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In the course of a single day, as many as 600 people can filter through this office, including perhaps half a dozen new patients.

“It’s non-stop,” said Diana Warrilow, the clinic’s lead behavioral technician. “I’m wearing my running shoes; he’s constantly saying ‘Go, go, go’.”

It may get even busier soon. A proposed new state law could send hundreds more people into the state’s addiction treatment system, and doctors are bracing for an unknown impact.

“We’re definitely going to have capacity issues. We’re going to have management issues and we’re going to need to have all hands on deck,” said Dr. Josh Blum, Denver Health clinic director.

The state bill focuses on fentanyl, the deadly and addictive synthetic opioid. Among other changes, the legislation would require anyone convicted of fentanyl-related charges to be evaluated and potentially ordered into addiction treatment, either at an outpatient clinic like Denver Health or a more intensive residential facility.

220419-FENTANYL-ADDICTION-METHADONEHart Van Denburg/CPR NewsDr. Joshua Blum, who runs one of the busiest methadone clinics in the Mountain West at Denver Health’s outpatient behavioral health clinic for addiction treatment. Photographed at the clinic on April 15, 2022.

No one seems to know exactly what to expect from this change, as there is no firm statewide data on fentanyl cases.

In a cost estimate of the bill, legislative staff projected that about 300 people a year could face fentanyl possession charges, which can result in treatment orders. They arrived at that figure by estimating that 5 percent of annual drug possession convictions involve fentanyl.

Some advocates think the reality will be higher. In Denver County alone, prosecutors filed about 340 fentanyl-related cases in 2021. In El Paso County’s 4th Judicial District, they have filed about one case per day. (Not all charges result in a conviction.)

The goal of the new state bill is to “make sure you get the evaluation and recommendations for further treatment if needed, because fentanyl is more addictive than any substance we’ve ever seen,” said the president of the Alec Garnett Chamber. a Democrat who is leading the bill, in an interview.

220419-FENTANYL-ADDICTION-METHADONEHart Van Denburg/CPR NewsMethadone Safety Seals for Methadone Doses at the Denver Health Outpatient Behavioral Health Clinic for Addiction Treatment. Photographed at the clinic on April 15, 2022.

The issue of pushing more people into treatment has divided doctors, lawmakers and patients.

Some treatment providers, such as Dr. Blum of Denver Health, think an influx of new patients would be a good thing, even if it causes some temporary strains.

“I love the idea of ​​getting more people into treatment … because, honestly, people need that little kick,” said Blum, who is confident her clinic can scale to meet higher demand.

There is reason for optimism, especially in the larger clinics. Today, about 19,000 people a month receive medication-assisted treatment in Colorado, and the state’s 30 methadone clinics are able to handle that demand without putting people on waiting lists, according to state officials.

“I think it’s a good problem to have,” Blum said. “If there are so many people seeking treatment, it’s up to us to meet people where they are.”

But these large methadone clinics cover only part of the state. The system is overburdened in other areas, particularly for those seeking treatment in rural areas or residential facilities, where they may face long waits for care.

“We don’t have enough providers at any level,” said Rob Valuck, executive director of the Colorado Consortium for Prescription Drug Abuse Prevention.

“We don’t have enough primary care doctors to do this. We don’t have enough behavioral health professionals doing this. We don’t have enough addiction treatment centers and providers that do this. We don’t have enough school nurses to do that. We don’t have enough.”

220419-FENTANYL-ADDICTION-METHADONEHart Van Denburg/CPR NewsDr. Joshua Blum, who runs one of the busiest methadone clinics in the Mountain West at Denver Health’s outpatient behavioral health clinic for addiction treatment. Photographed at the clinic on April 15, 2022.

Waiting lists of months for residential treatment

In all, state officials estimate that more than 43,000 people in Colorado have an opiate use disorder, and an independent data source estimates that far fewer than half of those with addiction are currently eligible for treatment in Colorado.

“The state doesn’t have the capacity to support what this bill is asking for, in my opinion,” said Butch Lewis, executive director of the Colorado Association of Recovery Homes.

Lewis is particularly concerned about residential services, where care is more expensive and harder to find, compared to outpatient services like methadone clinics. Facilities where patients can stay for days or weeks while they learn to manage their addictions are few and far between. Many have months-long waiting lists and include hundreds of people, advocates said.

The residential approach offers benefits that medication alone cannot, said Breeah Kinsella, executive director of the Colorado Association of Providers, a trade association for substance use treatment services.

Residential treatment “provides the connection. And for some people who have been living in addiction for a long time, they don’t know how to live anymore,” he said. “These recovery services … teach you how to live again, in recovery, drug-free, surrounded by a community of people who understand.”

The Legislature isn’t doing enough to build residential treatment capacity, he said.

“They’re asking for treatment and there’s no money for treatment,” Kinsella said. “We can hardly do what is being asked of us now.”

More broadly, the shortage of all types of treatment is particularly pronounced in rural areas. An estimated dozen Colorado counties have zero or one doctors offering addiction treatment, according to state data.

Source: Colorado’s fentanyl bill will force more people into treatment. Treatment providers may not be ready

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