Testimony of Mr. David Guth, CEO, Centerstone America. Combating the Opioid Crisis:

Transcription

1 Testimony of Mr. David Guth, CEO, Centerstone America House of Representatives Committee on Energy and Commerce Hearing Subcommittee on Health: Combating the Opioid Crisis: Improving the Ability of Medicare and Medicaid to Provide Care for Patients I would like to thank Representatives in our service area, who have invested great time and leadership into these issues before us today. Thank you Congressmen Guthrie, Bucshon, Brooks, Bilirakis, Shimkus, and Blackburn and this committee for your dedication to seeking solutions for the opioid crisis ravaging so many American communities today. I m honored to be here as the voice of my colleagues at Centerstone and the people we serve and grateful for this opportunity to share our perspective. Centerstone is a non-profit provider of mental health and addiction services that has been in operation for more than 60 years. We offer a broad range of services to people of all ages at locations in Florida, Illinois, Indiana, Kentucky, and Tennessee. We serve many people beyond these states through our research institute and our specialized programs for veterans and their loved ones. I m going to begin today by answering a question I and I m sure a lot of my peers in the behavioral healthcare sector hear a lot: Do we really know how to treat opioid addiction? Do we have the tools, the ability, the treatments to help a person get clean and stay on the path of recovery? The simple answer to this line of questioning is, yes, we do. But, unfortunately, far too few people have access to the comprehensive, evidence-based treatment they need. There are several reasons why this is the case. A major challenge is lack of providers. We know that there are more than 30 million people living in rural communities in which no treatment options of any kind exist today let alone comprehensive, evidence-based ones.

2 Another challenge is that in places where treatment options do exist, many available options are woefully inadequate. This stems from the fact that, fundamentally, we do not, as a nation, treat opioid use disorder like the chronic disease that it is. There are no standards of quality care that providers are held to and no consistent protocols for care. This is a dramatic departure from a condition like heart disease. When a person goes to an emergency room with signs of a heart attack, their experience pretty much anywhere they are in the nation is similar standard medication protocols, tests that are administered, questions that are asked. Once their condition is assessed and initial treatment is performed, they follow a treatment path medication management, cardiac rehab, regular visits to a physician. Their other healthcare providers such as their primary care physicians are probably informed of their condition and looped into the ongoing treatment plan. They are likely given access to resources to help them make the lifestyle changes they need to be healthier dieticians, counselors, peer groups. Their families are often times brought in to support them as well. We have a standard of care that providers are held accountable to providing, and we engage the patient, with heart disease, in their health and give them the support and treatment they need to succeed. The experience for someone seeking treatment for substance use (or opioid use) disorder is entirely different than that of a heart patient. If a person visits five different treatment centers, they might receive five different treatment protocols. In some cases, this protocol might be only medication or only counseling. In others, it might be a combination of treatments. There is no set path a provider is encouraged to follow, and no one is holding that provider accountable for administering an evidence-based protocol or for ensuring that the patient has a positive outcome. It is also possible that healthcare providers engaging in a patient s care may not know that they are in treatment, or have access to their full record.

3 In short fragmented care, an absence of quality standards, and immense workforce shortages result in delayed access to quality, lifesaving care. This is what we have to change. Opioid use disorder is similar to heart disease in that there is no one magic bullet for treating it. You cannot take a pill so that it disappears. It is a condition that, based on the patient s presentation and severity, requires a combination of treatments medication, therapy, follow up care. A condition that may require significant life changes to overcome. A condition that often times requires long-term support. Fortunately, there is data that shows what can work. This is why we support treatment initiatives that approach addiction as a chronic and relapsing disease with emphasis on building a patient s recovery. However, in order to ensure positive outcomes, we also need to modernize our health IT infrastructure and optimize our workforce. I realize that saying this is the solution is easier said than done. Getting people in need the right care close to home means dealing with standards of care, infrastructure issues, knowledge gaps, technology gaps, and serious shortages amongst addiction treatment providers. Fortunately, many of the bills before this committee, both today and in previous hearings, are a great start to addressing these issues. Centerstone supports all legislative action that eliminates barriers to care and, instead, creates and rewards providers for following quality standards so that when a patient walks through the doors of any treatment provider, they have the best chance possible at receiving the right services that will put them on the pathway to recovery. We support advances in technology-enabled solutions such as prescription drug monitoring programs and incentives to modernize behavioral health IT. Investments in the health IT backbone of our behavioral health care delivery system are a critical tool in improving care and moving our industry from one that is siloed and inefficient to one that is integrated and provides whole person care. Individuals who are opioid dependent often present with co-occurring physical, mental, and behavioral

4 health concerns. For example, six out of 10 people with a substance use disorder also suffer from another form of mental illness 1. Allowing integrated care for treatment of individuals with opioid use disorder care that loops in their other healthcare providers and takes into account all of the healthcare challenges they have will not only save costs, but save lives. At the end of the day, the most expensive form of care we can ever deliver in this country is care that does not work. As members of the committee consider a myriad of potential policy solutions, Centerstone urges members to consider policy priorities that (1) establish a standard of care for comprehensive addiction treatment (2) develop our nation s behavioral health workforce, and (3) modernize our nation s behavioral health IT infrastructure. Taking action in these targeted areas, while not the only solutions, will play a meaningful role in stemming the tide of the nation s opioid crisis by transforming the way we deliver care, and ultimately, it will change people s lives. I will conclude my remarks with a real life example of recovery and hope from one of my colleagues at Centerstone. Keith Farah, now a peer support specialist at Centerstone, struggled with severe and persistent addiction for years. After Keith experienced numerous trips to treatment, he finally found himself with two choices: either die from addiction or live. He chose life. As Keith puts it, I had given everyone who loved me more than enough reasons to give up. I was homeless, unemployed and a convicted felon. Even worse, I was hopeless and terrified of living life sober. Keith made the choice to walk into the doors of Centerstone Addiction Recovery Center in Kentucky. After admitting complete defeat, today he celebrates a life that he never dreamed possible. I have the privilege of being a true father to three amazing girls, he describes. Keith is also pursuing a degree in counseling and is engaged to be married. As a peer support specialist, Keith believes that on most days, his job feels more like a privilege than a job. The longer I stay on this road, it becomes more 1

5 and more apparent that the reason we get sober is to be of purpose to others and become useful in ways that we had always intended. Centerstone Kentucky Addiction & Recovery Center, through the implementation of the recovery-oriented medication assisted treatment model, has seen a 108% increase in full time employment and 66% decrease in any opioid use within their patient population, one year after intake. Stories like Keith s, who is now celebrating 5 years of sobriety, demonstrate the great potential of a comprehensive system of care. However, we also know we can do better, and believe the recommendations in our testimony as well as the work before this committee will take aim at changing the course in our nation s opioid and drug crisis. From our teams who are working on this issue, in communities, every single day, to our board members, we are beyond grateful for congressional attention and action on this matter. Thank you for your work, and I look forward to your questions.