Ga. opioid abuse treatment improves, but more can be done, audit says

Georgia’s made progress since a state report spotted significant barriers for those trying to access medical treatment for opioid abuse in 2017, just as the crisis killed a little more than 1,000 people in the state, according to an update.

But the new report also found that more remains to be done.

The pair of reports by the state Department of Audits and Accounts focus on how well the state is doing when it comes to providing access to medications, such as methadone, that are designed to ease withdrawals and stave off cravings for powerful prescription painkillers and heroin.

This form of addiction treatment — known as medication-assisted treatment — couples counseling with the use of federally approved drugs, which also include buprenorphine and naltrexone.

The 2017 review found that the state had done little at that point to expand access to these potentially life-saving medications.

Steps taken to expand treatment access

A follow-up report, released earlier this summer, returned to find state agencies that were taking steps toward addressing the lapse.

Georgia now has a strategic plan for the crisis. State agencies like the Division of Family and Children Services no longer frown on the medications as a form of treatment. More accountability court judges are also now allowing participants to use them.

And although there are no more treatment clinics available now than there were in 2017, the report did fine that the number of doctors and others writing prescriptions for buprenorphine had increased by about 35%.

Georgia has also made strides in removing obstacles standing in between Medicaid patients and the medications that could help them kick their addiction, the report found. And the state has done this through changes made within the program’s existing framework.

The state Department of Community Health, for example, has pushed at least two of the four care management organizations in Georgia to significantly increase the number of treatment providers in their network. Notable gaps, though, still exist in south and east Georgia.

The agency also tackled administrative requirements within Medicaid that were limiting access to the drugs.

“The recent state audit recognizes that opioid use in Georgia is an epidemic and identifies expanded access to care as a clear opportunity to reduce dependence,” said Laura Harker, a health policy analyst with the Georgia Budget and Policy Institute.

But Harker said that clearing administrative hurdles won’t be enough.

“Georgia must not only continue working with providers to expand treatment options via Medicaid, but fully expand Medicaid to provide more Georgians with access to care,” she said.

Georgia is now exploring its options for a possible partial expansion of the state’s insurance program for the poor and disabled through a federal waiver. Gov. Brian Kemp has said he is opposed to full Medicaid expansion.

More can be done to improve access

Laura Colbert, director of the consumer advocacy group Georgians for a Healthy Future agreed that expanding health coverage is key. But she said the state could build on the progress in other ways too, such as through more training for health care providers on practices like verbal screening and brief intervention.

“A focus on prevention is necessary to ultimately slow the tide of substance abuse that is devastating Georgians and their families,” Colbert said.

The report offered its own suggestions.

Many county nurse managers are still unprepared to identify opioid abuse disorder and recommend local treatment options, the report found. The state Department of Public Health said it would assess its staff training needs.

There are still 70 clinics in Georgia that treat opioid addiction with medication, with many of them clustered around the Atlanta area. But it’s unclear whether that is insufficient because there is no state agency responsible for monitoring the capacity of these facilities or assessing the need.

The state’s new plan could go a little further, too, with tasking specific entities with the job of raising awareness among providers and the public about the medication-assisted treatment resources available in Georgia.

Overdose deaths slow but threat remains

The follow-up review came as the Centers for Disease Control and Prevention announced that overdose deaths dropped about 5 percent from 2017 to 2018, representing the first decline in nearly three decades.

But Jim Langford, director of the Georgia Prevention Project, said that the good news may be deceiving.

Langford noted the rise of an overdose-reversing drug called naloxone. Georgia made the drug available over the counter in late 2016 and empowered first responders to carry it even before that. Nationally, the number of naloxone prescriptions dispensed at pharmacies doubled from 2017 to last year.

“That doesn’t mean we have fewer people who are addicted,” Langford said of the decline in overdose deaths. “It doesn’t mean we have fewer people on opioids. It just means we’ve found ways to keep those people from dying.”