to the president in October. Suggestions range from making changes to the IMD exclusion and HIPAA rules, to instituting requirements that providers of medication-assisted treatment (MAT) offer all available types of MAT. According to the report, the commission received more than 8,000 comments from the public as well as from 50 stakeholder organizations.

Clear miss

Coderre says one glaring omission among the group’s recommendations, however, is the ongoing recovery support that’s required after treatment, such as coaching and recovery housing.

“We invest in the prevention side, and we see that in the report directly,” he says. “We see why it’s important to prevent people from becoming addicted in the first place, then we invest in treatment. But we don’t invest in recovery support, which is the chronic-care piece of the continuum that really helps somebody start to maintain a recovery lifestyle.”

The chronic nature of addiction requires the wraparound services of recovery support in communities to ensure better long-term outcomes. Plus, they are also part of a recovery-oriented system of care, in which recovery is the expectation. Coderre says it can take up to five years of aftercare before an individual’s risk of relapse drops below 15%.

“If you’re not investing in recovery support, you’re ultimately throwing good money after bad,” he says.

Coderre—who is in long-term recovery—hopes the commission will consider the idea for its final report to the White House.

Positive acknowledgements

Language in the report seems to speak to the public health approach of treatment rather than incarceration, which Coderre says he was pleased to see, along with the suggestions that call for improved Medicaid coverage. For example, the commission calls for Medicaid to cover all FDA-approved MAT drugs. The recommendation should be encouraging considering the recent policy proposals that have included dramatic reductions in federal spending on Medicaid.

“We’ve heard a lot about Medicaid the past couple months, and it’s been on the chopping block in several proposals before Congress,” he says. “It was good to see Medicaid in the report being highlighted as something that’s really important for people suffering from substance use disorders.”