In Maryland, opioid overdose deaths have more than doubled since 2010. In Baltimore, there are more people dying from overdose than from homicide.
Last week, the Maryland Department of Health and Mental Hygiene announced that it will implement a new payment policy for community-based medication-assisted treatment (MAT) – a clinical intervention that combines the use of medications and substance-use-disorder counseling. Our state’s current system funds an array of medications to treat opioid use disorders, including methadone, buprenorphine and naltrexone; however, the decades-old state payment policy does little to incentivize the critical second component of MAT: counseling.
We know that medication combined with counseling is more effective treatment than medication alone. As we have seen across the country, there is an increasing understanding of what we know from science and research: Addiction is a disease, treatment exists and recovery is possible. Through counseling, individuals learn critical skills to decrease stress and to help prevent relapse. In group counseling, patients are able to find encouragement and to connect with peers also in recovery. Federal regulations already recognize the importance of counseling and require opioid treatment programs to include counseling as a part of treatment unless the program enters into an agreement with another provider for this service.
In December, the state proposed increasing the use of counseling services in conjunction with medication by modifying the way it reimburses opioid treatment programs. Since then, the state has worked to structure a new payment policy that will support evidence-based care. After substantial discussions with the treatment community, Maryland has announced that this desperately needed change will be implemented in March.
This model is consistent with Baltimore City’s three-pillar response to addiction and overdose: prevent overdose deaths and save lives; increase access to quality, on-demand treatment; and reduce stigma of and encourage prevention and treatment for addiction. Improving reimbursement policies for medication-assisted treatment also improves access to quality and effective on-demand treatment, as well as long-term recovery support.
In the coming months, the state will propose regulations and seek federal approval in order to implement these improvements in collaboration with Maryland’s treatment community. By better aligning payment with evidence-based treatment, we will improve the quality of medication-assisted treatment. This may save the lives of Marylanders suffering from addiction and, in turn, support families and strengthen communities.
Our local health departments, community leaders, hospitals and clinics continue to focus on changing the conversation about recovery to make sure individuals understand addiction as a disease. The first step is to save lives. Last year, Maryland passed a Good Samaritan law that protects someone who reports an overdose from arrest. New laws also expand access to naloxone – the opioid overdose antidote – across the state. In Baltimore City, the standing order for naloxone gives every resident the power to save a life. Since last year, more than 14,000 people in Baltimore City have been trained to use the medication, and it has been used more than 400 times to save a life.
If we cannot save a life today, there is no hope for recovery tomorrow. Only 11 percent of people nationwide who need addiction treatment receive it. As we work to combat the opioid epidemic, we are only treading water until we can ensure that everyone receives the treatment at the time when he or she needs it. The new reimbursement model for medication-assisted treatment is a step in the right direction.
Through shared vision, we stand together to increase the availability and quality of substance use services for Marylanders in recovery. The path to treatment can be incredibly difficult for someone grappling with this disease. We are working to make sure the care people receive equips them to make their time in treatment worthwhile.
Elijah E. Cummings, a Democrat, represents Baltimore in the U.S. House. Van T. Mitchell is secretary of the Maryland Department of Health and Mental Hygiene. Leana Wen is commissioner of the Baltimore City Health Department.