Oregon's success in treating addicts is a lesson for Kentucky

PORTLAND, Ore. —The guiding principle behind addiction treatment in Oregon is simple: Pay for it now, make it easy to get and you’ll save money and lives down the road.

Research from across the nation shows that treatment reduces crime and medical expenses while boosting employment, meaning every dollar spent on treatment actually saves an average of $7.

“There’s absolutely solid, irrefutable evidence that there is a savings — always — in funding addiction treatment and prevention,” said Karen Wheeler, addiction programs administrator for the Oregon Health Authority. “You pay one way or the other.”

That philosophy fuels Oregon’s nationally reputed system of addiction care that officials, health experts and treatment professionals say provides lessons for Kentucky as it struggles with a crippling prescription drug-abuse problem and an overwhelmed treatment system.

Oregon, like Kentucky, is a largely rural state with about 4 million people — and a substantial prescription-drug abuse problem. But Oregon has acted more quickly and aggressively to tackle treatment:

• The Oregon Health Authority is spending about $51 million annually on substance abuse treatment — up $11 million from six years ago. Kentucky’s Department of Behavioral Health, Developmental and Intellectual Disabilities spends $29 million a year, and hasn’t increased that amount in more than a decade.

• Oregon’s Medicaid program, the state-and-federal health insurance program for the poor and disabled, covers substance abuse treatment, while Kentucky, with a few exceptions, does not.

• Oregon is admitting more than twice as many addicts for treatment as Kentucky — 48,833 compared with 21,474, according to the latest state-by-state federal data from 2009. And Oregonians are much more likely to receive intensive treatment; for example, 10 percent of treatment admissions were to long-term, residential facilities, compared with 1.1 percent in Kentucky.

• Drug overdose death rates in 2008, the most recent year available, were significantly lower in Oregon than Kentucky — 11.7 per 100,000 compared with 17.9, according to the U.S. Centers for Disease Control and Prevention. Health experts say effective treatment leads to fewer overdoses.

“Oregon is a good state for treatment,” said Liz Smith, a 35-year-old recovering prescription-drug addict from Portland who entered an intensive residential program in 2010 and is now sober.

“We have an abundance of treatment centers and detox centers, and a lot of states don’t. We’re lucky.”

Officials and treatment professionals acknowledge that Oregon’s treatment infrastructure isn’t perfect. As in Kentucky, some of Oregon’s 213 treatment facilities have waiting lists.

But addicts generally are guided to other available programs or placed into support groups with others on waiting lists so they don’t slip back into drug use.

Addicts also get help when they’re looking for a place to turn, because Oregon’s state, county and municipal governments, and its treatment providers, have created a coordinated network that gets them into treatment.

Portland has a reputation for aiding the addicted and homeless, with organizations offering free food and clothing and working to get them into treatment.

“We tend to come together to solve problems,” Wheeler said.

Treatment covered

Oregon began covering addiction treatment in its Medicaid program in the mid-1990s, before prescription-drug abuse proliferated. Officials now estimate that 228,000 Oregonians abuse prescription drugs each year — making treatment even more crucial.

“We want people to access addiction treatment because it will save money on the physical health side of things,” Wheeler said. “People will be less likely to go to the ER or have an unwanted pregnancy, for instance.”

Officials said the way the state views substance abuse informs how they address and pay for it.

“We look at addiction as a chronic, relapsing brain disease,” said Therese Hutchinson of the Oregon Health Authority. “It is a physical health issue, and you treat it like a physical health issue.”

Officials said Oregon Medicaid, which covers more than 600,000 people, pays for such services as outpatient and medication-assisted treatments, hospital-based detoxification and residential care.

In July, funding for residential treatment will go through new coordinated-care organizations, networks of health providers serving Medicaid recipients in most parts of the state.

“Our state footed the bill for me,” said Smith, who enrolled in Medicaid and stayed in a state-funded bed for treatment. “They helped cover everything. I did not have the funds, and I don’t know if I could have done it myself.”

Kentucky’s Medicaid program, which has more than 800,000 members, only covers substance abuse treatment for pregnant and postpartum women, and for residents under 21 in a special program. It also covers Suboxone medication treatment, and a new waiver program lauded by Kentucky leaders will pay for outpatient addiction treatment for 5,800 people.

Most states do more. A survey by the National Association of State Alcohol/Drug Abuse Directors says Kentucky is one of seven states that don’t provide overall Medicaid coverage for even the minimum level of treatment.

Some legislators say they understand the potential advantages of increasing coverage but don’t know where the money would come from during these tight economic times.

Treatment providers in Oregon said more complete Medicaid coverage ensures more addicts get the help they need.

“Oregon is, in many respects, a good starting point” for other states, said Timothy Hartnett, executive director of the Portland behavioral health agency CODA, which offers medication-assisted treatment as well as outpatient and residential care. “Not only have we built treatment into the state’s Medicaid program, we’ve also been forward-thinking about treatment for children and moms.”

