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  May 31, 2017

How Insurance Companies and Prisons are Making the Opiate Crisis Worse

A longtime addiction specialist says health insurance companies' reluctance to treat heroin addiction as an emergency and prison officials' refusal to allow inmates access to methadone are only making a bad situation worse by Taya Graham and Stephen Janis
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Taya Graham: This is Taya Graham reporting for the Real News Network in Baltimore City, Maryland. I'm standing outside a Baltimore-based treatment center. "Ground Zero" in our country's battle against opium abuse. But, amid all the public concern, the question remains. Does this strategy touted by politicians actually address a problem? Or, is all the public handwringing about what to do to fight addiction masking a bigger issue: the culture of the war on drugs? To answer this question, the Real News will be talking to people with a firsthand perspective on the problem. Medical professionals and addiction workers and people fighting it in their own lives. Our first interview is with Marian Currens, a woman with over forty years experience in the field, who has a firm grasp of what does and does not work when it comes to opium abuse treatments.

So, the price of Narcan was tripled, recently, actually by the pharmaceutical company that holds the patent for it. Has that affected your ability to give out Narcan to people who need it?

Marian Currens: We, in Maryland are really blessed that Medicaid will cove Narcan. So, thank goodness, there are several different products of Narcan. Some that are very difficult to use, you have to take pieces apart and we put an atomizer in and the atomizer was recalled, so we don't do that anymore. A product that came along, that was a really cool product, was called [inaudible 00:01:21] and the company gave us five hundred doses which I gave out to my staff, it was for free. To buy the [inaudible 00:01:29], a couple years ago, it was $500. But, they gave it to us for free. But, it got our patients. They liked it. Bop it on the leg and it talks to you. That product right now, I checked with our pharmacist just last week, is $4500, if you would buy that medication today. So, it's just crazy.

One of the things that, in my particular office, we were gonna go in - they were gonna tear down our building. And so, Dr. Hayes and I decided, we're gonna go into the neighborhood and we're gonna try to rent a building downtown. Went to at least twenty different buildings that were up for lease and said, we want to come here and we want to treat our patients here. They said, 'Oh okay. What kind of patients do you treat?' And I told them I treat patients who have substance abuse disorder. 'Nope. Not here. Not in my backyard.' The NIMBY phenomena. We were turned down twenty times in Baltimore City. We could not find a place where we could put up a program to be able to help our substance-using patients. There are lots of different programs that are opening up right now. Why are they opening up? How do they get to open up? And that's because they don't always tell the community until it's too late.

Taya Graham: What are the barriers to addiction treatment? What prevents people from getting help?

Marian Currens: The insurance company doesn't consider heroin as a medical necessity to admit you to the hospital. So, they say, okay. Go find treatment. All right, it's midnight at night. Where you gonna go? So, we have an office across the street. So, we open at six in the morning. The emergency room usually lets their patients stay there until 6:00. They walk them across and there we are. Ready for them, with open arms, to see our patients.

Taya Graham: Some people say methadone and other forms of opiate maintenance are just as bad as heroin if the people aren't really getting sober, they're not in recovery. What do you say to those critics?

Marian Currens: I've heard that so many times. And again, it goes back to my nursing. I believe that addiction is a disease. It's a disease that needs to be treated. And, it's a chronic disease. It's not something that goes away. Sometimes, people relapse. But that's part of the process of recovery. So, if you're on a medication, it's okay. If I told you, you had high blood pressure and you needed to be on blood pressure medicine, what would you say? Well, I'd take it. I have to because it's what I need to manage my disease. There's no difference between Methadone and Buprenorphine. I think that some people don't act well on Methadone and that makes a bad stigma in the neighborhood, but those are more of an exception to the rule.

And, many people - if you're managed correctly, if the healthcare provider is giving you good care, there's no way you can tell a person is on Methadone. You should not. That patient - I have people that have been with them for thirty years. You could not tell they are on Methadone. They go to Annapolis with me, they hold high-ranking jobs, they're public officials, they're nurses, and they're in treatment. But they're healthy and they're going to stay healthy with the right treatment for as long as it takes.

Taya Graham: Some people believe that addiction treatment centers, like Methadone clinics, create problems. They don't want them in their neighborhood. How do you respond to those people?

Marian Currens: And, I would say to them, in that association meeting, I would ask them, do they know anybody that's ever needed treatment? And in that room, you won't find anybody that hasn't known somebody that needed treatment. There have been more deaths - and I have some of the statistics here with me, about how many lives have been lost in the past year for heroin overdose, prescription drug overdose, for unnecessary loss of life. I think there's a stigma against Methadone as you mentioned earlier. People are afraid of it. That's because they don't know. They only see some people in the corner that may not be acting as appropriately as they should be. But, education - inviting them into the programs, letting them see, letting them understand that medications are safe.

