Report: Montanans struggle to find substance abuse treatment

More than 90 percent of Montanans with alcohol or drug problems do not receive treatment, according to a new report.

The joint report by the Montana Department of Public Health and Human Services and Montana Healthcare Foundation estimates that roughly 4,000 adults in Montana may be seeking — but unable to access — outpatient substance abuse treatment.

“We set out to find a shortfall in the treatment system,” said Aaron Wernham with the Montana Healthcare Foundation. “We didn’t necessarily expect it to the degree we found it.”

Manatt Health authored the report.

Wernham said in a recent survey of rural hospitals, 100 percent of respondents listed substance-use disorders among their greatest concerns.

Zoe Barnard, the state’s Addictive and Mental Disorders Division administrator, said the estimation of Montanans struggling to tap into substance abuse treatment is partially based on an analysis of a National Survey on Drug Use and Health survey.

“We’ve had limited resources, so we provide services to the people in the highest need when their abuse gets severe enough that inpatient treatment is required,” Barnard said.

As Montana law stands, the state cannot approve a facility that wants to offer chemical dependency treatment if it duplicates efforts in an “existing local service.”

House Bill 95, which is headed to the Governor for approval, would remove that restriction.

Barnard said that rule change will expand access to chemical dependency treatment. But she said that’s just a start.

WHILE many areas of Montana’s health care system have expanded outpatient treatment, Barnard said mental health and addiction services lag behind.

Out of the 32 state-approved facilities that provide substance abuse treatment, more than 50 percent don’t report services for people with co-occurring addictions or mental illness, according to the report.

Montana has the second highest rate in the nation for its use of substance abuse treatment beds, according to the report. Barnard said that means not enough people are accessing early-on outpatient treatment “before they’re in trouble with the law or in the hospital.”

Montana drug overdoses account for nearly 250 deaths and 2,500 emergency room and inpatient admissions each year, according to the report.

For those who end up in the court system, more than 50 percent of Montana’s prison inmates are receiving, or in need of, drug or alcohol treatment.

That impact rolls into Montana’s younger populations.

The report found that 6 percent of state-approved facilities report programming tailored to pregnant women. Yet, the percentage of infants younger than 1 enrolled in Medicaid with evidence that their mom used drugs while pregnant increased from less than 200 babies in 2010 to more than 500 last year. Simultaneously, the number of kids in foster care because their parents have a substance use disorder has doubled since 2010.

WERNHAM said the state needs to continue working toward weaving mental-health services with primary care.

For example, he said facilities like community health centers, rural health centers and tribal programs can screen for substance use disorders and offer addiction counseling.

“If a doctor sees high blood pressure, they begin treatment there and refer the patient on to a specialist after that if needed,” he said. “Like any chronic illness, screening for substance-use disorder should be routine in primary care.”

Another piece of the effort is already unfolding, she said. Montana’s 2015 expansion of Medicaid allowed adults to enroll in coverage for chemical dependency, behavioral health treatment, screening and diagnosis. The expansion currently covers more than 71,000 Montanans.

Prior to the expansion, substance-use disorder services were funded through a patchwork of federal grant dollars, taxes and general funds. The expansion allowed the state to bring in $9 in federal funds for every $1 spent on substance abuse treatment, according to the report.

On Friday, Republicans in Congress pulled their health reform bill to repeal and replace the Affordable Care Act, which would have resulted in a rollback to the nation’s Medicaid expansion program.

It’s still uncertain if health reform will happen and, if so, what shape it would take.

Barnard said the department is “tentatively moving ahead” as if the expansion isn’t going away.

“I’m terrified at the prospects,” Barnard said. “Not providing proper mental health treatment is going to result in a less healthy population and that will be more expensive over time.”

She said savings from the expansion could be used to strengthen preventative care and offer more peer support for people transitioning out of treatment.

“This report is a really good summary of what we should do in the current environment,” she said. “We will triage if the medicaid expansion goes away.”

Reporter Katheryn Houghton can be reached at 758-4436 or by email at khoughton@dailyinterlake.com.