Ongoing substance use disorder crisis demands state, federal policy responses: Brian Lane and Daniel Lettenberger-Klein

CLEVELAND — The substance use disorder crisis in our region, and across the country, is not going away. In fact, it’s getting worse. The state of Ohio is ground zero for opioid overdose deaths, leading the nation with an overdose death rate of 38.3 per 100,000, compared to 21.6 per 100,000 nationally. And it’s not just about opioids anymore. The crisis has worsened and evolved. We are now in the fourth wave of the epidemic characterized by concurrent stimulant and synthetic opioid abuse.

Here in Cuyahoga County, the numbers are even more staggering. Overdoses from cocaine and fentanyl mixtures increased 85% in 2021 compared to 2020, as calculated from the Medical Examiner’s July 12 midyear update draft report on “Heroin/Fentanyl/Cocaine Related Deaths in Cuyahoga County.”

We need to start thinking about how we can increase access to care so individuals can obtain treatment. Effectively addressing this crisis requires a re-examination and revamping of Medicaid reimbursement rates, as well as addressing the mental health workforce shortage – ensuring all Ohioans have access to much-needed care.

First and foremost, our Medicaid reimbursement rates are woefully inadequate and not commensurate with the rates paid by private payers. This, in turn, leaves our most vulnerable populations at risk as they face significant barriers to accessing care. Rising inflation, coupled with these below-market rates, has only exacerbated this long-standing problem. Policymakers need to re-examine these rates and adjust them to reflect market demand.

While there was a Medicaid behavioral health redesign in Ohio in 2018, some of these rates, when re-examined, actually resulted in rates that were lower than they were in 1999, the last time they were revised. And strangely enough, reimbursement rates for 24-hour inpatient residential care are lower than for full-day outpatient treatment.

Brian Lane is s president and CEO of The Center for Health Affairs in Cleveland.

While cost-effective treatment is a necessity, providers who work diligently to appropriately assess and place clients in specific levels of care should be fairly compensated. This current reimbursement model creates the potential for clients to not receive appropriate placement and care during the continuum, which ultimately could lead to less successful long-term outcomes, such as relapse and overdose. This trend is not only unacceptable, it cannot be sustained if we want to treat substance use disorder and help those most in need.

In addition, as depression and anxiety have increased dramatically during the pandemic, we have fewer and fewer mental health care professionals to treat individuals needing treatment. Help is needed from policymakers to address the health care workforce challenges, in general, and particularly in the mental health field, where the shortages are dire. Meaningful legislation that provides incentives to both recruit and retain these professionals needs to be enacted at both the state and federal level. And while measures like loan forgiveness can help recruit new workers into mental health care, we also need to look at ways to keep the workers we have by addressing staff burnout and promoting worker resiliency. Grants, released by the government, can and have ameliorated some of these challenges, but they need to continue, and with increased frequency.

Daniel Lettenberger-Klein

In sum, although Ohio currently leads the nation in opioid overdose deaths, Ohio also has the opportunity to lead the country in addressing this crisis by enacting meaningful reforms to the Medicaid reimbursement structure, which could then be replicated nationwide. This would provide more parity and more access to critical substance use disorder services and would position Ohio as a national model for reform while enacting a policy framework that drives talent and resources into the mental health care field.

Brian Lane is president and CEO of The Center for Health Affairs, the voice of Northeast Ohio hospitals for more than 100 years. Daniel Lettenberger-Klein is CEO of Stella Maris, the oldest treatment center in Ohio, providing transformational addiction and mental health treatment services to the people of Greater Cleveland since 1948.

Have something to say about this topic?

* Send a letter to the editor, which will be considered for print publication.

* Email general questions about our editorial board or comments or corrections on this opinion column to Elizabeth Sullivan, director of opinion, at esullivan@cleveland.com.

No Byline Policy

Editorial Guidelines

Corrections Policy

Source