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Untreated: Suboxone

Suboxone is made up of 80 percent buprenorphine, an opiate that satisfies cravings, and 20 percent naloxone, an antidote that blocks a high and reduces the risk of overdose. It is safer than previous medications, like methadone, if it is not used with other drugs, but can be abused for a mild high at large doses.

Tailyr Irvine for the Missoulian

When we should be moving forward with increased treatment options for substance abuse, we are heading in exactly the opposite direction.

Montana’s revenue shortfall continues to cause drastic cuts to services for Montana’s most vulnerable populations. To date, cuts have been implemented that have severely reduced local capacity, caused the closing of treatment programs, eliminated case management services for persons with serious mental illness and for persons with other disabilities required large numbers of staff to be laid off (60-plus at Western Montana Mental Health Center), and put in jeopardy our ability to continue to treat our clients through community-based programs. These cuts are worse than the managed care debacle when the state partnered with an out-of-state company, Magellan, in the mid-1990s.

The state wisely expanded substance use disorder service options through Medicaid expansion so that enhanced treatment could be provided. This should have been excellent opportunity to increase access, as most states did when they passed Medicaid expansion. However, the Department of Public Health and Human Services is proposing additional cuts to treatment for our behavioral health clients.

Proposed for March 1 implementation: a 2/3 reduction of reimbursement rates for assessments and group therapy, time restrictions for groups, new additional “utilization review processes” which add administrative cost and complexity to an already underfunded system. There will be fewer funds available in the future than that which existed under the old system and no one seems to know where the funds that were available before Medicaid expansion passed have gone. DPHHS is, wittingly or unwittingly, forcing a reduction in access to available treatment at a time when common sense dictates an improved response.

Substance use disorders and mental health conditions overlap 80 percent of the time. These are people living with a substance use disorder from alcohol, prescription drugs or substance use. We find ourselves on the front line of a national epidemic. According to Montana’s Attorney General Tim Fox, one in 10 Montanans is dependent on or abusing drugs or alcohol (AID Montana, "Substance Use in Montana," Montana Department of Justice, September 2017).

The DPHHS state plan for 2018 lists as its first goal, “To provide evidence-based program supports and services that improves and sustains the recovery of individuals with substance abuse disorders to provide needed services to a minimum of 10,000 people per year.” (DPHHS, Substance Abuse Prevention and Treatment Services State Plan 2015-2018).

However, the new rules and rate reductions proposed by DPHHS actually will grossly reduce the availability of services in Montana communities. These reductions in reimbursement further cripple the ability to pay a fair wage to the clinicians who serve these clients. These short-sighted measures only result in a shifting of costs to the criminal justice system, our hospitals, emergency rooms, social services, foster care and Montana State Hospital. Let alone the guaranteed increase in deaths from overdoses that accompany a lack of available resources.

These proposed changes appear arbitrary and not well thought out. In any medical treatment system, one seemingly small or relatively insignificant change causes a domino effect on the entire treatment delivery system, which results in devastating reductions in the treatment efficacy. These changes are neither based on best practices nor do they align with the national standards of care. If the proposed rules are brought into being, Montana will experience a collapse of treatment for substance use disorders, simply because we cannot afford to sustain our services.

This opinion is signed by following medical directors from Montana’s four comprehensive community-based mental health centers: Daniel Nauts and Edward Erbe, Western Montana Mental Health Center, Missoula; Eva LaRoque, Center for Mental Health, Great Falls; Bruce Whitworth, South Central Montana Regional Mental Health Center; Joan “Mutt” Dickson, Eastern Montana Community Mental Health Center, Miles City.

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