During President Donald Trump’s recent announcement that federal guidance on physical distancing measures would remain in place through the end of April, he issued a warning about a shadow crisis lurking behind COVID-19.
The physical distancing measures meant to save so many lives from the COVID-19 pandemic come at a steep price for Americans with mental illness and addiction. While we must do everything in our power to arrest the spread of SARS-CoV-2, the virus that causes COVID-19, we must simultaneously shore up our nation’s addiction and mental health care systems to avoid an aftershock of increased suicides and overdose deaths.
The addiction treatment centers where I serve as chief medical officer are already seeing signs that our country’s long-standing mental health and addiction crisis is starting to spiral further out of control. My colleagues and I have fielded hundreds of calls from patients with addiction who are wondering how — or even if — they will still be able to access treatment for their disease.
They are concerned about running out of medications to treat their opioid use disorder, depression or schizophrenia, and they are experiencing severe anxiety. Many are too afraid to venture outside their homes for fear of catching the potentially deadly virus — their complex health profile puts them at high risk for complications. Others who have been in remission and recovery for years with the help of mutual support groups suddenly find themselves disconnected from what has been their lifeline.
Without needed medication and social supports, and with the added stress of social isolation, many patients with addiction risk relapse that may lead to further strain on our emergency departments and hospitals. We are mitigating many of these concerns to the best of our abilities using technology and other innovations, yet significant challenges remain and are substantially stressing our systems.
And while emergency rules released by state and federal governments have given addiction treatment providers increased flexibility to prescribe medications for addiction treatment and practice telehealth, without emergency financial relief for addiction treatment providers, I fear that many individuals with addiction could be more likely to overdose during this time.
Fear doesn’t have to get the final word, though. There are ways we can prevent a second wave of overdose deaths and the further depletion of a healthy workforce. However, we need policymakers and insurers to act now.
While we are keeping some patients connected to their treatment providers via telehealth, to make this a reality for as many patients as possible, insurers — including state Medicaid programs — need to reimburse clinicians for telehealth and telephonic services the same way they would if those patients were physically in the exam rooms.
In addition, insurers and Medicaid programs need to cover all addiction treatment medications without prior authorization today. At a minimum, Health and Human Services Secretary Alex Azar needs to double the Drug Addiction Treatment Act waiver patient limit to allow addiction specialist physicians who treat patients with OUD using buprenorphine to take on bigger caseloads.
Next, we need Congress to invest in a more robust addiction treatment workforce and systemically expand access to mental health and addiction treatment. There are already programs in place to help clinicians who train in addiction treatment repay their student loans and to fund their training. Congress should expand those programs to incentivize more clinicians to specialize in addiction treatment.
Addiction treatment centers need immediate crisis funding the same way that hospitals do right now, to purchase needed supplies including personal protective equipment, hire staff, implement telehealth technologies and adjust their operations to meet the dual demands of physical distancing and an onslaught of patients in crisis. Finally, Congress must also increase treatment access through Medicaid, our largest payer of behavioral health services, by raising the federal match for increased mental health and addiction treatment services and expanding coverage to people who are about to re-enter the community after being incarcerated.
In an unprecedented move by numerous organizations in the fields of addiction and mental health, stakeholders have coalesced around specific provisions requiring emergency supplemental funding for addiction and mental health disorder treatment providers. Their urgent request of Congress to include immediate funds in the next stimulus package will help keep these behavioral health organizations solvent and open to serve Americans in desperate need of ongoing services.
We have seen our country make once unthinkable changes to our everyday lives in a matter of mere weeks to “flatten the curve” of COVID-19. Congress has passed legislation, and the administration and state governments have changed regulations at record speed to infuse our economy with money and to support many parts of our health care system. Now we need a similar sense of urgency when it comes to responding to the mental health and addiction ramifications of the COVID-19 pandemic and to ensuring that we have a healthy workforce after this pandemic passes.
Our patients’ lives — and the future of our nation’s economic recovery — depend on it. It’s time to invest in a recovery of a different kind.
Shawn A. Ryan, MD, MBA, FASAM, is chair of the ASAM Legislative Advocacy Committee.
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