Substance Use Disorder Treatment: Challenges and the Future

Transcription

1 County of Los Angeles-Department of Public Health Substance Abuse Prevention and Control Substance Use Disorder Treatment: Challenges and the Future Wesley L. Ford, MA, MPH Director 1

2 Outline Addiction- Magnitude of the Problem. Consequences of Unaddressed Substance Use. Funding for Addiction Care and Services. Current System of Care. Future System of Care. Drug Medi-Cal Waiver. 2

3 Magnitude of the Problem Over 1 in 4 Americans will suffer from a substance use disorder (SUD) during their lifetime. 1 United States: 23.5 million people need SUD treatment. Only 2.6 million people receive treatment 11% penetration rate Kessler, Ronald C., et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of general psychiatry 51.1 (1994): Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA Findings). Rockville, MD. 3

4 SUD Prevalence in Los Angeles County 15.4% of individuals over 12 years of age in LA County (LAC) have used illicit drugs in the past year. 1 Illicit drug use (%) Age Group 12 or older or older 26 or older United States* California* Los Angeles County** 15.4 * NSDUH 2013 estimates of illicit drug use in the past month ** NSDUH annual average estimates of illicit drug use in the past year 1. Substance Use and Mental Disorders in the Los Angeles-Long Beach-Santa Ana MSA. Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration, Rockville, MD

5 Consequences of Inadequately Addressing Addiction National costs related to crime, lost of productivity, and healthcare as a result of substance use amounts to ~$600 billion annually. 1 Individuals with substance use disorders incur 2-3 times the total medical expenses of people who do not have SUD. 2 Nearly one-third (32.3%) of all hospital inpatient costs are attributable to substance use and addiction National Institute on Drug Abuse. Trends & Statistics Retrieved from 2. Thomas, Marshall R., et al. Prevalence of psychiatric disorders and costs of care among adult enrollees in a Medicaid HMO. Psychiatric Services (2005): National Center on Addiction and Substance Abuse (CASA) at Columbia University. Addiction Medicine: Closing the Gap Between Science and Practice

6 Annual Direct and Indirect Costs of SUDs in LAC Cost Category Alcohol Illicit Drugs Total % of Total % of State Total Medical $ 2.2 Billion $ 954 Million $ 3 Billion 7.8% 7.1% Wage Work $ 4.3 Billion $1.1 Billion $ 5.4 Billion 13.7% 13.1% Household Work Public Services Property Damage Misc. Motor Vehicle Subtotal: Tangible Costs $ 1.6 Billion $ 360 Million $1.9 Billion 5.0% 5.0% $ 331 Million $ 857 Million $1.2 Billion 3.0% 2.7% $ 497 Million $ 107 Million $ 604 Million 1.5% 1.3% $ 499 Million $ 20 Million $520 Million 1.3% 1.2% $ 9.5 Billion $ 3.4 Billion $13 Billion 32.3% 30.5% Quality of Life $ 21.2 Billion $ 5.8 Billion $27 Billion 67.7% 69.6% Total $ 31 Billion $ 9.2 Billion $ 40 Billion 100% 100% Fact sheet prepared by Ted R. Miller (2012). Total Direct and Indirect Costs of SUD in LAC. Pacific Institute for Research and Evaluation. 6

7 Community Impact > 70 medical conditions requiring hospitalization are attributable to substance use, including: Cancer, Respiratory disease, Cardiovascular disease, HIV/AIDS, Pregnancy complications, Cirrhosis, Ulcers, and Trauma. 1 Individuals with SUD alone died at an average age of 50.5 years 26.1 years younger than the general population National Center on Addiction and Substance Abuse (CASA) at Columbia University. The Cost of Substance Abuse to America s Health Care System, Report 1: Medicaid Hospital Costs Oregon Department of Human Services. Addiction and Mental Health Division. Measuring Premature Mortality among Oregonians

8 Spending on Treatment Condition Affected Population Investment in Treatment Diabetes 25.8 million $43.8 billion Cancer 19.4 million $86.6 billion Heart Disease 27.0 million $107 billion Addiction 40.3 million $28 billion 1. National Center on Addiction and Substance Abuse (CASA) at Columbia University. Addiction Medicine: Closing the Gap Between Science and Practice

9 Current System of Care for SUDs SUD programs largely dictated by funding as opposed to community need. Results in fragmentation of service delivery. Healthcare Hot Spotting 9

10 Redesigning the System of Care for SUDs Health Care Reform Drug Medi-Cal (DMC) Waiver Parity SUD System of Care Focus on Quality Care Growing recognition of the medical, mental health, and financial impact of untreated SUDs 10

11 Drug Medi-Cal Waiver: Foundational Elements Funding for full continuum of SUD care. Opioid Treatment Program (OTP) 11

12 Drug Medi-Cal Waiver: Foundational Elements (cont d) BioPsychoSocial approach to care Particular emphasis on biomedical treatments, such as Medication-Assisted Treatments (e.g.: Methadone, Buprenorphine, Naltrexone, etc.) Biomedical Social Health Psychological

13 Drug Medi-Cal Waiver: Foundational Elements (cont d) The ASAM Criteria (American Society of Addiction Medicine) Based on Medical Necessity ASAM software analyzes 6 key dimensions of client information and uses algorithm to calculate appropriate levels of care.

14 Summary For a variety of reasons, SUD systems of care are not adequately meeting the needs of our communities. Changes in health care policy are allowing for an opportunity to transform addiction treatment. Move toward an organized system of care, with a full continuum that is client-centered and based on clinical needs. 14

15 Thank you!