ON THE FRONTLINES OF THE OPIOID CRISIS.

AuthorStrach, Patricia
PositionMEDICINE & HEALTH

IN A PREVIOUS research piece, we introduced the "illusion of services," or the disconnect between opioid treatment services that appear on paper and people's actual ability to access them in person. We highlighted several obstacles to access, including the lack of medically supervised detox, length-of-stay restrictions, and regulations that make it easier to prescribe opioids than medication-assisted treatment--but how do we end this illusion of services?

Part of the answer will be complex policy changes, but part of the answer is making sure everyone is on the same page: sharing information about accessibility, existing laws, and new research. We spoke with Rob Kent, legal counsel for the Office of Alcohol and Substance Abuse Services (OASAS). Afterwards, we identified several takeaways that everyone on the frontlines of the battle against opioid abuse should understand.

Anyone who wants to get treatment should be able to get it. Not every individual requires inpatient detox but, even if patients are not presenting physical withdrawal symptoms, they should be connected to adequate services. Under the law, if a hospital does not provide substance use disorder services, "then it shall refer individuals in need of substance use disorder services to and coordinate with substance use disorder service programs that provide behavioral health services."

Furthermore, when a person with a substance use disorder is discharged, "the hospital shall inform the individual of the availability of the substance use disorder treatment services that may be available to [him or her]." As Kent observes, discharging people into a parking lot or telling them to come back when the symptoms are worse is not considered an adequate referral. The Department of Health's website lists hospital patients' rights, while the ER Survival Guide provides advice to individuals who have been turned away.

Insurance companies cannot require patients to get prior authorization for inpatient or outpatient substance-use treatment in certified OASAS facilities: New York, for example, eliminated insurance prior authorization requirements in 2016.

Moreover, it is illegal for an insurance company to tell individuals that they must fail at outpatient treatment before they will cover inpatient treatment: "fail first" policies, also known as "step therapy" protocols, are insurance policies that begin with the most cost-effective therapy and move to other, more-costly therapies only if...

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