To enter the drug treatment system, such as it is, requires a leap of faith. The system operates largely unmoved by the findings of medical science. Peer-reviewed data and evidence-based practices do not govern how rehabilitation facilities work. There are very few reassuring medical degrees adorning their walls. Opiates, cocaine and alcohol each affect the brain in different ways, yet drug treatment facilities generally do not distinguish between the addictions. In their one-size-fits-all approach, heroin addicts are treated like any other addicts. And with roughly 90 percent of facilities grounded in the principle of abstinence, that means heroin addicts are systematically denied access to Suboxone and other synthetic opioids.
…While medical schools in the U.S. mostly ignore addictive diseases, the majority of front-line treatment workers, the study found, are low-skilled and poorly trained, incapable of providing the bare minimum of medical care. These same workers also tend to be opposed to overhauling the system. As the study pointed out, they remain loyal to “intervention techniques that employ confrontation and coercion — techniques that contradict evidence-based practice.”
…Chrysalis House …has more success than most, with about a 40 percent dropout rate, administrators said, but among those who complete the program, roughly half will relapse within a year. Many, if not all, had previous treatment stays.
…What addicts face is a revolving door, an ongoing cycle of waiting for treatment, getting treatment, dropping out, relapsing and then waiting and returning for more.
…The squeeze of regulation has left the door open for more opportunistic forces, such as cash-only clinics and shady doctors. A vibrant black market has sprung up.
…Even for doctors trained in addiction medicine — motivated to treat opioid addicts with buprenorphine and able to work within Medicaid’s numerical limits — there are still roadblocks. Kentucky’s Medicaid program, like those of many other states, requires prior authorization before it agrees to pay for the medication. One managed care organization mandates such authorization every month. And negotiations, Kalfas said, can take an illogical turn: Medicaid has tried to deny payment for Suboxone if a patient has failed a drug test while it has also used clean tests to deny payment. Why pay for Suboxone for a drug-free patient?
…Addicts going outside Medicaid face potentially prohibitive costs. At Droege House, a publicly subsidized detox center in Northern Kentucky operated by Transitions, Inc., addicts must pay $410 up front if they want Suboxone and additional fees depending on whether they enroll in an outpatient or a residential program. It can end up costing them thousands of dollars. Laura Duke, who was recently the detox unit’s supervisor, said the cost put the medication out of reach for all but 1 to 2 percent of the addicts she saw.
Dying To Be Free – The Huffington Post
hmmmm