Taya Graham: What do you want the public to know about opiate addiction and addicted people?

Marian Currens: Treatment works. You have to allow a patient to open their lives, go to treatment. It's not about what mom wants, what grandma wants. It's got to be about what the patient needs and the patient actually can follow, a life of recovery.

Stephen Janis: So the city has a predominant, almost more than the majority of Methadone clinics. Doesn't it seem one of the reasons people seem to resist it is because we, in the city, have the most? And, why are most of them in the city?

Marian Currens: There's a lot of them in the city. Aren't there? And, a lot of patients that attend them. But again, Baltimore city is a very impoverished city. It's a very - not a lot of economy in our city. And that's what breeds some of the addiction in our community. So, as I don't want a lot of - I want recovery and recovery goes where the patients are. And, they're here in Baltimore city. And, if you - there's a lot more growing in the county too. There had to be three of them opened up in the past month in the county. So, it's an east coast phenomenon.

Stephen Janis: But most of the money still goes to law enforcement? Do you think that's a mistake?

Marian Currens: I think we have to treat our patients, not jail them.

Stephen Janis: Do you think the war on drugs has been a failure?

Marian Currens: I think that - not a failure so much as I'd love to see it so much better. I think there needs to be treatment behind the walls. I get very, very upset when I do have a patient who is on Methadone or even Buprenorphine, who becomes incarcerated for whatever reason, that they can't get treatment. It's just pulled right out from under them.

Stephen Janis: So, that is true? They can't get Methadone or Buprenorphine when they're locked up?

Marian Currens: Absolutely. There's only two - I think three now, systems that give Methadone to their patients when they are incarcerated. Baltimore County will not. If you get arrested and put in Baltimore County, they put on their three-day taper not using Methadone. Baltimore city does keep their patients on Methadone. They'll call me and say 'Marian, I have Joe in incarceration and send me a confidential signature, and they'll continue that patient on Methadone.' While they're incarcerated in the city and in Annapolis is the second place. But, every other place that you go to, they will not continue them on their medication.

Stephen Janis: What about Buprenorphine?

Marian Currens: No.

Stephen Janis: None of them?

Marian Currens: No. No.

Stephen Janis: So, the people who end up on Buprenorphine in jail go cold turkey?

Marian Currens: Yes.

Stephen Janis: What kind of effect does that have on the patient?

Marian Currens: It's miserable. But, as I said earlier, if you have a patient who has a heroin problem and they go to the emergency room, the insurances do not consider an opiate dependency as a medical necessity. So, they will not admit you to the hospital unless you have a life-threatening illness. That would be an alcohol withdrawal that might give you seizures or a benzodiazepine withdrawal, like Ativan, Valium, Xanax, that might give you seizures. Those are the things that will put you in the hospital, that will meet the medical criteria. But, opiates alone - according to the DSM criteria - do not the medical necessity for an in-patient admission.

Stephen Janis: So, even given the opium crisis and all the publicity, when you go to the hospital with an opium emergency, it won't be treated as an emergency? Is that what you're saying?

Marian Currens: That's what I'm saying.

Stephen Janis: Is that wrong?

Marian Currens: I think that - and again, our state of Maryland is doing something absolutely phenomenal in that they are opening up in July - they're allocating more money to be able to put in for residential treatment facilities. So, we'll be able to get more facilities, not in the hospital, but in a residential treatment facility. Some things changed a couple of years ago when we changed from an MCO to an ASO and the IMD waivers, a lot of different numbers and letters, that are confusing sometimes, but what it meant is that inpatient rehab's weren't covered by our Medicaid system. So they've made some changes and they're with a lot of pull in Annapolis. And, our legislators were going to be able to get a lot of that treatment back.

Stephen Janis: [That proposal] to give people a place to go and take their heroin, that's safe, that's clean, do clean needles. Do you support that? And, what do you think of that idea?

Marian Currens: I've seen it, it's in Vancouver, I believe now. And over in Europe. And it seems to be very successful there. I, personally, have - a little scared about it, I would not want to be the nurse that works in that particular facility. But, I don't know enough about it to be able to say that I would support it. I was a little afraid of the needle exchange when first learned about it. I go, 'Really, what is that?', but then I worked the needle exchange van and I was in the vans on the corners and I have the patients coming into the van and how happy they are and how happy I am to be able to give them needles that are clean and safe. It's better than treating them when they are dying of HIV.

In our particular treatment program, 53%t of our patients on Methadone in our program are Hepatitis C positive. For awhile, that was almost a death sentence itself, like HIV was. Only 3% of our patients are HIV positive now. And so, they've learned how to be able to have good behaviors. And so, I believe that the Methadone or the Buprenorphine has decreased their risk of other communicable diseases.


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