Delaware legislators are introducing legislation to prevent overdose deaths.
Mary Beth Cichocki said her son Matthew became addicted to prescription drugs after doctors prescribed him a heavy dose of pills after surgery.
For years Matthew attempted to get help at rehabilitation centers across the state and in Maryland, but Blue Cross Blue Shield, and later Medicaid, would not cover his treatment for more than 30 days a year—and not more than about 7 days at a time.
“It would be the same thing as someone having a tumor and you go into surgery and they only remove half the tumor and tell you, ‘Come back in 30 days and we’ll take care of the rest of it.’” Cichocki said. “That’s how they treat addiction. They treat these people like they’re unworthy of being treated, like they’re disposable, so who cares?”
Not being able to afford the $8,000 a week treatment out of pocket, Matthew was in and out of rehab for five years.
Then in 2015, at 37, he died of an overdose.
“Now I have to live with the fact I’ll never have another birthday with him, I’ll never dance at his wedding, I’ll never hold his child in my arms,” Cichocki said. “The loss of a child is devastating and it’s a life altering grief that never goes away.”
Delaware legislators are now introducing three bills this week to address over-prescribing and access to treatment in an attempt to prevent more overdose deaths.
Last year there were 308 overdose deaths in Delaware—that’s up from 228 in 2015 and 224 in 2014. In 2015, Delaware’s drug overdose rate was the 12th highest in the country.
Attorney General Matt Denn, D-Delaware, who brought the bills to legislators, announced the legislation in Legislative Hall in Dover on Wednesday, alongside the bill’s sponsors, Insurance Commissioner Trinidad Navarro and Public Health Director Karyl Rattay.
One measure, modeled after a new law in New York, would not permit pre-authorization and referral requirements imposed by private insurers to get initial treatment for substance abuse.
The only “utilization review” permitted by insurers of the first 14 days of treatment would be to ensure that treatment providers were complying with national guidelines for substance abuse treatment. That review would occur after the 14 days had expired, and the Insurance Commissioner would be responsible for overseeing those reviews.
Another bill addresses the issues of individuals being denied coverage, sent to an inadequate type of treatment or cut off from treatment after an inadequate period of time. It would allow the Department of Justice to tap into consumer protection funds to secure expert medical advice for those denied coverage, and to provide legal assistance in navigating the appeals process.
Denn said denying coverage or limiting coverage is practiced by private, employer funded and Medicaid insurance.
“Today you’ve got nothing [if you’re denied],” he said. “So what this bill would allow us to do is set things up so those individuals could have a doctor who would give them an informed opinion, ‘Yes, they do need the specific treatment they’re receiving.’ They would have someone who could help walk them through the claim and appeals process, so they know how to file and argue their appeal. So all those things put people on better footing in terms of getting the treatment they need and hopefully result in more people who need treatment getting what they need.”
A final piece of legislation establishes a new committee to help oversee the state’s prescription drug database. The committee would be able to establish which doctors have extraordinary opiate prescription patterns, and determine if referrals to licensing authorities or law enforcement authorities are necessary.
Denn said the state is aware there are some individuals and practices that are prescribing at a much higher rate than others.
“Right now we don’t have as an effective enforcement mechanism as we should to pinpoint those who are overprescribing and take appropriate steps,” he said.
“The Office of Controlled Substances can do reporting now, but they don’t have the horsepower to be as effective as they can be. This will allow them to be more effective and efficient in terms of targeting prescribers and figure out what the steps are.”
The bills will be sponsored by Senators Margaret Rose Henry, Stephanie Hansen, David Lawson and Anthony Delcollo, and by Representatives Helene Keeley, Michael Mulrooney, Timothy Dukes and Ruth Briggs King.
“It is tragic to consider that we’ve lost Delawareans to addiction because they couldn’t get the help they needed. Frankly, it’s unacceptable,” said Senate Majority Leader Margaret Rose Henry, D-Wilmington. “Insurance and health care providers should not stand in the way of people getting the help they so desperately need and this legislation will help more Delawareans access critical rehabilitation care.”
Cichocki, who was one of several speakers on Wednesday who have lost loved ones to addiction, said she believes the three pieces of legislation would have helped her son.
“If [the pain management doctors] had been investigated, and stopped and forced to put Matthew on a waiting protocol that would have helped him tremendously to get off the amount of opioids he was on slowly and safely and under doctor supervision,” she said.
“I truly believe if a better plan was in place, if Matt was allowed to stay in Bowling Green [addiction treatment center] for six, weeks, seven weeks, eight weeks, he would have come out stronger, healthier and more capable of handling things without resorting to his comfort zone, which is the pills.”
All of Wednesday’s speakers told stories about struggles with insurance companies when they or their loved ones tried to receive substance abuse treatment.
In 2007, Matthew Guthrie, 28, of Wilmington sought treatment at an inpatient facility only to be told his addiction hadn’t progressed enough to receive coverage. He wasn’t able to receive proper treatment until 2011.
“Often I look back at my story and I think what could have happened in those four years if I received proper treatment in 2007—my story could be very different. That experience was valuable in teaching me some life lessons, but ultimately if I could have received treatment in 2007, obviously I wish I could have done that,” Guthrie said.
“The disease of addiction doesn’t discriminate. It’s not something I chose. I came from great family, I had all the support in the world—but I couldn’t beat this thing, much like a lot of other people can’t beat the disease they have. If we can treat this in the same way, I feel like we’re taking positive steps.”
Cichocki said she has a message to any parent trying to help their child recover from addiction.
“I would tell them to fight as hard, and loud and be as ugly as you have to be. I tried, being a nurse I tried to be respectful, I didn’t want to be that screaming mother, but if you have to be that screaming mother to save your child absolutely go for it,” she said.
“Call the newspaper, call your Congressman. call your Attorney General, call your Insurance Commissioner. Do not be ashamed. Addiction is a disease and it needs to be treated. People do recover, but they need treatment. Continue to fight as long as your child is alive, and always tell them you love them.”