These behavioral health centers — which serve nearly half a million people in the United States — are certified to provide medication-assisted treatment for opioid abuse that's approved by the Food and Drug Administration. This approach to addiction has been shown to be highly effective and has gained more acceptance across the country as states and localities sought over the past few years to lessen addiction's toll on their communities.
Now these substance abuse health providers are concerned about their financial state in an environment primed for increased struggles with addiction: The centers are anticipating a crushing wave of new demand amid the public health and economic crisis, even as they grapple with how to provide remote care.
Opioid treatment providers weren’t eligible to share in the $50 billion for Medicare providers from the Cares Act that lawmakers approved in March.
They are indeed Medicare providers: As of January, they were able to participate in the program. Congress made that change as part of the opioid response bill it passed in 2018.
But the Cares Act payments are based on 2019 Medicare payments. And opioid treatment providers didn’t get any Medicare payments that year, because they weren’t yet eligible.
To be fair, it's Medicaid — not Medicare — that is the country's biggest payer of addiction and mental- health services. Medicaid covers four in 10 people with opioid addiction.
But executives for these centers feel like they’ve been demoted from higher-priority health providers to more of an afterthought.
The coronavirus pandemic has killed nearly 80,000 people in the United States.
Before the virus struck, politicians and policymakers were wringing their hands over how to stem an opioid abuse crisis that has killed more than 400,000 people in the United States since 2000.
“Now is precisely the moment when we need to be supporting these kinds of programs that help folks who want to get into recovery,” Jason Kletter, president of BayMark Health Services, the country’s second-largest provider of opioid treatments, told me.
Experts predict the coronavirus crisis will lead more Americans to suffer from mental illness and abuse drugs and alcohol.
Some of the factors include increased isolation, stress and fear stemming from the pandemic.
In a report released Friday, Well Being Trust estimated 75,000 Americans could die from drug or alcohol misuse, or suicide, as a result of the pandemic.
“Heightened anxiety is a near-universal trigger for drug use, and it is difficult to think of a more stressful event — for all of us — than this pandemic,” wrote Peter Grinspoon, a doctor at Massachusetts General Hospital.
Kletter noted that “opioid use disorder is fundamentally a disease characterized by isolation and hopelessness.”
“There is evidence that epidemic is being exacerbated by this pandemic, so we need to make sure as a country we are continuing to provide recovery services to folks who need it to prevent a fourth wave of the opioid epidemic,” he added.
Congress hasn’t left substance abuse providers entirely out of its pandemic response bills, but the funding has been relatively meager.
The Cares Act provided $425 million for states to address mental illness and substance abuse, to be awarded by the Substance Abuse and Mental Health Services Administration at the Department of Health and Human Services.
“It was like a drop in the bucket,” said Chuck Ingoglia, president of the National Council for Behavioral Health.
Compare that to the $175 billion emergency fund Congress has set up for hospitals and other providers. Much of that funding has gone to hospitals directly caring for covid-19 patients. But other providers not on the front lines — such as orthopedic practices — also received dollars to help make up lost revenue when they were forced to suspend nonessential services for weeks on end.
Substance abuse providers stress that they’ve also suffered financial losses.
Six in 10 community behavioral health organizations believe they can survive financially no longer than three months amid the pandemic, according to a survey released last month by NCBH.
The council and the American Society of Addiction Medicine have asked Congress for $38.5 billion in emergency funds for behavioral health organizations “to avert a large-scale public health calamity.” They want much of the funding awarded through the Medicaid program, considering the outsize role it plays in paying for treatment for people who abuse opioids.
“This pandemic has spread fear and anxiety across our nation, leaving no one unaffected,” the letter said. “Our mental health disorder and addiction treatment providers are facing an influx of need.”
Ahh, oof and ouch
AHH: Some of the nation's highest-ranking health officials are self-quarantining after a pair of White House aides contracted the coronavirus.
- Food and Drug Administration Commissioner Stephen Hahn and Centers for Disease Control and Prevention Director Robert Redfield will self-quarantine or telework for two weeks.
- Anthony Fauci, the top U.S. infectious diseases official, will work from home sometimes, a spokeswoman said. Fauci himself said Sunday he will always wear a mask in public but won't completely isolate himself.
Other officials are not isolating.
- Vice President Pence, whose spokesperson Katie Miller tested positive for coronavirus, plans to go to work: “Late Sunday, the White House put out a statement saying that [Vice President] Pence would not alter his routine or self-quarantine,” per the New York Times's Michael D. Shear and Maggie Haberman. Pence “has tested negative every single day and plans to be at the White House tomorrow,” his spokesman Devin O’Malley told them last night.
- Pence was self-isolating yesterday, the Associated Press’s Kevin Freking and Zeke Miller reported. “He has repeatedly tested negative for COVID-19 since his exposure but was following the advice of medical officials,” they write.
“[S]everal administration officials said White House staffers were encouraged to come into the office by their supervisors, and that aides who travel with President Trump and Vice President Pence would not stay out for 14 days, the recommended time frame to quarantine once exposed to the virus,” Seung Min Kim, Josh Dawsey and Amy Goldstein report.
Many officials weren’t sure whether they should keep going to work, citing Redfield and Hahn’s decision to stay away. The nervousness and concern among White House staffers became more palpable on Saturday, our colleagues report. It all raises questions about how the White House is responding to the challenge of maintaining a safe work environment for Trump, Pence and their staff.
