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Patrick Sison, AP
This Tuesday, Aug. 15, 2017 photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York. (AP Photo/Patrick Sison)

The rooms in Salt Lake’s adult detox center are filled wall to wall with metal bunk beds and blue foam mattresses. Sixty-five men and 18 women of all ages sleep to sober up on borrowed blankets. One of the residents is Paul, a 31-year-old with a shaved head and bright blue eyes that are begging for a change after more than a decade of drug use.

The detox center has been Paul’s home for about six weeks, and it could be his home for another three to six months, depending on when he’s able to get off the waiting list for residential treatment.

Even as funding for substance abuse treatment steadily increases, the number of locations in public addiction treatment programs has declined over the past five years. Whereas 17,026 people were treated in 2012, only 14,729 were treated in 2016, according to the 2016 Division of Substance Abuse and Mental Health annual report.

Aaron Thorup, Utah Division of Substance Abuse and Mental Health 2016 annual report
Utah Division of Substance Abuse and Mental Health 2016 annual report

The detox center, run by Volunteers of America, is a shining alternative to the other options Paul has: homelessness or jail. But getting in is not easy. The center turns away between 30-40 people a day. For those who do get in, waiting for a coveted residential treatment spot is another test of willpower and patience. For many, it’s a nearly impossible hurdle.

“There are waiting lists at every level of treatment,” said Audrey Rice, clinical director at the detox center. “The crisis point has been with residential treatment.”

The bottom line? There isn’t nearly enough funding to support the estimated 146,000 people in Utah who need help recovering from addiction.

Lawmakers and advocates have worked tirelessly in recent years to secure additional funding for treatment as the opioid crisis has risen to the level of an epidemic. From 2015 to 2016, state funds for treatment increased by more than $5.5 million. But a workforce shortage and the increased costs of treating opioid addiction have limited the number of people who can benefit from those funds.

Now, Utah’s Division of Substance Abuse and Mental Health is working to correct these downward trends. With new federal money, director Brent Kelsey hopes to expand capacity and access to treatment. And in the coming year, he expects treatment numbers will start going back up.

Telehealth: an answer to the workforce shortage

Dr. Elina Chernyak, a physician at the Utah County Department of Drug and Alcohol Prevention and Treatment, has come a long way from her hometown of Moscow to treat patients in Provo, but she wants to take her skills even further.

Through a new telehealth initiative, Chernyak will soon begin seeing patients in more rural parts of Utah, including Vernal and Roosevelt. Starting next week, Chernyak will be able to sit down at her computer, open up a video chat program called Zoom, and within seconds, start counseling a patient who lives 150 miles away.

Statewide, there is a workforce shortage in the field of substance use treatment, but that shortage is most acutely felt in rural areas. The lack of qualified professionals is part of the reason why Utah’s substance abuse treatment capacity has not been able to keep up with need.

That’s why Utah County has decided to try treating opioid-addicted patients via the internet. The telehealth program is the first of its kind in Utah, and after months of planning, it’s finally taking off.

For now, there are just three patients identified for participation, but Chernyak hopes that by dedicating 10 hours to telehealth each week, she will eventually be able to manage between 30-60 patients at a time.

Still, there are barriers to treating substance abuse disorder patients remotely. One such barrier is a federal regulation that requires the first visit with a client who will receive an opiate medication like Buprenorphine to be face to face.

Health advocates are working to get this rule changed, but in the meantime, Chernyak will have to travel to meet her patients initially. She will also use Zoom to counsel doctors in Vernal and Roosevelt as they meet their patients in person.

Competition and pay: the root of the problem

Like Vernal and Roosevelt, San Juan in southeastern Utah is short on qualified staff who can help people overcome addiction.

Tammy Squires, the executive director of San Juan Counseling, has had trouble hiring substance use disorder therapists because the job doesn't pay enough for how difficult it is, and most people don’t want to live in such a remote area.

More college programs in this field, and more scholarship programs like the National Health Service Corps, which helps young medical professionals repay student loans in return for working in underserved areas, are needed to address the root of the workforce shortage, said Tammy Squires, executive director of San Juan’s Community Behavioral Health Center.

For the better part of the year, two out of San Juan’s five clinician positions were vacant. After more than six months, one of the jobs was finally filled by a participant in the National Health Service Corps. But the other — the addiction specialist position — remains empty.

Squires said there has always been a workforce shortage, but as the opioid epidemic balloons and demand for addiction treatment increases, it is getting worse.

“We kind of feel like we’ve never been fully up to staff,” said Squires. “Up until this point, we’ve managed pretty well to see the number of people coming in, but now we are at a crisis point.”

The workforce problem doesn’t just plague remote areas. Even in Utah County, about 20 percent of the 56 full-time positions at the Division of Substance Abuse are unfilled. In particular, Utah County has had trouble hiring registered nurses to help with detox, substance use disorder counselors and social services workers, according to director Richard Nance.

“We can’t deliver services if we don’t have those clinicians,” said Nance, who is working with Utah Valley University to expand the number of students in their addiction counseling certificate program. “I’m surprised we have as many people in treatment as we do.”

Part of the reason for the shortage of workers is that the public system has to compete with private treatment programs that can pay clinicians more and move faster in the hiring process.

“These are master's level professionals doing a hard job,” said Squires. “But the funding is not there to pay what you’d think a master's level should pay.”

The jobs in San Juan pay $26.43 an hour for experienced counselors and $22.60 an hour for counselors starting out, said Squires, who noted that master’s level employees in medical fields other than mental health, tend to be paid more.

More funding needed to match increasing costs of care

In 2010, more than 40 percent of people treated for addiction in Utah indicated that alcohol was their primary drug of abuse. That number has since fallen to 25.8 percent. And for the first time, opioids ranked as the number one drug of choice, according to 2016 data.

People with opioid addiction require much more intensive, long-term care, which has contributed to a decrease in the number of people who can be treated, according to Nance.

“You can treat three persons for 30 days or one person for 90 days. We want to deliver the most effective treatment,” said Nance.

“Sometimes it looks like we’re not treating more people, but we’re treating them longer,” Squires added.

At the same time, medication-assisted treatment has become a more popular method for treating opioid addiction. Some of the preferred medications can cost hundreds of dollars a month, significantly increasing the cost of care.

At the beginning of November, Utah County had 850 people in addiction treatment and 170 on a waitlist.

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But if you look back at the numbers from 2012, Utah County reported the capacity for 1,248 adults in public treatment. By 2016, the reported capacity had dropped to 971, according to annual reports.

“In Utah County, the population has exploded, but the amount of public funds have not kept pace,” said Nance, adding that inflation has also raised prices.

Providers are adamant that reducing the quality or comprehensiveness of services is not a viable solution. According to Nance, the only answer to this problem is more funding.