Residential addiction treatment centers for adolescents are limited and expensive across the U.S. amid a fentanyl addiction and overdose crisis, a study led by Oregon Health & Science University researchers found.
The study, published on Monday in the January issue of Health Affairs, found that about half of the facilities had a wait time that averaged nearly a month. The findings demonstrate the need for youth to have access to addiction treatment in other settings like primary care, researchers said.
They gathered data for the study with a “secret shopper” methodology, with a person posing as the aunt or uncle of a 16-year-old who needs treatment after surviving a recent fentanyl overdose. In this scenario, the child was uninsured and not on Medicaid, but likely eligible. The researchers investigated 160 residential treatment centers across the country that serve youth under 18.
They obtained cost estimates for 108 of them, discovering the average daily cost is $878. For a one-month stay, that’s a cost of about $26,000, which nearly half of facilities nationwide require upfront in full or part. They found that 57% of the facilities accept Medicaid, which provides health care to low-income people.
“If you are a family in crisis and you have a kid for whom outpatient treatment is not an option, you hope to be able to call the closest residential facility to you and have access to timely, safe, affordable care for your child,” said lead author Dr. Caroline King, who conducted the study as a medical student at OHSU and is now an emergency medicine resident in the Yale School of Medicine. “This study shows that affordable, timely and effective treatment is severely lacking for the most vulnerable kids in our population.”
Only half had immediate opening
Among the 160 facilities, 87 of them — about 54% – had a bed immediately available. Almost 40%, 63 facilities, had no beds available or a waitlist. Another nine facilities were unsure of bed availability.
The study did not break out facility results by state. But the findings reflect known gaps in Oregon’s behavioral health system. Policymakers have tried to address the problem in different ways, including programs and incentives to encourage more people to enter the workforce, higher Medicaid rates for providers and money to help youth facilities start or expand.
Gov. Tina Kotek recently announced that Medicaid insurers have agreed to provide $25 million from their profits to pay for youth-focused behavioral health facilities across the state that will add 100 more beds to the system.
There are other ways to help youth, too.
King said the solution isn’t to build new treatment centers, but to strengthen care for addiction in primary care settings.
Pediatricians in communities are smart, know families and can expand outpatient addiction treatment with different tools, King said in an interview. Examples include partnerships with academic centers and other programs like the Oregon ECHO (Extension for Community Healthcare Outcomes) Network, which allows professionals to obtain mentoring and gain insights about best practices to advance their skills.
“Our goal would be that if you have a child who for whatever reason can’t participate in outpatient treatment, either because you can’t access it or because they’re not a good fit for it, then you should be able to safely call the center close to you and know that you’ll be able to get affordable, safe and reliable treatment for your child,” King said. “And that is certainly not the case for most of America.”
For-profit treatment centers had shorter waitlists, but cost about triple what nonprofit facilities charged on average. Researchers found that some facilities offered loans through an outside party or recommended they take other actions to cover the costs like taking out a second mortgage on their home or using a credit card.
“When your kid is in a crisis and needs treatment, it can be terrifying to know where to turn,” said senior author Ryan Cook, a research and training scientist for addiction medicine at OHSU. “Many parents or family members will look first for residential care and find the experience profoundly disheartening. Systems-level changes are needed to ensure effective, affordable treatment options for adolescents.”
And even with deep pockets to pay for treatment, the solution can be elusive. A prior OHSU-led study found that only one in four addiction treatment centers provides buprenorphine, a medication to treat opioid use disorder that is approved by the Food and Drug Administration for people age 16 or older.
by Ben Botkin, Oregon Capital Chronicle
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