There’s a saying often attributed to Voltaire (though similar antecedents date back to Shakespeare and even Confucius) that is often translated or paraphrased: “Don’t let the perfect be the enemy of the good.” It was sometimes used in politics to urge compromise on legislation rather than hold out for a bill that has everything you want and nothing you don’t.

That could be said about the recently signed bipartisan Substance Use-disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. It’s not perfect but it starts to address the opioid crisis in some important ways, including:

  • Allowing wider prescription of medication-assisted treatment (MAT) drugs such as buprenorphine, which help wean patients with addictions off of stronger, more addictive and dangerous opioids
  • “A grant program to expand the use of ‘comprehensive recovery centers’ ”, though funding for it will come later.
  • “Expand Medicare coverage for opioid treatment”.

Not all changes are so beneficial. In Michigan, some changes suggested by state regulators may hurt substance abuse recovery efforts without meaning to.

According to Bridge magazine, proposed changes to Michigan’s opioid treatment center regulations could drive up costs unnecessarily and maybe make it impossible to hire enough staff.

The Michigan Department of Licensing and Regulatory Affairs (LARA) is considering requiring opioid treatment centers to provide on-site medical staff—a physician, physician’s assistant or advanced practice registered nurse—24 hours a day. Most experts say such constant care is not warranted so long as care is on call.

It is true that when a patient is going through detoxification or withdrawal, it can be life-threatening, but usually only in the case of severe addiction to alcohol or sedatives such as benzodiazepines (such as Xanax and Valium). In those cases, a hospital detox is recommended.

Jason Schwartz of the Dawn Farm rehab network says routine 24-hour care is unnecessary because “For most people, withdrawal is not dangerous. It’s uncomfortable”. Dawn Farm has never had 24-hour medical staff since it opened in 1994, but it also has had no deaths or “long-term medical injury”.

It also would be expensive. For Dawn Farm, a nonprofit, such a requirement would raise its costs 50 from $800,000 to $1,200,000 for only 600 patients. That’s if they could find and afford the qualified staff, given the state’s physician shortage. Layoffs would be more likely.

Increasing that likelihood is the new proposed requirement that all the staff who do not have a medical license have a master’s degree in social work or get one within nine months. It can take three years to earn that degree. Almost 1,400 workers would likely fail to qualify.

Another publication observes that the requiring such “burdensome regulations” is reminiscent of states where abortion clinics are required to have hospital privileges, wide corridors, and other things that put them functionally out of business. Many have presumed these state regulators were trying to de facto ban the clinics under the pretense that the regulations were to save lives.

Presumably Michigan and other states don’t mean to ban addiction treatment, but that might be the unintended result if they’re not careful. With the opioid overdose death rate continuing to climb, it would be preferable to treat more people with substance use disorder rather than fewer, even if the facility is only good enough, not ideal or perfect.

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