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State's Opioid Action Plan proposes solutions. But does it go far enough?

Belleville News-Democrat - 12/23/2017

Dec. 23--Three months after Gov. Bruce Rauner released the state's Opioid Action Plan, decisions on solutions and funding have yet to be resolved.

"Illinois needs a comprehensive opioid strategy that destigmatizes addiction and appropriately aligns resources across state agencies in partnership with community priorities," Lt. Gov. Evelyn Sanguinetti said in a news release.

The main goal of the Action Plan, which outlines programs to work on specific issues of the crisis, is to slash by a third the projected number of increasing overdose deaths in which heroin and opioids played a role, from about 2,750 to 1,850, which is fewer than the number of deaths in 2016. The plan was released on Sept. 6, but there is no time line to release how programs will be implemented.

The report is the first multi-agency statewide approach to address the opioid epidemic, according to Illinois Department of Public Health spokeswoman Melaney Arnold, but not everyone is pleased with it.

"It's a crock," said Rep. Lou Lang, D-Skokie, who authored the 2015 Heroin Crisis Act, which strengthened drug laws. "This is a governor that completely ignored the work the legislature did for a year and a half ... and now he wants us to think he cares about opioids?"

Speaking for the governor's office, Sanguinetti took issue with Lang's assessment.

"We're hoping not to go the political route like it seems Lou Lang wants to," she said. "There is enforcement, and we respectfully disagree with his rendition of the facts."

In addition to expanding Medicaid coverage to all forms of medication-assisted treatment, the Heroin Crisis Act also strengthened requirements that insurance providers reimburse mental health claims, which includes substance use, at the same level as medical and surgical claims. The idea is that if insurers reimbursed more, then doctors would treat addiction more.

"It's not a cure-all," but it is important, said David Lloyd, the policy director at the Kennedy Forum, a national mental health organization with a presence in Chicago. It hard to know whether parity exists, though, because analyses of insurance plans' treatment limitations for different types of coverage aren't public, he said.

"We think it is critical for regulators to ask for the analyses that plans should already be doing and verify that the analyses do, in fact, demonstrate compliance with parity laws," he wrote in an email.

In addition to the question of money, parity goes to the heart of one of the biggest obstacles of the opioid epidemic: stigma. Changing the way people view addiction is difficult, but failing to provide similar coverage for recovery services reinforces and institutionalizes a way of thinking.

"(Parity is) fundamentally an anti-discrimination law," Lloyd said.

About the Opioid Action Plan

The Opioid Action Plan addresses three main issues -- preventing people from using drugs, treating those who have and stopping those who do from overdosing -- through a variety of programs, and though some have unrolled statewide, others are still local or grant-funded, could limit their reach.

An example of an ongoing function is the state's interest in speaking to middle- and high-school students about substance use and learning how young people use and think about controlled substances.

Since the biennial Illinois Youth Survey began in 1993, about 215,000 students have supplied information for schools and health workers, according to the Action Plan.

In addition, the governor's office announced on Dec. 5 a 24-hour hotline people can call for "immediate assistance" about opioids and other drugs. And, on Dec. 13, Rauner signed legislation that expanded the state's Prescription Monitoring Program, which records controlled substance prescriptions, to require doctors and others to check the program when they write some prescriptions to patients for the first time, which is expected to decrease doctor-shopping.

At the same time, programs like linkage services, which connect drug recovery coaches with people at hospitals when they're treated for opioid use disorder, are new and have limited resources. One outreach project is being funded by part of the $16.3 million Opioid State Targeted Response grant, but it will fund teams at just seven hospitals. A second year of the federal grant was announced on Oct. 30.

After the Action Plan was released, the Opioid Task Force, which was established on the same day, began a three-day tour around the state to learn what local methods were being used to fight addiction.

"I can sense the incremental improvements," said John Roberts, who founded the Heroin Epidemic Relief Organization after his son died of an overdose, at one of the listening stops in Chicago.

Roberts appreciated the framework of the plan and liked that more attention was being paid to school intervention, but thought it would be years before overdose levels decline. Confronting the problem at all levels would be a test of funding and follow-through, he said.

Angie Bailey, the community benefits manager for the Southern Illinois Healthcare hospital system, which serves the lower 16 counties of the state, also praised the plan's framework.

"It's not going to just take healthcare and substance-abuse agencies. It's really this multipronged approach," she said.

The Targeted Response grant provides funding Southern Illinois Healthcare to teach 45 medical professionals about the benefits of medication-assisted treatment, which helps control opioid cravings, Bailey said. Going forward, she hopes to see more coordination from the law-enforcement and justice system.

The Action Plan could address some of Bailey's concerns. Illinois currently funds a program offering pre-release injections of Vivitrol, which has been known to decrease opioid cravings, and post-release referrals to recovery services, at the Sheridan Correctional Center and the Cook County Jail. The Targeted Response grant will expand these services at six high-need jails throughout the state with possible expansion to others, but it is unknown whether the program will exist statewide.

Addressing parity

The Action Plan is full of targeted programs, but the Kennedy Forum doesn't think it spends enough time addressing the issue of parity.

"The lack of urgency around this issue is not only palpable but tragic," said its director, Kelly O'Brien. Parity is just one issue concerning insurance plans, but when it's not enforced, people are covered by the state of Illinois, which passes costs onto taxpayers.

A December study from Milliman, a consulting group with a focus on healthcare, that was released by mental health groups found that people paid for behavioral health, which includes substance use disorder, at out-of-network rates at between 1.5 and 3 times the rate of medical and surgical claims for inpatient and outpatient treatment from 2013 through 2015.

Out-of-network payment rates are one way of measuring the quality of insurance coverage when claims aren't paid at lower, in-network rates. According to Milliman, which looked at claims for plans that covered 42 million people in 2015, Illinoisans paid about 6.9 percent of medical and surgical claims out of pocket but paid 17.3 percent of behavioral health claims out of pocket that year.

The Heroin Crisis Act mandated that the Department of Insurance review and enforce parity laws, but the Kennedy Forum says the department hasn't reported how it's working on the issue.

So far, there hasn't been a single complaint filed by the insurance department against insurance companies regarding parity, according to Rep. Lang.

"It's not possible," he said.

The Department of Insurance said that it regards mental health parity as a top priority.

"Over the next year, DOI is conducting targeted market conduct examinations to ensure that health insurance coverage for mental health and substance use disorders is treated the same as for medical or surgical care," said Whitney Barnes, the department's spokeswoman.

Casey Bischel: 618-239-2655, @CaseyBischel

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(c)2017 the Belleville News-Democrat (Belleville, Ill.)

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