One of the factors often cited as helping fuel the recent opiate epidemic is lack of access to addiction treatment services in rural areas of the United States.
In Montana, one of the country’s lowest population-density states, lawmakers and other officials have been taking steps to make it easier for addicts to access treatment in rural areas.
One of Montana’s statewide resources to fight addiction is a network of more than 800 peer support specialists – people in long-term recovery who have been trained to support others who are in earlier stages of recovery. In the past, the state has provided some limited grant money to pay for peer support, but many of the specialists have worked on a volunteer basis.
The profession had been unregulated and uncertified in Montana, until a new law that took effect on October 1. Peer support services in Montana can now be billed to the state’s Medicaid program, as in at least 38 other states.
During the 2017 legislative session, lawmakers also removed a ban on violent offenders in drug courts. Not all of the state’s 26 drug courts observed the ban, a 2015 audit discovered, and some violent offenders were able to succeed in drug court. Some court officials lobbied to remove the ban, and the legislature responded. (Sex offenders are still banned from drug courts).
Drug courts are a major source of referrals to addiction treatment, since one-third of the state’s counties have no licensed addiction counselor, according to census data. Along with about 20 counties, drug courts are also active on four Native American reservations, according to the Billings Gazette.
Between 2008 and 2015, drug arrests went up by 62 percent in Montana, with felony arrests doubling. Meth violations, which were on the decline in Montana between 2005 and 2010, increased by more than 500 percent in the past five years.
These drug cases, combined with probation and parole violations and no-shows in court, are a major driver in the state’s prison and jail overcrowding, a recent study found.
Legislators also took action to to expand access to Naloxone, and to move criminal offenders who receive deferred sentences into treatment more quickly, when space is available.
Another new law removes geographic restrictions on state-approved substance abuse treatment providers. The restrictions, established back in the 1970s were intended to geographically disperse services in rural Montana, but had the unintended effect of reducing the number of providers.
“It was set up so that we could have coverage across the state,” Zoe Barnard, director of the Addictive and Mental Disorders Division of the state Department of Public Health and Human Services, told the Gazette. “That was the original intent. But over time it turned into a situation where there couldn’t be any duplication and there was only one.”
To obtain state approval, any new facility planning to open must demonstrate an unmet need in the area it plans to serve, but officials still expect the change will enable more state-approved treatment centers.
Treatment providers need state approval to qualify for Medicaid reimbursement and other federal funding. They can also receive county reimbursement services from a federal block grant and can access county money that comes from a tax collected on alcohol sales.
In 2015, the state expanded its Medicaid program under the Montana Health and Economic Livelihood Partnership (HELP) Act, which extended coverage to those making up to 138 percent of the federal poverty level. The 71,000 Montanans who signed up for coverage under expansion became eligible for coverage of substance abuse treatment.
“When that passed, we had to go in and look at what we were providing and figure out how it fit in with Medicaid,” Barnard told the Gazette. “The statute kept coming up and presenting problems because if you’re going to try to improve access to care and you only have one provider per area, obviously you’re going to have a limitation on access.”
Even though the Eastern Montana Community Mental Health Center provides mental health and substance abuse services across most of the eastern side of the state, it couldn’t treat people for drug and alcohol addiction in Dawson County under the law.
Jim Novelli, the Center’s executive director, told the Gazette that one of the ripple effects of the Bakken oil boom in eastern Montana has been more addiction and alcoholism. Removing the limit on providers has enabled Novelli to begin providing services out of a satellite office in Glendive, in southeastern Montana, the Gazette reported.
Barnard estimates about 80,000 people in Montana have a substance abuse problem, but just 10,000 have sought treatment. In a recent survey of 31 Montana counties, 24 said alcohol and substance abuse was their top concern. It was cited as one of the top three issues in all 31 counties.