A White House official said that the building is “nearly entirely essential staff. The levels of our government can’t come to a halt during this crisis, so we’ve implemented measures to work through this,” the official said.
White House economic adviser Kevin Hassett acknowledged the heightened risk of heading to the office. "It is scary to go to work,” Hassett said in an interview on CBS's "Face the Nation." “... It's a small, crowded place. It's, you know, it's a little bit risky. But you have to do it because you have to serve your country.”
He said he practices “aggressive social distancing” and plans to wear a mask “when I feel it’s necessary.”
OOF: Most states and U.S. territories have started to ease lockdown restrictions on businesses and social activity.
At least 100 million people can move around again after weeks of stay-at-home orders.
Public health experts warn there may be another surge of coronavirus infections following this revived activity. Already, cases are continuing to rise in places that have been the most lenient in opening back up places such as salons and gyms.
A Post team will update details here as states progress through stages of reopening.
OUCH: The federal government turned down an offer from a U.S. mask manufacturer in the early days of the pandemic.
Mike Bowen, vice president of Prestige Ameritech, contacted the federal government the day after the first case of covid-19 was detected in the Untied States. He said the company, which is the last major domestic mask maker, would be able to increase production to make an additional 1.7 million N95 masks a week.
“But communications over several days with senior agency officials… left Bowen with the clear impression that there was little immediate interest in his offer,” Aaron C. Davis reports. “…In the end, the government did not take Bowen up on his offer. Even today, production lines that could be making more than 7 million masks a month sit dormant.”
“U.S. mask supply is at imminent risk,” Bowen wrote to Rick Bright, the ousted vaccine official who filed a whistleblower complaint last week following initial communications with federal officials. He later added: “Rick, I think we’re in deep s---.”
“Within weeks, a shortage of masks was endangering health-care workers in hard-hit areas across the country, and the Trump administration was scrambling to buy more masks — sometimes placing bulk orders with third-party distributors for many times the standard price,” Aaron reports.
The administration's response
Federal officials are preparing to accuse hackers in China of trying to steal American research on vaccines.
The FBI and the Department of Homeland Security will issue a public warning, the New York Times’s David E. Sanger and Nicole Perlroth report about efforts that are “part of a surge in cybertheft and attacks by nations seeking advantage in the pandemic.”
“A draft of the forthcoming public warning, which officials say is likely to be issued in the days to come, says China is seeking “valuable intellectual property and public health data through illicit means related to vaccines, treatments and testing,’” they write. “It focuses on cybertheft and action by ‘nontraditional actors,’ a euphemism for researchers and students the Trump administration says are being activated to steal data from inside academic and private laboratories.”
Brett Giroir, the federal official overseeing coronavirus testing efforts, was confirmed by the Senate on Thursday to represent the United States on the World Health Organization's executive board, according to a spokeswoman from the Department of Health and Human Services.
Giroir, recently under scrutiny as testing has been slow to ramp up, has led a number of President Trump's other initiatives, including on opioid abuse and slowing the spread of HIV in the United States.
Here are a few more stories to catch up on after the weekend:
Congress on coronavirus:
- Sen. Chuck Schumer (D-N.Y.) is calling on Veterans Affairs Department to explain why it allowed the use of hydroxychloroquine, an unproven treatment for coronavirus, on patients, the Associated Press’s Hope Yen and Michael Balsamo report.
The economic fallout:
- White House economic adviser Kevin Hassett and Treasury Secretary Steven Mnuchin project unemployment will continue to surge. Hassett said he thinks the rate will climb “north of 20 percent” in the next month, Aaron Gregg, Felicia Sonmez, Lenny Benstein and Carolyn Y. Johnson write.
- Senior administration officials are increasingly worried about how the stimulus efforts are affecting the national debt, Jeff Stein, Josh Dawsey and John Hudson report.
It’s still an election year:
- Both parties are struggling with whether and how to hold their political conventions, still hoping they can hold in-person events, Josh, Michael Scherer and Annie Linskey report.
- Republicans are growing more worried that the president’s handling of the pandemic, combined with the economic fallout, could threaten their hold on the Senate, Seung Min and Mike DeBonis report.
There are still things to learn about the coronavirus:
- Doctors are still finding new ways the coronavirus attacks the body. It attacks the heart and kidneys; travels along the nervous system and can reach the brain; it creates blood clots and it can inflame blood vessels, Lenny and Ariana Eunjung Cha report.
Good to know:
- The FDA granted emergency authorization for a new antigen test, meant to allow health-care providers to deploy a faster and cheaper diagnostic test, Katie Mettler reports. The antigen test – a common type of screening used for infections like influenza or strep throat – is the first such test specific to the coronavirus.
- Yesterday had the lowest reported number of new coronavirus deaths in the country since March 31 and the fewest new cases since March 30, Kareem Copeland and Jacqueline Dupree write for The Post’s live blog.
- Johnson & Johnson said in an interview on ABC’s “This Week” that the company’s goal is to deliver 1 billion vaccine doses next year.
- A Swiss company says it has developed a fabric treatment that can destroy more than 99 percent of coronavirus pathogens on masks and wipes, CNN Money reports.