Catching the ‘crucial window of opportunity’ to escape opioid disorders

Opioids are insidious. They are unique in the way they trap people in a vicious cycle of use and withdrawal. The moment that a user expresses willingness to get help there is a small, crucial window of opportunity. But that window slams shut when symptoms of withdrawal hit: stomach cramps, chills, nausea, vomiting, diarrhea.

Within weeks of habitual use, an opioid addict learns that only one thing makes the withdrawal disappear—more opioids. Many say: “I don’t even get high anymore. I have to use to function and not be sick.”

Imagine what it’s like when that person seeks help. Their life is unmanageable. They’ve lost relationships, job, possessions, self-respect — maybe even their freedom, as opioids often lead people to commit crimes to obtain their daily dose. That fleeting desire for treatment is soon overwhelmed by sickness and the unshakable knowledge of what will make it go away.

You’d think I’d be able to help a client in need of an inpatient option. I’m a psychiatrist and medical director for a large mental health and substance abuse agency. I’ve written books and I sit on statewide committees and lecture on opioids. But winning the battle against addiction depends on the patient’s insurance card and a host of other factors, so my expertise, connections, and clinical experience don’t always work — at least not without calling in favors. And with people dying from high-potency heroin and fentanyl analogs arriving from China, that’s just wrong.

Yes, parity laws say mental health and substance-use problems must be covered by health insurance the same as routine medical issues, but it doesn’t always work that way. Gains have been made, and many are working hard to get in-the-moment treatment and resources to people who need them now—not in 24 hours or “once a bed clears up” or “when we have an opening.” Now is when that window is open.

Where do you start? I recommend using a pad of paper and pen to document as you go. If you or someone you care about needs help escaping opioids, pull out your insurance card and dial the number on the back. Explain the situation and find out what treatment facilities and programs are covered. Alternatively, you can go to their website—but don’t trust it absolutely, as lists of available providers often are out of date.

A useful resource is the Department of Mental Health and Addictions Services Access Line at 1-800-563-4086. Before dialing it, get out that insurance card. For state-supported inpatient and residential levels of treatment and support—detox, rehab, and recovery houses—DMHAS maintains a Truvago-style bed availability website that is updated daily. That site continues to expand. It now includes some providers that also take private insurance in addition to Medicaid/Husky.

For people insured under Husky (Connecticut’s Medicaid, managed through Beacon Health Options), eligibility is based on the type of Husky you have. There is a robust website for Medication Assisted Treatment (MAT) for opioid use disorders.

Those over age 65 or disabled with Medicare, Medicare disability, and/or a Medicare Managed Care product will only be able to see Medicare providers. For higher levels of care for substance use, such as rehabilitation programs for opioid use disorders, there are limited options. Medicare won’t readily cover certain medications used to treat opioid use, such as methadone and buprenorphine (Suboxone), although Medicaid will.

If this seems complex, it is. And it gets worse. Those with private insurance will find that not all policies and carriers are equal. Each company has a dizzying array of what’s covered and what’s not. For many, steep co-pays and annual deductibles of $4,000 to $5,000 can be deal-breakers. Most insurers will steer you toward medications with preferred status. The cost of medication-assisted treatment— the most effective treatment for opioid disorders— can run into thousands per month. So sending a urine drug test to a lab for someone with Medicaid, which will pay 100 percent, compared with someone relying on private insurance, may mean a $400 out-of-pocket difference.

Calling the Connecticut Insurance Department’s Consumer Helpline at 800-203-3447 or 860-297-3900 or the Office of the Healthcare Advocate at 866-466-4446 may help if you hit a problem with your insurer, such as being told the patient “hasn’t failed at a lower level of care.” The department website is: www.ct.gov/cid/cwp/view.asp

Connecticut also has a strong consumer support network. This includes wonderful new programs where “recovery coaches”—people with addiction experience—are available to meet and work with people with substance use problems. These advocates can help connect clients to appropriate treatment (and not just for opioids). These new programs have shown great results, with connect-to-care rates of over 90 percent. The Connecticut Community for Addiction Recovery at 866-205-9770 also provides recovery community centers and a telephone support program that will keep in touch, daily if necessary, to support someone in the recovery process.

If you’re in search of help for yourself or someone you care about, your efforts may save a life. Yes, the card in your wallet, the nature of opioids, and our current healthcare maze present many challenges, but don’t give up. Persevere,, get support, and educate yourself about what’s out there. There is recovery from opioid use disorders. There is real hope.

Some additional resources:

https://turningpointct.org/, a site geared toward younger people that includes a searchable resource map with treatment facilities, support groups, and fun sober activities

www.intherooms.com/, the largest on-line recovery social network, with links to all sorts of peer-support groups from classic AA and NA to gender-specific, LGBT, SMART recovery, All Recovery and a searchable ZIP code finder for in-person groups and 24/7 on-line recovery activities.

Substance Abuse Walk-In Assessment Centers:
www.ct.gov/dmhas/cwp/view.asp?a=2902&q=577738

Methadone Clinics in CT:
www.ct.gov/dmhas/lib/dmhas/publications/MethadoneClinicsMap.pdf

Connecticut’s Network of Care:
www.connecticut.networkofcare.org/mh/

Consumer Toolkit for Navigating Behavioral Health & Substance Abuse Care Through Your Health Insurance Plan:
www.ct.gov/cid/lib/cid/Behavioral_Health_Consumer_Tool_Kit.pdf

Support site for parents:
www.addictsmom.com 

Charles Atkins, M.D. is a psychiatrist, author, and chief medical officer for Community Mental Health Affiliates in New Britain.