Overturning the Affordable Care Act could undermine the progress Central Oregon has made in addressing the opioid crisis, local health and law enforcement officials told Rep. Greg Walden, R-Hood River, in a roundtable discussion in Bend on Monday.
Prescribing of opioid medications in Central Oregon dropped 12 percent from 2015 to 2016, and 15 percent statewide after new prescribing guidelines were implemented, they told the congressman, while the expansion of insurance coverage increased access to addiction treatment.
“When people have insurance, they get treatment,” Dwight Holton, executive director of Lines for Life, an Oregon-based suicide and drug abuse prevention organization told the lawmaker. “I know you know this, and I hope you’ll get your colleagues to understand this: Any changes to the ACA that reduce availability of addiction treatment will be like a sucker punch to our efforts to combat the opioid crisis.”
Walden has been one of the key players in the Republican efforts to repeal and replace the ACA. He drew raucous crowds at town hall meetings throughout the state earlier this year, with many voicing their displeasure at the repeal efforts.
The House has voted numerous times to roll back the law, but those measures have fallen short in the Senate so far this year.
Oregon took advantage of the ACA, also known as Obamacare, to expand Medicaid, bringing the total number of Deschutes County residents eligible for the Oregon Health Plan to 40,000. Along with subsidies that allowed people to afford private insurance, more people in the county have been able to get help with their substance use problems. Medication now pays for nearly 24 percent of the addiction medicines prescribed in Oregon.
“We’ve had a huge expansion. We’ve really been able to help people get into treatment,” said Wil Berry, medical director for Deschutes County Behavioral Health. “If all of a sudden these people are losing OHP, we’re going to be going backward.”
The Oregon Health Plan also increased access to alternative pain treatments, such as acupuncture, massage and physical therapy, to reduce reliance on opioid medications for those in chronic pain.
Walden has been holding roundtable discussions around the state to learn about the opioid epidemic, including one in Bend last year.
Bend Police Chief Jim Porter also urged Walden to support continued funding for the High Intensity Drug Trafficking Areas program, a program created by Congress in 1988 to intervene in critical drug-trafficking regions. Deschutes County is one of the designated areas and has used funds from the program to train and equip police officers in the region with the overdose reversal medication naloxone.
Police now carry the medication in their cruisers in Deschutes and Crook counties, and efforts are underway to supply police in Jefferson County as well. Porter said his officers have reversed 13 overdoses since starting to carry naloxone in June 2016, but expressed concern that future funding for the medication could be at risk if the program is consolidated with another federal drug intervention program.
“It gives us the ability locally to use that money within the state to meet our immediate needs and threats,” Porter said. “We believe we can assess that here locally better than we can from D.C.”
Dr. Kim Swanson, a licensed psychologist at Mosaic Medical and chair of the Central Oregon Pain Task Force, asked Walden to look into the price for naloxone, which was increased from $575 per dose in 2014 to $4,500 per dose this year.
“I think that deserves the same attention that the EpiPen deserves in the midst of an opioid crisis,” she said.
While law enforcement and public health entities can purchase naloxone at a reduced price, patients prescribed the medication by their doctors bear the brunt of the cost if they do not have insurance.
“We’re being encouraged to prescribe naloxone with our short term opioid prescriptions,” said Dr. Gillian Salton, an emergency physician at St. Charles Bend. “It sends a very powerful message to the patient to say, ‘I’m prescribing these pain pills. They could be deadly, so I’m also going to prescribe you this antidote.’”
Many Central Oregonians now rely on the Oregon Health Plan to cover the cost.
“If that funding goes away, that medication becomes much more expensive,” Salton said.
Deschutes County officials also told Walden of plans for a new crisis stabilization center that would provide a place those in the midst of a mental health crisis or in need of detox.
“Oftentimes at 2 in the morning, it’s the emergency room or nothing,” Berry said.
The center is a joint effort between Deschutes County Behavioral Health and the Deschutes County Sheriff, but according to Sheriff Shane Nelson, they are still searching for funding.
“It needs to be open 24 hours a day,” he said. “And right now we don’t have enough money.”
(Editor’s note: This article has been corrected. The original version misspelled Dwight Holton’s name. The Bulletin regrets the error.)
— Reporter: 541-633-2162, firstname.lastname@example.org