The Redux

Fund housing - Supportive, stable environments reduce costs and improve outcomes. MN is basically outsourcing the payment for recovery housing to NuWay at this point. We need more intentional, better-funded solutions across the state.

1. Kill the X-waiver. If you can prescribe fentanyl without the DEA being involved, you should be able to prescribe much safer medications like buprenorphine.

2. Racism is a public health crisis, especially in the context of behavioral health and SUDs. Antiracist work is our business. Everywhere. All the time.

3. Don't pay for abstinence-only treatment - Abstinence isn’t off the table, but medications for opioid use disorder reduce overdose risk by 50%-70%. Everyone should understand the risks and benefits of the treatment they choose. Don't reimburse providers who try to make recovery pathways universal and narrow.

4. Fund harm reduction. The Biden administration recently worked with congress to get $30m in funding for HR efforts into the Covid relief package. It’s a start.

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This the second post in a series that looks at what we are trying to accomplish at YourPath. The first post looked at what we have been doing in preparation for our formal launch in early summer. This post will look at the plans we have for YourPath in the coming years. There will likely be a third installment, if not a semi-monthly series.

This stuff changes daily, so we’ll see where it actually ends up going, but this is where our thinking is at today. Maybe we will get into the t-shirt game someday. Everybody likes t-shirts.

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I have a tendency to write about things I see as problematic. It can leave the impression that I am not necessarily for much of anything besides complaining. Well, here is an attempt at defining what it is we have been working on for the last 9 months, and what we have planned for the coming months. Part two of this will be on our plans in the coming years and what we would love to see at organizational, state, and federal level to improve systems of care for the people we serve.

Everything comes down to increasing access to person-centered, quality care for families and individuals. We have two basic areas of services that we are launching early this summer. Assessments and medications for substance use disorders.

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TSF, more than anything, is just not designed for the presentation we see every day. It requires an amount of self-regulation that we rarely see with people with opioid, methamphetamine or polysubstance use disorders. It requires an amount of stability among social determinants that is rarely seen, and an amount of insight that is nearly non-existent. That said, the best piece of this approach is the connection to a recovery community and explicit, behavioral focus on making the most of community recovery supports.

If this approach were less-focused on abstinence, more person-centered, and had a simpler, more behavioral focus, it would be The Jam. Then again, if my grandmother had wheels, she’d be a bicycle…

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Peer support services are sitting ducks.

We tend not to play nice with people who have a stranglehold on the system of care that treats us so poorly. Our refusal places us at risk. I believe we are one of the few constituencies that has the back to tell the truth when it is inconvenient, placing us directly at odds with those forces that maintain an unacceptable status quo.

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For the first time in my lifetime, a diverse coalition of people from across the political spectrum have recognized the failures of our approach to drugs in this country. Despite this realization, we continue to work in systems with laws and funding that ignore the futility of this approach. Also for the first time, the recovery community is leaving behind the outdated, “Just say no to drugs,” abstinence-dominated culture that has permeated recovery advocacy. While many of us found healing and hope through abstinence — and 12 Step — pathways, many of the most vocal and effective advocates for increased access to effective, person-centered, harm reduction solutions come from these traditions.

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Joe Biden is entering office with nearly the entirety of the republican establishment pretending his win is illegitimate. These arguments are not fairing well in court, and Biden will be inaugurated as the next president of the US. His administration, and his ability to drive policies around SUD treatment, comes down to how the Senate runoff races play out in Georgia and if democrats toss the filibuster. Even if the democrats win both races and take the senate, if they don’t get rid of the filibuster, little will be accomplished. Senator Mitch McConnell’s universal use of the filibuster ensures that nearly nothing will be accomplished without his go-ahead or a supermajority.

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The Medicaid Inmate Exclusion Policy needs to be rescinded. This policy is a legislative error, one that increases recidivism and mortality, decreases health outcomes, is a violation of 5th constitutional right to due process, and is the financial equivalent of stacking piles of cash from counties’ budgets and giving them the torch.

County jails the largest providers of behavioral health services in our country, and the people receiving services in this setting are ineligible for having their care covered by Medicaid. The costs related to this population are enormous and are borne nearly entirely by counties.

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Like nearly all of the treatment jargon tossed around on websites and marketing materials, the term “person-centered” has become as useless as it is ubiquitous. The tradition of sloppy thinking and a lack of focus or intention around the development and quality of therapeutic programming results in all sorts of situations that should produce intolerable amounts of cognitive dissonance. So, instead of rehashing the requirements of person-centered programs and practice, looking over the Rogerian philosophies, or waxing about the power of unconditional positive regard, we are going the listicle route. Eleven ways you know your program isn’t person-centered.

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What is “political” has been defined as that which might threaten the status quo. Despite the overwhelming problems driven by poor policy and ineffective organizational leadership across almost all aspects of American life, healthcare has sat on the sidelines while we have watched our system become subservient. We have watched the needs of the individuals we serve, the needs of our staff and providers, and the needs of our communities be relegated to the backseat while the needs of the businesses extracting money from these groups are prioritized.

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The addiction and mental health crises were driven by profit. Period.

Across the board, communities, institutions, organizations and individuals chose, in small ways and large, to ignore — or capitalize on — the suffering of the most-vulnerable. Government and private sector, for-profit and non-profit, large and small, the opioid crisis is a revelation more than it is the crisis itself. It is a revelation of the morally-bankrupt nature of our institutions and the inability of our current power structure to ensure safety or justice.

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