CHARLESTON, W.Va. — Under a bill that West Virginia lawmakers are considering, state opioid settlement money would no longer go solely to licensed medical facilities that offer addiction treatments like medication and therapy.

House Bill 146, which unanimously passed the West Virginia House of Delegates last week during special session, would let Ryan Brown funding – settlement money from lawsuits against opioid makers and distributors – go to peer-led facilities. That may include places like transitional living homes, sober living homes and recovery residences. Recovery Point is one well-known name in West Virginia that falls under this classification, but many are much smaller and their approaches and helpfulness vary.

While many people are helped through these organizations, neither the state nor the federal government requires them to offer evidence-based approaches, like offering types of therapy that have been shown to help addiction, such as cognitive behavioral therapy, or offer medication treatment, like Suboxone, an opioid addiction treatment which has been shown to reduce overdoses and save lives. 

West Virginia lawmakers passed a bill creating the Ryan Brown Addiction Prevention and Recovery Fund in 2017. The money was meant to expand the number of treatment beds in the state. Lawmakers wanted to improve access to long-term, inpatient care.

Kim Miller, an addiction treatment specialist and spokeswoman for the mental health and addiction treatment provider Prestera, said that long-term, inpatient care, intensive care is still the gold standard for addiction treatment – “intensive,” meaning that a multitude of services are provided, from medication to group and individual therapy to 12-step classes.

She noted that as people in West Virginia have entered recovery since the start of the addiction crisis, sober living homes have sprouted up across the state, but they lack federal or state oversight.

"There are recovery residences that are really profiteering off the addiction problem in West Virginia," Miller said. "There are people making money on individuals with disadvantages and whose families are willing to pay."

Some peer-led facilities follow the standards of the National Alliance for Recovery Residences. Participation in that organization is voluntary. The state also has its own West Virginia Alliance of Recovery Residences, which recovery organizations can join to show they've promised to abide by a number of standards, including agreeing to operate ethically and safely.

In an email, Allison Adler, spokeswoman for that department, said that if the bill passes, peer-led facilities that would be newly eligible for Ryan Brown funding would need to follow National Alliance for Recovery Residences standards.

Miller said that while the National Alliance for Recovery Residences provides some guidelines, such as requiring member organizations to drug screen, it doesn't require sober living homes to have access to proven treatments, like cognitive behavioral therapy or medication.

She is also concerned that organizations will say they're following the standards just to accept the money, and DHHR won't follow up.

At licensed medical facilities, such as Prestera, the state Office of Health Facility Licensure and Certification reviews safety as well as treatment options at facilities, she said.

"OHFLAC comes regularly and we never know when they’re going to show up," she said. "At other places, there isn’t that check in place."

She thought, though, that the money could possibly be put to good use when people exiting licensed treatment providers need transitional housing.

"At the end of the day, all programs help some people," she said. "No program helps everybody."

The bill is supported by the West Virginia Department of Health and Human Resources. In an email, Allison Adler, spokeswoman for that department, said that the bill would give them more flexibility in allocating funds. 

"The changes made to the Ryan Brown statute will allow DHHR to utilize additional funding in other ways which can impact this epidemic the most," Adler said in an email. She said that DHHR maintains "commitment to providing evidence-based services."

The bill states that it was introduced at the request of the executive. In response to a question about whether that was Gov. Jim Justice or someone else at DHHR, Adler said, "Fighting the opioid epidemic has been one of Governor Justice’s top priorities." 

Justice left the state Office of Drug Control Policy with acting directors and no official head for eight months. In December 2018, he appointed Bob Hansen, director of Addiction Services for the Marshall University School of Medicine and Marshall Health Systems, to lead that office. He appointed Brian Gallagher, chief of government affairs and health care policy for the Marshall University Schools of Medicine and Pharmacy and Marshall Health Systems, to serve as chairman of the Governor's Council on Substance Abuse Prevention and Treatment. 

Dr. James Berry, director of addictions and interim chair of the Department of Behavioral Medicine and Psychiatry at West Virginia University School of Medicine, also sits on that Council. He said he feels confident that new leadership will ensure Ryan Brown money is well-spent.

"We've got folks from both Marshall University, experts from Marshall, we've got experts from WVU, so the academic and research centers in the state are involved in the decision-making, are being consulted," he said, adding that national experts are also being consulted. Johns Hopkins University has been helping with a new strategic plan – although West Virginia has already released several addiction plans. 

"I'm encouraged," Berry said.

The bill now goes to the state Senate, which reconvenes for a special session, mainly focused on education, on Monday.

Current Ryan Brown recipients include Heart 2 Heart Volunteers Inc. (Serenity Hills) in Wheeling, Mountaineer Behavioral Health PLLC in Martinsburg, St. Joseph Recovery Center LLC in Parkersburg, Westbrook Health Services Inc. in Parkersburg, Valley Healthcare System Inc. in Fairmont, West Virginia University in Morgantown, Marshall University in Huntington, FMRS in Beckley, Welch and Summersville, and Thomas Health in Charleston.

Erin Beck is a staff writer for The Register-Herald of Beckley. Email: ebeck@register-herald.com and follow on Twitter @3littleredbones.

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