While Florida may be viewed as the RECOVERY capital of the United States, it appears that West Virginia is the OVERDOSE capital. And there is great panic in the state that the promises made by Donald Trump to fix that problem have now fallen by the wayside.
There were about 39 drug overdose deaths per 100,000 West Virginia residents as of 2015, according to state data. Additionally, 31 of every 1,000 births in the state involve a baby born with neonatal abstinence syndrome, which is the result of substance abuse among pregnant women. The state “has the highest rate of drug overdose deaths in the country, more than double the national average,” Cynthia Beane, acting commissioner of the Bureau for Medical Services for the state’s Department of Health and Human Resources, said in a letter to the CMS in December of 2016.
Back in early January, Modern Healthcare reported how West Virginia was asking CMS (the Centers for Medicare & Medicaid Services) to approve a waiver that would expand treatment for Medicaid enrollees.
Medicaid beneficiaries are at three to six times the risk of opioid overdose, the CMS reports.
In 2015, California received approval to expand its substance abuse offerings to include partial hospitalization services, residential treatment services and recovery services. Massachusetts got the green light for a similar waiver last year.
It’s unclear how the incoming Donald Trump administration will view this and other similar waivers but his administration picks have supported increased state control over Medicaid spending.
Trump’s administration could deny West Virginia’s waiver and terminate the waivers already granted. A standard provision in each waiver’s terms and conditions allows either a state or the CMS to terminate a waiver at anytime.
U.S. Rep. Tom Price, Trump’s pick for HHS and a strong opponent of the Affordable Care Act, wants state governments to determine how to spend their healthcare dollars.
During the campaign, Trump promised to give people struggling with addiction treatment options. He committed to expanding incentives for states and local governments to use drug courts and mandated treatment and dramatically expand access to treatment and end Medicaid policies that obstruct inpatient treatment. However, few details were revealed and he hasn’t again discussed the issue.
Trump’s commitment to repealing the ACA, which expanded Medicaid coverage for millions of people, could worsen the nation’s addiction woes. In the 31 states that have expanded, 1.2 million individuals with substance abuse disorders have gained access to coverage, according to Manatt. In non-expansion states, at least 1.1 million uninsured adults with substance use disorders would have access to coverage if their states were to expand.
West Virginia consistently leads the nation in drug overdose deaths. President Trump and other candidates addressed the nationwide addiction crisis many times on the campaign trail, sometimes with testimony from family members of those affected.
Now, people who have been affected by the crisis are looking to the president for help. But the disarray at the Trump White House is causing this public health emergency to have to wait to get in line.
Many West Virginia’s are worried about politicians’ talk of repealing the Affordable Care Act and, in particular, the popular Medicaid expansion program. Some residents get their health insurance through the federal Medicaid program, which was expanded under the ACA and now covers more than half a million West Virginians — more than one-quarter of the state’s residents.
Trump’s promise to undo the health law could compromise anti-addiction efforts, says Michael Botticelli, the Director of the White House’s Office of National Drug Policy under President Obama, a post he assumed in early 2014 as the opioid epidemic began making national headlines. The drugs, which claimed more than 33,000 lives in 2015, include heroin and painkillers like OxyContin. Botticelli points to Medicaid, the federal-state insurance for low-income people, which payed for about $60 billion worth of mental health services in 2014. It’s now expected to shrink.
Meanwhile, the West Virginia Department of Health and Human Resources (DHHR) plans to distribute more than 8,000 naloxone rescue kits to react to the health crisis. The state-level naloxone distribution project is a partnership of DHHR’s Bureau for Behavioral Health and Health Facilities (BBHHF) and Bureau for Public Health (BPH). The project is being funded primarily through a $1.07 million federal block grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance Abuse Prevention and Treatment. The grant is being managed by the BBHHF, and is being administered by the BPH as part of its statewide harm reduction efforts.
BBHHF Deputy Commissioner Kimberly Walsh said the partnership marks the first concerted, statewide effort to make naloxone more widely available to all who can potentially save a life.
“This initiative will significantly enhance the state’s ability to ensure that non-EMS first responders, as well as others with existing programs or those who have interest in establishing programs, have access to naloxone,” Walsh said.
DHHR has contracted with the West Virginia University Injury Control Research Center (WVU ICRC) to implement and evaluate the program through a census of existing naloxone programs. The WVU ICRC will use the data collected from its recent survey to compile a priority list of programs for the naloxone distribution.
The WVU ICRC has acquired more than 16,000 doses of medication, which will enable the distribution of more than 8,000, two-dose naloxone rescue kits to new and existing programs across the state.