State Officials Rethinking Approach To Substance Abuse Treatment

Leaders across the branches of state government are in broad agreement that the state needs to increase access to mental health and substance abuse treatment, with many saying there is a deficit of services and a lack of insurance coverage to pay for treatment.

"We treat someone who has a cardiac problem due to a lifetime of unhealthy habits better than we treat someone who has an addiction problem and it could have started from something as simple as a back surgery," said Sen. Jen Flanagan, who is chairing a new commission looking into the issue.

"I could not agree with you more," Health and Human Services Secretary John Polanowicz told Flanagan at a budget hearing in Watertown last week after she said she was "disheartened" that so much substance abuse treatment takes place in correctional facilities rather than health care settings.

Polanowicz said there is a need for more services, and said, "Once we've created that capacity, we need to have that second-order discussion here. We've created in effect an on-demand system and allowed a number of organizations in the Commonwealth to wash their hands of the substance abuse issue."

Massachusetts residents are open to "rethinking how drug crimes are treated," according to the results of a new statewide poll conducted by The MassINC Polling Group for MassINC and The Massachusetts Criminal Justice Reform Coalition. The poll results were released at 10 a.m. Thursday by MassINC, which in 2013 released a report making the case for reforms "to reduce prison populations and save money while reducing crime rates."

By more than a 2-to-1 margin, the poll showed residents are "more likely to perceive drug use as a health problem (64 percent) than a crime (24 percent)." Seventy-eight percent "would consider early release for drug users, and 83 percent think sending drug users to treatment instead of prison would be effective at reducing crime."

Drug Treatment Over Incarceration

On Tuesday, the Committee on Mental Health and Substance Abuse advanced a bill (H 3825) that would establish three commissions investigating the use of drug treatment in lieu of incarceration, cutting down on a state prison population where officials estimate 80 percent of inmates have a substance abuse problem.

"We have to address this. It's a public health emergency, so we need some better treatment long-term," said committee co-chairwoman Rep. Elizabeth Malia, a Jamaica Plain Democrat.

Bill sponsor Rep. Randy Hunt, a Sandwich Republican, said the goal is to move people with drug and alcohol problems out of prisons and into treatment, and said the commissions should determine the proper course "so that, when we're dealing with health insurance companies, that there is a standard of treatment that we would encourage them to support with health insurance dollars from their subscribers."

Public Safety and Security Secretary Andrea Cabral has discussed the need for recovery treatment to begin during incarceration and extend after release, and Trial Court Administrator Harry Spence said the court's plans for more drug courts require funding for treatment as well.

"Within three years, every person who needs it and for whom it is appropriate, will have access to a drug court in Massachusetts. That's our goal," Spence told a budget panel in Fitchburg.

Later he said, "We could have come to you with a specialty courts request for $700,000 by leaving out any treatment, any clinical supports. We could have just set up a judge and a probation officer and called it a specialty court. It's clear to us that to do so would be irresponsible. Secondly, not to include the treatment beds just means the court becomes a way of somebody jumping the line for an already desperately limited resource."

While some have said insurance policies are not accommodating enough for drug treatment, an official with the state's health insurance association said insurers follow national guidelines for coverage.

"Plans already cover a wide range of services for substance abuse and chemical dependency issues," said Eric Linzer, senior vice president of public affairs and operations for the Massachusetts Association of Health Plans. Saying MAHP is willing to sit down with advocates on the issue, Linzer said, "This needs to be a discussion that focuses on data and the facts."

Linzer said Division of Insurance statistics show coverage of inpatient and outpatient treatment for chemical dependency increased from 2011 to 2012, the last year of available data.

Why Getting Help Can Be Hard

"I was talking to a gentleman in detox last week, where he's literally sat - I believe he was drunk - waiting for the insurance company to approve his care. Now if you're someone who has a drug problem, or an alcohol problem, and you're looking for treatment, are you really going to wait six hours?" Flanagan asked the News Service. She said, "There's a lot of times when providers will say, 'We've done everything we can, and the insurance companies will only approve three days.'"

Detox is only the first step in a long treatment process, health officials and lawmakers have said.

