The state Legislature must continue to call upon the Trump administration to expedite the approval of a Medicaid waiver that will provide essential funding to rehabilitate Utah’s addicts. The state is currently implementing “Operation Rio Grande” — an initiative to address homelessness and addiction — however, additional funding is needed to ensure the program’s success. Utah law enforcement personnel and state administrators are seeking to prioritize rehabilitative treatment over punitive measures; however, their laudable vision will fail without federal support for the initiative’s $67 million price tag.
Last June, Gov. Gary Herbert submitted a request to the Department of Health and Human Services asking it to waive the Medicaid Institutions for Mental Diseases exclusion under the Social Security Act. This waiver would allow the state to circumvent an arcane rule that prohibits the use of federal funds to support addiction treatment facilities with more than 16 beds. The rule was originally intended to avoid the creation of large, impersonal “institutions for mental disease” and instead incentivize states to establish more effective, community-based treatment facilities.
The unfortunate reality is that the scale of the opioid epidemic nationwide has forced states across the country to seek exemption from this rule in an effort to treat more people (drug overdoses are now the leading cause of death among Americans under 50). The Obama administration granted waivers to California, Maryland, Massachusetts and New York, and Utah joins seven other states in seeking comparable support from the Trump administration.
Last March, Health and Human Services secretary Tom Price assured governors that the new administration would continue to approve waiver requests. However, in a chaotic transition, this approval process has stalled. It is imperative that the state Legislature places pressure on the agency to prioritize the approval of these waivers — the success of Operation Rio Grande and the health of hundreds of Utah’s residents depends on it.
According to the Centers for Disease Control, in 2016 Utah ranked seventh in the country for deaths by drug overdose despite having one of the smallest populations of illicit drug users nationwide. This statistic reveals that Utah residents are significantly more likely to die from opioid overdose than citizens around the country — and that the state has not done enough to support, rehabilitate and protect this population. Operation Rio Grande, with its three-part plan to identify, treat and train addicts for re-entry into society, is a step in the right direction.
Research over the last decade has overwhelmingly proved that success at curbing the opioid epidemic can be achieved by first, drastically limiting the supply of opioids to the public, and second, making rehabilitative treatment more accessible than the opioids themselves. This model was used in treating tobacco addiction in New York City in the early aughts. Raising taxes on cigarettes and banning smoking in public parks disincentivized tobacco use while free access to nicotine patches and nicotine gum, subsidized by the city, encouraged addiction treatment. This approach seems to have had an impact: there has been a nearly 10 percent decrease in tobacco use among residents in the last decade.
This model should be used to curb Utah’s epidemic. Private companies are already working to cut the supply of opioids in the state. Currently, 7,000 prescriptions for opioid painkillers are issued per day on average across the state; however, Intermountain Healthcare recently committed to cutting opioid prescriptions by 40 percent by the end of 2018. Still, high barriers to treatment remain: wait times at private facilities are currently between three and six months. Additionally, while the state is working to free up space in treatment facilities, it has only been able to devote 37 beds to Operation Rio Grande. Thousands of Utahns will still be left to fight their opioid addictions without the kind of intensive, in-patient care they need.
The state plans to add 240 new beds by the end of the year — though that is contingent on federal approval of the Medicaid waiver. The state Legislature must assure this waiver gets approved and then to continue investing in proven methods of addiction treatment. According to the National Institute of Drug Abuse, every dollar devoted to rehabilitation results in up to $7 saved on drug-related criminal justice costs.
President Trump recently declared the opioid epidemic a “national emergency”; the administration and the state must now act to treat it as one.