The struggle to treat adolescent drug addiction

Prescription drug abuse is a national problem, and the scope is more severe than many of us realize.  Recent statistics indicate that drug overdoses now kill more Americans than traffic accidents--a sudden and alarming development.

I became aware of this plague through conversations Representative Rob Sampson and I had with parents in Southington and Wolcott who--despite private health coverage--had struggled to secure proper treatment for their drug-addicted children.  In response to our concern, the legislature's Program Review committee (on which I serve) undertook an investigation into barriers to proper substance abuse treatment.

During hearings in June of last year, I listened to story after story about teenage drug use destroying the lives of young people and their families. Here is a portion of one parent's emotional testimony:

“In the midst of the horrific nightmare journey of heroin addiction that hit our
beautiful twenty-one year old son, we were completely lost and confused, and
had given up almost all hope and sanity. Our lives were a mess.  Then came
the day our son, lying in bed with death at his door, begged for help.  It was at this point the reality of the system rocked our world."

These families had private health insurance, which they expected would cover the cost of rehabilitation.  Instead, many found that securing help was yet another struggle.

The Program Review committee's final report suggests that insurance companies often lack clear standards for coverage, don't have qualified practitioners making
decisions, fail to make a timely determination, and disallow the most appropriate treatment for young people. The report also found a lack of communication when it comes to informing parents that they can appeal a denial for free, and receive help from the state in preparing the appeal.

It seems some insurance companies often employ a “fail first” approach, forcing teens and their families to suffer through inadequate treatments before receiving the level of help they truly require.  How many times must these kids, who have their whole lives ahead of them, have to plead for help? 

As the PRI report suggests, substance use has tremendous costs to society, families and individuals and it often results in cost-shifting from the private to
public sector.  Changing the way insurance companies decide who gets what care in a thoughtful and responsible way will not only help society as a whole, but it will give our young people a fighting chance to recover, and bring their families some peace.

In an effort to achieve the overall goal of improving insured youth's access to
appropriate treatment, recommendations in the report include:

1. Improve CID oversight by instituting a new check of plan compliance with the
federal parity law and requiring data be used to actively monitor utilization
review results.

2. Require substance use treatment coverage decisions be made more quickly and
appropriately, by having stricter requirements about the decision timeframe and
methods.

3. Make the appeals process more user-friendly, by being explicit about the
availability of state assistance and how to support an appeal.

Representative Sampson and I will work to craft this report and its recommendations into legislation which we can usher through the process this session. The facts and figures, coupled with the heartfelt stories, demand attention and action for the sake of us all.

(Sen. Markley is a member of the Program Review committee, and ranking Republican Senator on the Human Services committee.)