Oregon officials pointed to a state program called Intensive Treatment and Recovery Services, which since 2007 has worked to get children out of foster care and back to their families.

The program gives addicted parents residential treatment that allows them to stay with their children; it also provides intensive outpatient treatment, case management, peer mentoring and drug-free housing for parents and pregnant women.

State statistics show that more than 1,800 children have been reunited with their parents by the program — leading to big savings in areas such as foster care.

Officials said the program costs Oregon $10.4 million in two years but pays for itself in six months.

On a late-September night, more than 100 recovering addicts, treatment providers, officials and families gathered for a vigil at Pioneer Courthouse Square in Portland near a sign that read “Supporting Recovery.”

The gathering reflected a spirit of cooperation and common purpose in a state where government agencies and treatment providers have forged connections to fight substance abuse.

“We’re a small state,” Hartnett said. “But people feel a real sense of pride in working together to come up with real and effective solutions.”

Oregon’s governor, Democrat John Kitzhaber, is a doctor who Wheeler said is extremely supportive of addiction treatment. She said state lawmakers also understand the importance of drug treatment and the savings it brings.

“When you have a system that values cooperation, you’re able to work toward a common vision and common goals,” Hutchinson said.

Coordination begins with financing treatment. The state distributes treatment funds to Oregon’s 36 counties and its American Indian tribes, which provide the services directly or subcontract with private providers. Susan Montgomery, who works at the health department in Portland’s Multnomah County, said this system has produced “a fairly rich treatment array.”

Treatment providers meet monthly, keeping abreast of each other’s services, strengths, needs and constraints, and identifying statewide and community trends. They share information and communicate about clients. “It works very well,” said Margaret Weil, director of adult residential services at De Paul Treatment Centers.

Primary-care doctors and clinics are also linked into this network. Dr. Gary Oxman, health officer for Multnomah County, said many addicts there enter the system through primary-care clinics because the health department is the largest provider for the poor. From there, they are referred to the services they need.

Multnomah County also has a 24-hour mental health call center that helps people find treatment, and a nonprofit organization called Lines for Life in Portland also runs around-the-clock crisis lines.

Christian Fossdal, 34, of Portland, said providers at several agencies worked together to get him the help he needed. He became addicted to OxyContin after a doctor prescribed the painkiller when bones in his back were fused.

This summer, Fossdal went to a private psychiatric hospital in Oregon, where he detoxified. He is now in residential care at De Paul and is attending outpatient groups. De Paul also referred him to a pain clinic, where he receives Suboxone. Fossdal said De Paul “definitely saved my life and put a shattered life back together.”

Support for addicts

Even with its coordinated efforts, Oregon still has waiting lists for some residential-care centers.

Those waits often stretch two to four weeks, officials said. And while that’s far less than the three months or more many Kentuckians wait, experts say it’s a danger to addicts who may slip deeper into abuse before a bed becomes available.

To prevent that, Oregon treatment providers and health officials take steps to keep potential clients on the path toward sobriety.

De Paul, for example, has support groups for those on its waiting list. They motivate people to stay sober and in some cases start them in outpatient treatment as they wait. Treatment providers also use their links with other agencies to get people into outpatient treatment.

“We’ve had a wait list for residential services for a long time,” said Devarshi Bajpai, addictions manager for Multnomah County. “But we make sure to offer something in the interim.”

Oregon communities also offer support. In Portland, a nonprofit organization called Potluck in the Park provides free hot meals every Sunday to anyone in need, serving 400 to 600 people each week in O’Bryant Square downtown.

That’s across the street from sober-living housing run by Central City Concern, which provides drug treatment and other services to people facing homelessness, poverty and addictions.

Patricia Green of Portland, a 50-year-old recovering drug addict who lives in the building, said she often eats at the potluck. “Portland really embraces people like me, and we are thankful.”

Union Gospel Mission in Portland, which provides addiction recovery and other services, holds an annual street fair that draws hundreds of the homeless. It features a barbecue lunch, music, free coats and other clothing, and information about such services as addiction recovery.

Officials said the climate in Portland is so friendly to the homeless and addicted that people move from other states or decide to stay after getting help. Ina Hendrixson of North Carolina said she received drug treatment through Central City Concern and is now staying in one of the agency’s sober living buildings in Portland.

“They have everything for recovering addicts,” she said. “There’s just so many resources, so many opportunities.”

Sarah Goforth, director of mental health and chemical dependency services at Central City Concern, said that’s because of a commitment throughout the state to caring for the addicted.

“Portland is a much kinder, gentler place than other places when it comes to people who are different, who are homeless, who are living on the fringes,” she said. “There’s more help here.”

This series was first published in the Courier-Journal on December 18, 2012
Photo Credit: Alton Strupp/Courier-Journal