As for-profit programs grow, so, too, does debate over regulations

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As opioid addiction has increased in prevalence among affluent and middle-class Marylanders, for-profit treatment centers are flourishing in the state.

Some in the industry argued that cumbersome regulations prevent these businesses from providing the access to treatment needed to adequately address what’s been called a crisis. Other industry professionals, however, urged caution in reducing oversight because of the potential for “bad actors” to enter the market looking to make a quick buck and exploiting vulnerable people.

The case for easing regulations is made by Mike Gimbel, a former director of Baltimore County’s Bureau of Substance Abuse, a recovering addict and a consultant at Maryland Addiction Recovery Center in Towson.

“Maryland is so far behind because of bureaucracy,” Gimbel said.

The more for-profit treatment centers, he said, especially residential facilities providing a full continuum of services, the better for the state and addicts. Increasing treatment options for addicts who have insurance frees scarce government resources to help more poor addicts, Gimbel said.

But a host of regulatory hurdles, ranging from the state’s certificate of need requirements, which Gimbel called “insane,” to local zoning regulations make it hard to open facilities providing services addicts need to begin recovery.

“You pretty much have to be in a factory zone to open (a treatment center),” Gimbel said.

Michael Silberman is the co-founder and chief operating officer of Amatus Health, an umbrella firm that has several facilities in a handful of states, including local facilities Foundations Recovery Center in Woodlawn and Fresh Start Treatment Center in Gaithersburg. He said his company’s growth exceeded expectations.

The majority of patients getting treatment at Amatus facilities have private insurance, he said, but the firm allocates 15 percent of its slots to “scholarships” for residents who can’t afford treatment.

“The demand (for opioid treatment) is much higher than we thought it would be,” said Silberman, who is also a recovering addict.

Compared to other states, such as Ohio, where a facility can be approved in months, Maryland’s process is cumbersome, Silberman said. The certificate of need requirements for residential facilities providing detox services, he said, is especially slow and limits the amount of treatment available.

Amatus Health expects to close on a property in Hagerstown nest week and intends to open a Medicaid facility providing a residential level of care. It would be the first such facility in Washington County. But Silberman said the stringent regulations make it difficult to provide the various levels of treatment addicts need.

“Not everyone is going to be right for our level of care,” he said.

The state can’t say how much the for-profit drug treatment industry has grown in response to the opioid addiction crisis.

Increase in programs

The Maryland Department of Health’s Behavioral Health Administration issues licenses when a program opens and when an accreditation needs to be renewed, according to Brittany Fowler, a spokeswoman for the department. But the agency does not track the exact date a facility opens or whether it’s a for-profit or nonprofit treatment center.

There are currently 86 programs licensed in the state, she said.

“There has been an increase in all program types over the last five years. Under current regulations, programs must be accredited in order to be eligible for a license. These regulations are designed for the safety of the patients to ensure that they receive the best care, individualized for their specific needs, and in the least restrictive environment possible,” Fowler wrote in an email.

Determining the exact demand for the treatment is tricky because it’s unknown how many people are addicted to opioids. The best documented indicator of the number of addicts comes from the number of people who have died as a result of opioid use.

According to the National Institute on Drug Abuse, as of February, Maryland was among the top five states in the nation in terms of opioid-related deaths. Since 1999 Maryland has experienced between 1.5 and three times the average death rate from opioid overdose.

In 2016 there were 30 deaths per 100,000 persons in the state related to opioids, including prescriptions, heroin, and fentanyl. The national average over the same time was 13.3 deaths per 100,000 residents.

Of the 1,821 deaths in Maryland in 2016 more than 35 percent were the result of synthetic opioids, such as fentanyl.

Deaths tied to heroin and prescription opioids have been “increasing rapidly” in Maryland, according to the institute. The number of deaths from heroin increased from 173 in 2012 to 650 in 2016. Overdose deaths tied to prescription opioids jumped from 52 to 812 during the same time period.

Zach Snitzer, director of business development and co-founder of Maryland Addiction Recovery Center in Towson, agrees regulation of facilities in Maryland, particularly for facilities that require a certificate of need, can be burdensome. The center uses a Pikesville apartment property along with a clinical campus in Towson. Snitzer said demand for treatment continues to increase.

“Our projections were to grow much slower,” Snitzer said.

But he said the state needs to be thoughtful in easing regulations. Snitzer worries if Maryland backs too far off oversight, unscrupulous firms will enter the market taking advantage of addicts and families desperate for help.

Without effective regulation, he said, “you make it the wild wild West where (a facility) can open up with little oversight,” he said.

This article is part of The Daily Record's special edition examining Maryland's response to the opioid crisis

Read articles in the series:
Attorney addiction | Local government litigation | Outpatient treatment | County programs | A mother's message | For-profit treatment | When to prosecute? | When to prescribe? | Employers' best practices | Rural communities' response | Opioid chief interview

Read commentary:
Maryland's courts | MSBA Lawyer Assistance Program | Using data | The good, the bad and the ugly