An estimated two million Americans continue to suffer from opioid abuse, but only 2.7 percent of all the country’s treatment centers offer the gold-standard for opioid misuse treatment: methadone, buprenorphine and naltrexone. A piece written by German Lopez for Vox reports that many addicts cannot access adequate opioid addiction treatment simply because they are not in geographic proximity to a treatment center. In Cleveland, the vast disparity remains and not enough opioid addicts are getting the help they need.

Dr. Christina Delos Reyes is an addiction psychiatrist at University Hospitals, and she is all too familiar with the disparity that is present within Cleveland prisons. She recalls, “In Cuyahoga County Jail, at one point, there was one psychiatrist for 2,000 inmates. So how could you possibly treat everyone who needs to be treated even for bipolar and depression, let alone addiction? It’s really hard to staff.” 

Even with a psychiatrist, incarcerated opioid addicts may not receive specialized treatment for their addiction, simply because addiction-trained psychiatrists are far and few between, according to Dr. Reyes.

The situation further deteriorated when the jail had no in-house psychiatrist for seven months in 2018. Even five Cuyahoga County judges—Hollie Gallagher, Robert McClelland, Deena Calabrese, Michael Shaughnessy and Shannon Gallagher—have criticized the lack of mental health treatment within the county jail. They went on to criticize the untimely manner in which the inmates were evaluated, a process that can take up to four months in Cuyahoga County Jail. As a result of the psychiatric staffing shortage, there were six deaths, one of which was an overdose and two of which were suicides.

Many opioid addicts who are not incarcerated in Cleveland also experience long wait lists, according to Dr. Reyes. However, she knows that people who suffer from mood disorders and opioid addiction are also in an even worse position. People with mood disorders and opioid addiction disorders need treatment for both conditions simultaneously and efficiently, she said. However, treatment centers in Cleveland that treat opioid addiction in conjunction with mood disorders are far and few between. In fact, Cuyahoga County’s Alcohol, Drug Addiction and Mental Health Services lists 10 heroin addiction treatment centers in the county, but only one treatment facility, ORCA House, treats both conditions together.  

As a result, patients suffering from mood disorders and opioid misuse across the city—and the U.S.—are put on waiting lists that last more than one year. The University of Western Ontario Medical Journal (UWOMJ) notes that significant wait-times increases the likelihood of life events that obstruct treatment initiation. Thus, many addicts with mood disorders wait for months on end and never make it to treatment.  

Unfortunately, long wait-times can hold worse consequences than an untreated addiction, sometimes leading to lethal outcomes. The Journal of Addiction Medicine reported that long waiting lists across the country lead to an increased risk of overdose deaths. Dr. Reyes emphasized, “When you’re trying to get help, it’s really important to get the help right now.” 

Even if addicts survive the wait time, transportation costs prevent many patients in Cleveland from arriving at the treatment center. 

“We’re talking simple things. Because you can’t get a bus ticket or don’t have a working car, then you get kicked out of treatment because you can’t ‘comply’ with treatment, and then you’re back in the cycle [of untreated addiction],” described Dr. Reyes.  

There have been some initiatives to bring patients into treatment with free van rides from insurance companies like Paramount Healthcare. Nonetheless, Dr. Reyes finds that these efforts are rather uncoordinated, as van drivers sometimes are “two hours early” or “two hours late.” As a result of the inconsistent van arrival times, some patients may not be able to arrive at their appointment on time—or at all.  

After making it to the treatment center, patients still have to face insurance costs. Dr. Reyes commonly sees that patients’ insurance plans only provide partial coverage of addiction treatment.

“You walk in and your insurance doesn’t cover that, even though we’ve had the Mental Health and Addiction Parity Act since 2008,” explained Dr. Reyes.

Dr. Reyes has seen some plans only covering 30 days of inpatient treatment. However, she knows that an opioid addiction treatment takes more than a month, so she finds that 30 days of inpatient coverage is simply insufficient. 

“Addiction is a chronic illness. You’re going to have to treat it more than once over time. Not just one 30 day period,” Dr. Reyes said. 

The patient will have to pay out-of-pocket for the rest of the outpatient treatment, which can cost up to $14,000 out-of-pocket. If patients are subject to inadequate insurance coverage, one study suggests that addicts may stop coming to treatment altogether, again putting themselves at risk for relapse. In fact, the National Institute on Drug Abuse (NIDA) states that a minimum of 12 months is often needed for effective, long-lasting treatment outcomes.  

For Dr. Reyes, there is a cost to each barrier. She warns, “The cost goes somewhere. It either ends up in dead people, or the cost goes to emergency rooms that provide charity care.”