Substance use recovery leaders discussed challenges and progress made in treating addiction at the 2023 Arizona State of Reform Health Policy Conference, and one concern cited was crimes committed against the Medicaid program.
Fentanyl has been ranked as the most commonly reported substance found in overdose cases in the state, where more than five people die daily from opioid overdoses. Eric Lott, MD, medical director of addiction medicine at Community Bridges, Inc., said he’s seen a difference in the modern opioid crisis compared to what it was like in previous decades. Today, not everyone entering addiction does it due to pain, surgeries, or opioid prescriptions, Lott said.
“That has shifted and the data supports that,” Lott said.
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In recent decades, synthetic fentanyl and derivatives have taken over, he said, noting that the law enforcement of illegal substances entering the US is something that he, as a medical professional, advocates for. He is well-informed on what sorts of opioid substances and derivatives patients are using.
“There are probably a dozen opioid substances that are just waiting in the background to kind of come out and play.”
Lott said xylazine (tranq) mixed with fentanyl and nitazene—a dangerous synthetic opioid—are being found in drugs today. He said it’s crucial to understand the importance of comprehensive collaborative care for patients.
“Mental health is not siloed from addiction, and vice versa.”
Lott said Arizona requires greater accessibility to substance use disorder treatments, and if individuals seeking care are unable to visit with a primary care physician or are unsure of where to meet with an addiction specialist, that is a barrier in itself.
Sara Salek, MD, deputy director and chief medical officer at the Arizona Health Care Cost Containment System (AHCCCS) highlighted additional challenges with substance use treatment within the state. She said organized crime targeted and exploited Medicaid programs for financial gain, and human traffickers have targeted the unhoused population. They exploit those living on the streets with substance use disorders, while exploiting Medicaid program billing for services that had never been rendered. Salek said she’s seen substance use disorder providers neglect to provide addiction treatment services altogether.
“That is the biggest challenge we’re facing as a Medicaid agency,” Salek said. “Part of the challenge is, in order to stop the bad actors…unfortunately the good actors, based on the processes, are impacted by that.”
To address fraud, Salek said more regulations and oversight will be implemented in Medicaid fee-for-service programs. Since May, over 300 suspensions have been made due to issues of fraud. AHCCCS also installed a locator for opioid treatment providers.
“We also have residential programs, so when it comes to opioid use disorder, we currently do have a treatment locator on our AHCCCS website, so that our members or their family members can go on (it) and access who can be a credible provider.”
Traci Nicely, practice administrator at Core Recovery Integrated Behavioral Health, shared a positive patient recovery tale with the audience. Nicely said earlier this year, a male entered treatment with the sole intention of saving his marriage, although he didn’t believe in therapy, and was standoffish. For the first two months of treatment, the male showed up at the treatment facility five days per week, and eventually graduated from the recovery program.
“He’s now living in retirement and enjoying life sober without any substances, and a big fan of Core,” Nicely said.
She said education was a key factor in the individual’s successful treatment, and allowed him to be more open and break down stigmas about mental health and recovery.
“We do take the approach of harm reduction, and that means that sometimes people aren’t quitting right away. We’re not looking for perfection—we’re looking for movement.”