The opioid crisis is everywhere. Why aren’t our treatments for it?

A heroin user holds suboxone, a maintenance treatment for opioid dependence, on August 8, 2017 in New York City. (Spencer Platt | Getty Images)

In Appalachia, we’ve felt the opioid crisis in a way that few people outside of the region can really understand. West Virginia continues to have the highest overdose fatality rate in the nation — 90.9 for every 100,000 people compared to the national average of 32.4 — and we don’t have access to the resources needed to help folks recover from opioid use disorder (OUD).  We also know that incarcerated people in our state and across the country face an outsized struggle to receive treatment for substance use prior to, and after, release. 

At Community Education Group (CEG), we believe that providers of medications for opioid use disorder (MOUD), especially those serving 75 or fewer patients, sit at the nexus of not only addressing the opioid overdose crisis in America but the growing HIV and hepatitis C syndemic as well. If we can get these providers to expand HIV and hepatitis C screening and connections to care, we have a unique opportunity to address multiple health crises at once. And this must include expanding access to people incarcerated in America’s prisons. 

The Biden administration can move in this direction by approving a series of applications for what are known as Section 1115 Medicaid waivers that would make it easier for incarcerated people to receive MOUD and other medical care. Last year, the Centers for Medicare and Medicaid Services (CMS) issued guidance allowing states to request permission to expand MOUD treatment to incarcerated people up to 90 days ahead of release with the intention to help them succeed and thrive during reentry. Fourteen states, West Virginia included, have submitted proposals through the Section 1115 waiver process, but they have yet to receive a response.

Recently, a bipartisan Congressional coalition consisting of New York Representative Paul Tonko, along with Ohio Representative Michael Turner, Maryland Representative David Trone, and Nebraska Representative John Rutherford, all signed a letter to Centers for Medicaid and Medicare Services Administrator Chiquita Brooks-LaSure urging the passage of these 1115 waivers. This tells me that even in our fractured and polarized political environment, there is bipartisan agreement about the necessity of expanding MOUD access in pre-release care for our incarcerated neighbors. And as I’ve written in West Virginia Watch before, I believe increasing access to MOUD access should (and can!) increase access to services for infectious disease. The Section 1115 waiver allows for us to bring in more providers to our growing fight to address opioid use disorder and to eliminate HIV and hepatitis C.

Far too many American families and communities have been devastated by the opioid epidemic, and approving these waivers would help save lives among a demographic particularly vulnerable to substance use and overdose. I hope CMS will take action, with an urgency equal to the crisis we are facing in Appalachia and rural America. 

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