The opioid epidemic has devastated communities throughout Louisiana. Opioid-related overdoses continue to rise, and treatment is often out of reach for those in need. In fact, federal data show that just 1 in 20 residents who need treatment for substance use disorders receive it, compared with 1 in 9 nationally.
Recognizing the need for urgent action, state leaders partnered with Pew’s substance use prevention and treatment initiative over the past year to assess ways to tackle the public health crisis. Among those involved were Governor John Bel Edwards, House Speaker Taylor Barras, Senate President John Alario, Secretary of the Department of Health Rebekah Gee, HOPE Council Chair James Hussey, HOPE Council Co-Chair Matt Adams, and Drug Policy Board Director Chaunda Mitchell. State lawmakers created the Advisory Council on Heroin and Opioid Prevention and Education, known as the HOPE Council, in 2017 to combat opioid misuse throughout Louisiana.
As a result of this partnership, Edwards has recently signed several measures into law and the Legislature has approved a series of resolutions intended to increase access to evidence-based treatment for substance use disorders and reduce overdose deaths. These steps—informed by Pew recommendations—will help Louisiana build a more effective, comprehensive treatment system capable of helping those most in need, addressing specific issues within the health care system.
Treatment system transformation
People with opioid use disorder (OUD) seeking treatment are often unable to access medication-assisted treatment (MAT)—the most effective therapy available—in large part because not enough community-based providers offer this care. Therefore, HR291 instructs the state Department of Health to develop and implement a plan to increase the number of providers offering MAT. It also instructs Medicaid to pay for case management services in hospitals to help transition patients with OUD from emergency rooms to these providers. Separately, Act 425 requires that all licensed residential treatment facilities in the state offer at least two forms of MAT on-site by 2021—a significant provision because virtually no residential facilities currently offer any of the three medications used in this approach.
Louisiana does not have enough treatment facilities to help individuals struggling with OUD. In fact, the state has not opened a new opioid treatment program (OTP)—a federally regulated facility where patients take medications for OUD under the supervision of medical staff and receive counseling and other care services—in more than a decade. This treatment gap exists in part because the Department of Health first must conduct a needs assessment to determine if new OTPs are needed in certain geographic locations, a process that has not been completed since the requirement was created in 2010. In an effort to encourage new facilities to open, HCR71 directs the health department to establish a new pathway for OTPs to receive approval.
Substance use disorder workforce
Nurse practitioners and physician assistants can bolster the workforce in rural areas where there are not enough providers and where patients often have difficulty accessing evidence-based treatment for OUD. However, Louisiana state law and regulatory policies prevent these health professionals from prescribing buprenorphine, a drug used to treat OUD. Act 414 allows nurse practitioners and physician assistants to obtain and use a waiver to prescribe buprenorphine within the scope of their licenses, regardless of whether their collaborating or supervising physician holds a similar waiver and regardless of medical specialty.
Coverage and reimbursement
Although methadone is a well-studied and effective treatment for OUD, Louisiana had been among a minority of states that did not cover this treatment in Medicaid, leaving many residents without access to evidence-based care. The state’s budget, Act 10, ensures that methadone will now be covered by Louisiana’s Medicaid program. Also, HR257 recommends that the Department of Health evaluate the cost of removing prior authorization—in which clinicians must first seek approval from insurers before dispensing treatment—on naltrexone, another drug used to treat OUD, so legislators can consider action in the next legislative session.
What’s next for Louisiana
The state health department will focus on implementing many of these initiatives. Officials also will continue to build support for other recommendations, including a proposed pilot program to offer all three forms of MAT in three parish prisons, places where individuals disproportionately suffer from substance use disorders. Together, these reforms will help turn the tide on Louisiana’s overdose crisis and ensure that those struggling with OUD get the help they desperately need.
Beth Connolly is project director for Pew’s substance use prevention and treatment initiative.
This article was updated Aug. 28 to correct a misspelled name.