Since I joined Phoenix House New England in 1999, addiction to opioids, a class of drugs that includes prescription painkillers as well as heroin, has quadrupled nationally, and the states in this region have been particularly hard hit. Thankfully, our leaders are taking notice—and action. Most recently, Massachusetts Governor Charlie Baker created an Opioid Working Group to devise “specific, targeted, and tangible recommendations” for reversing this troubling trend.
The commission released those recommendations last month. They touch on important issues and current thinking: more treatment beds, wider access to naloxone (the opioid overdose antidote), and a concerted effort to educate various segments of the population, from the medical community to students and pregnant women. These are important, vital steps, and I applaud the members of the commission for putting them out there with the urgency they deserve.
But the opioid addiction epidemic isn’t an ordinary crisis, and it won’t be solved with ordinary thinking alone. While the group’s recommendations are all vital, I wondered: What out-of-the-box ideas were explored behind closed doors—and will they be a part of the larger effort?
So I asked the following questions of one group member, John McGahan, President of the Gavin Foundation. Our organizations have collaborated on several fronts, especially in the creation of our Intensive Treatment Services Program. I know John to be an innovative, dedicated advocate for those struggling with addiction. He gave me a fuller picture of the Working Group and told me where he hopes the recommendations will lead and how we’ll get there.
Q: Were you pleased with the findings that came out of the Working Group?
A: Yes, I thought there were a lot of good recommendations. It was a large group, so there was quite a lot of diversity about which way to start, but I was happy with the outcome of the report. There were a couple of things I wish had gone in it, but for the most part, I was very pleased.
Q: What were the couple of things you wish had gone in it?
A: First, I’ve got to give the Governor a lot of credit. I was fortunate enough that I also sat on Governor Patrick’s task force [on opioids], a little over a year ago. Governor Patrick focused on what DPH [the Department of Public Health] could do. Governor Baker and Secretary [of Health and Human Services] Sudders looked at who else should be involved and went across a lot of areas.
One of the things I tried to see if we could get accomplished was how to add onto the recovery homes more tools that would help young folks….. We’re seeing uneducated and unskilled people coming into [addiction treatment] programs. I would have liked to see more job training and education programs tacked on to the long-term programs.
Q: You’re saying that we need to have a case management type of arrangement, where ancillary services are available—because sometimes it’s not rehabilitation, but rather habilitation.
Q: We need to find a way for these clients to get into the job market, get their self-esteem back, and take steps toward success. A sober living house without a job and way to pay the bills doesn’t lead to a successful experience.
A: Exactly. The outcome isn’t the desired outcome. Someone can complete a [long-term addiction treatment] program and be clean and sober, but if they don’t have skills to move forward in their everyday life, they’re inevitably going to revert back to using because they feel like they’re getting nowhere.
Q: The Governor did a fantastic job of getting a diverse cross-section of government and industry representatives, including nurses, other medical personnel, recovery professionals, and law enforcement. I love what the police chief of Gloucester is doing: decriminalizing people who come in and seek help, and bringing them to treatment. I would love to do that in our area. Did any conversation come up in the committee about the Draconian criminal justice approaches? It can be very hard for people to get help for a child or other family member if they fear that his or her entire life would be destroyed with an arrest. We’ve always used the criminal justice system as a coercive force. How do we use it as a force for good?
A: Two things came up. One was to move Section 35 [civil commitment for someone who is a danger to themselves or society because of their substance use] beds out of the Department of Corrections, which would de-stigmatize it, and hopefully make it more open to certain communities and populations. Right now if you “Section 35” a 25-year-old woman, her first foray into treatment will be inside a jail, a prison—which is horrible. You’ll never get her back voluntarily if she thinks that’s what treatment is all about. That is one of the action plans the Governor and Secretary are committed to. They’re also committed to increasing beds for women. They’re actually going to double beds for women. And that’s a great thing.
Q: What do you think is the most important thing to come out of the Working Group?
A: The approach this administration is taking is to not put it all on DPH, but rather to de-silo addiction and ask who else can be helpful in solving this problem. For example, the Department of Education can be helpful in two ways: institute a prevention curriculum in middle school and up; and educate students and parents in the same manner as, say, concussions…. The Department of Children and Families can be helpful on neonatal education of pregnant women…. Those are just some examples. [The administration is] also working with the Division of Insurance. The Governor and Secretary deserve a lot of credit for this approach.
Q: In Massachusetts, 99.3 percent of the population is insured. We see a disproportionate share of that .07 percent, but, primarily, this epidemic affects the 99.3 percent. Shouldn’t insurance companies be paying for beds instead of the state? When people start treatment earlier, and are there for an appropriate amount of days, there are better outcomes, which is more profitable for the insurance companies in the long run. But they often pay too little too late. Did that come up in the discussions?
A: Yes. We’re working to make sure insurance companies pay a fair rate for the coverage and that they cover people for a long enough length of time. That was one of the findings of the Commission, and the Secretary is working with the Division of Insurance to make it happen.
Q: Is there anything you want to add?
A: Another thing that came out of the Group is that we’re going to be doing sober homes certification. That’s vitally important, because as people leave long-term programs like Phoenix House and Gavin House and go onto independent living, they’ll know that there’s a certain standard of care to which the homes are held. That means that all the work the clients have done can go on in a safe environment. That becomes an important tool because if you leave a program and go to a sober home that’s not good and you relapse, you’re back in the system.
Another piece I think is important is that the Governor and Secretary really want to strengthen the language around the PMP [prescription monitoring program]…. That will have a big impact as well.
The Governor has charged the Secretary to get moving, and he is expecting regular reports. There’s a lot of momentum surrounding this.
President and Chief Executive Officer
Phoenix House New England
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