Opioid Crisis Creating Access Issues in Different Areas of Behavioral Health

While opioid addiction dates back several decades, the phenomena only evolved into an epidemic in recent years.

Since 2000, opioid overdose deaths have increased by about 200%, according to the American Association of Addiction Psychiatry. And in 2017 alone, nearly 48,000 people died from opioid overdose, according to the Centers for Disease Control and Prevention (CDC).

As a result, the crisis has drawn attention — and funding —  from federal, state and community governments who hope to fix the problem. However, in doing so, some experts worry they’ve created another: By focusing so intently on opioid use disorder (OUD), other behavioral health conditions are falling through the cracks.

“In an attempt to address and respond to a public emergency like the opioid epidemic, there’s immediately some displacement effect around some, for lack of a better word, ‘legacy’ behavioral health conditions and people that suffer from them,” Matthew Hurford, chief medical officer at Community Care Behavioral Health, said.

Community Care Behavioral Health is a subsidiary of the University of Pittsburgh Medical Center’s Insurance Services Division and one of the country’s largest not-for-profit behavioral health managed care organizations. It helps Pennsylvanians with Medicaid get behavioral health care.

Hurford made his comments last week at the Payer’s Behavioral Health Management and Policy Summit, where he sat on a panel about forgotten mental illnesses and substance abuse disorders in the era of the opioid epidemic. 

The conference was held in Washington, D.C. It was hosted by World Congress, a global provider of health care conferences, and the Association for Behavioral Health and Wellness (ABHW), a national advocacy and educational group for payers managing behavioral health insurance benefits.

The issue comes down to one of supply and demand, Hurford told conference attendees. As the demand for OUD treatment increased, the size of the behavioral health workforce remained relatively stable, largely due to the nationwide shortage of behavioral health care workers. 

As such, there’s been a displacement effect for individuals suffering from non-opioid related conditions.

“Last I checked we didn’t cure alcoholism,” Hurford said. “We didn’t cure cocaine dependence. We didn’t cure schizophrenia, bipolar disorder [or] other major mental health conditions — nor did we increase the capacity or the workforce in behavioral health broadly to meet all of the … historically undermet needs.”

Those facts have frustrated Gabe Howard, a mental health advocate who has bipolar disorder. He was a panelist alongside Hurford.

“The capacity has never been there,” he said. “And now all of these funds are moving away from problems that still haven’t been resolved.”

For example, in September, the U.S. Department of Health and Human Services (HHS) announced it would give more than $1.8 billion in funding to states to help them continue to fight the opioid crisis. However, epidemics like homelessness, which often go hand-and-hand with mental illness, have never received the same attention, Howard argued.

On top of that, many behavioral health conditions are receiving even less policy and payer attention now than before the opioid epidemic. Hurford pointed to Pennsylvania, where he works, and the Medicaid population, which his company deals with, as an example. 

In 2000, OUD accounted for about 17% of substance abuse admissions there. In 2016, that number jumped to 47%. 

“We did not build that many more beds,” Hurford. “So where did they come from, and who is no longer in them?” 

One answer to that question is likely people wish alcohol use disorder, according to the Pennsylvania Medicaid data. Patients with alcohol use disorder accounted for about 47% of substance abuse bed occupancy in 2000 — but only 24% in 2016. 

However, dangerous drinking habits rose significantly during that time. In fact, high-risk drinking increased nearly 30% between 2002 and 2013, according to an 2017 article published in JAMA Psychiatry. 

As such, it’s important for alcohol use disorder and other non-opioid-related behavioral health conditions to remain priorities, lest they become worse problems themselves, panelists said. 

“I don’t see any conversations addressing the initial problem that we started with 50 years or 150 years ago,” Howard said. “I really think this is like charging something on a credit card, and then when the bill comes you’re like, ‘What is this? This is shocking.’”