Ortiz y Pino
Heroin, Our Ignored Plague
Bruce Trigg is retiring from the state's Department of Health this year. The soft-spoken, scholarly and intensely committed public health physician has one last policy campaign he’s waging. It's a sort of farewell gift to us. He wants to wake New Mexico up to the silent plague that for at least 20 years has been mowing down hundreds of our young people. It kills them in the prime of their lives—and incredibly, draws scarcely any attention.
At the town hall meeting last month at La Cueva High School, Dr. Trigg noted that between 1990 and 2005, more than a thousand people in Bernalillo County died of heroin overdoses. Worse, he says the rate of such deaths has actually been increasing. The use of heroin by young people has spread so rapidly that now it can be found in every high school, he says, every neighborhood in town.
Remember the media frenzy that accompanied last year’s swine flu epidemic? Daily newspaper and television alerts urged us to protect against that particular stealth killer for months. But while we abstained from shaking hands, wore paper surgical masks, queued up for inoculations and anxiously followed every prevention suggestion from the Department of Health, heroin overdose deaths outnumbered swine flu deaths in our state by a factor of at least 10 to one. But no one mentioned it.
And it hasn’t disappeared the way H1N1 did.
Beyond alerting us, Trigg also offers a blueprint for resolving the problem. He’s worked with addicts in public health clinics and the jail, and he’s convinced that simple changes in New Mexico’s Byzantine behavioral health policies can make a huge improvement. In the long run, this will save the state a lot of money that's being spent ineffectually.
He starts by emphasizing that any addiction is a brain disease with severe social implications. When state government refuses to fund scientifically proven treatments for opiate addiction, it is conspiring to ignore this plague. New Mexico refuses to include therapies using buprenorphine and methadone in our plan for federal addiction treatment money, although other states do so. Instead we rely on less effective methods. Sometimes, this results in deaths that could have been prevented.
When state government refuses to fund scientifically proven treatments for opiate addiction, it is conspiring to ignore this plague.
Trigg says drug therapy isn’t a controversy. The recommendations of government panels are clear on what needs to be done. Using buprenorphine and methadone to treat heroin addiction gets the best results. Yet we steer away from them—for no good reason.
We could also demand state government make treatment for addiction available "on request" using proven, recommended approaches. State Rep. Antonio "Moe" Maestas will again introduce a bill to divert first-time offenders with drug and alcohol addictions out of the criminal justice system and into treatment.
That will save the state a lot of money and produce far better results than jail time. There is no justification for telling an addict who wants to get clean “we have no room for you right now.” Waiting for a space can mean death.
Medicaid rules should be changed to cover treatment for addicted persons (in other words, let the feds pick up three-quarters of the tab). Thirty states are already covering methadone-assisted treatment through Medicaid. Several even have a special category of Medicaid for treatment of substance abuse disorders. As it is now, New Mexico’s version of Medicaid will pay for the buprenorphine prescription but not for the doctor’s time seeing the patient to prescribe it. This is counterproductive and serves to limit the number of addicts who can be treated.
We also ought to direct our state’s behavioral-health management company, OptumHealth, to pay for buprenorphine in primary care settings. As it is now, Optum will only pay for prescriptions written by psychiatrists. The company should be urged to continue to pay for counseling services that provide desperately needed support for medication-based treatment.
Trigg also says people leaving jails or prisons ought to be linked with voluntary treatment after they’re released. This would prevent potentially deadly relapses after they get out, he adds. We could have buprenorphine vouchers (for addicts not eligible for Medicaid) and increase the number of physicians who are trained and licensed to prescribe them.
Finally, he insists our budget crisis can’t be used as an excuse to avoid action. We already have enough money in the system. The challenge is to use it better.
Trigg has been at this a long time. He’s seen public health progress—and he’s seen it suffer setbacks. What he advocates now is basic: Let’s start using existing resources to put an end to this killer plague. Let’s not continue to bury our heads in the sand about it. Once the lethal crisis is under control, then we can begin working on realistic prevention and education programs with some hope of success.