Proposed law would refocus efforts on treating drug addiction

Washington will get a sweeping re-write of its approach to treating opioid addiction if a bill introduced in the state legislature becomes law.

House Bill 2489, and its companion in the Senate, would update treatment guidelines in state law to favor medication-assisted therapy, where addicts are prescribed methadone or buprenorphine to combat opioid withdrawal while also receiving counseling and other services.

That approach is evidence-based and shows better results than opioid treatment where addicts are expected to simply stop using opioids cold turkey or after brief detox periods. It’s already widely practiced in Washington, including at the Spokane Regional Health District’s methadone program.

But scientific evidence has often failed to prevail over the mistaken belief that addicts are simply being given a replacement drug to help maintain their addictions. Washington’s current law on opioid treatment begins by declaring, “The state of Washington declares that there is no fundamental right to medication-assisted treatment for opioid use disorder” and goes on to specify that abstinence is the preferred outcome of treatment.

Changing state guidelines will help emphasize to health care providers and addicts that “this is not a moral failing,” said Charissa Fotinos, deputy chief medical officer for the Washington Health Care Authority, which runs the state’s Medicaid program.

“Will that help people seek more treatment? In and of itself, no. But it will help change the tone and the frame of the conversation,” Fotinos said.

It also dovetails with what opioid users say they want. A 2017 survey of needle exchange clients across Washington, released Thursday by the University of Washington’s Alcohol and Drug Abuse Institute, found 69 percent of opioid users who wanted to reduce use were interested in medications to help.

“We’ve documented that they want to not be using. We’ve documented that they want the most effective treatment,” said Caleb Banta-Green, the ADAI’s principal researcher.

Providers also won’t have to warn pregnant women their baby will be born addicted to methadone if they start treatment while pregnant, a warning Banta-Green said discourages people from seeking treatment when it’s especially critical.

“What’s the alternative? They keep using heroin? That’s horrible for you,” Banta-Green said.

Instead, the bill simply mandates providers give patients current, medically-accurate information about the impacts of treatment and continued opioid use on their babies.

On its own, the bill won’t do much more than change language. But it also contains provisions to dramatically expand and interlink treatment options across Washington, many of which are contingent on funding that’s in Governor Jay Inslee’s proposed budget.

That proposal from December calls for almost $16 million in opioid treatment and $4 million in prevention, including integrating the state’s prescription monitoring program with electronic health records.

Together, the funding and the bill would expand a network of so-called “hub and spoke” treatment areas in Washington. Six pilot sites are currently operating thanks to federal funding received last fall, but all are in Western Washington.

“We could not fund enough for the entire state,” said Jason McGill, Inslee’s senior health policy advisor.

Under that model, people in treatment are referred to a central “hub” where they’re started on medication therapy and stabilized. Then, they’re able to get ongoing care, including medication and counseling, through a clinic, mobile provider or other “spoke” that’s closer to home.

“What we have today in Washington is, really, we don’t have a system. We have sort of ad hoc providers who are willing, but there’s no connectivity, there’s no resources for those providers,” McGill said.

The bill has a bipartisan group of sponsors and received a hearing Friday morning in the House Committee on Health Care and Wellness. McGill said he’s optimistic it will pass this session.