The amount of deaths related to opioid overdose in West Virginia has quadrupled since 2010, making West Virginia the state with the most opioid related deaths in America (“West Virginia Opioid Summary”). To mitigate the opioid crisis in West Virginia, officials are calling for a way to reduce opioid deaths: one possible option being the ED Bridge program, already implemented in California, which is designed to help opioid addicts with withdrawal symptoms using buprenorphine, a withdrawal-reducing opioid (Goodnough). The drug would not be prescribed, but rather provided to the patient in the emergency room, along with a referral to a rehabilitation clinic. Since West Virginia has been suffering from rampant opioid abuse, the implementation of the ED Bridge could potentially improve this crisis.
However, there are barriers to this program, one being that many people treat opioid addiction as a moral failure, rather than a disease that addicts are affected by (Lopez). As a result, many individuals believe that treating opioid addiction with medication is ineffective. Furthermore, supporters of this perception think that treating a drug addiction with more drugs would not work, due to their belief that buprenorphine may not be effective.
The controversy behind whether addiction is a moral failure or a disease, whether buprenorphine is effective, and whether this would be economically feasible to West Virginians prompts the question, “Should the West Virginia legislature adopt California’s ED Bridge program to provide opioid addiction treatment in emergency rooms?” The aforementioned question relies on the assumption that, if implemented, the ED Bridge program would be readily available to those suffering from opioid addiction in West Virginia. Thus, an analysis of how this program would be paid for will lend insight as to whether it is feasible for its recipients, prompting the question: “Would the ED Bridge Program be economically available to West Virginia citizens suffering from addiction?” An analysis of the demographics of those suffering from opioid addiction in West Virginia, the way that insurance companies cover addiction rehabilitation treatment, and the potential other methods for financing the ED Bridge program determines that the ED Bridge program is only economically feasible if the West Virginia government were to pay for aspects of it.
Because the main purpose of the ED Bridge program is to give buprenorphine to patients in the emergency room, understanding the cost of each dose would lend insight as to whether the out-of-pocket cost is feasible for addicts to pay. According to the ED Bridge website, the average cost for a dose of buprenorphine is around $5, and clinicians will usually give one to three doses in the emergency room. Thus, the accessibility of this treatment fully depends on whether opioid addicts can pay for the cost of the tablets.
The out-of-pocket cost, compounded with the amount of doses that must be taken, could hinder the accessibility of the drug. Analyzing which insurance companies give the most coverage will shed light on if the ED Bridge treatment is readily available for West Virginian citizens. According to the New England Journal of Medicine, most private insurance companies cover the cost of medication-assisted treatments (MATs). Furthermore, since insurance companies must be paid to insure citizens, those who are insured by these companies are likely able to afford the cost of buprenorphine even without insurance (Guy). The amount of individuals covered by these companies reveals how many addicts can afford the treatment through private insurance. According to Cynthia Cox, director for the program for the study of health reform for Peterson-Kaiser, 37% of opioid addicts in the United States are covered by private health insurance companies. However, the remaining 63% still would have to pay for the treatment in a different manner.
The next most accessible program is government-funded, through Medicaid. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), Medicaid will only cover the cost of the drug if it is provided in a “Medicaid certified” environment, including both inpatient and outpatient treatments. Because the ED Bridge treatment would use buprenorphine to detoxify addicts in withdrawal, and then refer patients to a rehabilitation clinic, Medicaid would likely cover the cost of the treatment. However, if treatment centers are not Medicaid certified, the clients would have to cover the cost themselves, deterring the accessibility of the ED Bridge treatment.
The amount of opioid addicts covered by Medicaid will lend insight as to how many more addicts will be able to afford the treatment, under the condition that Medicaid certifies the environment. Approximately 38% of those addicted to opioids in the United States are using Medicaid as their healthcare provider (Cox et. al). Therefore, most opioid addicts will be able to afford the treatment, either through Medicaid or a private insurance company.
However, those not covered by Medicaid or a private insurance company will have to find an alternate way to pay for the cost of the treatment. About 17% of opioid addicts do not have health insurance (Cox et. al). Moreover, those who are susceptible to opioid addiction come from poverty or unemployment, indicating that opioid addicts without health insurance are highly unlikely to be able to afford the cost of buprenorphine (“How Opioid Addiction Occurs”). Since a significant portion of opioid addicts does not have access to insurance to cover the cost of buprenorphine, analyzing statewide funds for a program such as the ED Bridge determines how those without insurance would pay for the ED Bridge. SAMHSA gave a grant to the West Virginia government which allotted an extra $330,000 – in addition to the $5.8 million they were granted from the 21st Century Cures Act – for the purpose of alleviating treatment costs for opioid addicts, in hopes of reducing the amount of overdose deaths (McKinley). Because this money is not in use right now, it could help fund the ED Bridge program for those who do not have access to healthcare, as the program is designed to help opioid addicts. However, these funds are limited, and therefore, some of the addicts would have to pay out of pocket for the cost of the drug.
Because Medicaid can cover the cost of the ED Bridge treatment if the treatment is provided in a certified environment, and most insurance companies will cover the cost of buprenorphine, ensuring that many recovering opioid addicts will have access to this treatment. However, those without insurance would have to pay for it themselves unless West Virginia were to fund parts of the program. Within the overall question there is the question of whether it is economically feasible for its citizens. From this perspective, it seems likely that it can be economically feasible, but only if the government will invest money to fund the program. Even so, the funds would be limited, and therefore those without insurance would potentially pay out of pocket.
However, the social perceptions of addiction, and the effectiveness of buprenorphine may serve as a barrier to government support of the ED Bridge program. Because West Virginia is the state with the most opioid overdoses, establishing the ED Bridge program there would ensure a precedent for other states that have been suffering heavily from the opioid crisis. Although this question acknowledges whether the program would be economically feasible, it doesn’t discuss other factors that determine whether the ED Bridge could even be implemented, such as the social perceptions of addiction, or the effectiveness of the buprenorphine treatment. Nonetheless, the ED Bridge program can be economically feasible for West Virginia citizens, with the addition of government funds.
