WASHINGTON, D.C. — As the death toll from drug overdoses soars to nearly 200 people a year in Hawaii and 64,000 nationwide, health care reformers are looking for ways get people treatment before it is too late.

One possible solution is an unusual bipartisan piece of federal legislation that would allow low-income people addicted to drugs who are on Medicaid to get treatment at large residential treatment centers.

The Road to Recovery Act, co-sponsored by Hawaii Congresswoman Tulsi Gabbard, would permit Medicaid money to be used for treatment at large drug-treatment facilities. It currently can’t be used for facilities that contain more than 16 beds.

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“Rather than pouring more resources into our criminal justice system by criminalizing addiction, we need to focus on expanding efforts to prevent opiate abuse, and increasing access and resources for treatment and prevention,” Gabbard said in an emailed statement to Civil Beat.

The proposed legislation comes at a strange time in the nation’s capital. Even as one group of congressional Republicans joins with Democrats to call for an expansion of Medicaid to help handle the opioid crisis, other Republicans are calling for major cuts to existing Medicaid programs.

For that reason, U.S. Rep. Colleen Hanabusa, Gabbard’s Hawaii colleague in the House, isn’t endorsing the idea, and some health experts say they are skeptical as well.

“The question is where it takes the money from,” Hanabusa said in an interview in her office.

Still, Hawaii officials are lining up in support of the bill.

“The Departments of Human Services and Health support the Road to Recovery Act as a positive step toward addressing the opioid epidemic,” said Keopu Reelitz, DHS’s public information officer, in an emailed statement. “Opioid use impacts everyone. The Act would expand our ability to get help to those who need it.”

Large Institutions Were Shunned

In 2015, 169 people died in Hawaii of drug overdoses, according to the Centers for Disease Control and Prevention in its most recent full state-by-state analysis. Preliminary data reported by the CDC on Friday suggests that overdose rates nationwide rose another 17 percent in 2016. If Hawaii rose at the same pace, it would bring the tally to as many as 200 deaths in Hawaii last year.

“Over the past decade, we’ve seen overdose deaths in Hawaii increase by 83 percent, underscoring the need for additional state and national resources to be put toward prevention and treatment,” Gabbard said.

According to the CDC, older people are more likely to die of accidental overdoses from prescribed medicines; young people when they combine heroin with synthetic opioids like fentanyl, the CDC has found.

On average, about 91 Americans die each day of opiate overdoses, according to the CDC.

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The proposed law change would reverse 50-year-old federal policies, adopted in the 1960s and 1970s, that cut back on care in large institutional hospitals in an effort to encourage care in community settings. At that time, large facilities were seen as simply warehousing the mentally ill, and news reports at the time highlighted abuse in such places. So did movies like “One Flew Over the Cuckoo’s Nest.”

Some big hospitals were shuttered. Instead, patients were supposed to receive care in more intimate and personalized community settings. But the community centers have never been given enough money or resources to meet the needs of the drug-addicted or mentally ill. Consequently, many people have been left without access to residential treatment centers either large or small.

The legislation may provide a remedy, according to a letter addressed to congressional leaders and signed by 39 state attorneys general, including Hawaii’s Doug Chin.

“HR 2938 will remove an unnecessary restriction on Medicaid funding for in-patient drug treatment,” they wrote. “The restriction is a holdover from the original 1965 Medicaid law that was intended to discourage the use of inhumane and ineffective state-run asylums.”

Leonard Licina, chief executive officer at Kahi Mohala, a residential treatment center in Ewa Beach, said the legislation is long overdue.

“It’s an old and outdated law that needs to be repealed,” said Licina, who is the behavioral health representative for the American Hospital Association’s regional policy board.

He said that the opioid crisis is less severe in Hawaii than other parts of the country, but it has the potential to worsen.

“It’s a problem that needs to be addressed before we become like West Virginia,” he said.

Concerns About Funding

So far, there seems to be no promise of additional money for drug treatment, even as President Donald Trump sought last week to highlight the crisis by calling it a national health emergency. While he offered a number of suggestions, he did not call for providing any additional funds to pay for more programs or medical care.

The legislation “seems like a very reasonable thing in the case of the opioid epidemic but not if there is a diversion of funds for other needed medical services,” said Jack Lewin, a Maui resident who is chairman of the Washington, D.C.-based National Coalition on Health Care and who served as Hawaii’s director of health from 1986 to 1994. “There needs to be additional funds added to make this effective and real.”

Lewin blamed the epidemic on a variety of factors, including doctors who prescribed opiates too freely and drug companies that minimized the danger of addiction.

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“Prescription medications have been used improperly and we physicians bear significant responsibility for that,” Lewin said. “The medical profession bears significant responsibility and the pharmaceutical industry does too … drugs were marketed in ways that fostered abuse.”

Gabbard said she would like to see pharmaceutical company executives held accountable for what she called “deceptive marketing and lying about opioids’ addictive nature, as they profit off the suffering of millions of Americans.”

The prospects of seeing cuts to Medicaid — not an expansion — is already troubling to health care providers and Medicaid beneficiaries in Hawaii. Under Obamacare, some 100,000 additional people obtained health insurance through the expansion of Medicaid.

Hanabusa fears that extending Medicaid to cover some people in new ways could result in cuts for other patients. Her particular fear is for the low-income senior citizens who get nursing home care through Medicaid, and whether that funding would continue if more strains were placed on the system.

“Will it send up red flags?” that result in new assaults on Medicaid spending, Hanabusa said.

Still, she said, it is also obvious that the promises made in the 1960s — that institutions would be replaced by small community-based facilities — have turned out to be false.

“We never got that community-based structure in place,” Hanabusa said.