"Some of those individuals will be detoxed but not rehabbed and the reality is we're going to have recidivism," Polanowicz told members of the House and Senate Ways and Means committees.

In budgetary hearings where the Leominster Democrat is vice chairwoman of the Senate Ways and Means Committee, Flanagan has found common ground on the need for more access to substance abuse treatment from Patrick administration Cabinet secretaries and officials representing the judicial branch.

"I think every aspect of state government that we've talked to so far is in agreement that there needs to be something done with substance abuse treatment in Massachusetts," Flanagan told the News Service. "The question is how do we do that, how do we re-direct the funds, and how do we make effective and quality treatment options available to people who are seeking treatment."

The Department of Public Health says the Bureau of Substance Abuse Services has licensed 869 detox beds for adults, 284 clinical stabilization service beds, 291 transitional support service beds, and 2,211 recovery home beds, along with beds for youths and families.

Gov. Deval Patrick's budget would add 32 detox beds and 32 beds for clinical stabilization service.

"I think it's going to create the kind of system where people who need access to rehabilitation can get that access and not handle them in our DOC system," Polanowicz said of the 64 new beds in the budget.

Through a program referred to as Section 35, the state can civilly commit individuals whose drug or alcohol abuse puts themselves or others at risk. Those individuals can be placed at treatment centers in Brockton or New Bedford or in correctional institutions in Bridgewater and Framingham.

"It's really disheartening to think that our prisons are one of the top providers of substance abuse and mental health treatment in Massachusetts," Flanagan said.

Daniel Mumbauer, who leads High Point Treatment Center, said there has been an expansion of services in recent years, but it is "inadequate" to meet the growing needs of substance-addicted people.

"We don't have enough detox beds. We don't have enough rehab beds. We don't have enough recovery home beds. The number of folks that are in need of services, particularly with the large number of opioid-addicted folks in the Commonwealth today, we're just not coming close to meeting the need," Mumbauer told the News Service.

High Point, which runs the Men's Addiction Treatment Center in Brockton and the Women's Addiction Treatment Center in New Bedford, said when someone is civilly committed that person is sent to one of his facilities, or sent to treatment at correctional institutions if he has no free beds.

"Our beds are filled every day, all our beds, 198 beds - 108 for men, 90 for women - and people are desperately trying to get into treatment," Mumbauer said. Insurers don't pay for treatment in correctional facilities, but they do pay for treatment at High Point, which Mumbauer acknowledged might create a financial incentive for the state to move treatment away from jails and prisons.

Public Health Commissioner Cheryl Bartlett said abuse of certain drugs is on the rise, and Massachusetts is above most other states in its access to treatment.

"The scale of prescription pain reliever abuse in Massachusetts exceeded the 2008-2009 national average of 4.8 percent, with 5.3 percent of the state population reporting past year misuse," Bartlett said in prepared testimony to the legislative budget panel. She said, "I am proud that according to [Substance Abuse and Mental Health Services Administration], Massachusetts provides the sixth-highest per capita treatment access in the nation."

Those seeking greater access said the need for drug abuse treatment is a nationwide issue, and praised other states, such as Texas, for reducing the number of prisons and increasing treatment.

"You would not believe the amount of time that probation officers spend just trying to find a bed today. It's dialing for beds," said Hunt, who visited Texas and said placements in Massachusetts can take three weeks or longer.

Rep. Paul Heroux, an Attleboro Democrat who was previously director of research in the state prison system, said the Department of Corrections does not measure the success of its own programs, which he attributed to "bureaucratic arrogance."

"We're using evidence-based models, but what we don't do is measure whether or not we're reducing recidivism. We have no idea if our programs work or not," Heroux said. He said, "There's resistance to that from the executive branch, broadly speaking."

Cabral became public safety secretary in 2013, after years as the Suffolk County sheriff, and Malia credited her with informing lawmakers about the need for substance abuse treatment.

In January, Senate President Therese Murray appointed Flanagan to head up a special committee dealing with drug addiction, and Patrick plans to talk about prisoner re-entry at a MassINC event on Thursday.