Twin Health Crises, COVID-19 And Opioids, Await Biden Administration

At Stella Maris, a nonprofit addiction recovery center on Cleveland’s West Side, the wait list for detox is more than 200 names long.

For those on that list, this moment is “the window of opportunity,” according to Daniel Lettenberger-Klein, Stella Maris’ director.

“Somebody might choose to go out on another run. They might have an overdose death. Literally, it is choosing between life and death, the coming into treatment or not,” he said. “And if somebody’s willing at that moment when they call, there’s no guarantee that when we call them back two days later when we have a bed for them, that they’re still willing.”

It’s just one sign that the opioid crisis continues to tear through Ohio, even though a different public health emergency — the coronavirus pandemic — overshadowed it in the recently concluded presidential race. President-elect Joe Biden’s administration will have to confront both crises when the Democrat assumes office in January.

Ohio treatment providers hope the new president will make fighting the addiction crisis a priority, preserving the Affordable Care Act’s Medicaid expansion and funding recovery services.

The number of unintentional drug overdose deaths rose dramatically in Ohio from 2010 to 2017 before dipping in 2018, according to the state health department. Last year, the death numbers grew again to more than 4,000. Figures for 2020 are not yet available.

Biden’s coronavirus task force should consider how the pandemic complicates the opioid crisis, leaving people to face their addictions in isolation, said Cheri Walter, the CEO of the Ohio Association of County Behavioral Health Authorities.  

“When you talk about mental illness and addiction, you’re kind of talking about those issues of despair, where people are losing their jobs, they can’t see their families,” Walter said. “I mean, we’re talking about the holidays, which are normally hard for people.”

Treatment providers credit Medicaid expansion with making it possible for many more Ohioans to afford recovery services, especially adults without children. Ensuring that Medicaid remains well funded is one of the biggest actions Biden could take on the opioid crisis, Ohio University associate health policy professor Dan Skinner said.

Gov. Mike DeWine appointed good administrators to face the opioid epidemic, Skinner said. But states don’t have the money to go it alone, which is why federal intervention is necessary, he said.

“I would assume that that’s one of the lessons the Biden administration is going to learn about a number of things, especially COVID but the opioid crisis as well,” Skinner said. “To convince states to take action, you need to offer support. States can’t bankroll some of these huge health crises.”

For instance, he recommended that Biden keep in place a pandemic-related bump in federal payments for state Medicaid programs.

The federal government has been funding opioid-crisis spending with the bipartisan Comprehensive Addiction and Recovery Act, which was sponsored by Ohio’s Republican Sen. Rob Portman. This year, the act made $658 million in grants available, according to Portman’s office.

Providers also want Biden to enforce “parity laws” requiring insurers to cover addiction recovery to the same degree they cover other health procedures. It’s something the campaign has pledged to do. But the hope is that Biden will go further, expanding the types of services eligible for Medicaid reimbursement.

“In the best of all worlds, we’d love to be able to see Medicaid cover room and board for people who are in residential treatment,” said Walter, who represents county agencies that fund addiction recovery. “We’d love to see Medicaid continue with individuals and help pay for recovery housing.”

Lettenberger-Klein, the director of Stella Maris, said the new administration should work to keep the price of prescription drugs used to treat addiction low.

The expansion of telemedicine during the coronavirus pandemic may actually be helpful for people in addiction recovery, Skinner said. He recommended continuing a Trump administration relaxation in health privacy enforcement that eased the way for video calls with doctors.  

That could help treatment providers better reach those who live far from recovery centers, Skinner said. But it could take an investment in rural internet access to lay a strong foundation for those services, he argued.

“If you’re in Columbus or Cincinnati or Cleveland, or one of the other major cities, there are pretty good services and supports that have been put into place over the last few years,” Skinner said. “But if you’re living in a rural area, you likely do not have that same kind of capacity.”

Treatment providers are already experimenting with telemedicine during the pandemic, switching in-person sessions to remote ones, for instance. It has forced them to balance coronavirus precautions with the social connection they say is necessary for people in recovery.

Jonathan Wylly, the director of IBH Addiction Recovery Center in Akron, worries that already-strapped providers will see a “post-COVID surge” in people seeking help with drug dependence, underscoring the need for a federal response.

“I think it’s been well documented, the increased level of anxiety and substance abuse that’s going on through the pandemic, because the pandemic is trying to be solved through isolation,” he said. “Well, that may be a solution for the pandemic and for COVID, but that’s just the opposite of what our folks need.”

Even so, Walter said help is still available.

“There are all kinds of places you can get help right now,” Walter said. “I think one of the things people think is a lot of doctors’ offices and so forth, they’ve ratcheted back what they’re doing. The recovery system is still open in the state of Ohio.”