Peter Mumma, former system director of psychiatry, behavioral health and addiction medicine at LifeBridge Health in Maryland, was appointed Phoenix House in New England’s new senior vice president and regional executive in August, which was announced in October.
Phoenix house, founded in Rhode Island in 1967, is one of the region’s premier nonprofit substance-abuse treatment agencies, serving nearly 7,000 individuals annually at more than 30 programs and facilities throughout New England.
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Providence Business News took the opportunity of Mumma’s appointment to ask his fresh-eyed view on the local and national response to the opioid addiction epidemic.
PBN: Were resources not an option, how would you solve the opioid crisis?
MUMMA: This is a very complex issue, with many physiological, psychological and social factors contributing to this multifaceted problem. While historical issues have included liberal access to prescription painkillers, and increasing rates of illicit drug use, the most alarming development is the resurgence and prevalence of the highly addictive drug fentanyl and other similar agents with much higher risk of addiction and lethality than even heroin. Cheaper than heroin or cocaine, fentanyl is being added into many street drugs, including even marijuana, that are being sold on the street. Often, the problem of “fentanyl in the mix” is unknown to the unsuspecting drug user until ingested, and addiction or even immediate overdose can occur.
A comprehensive solution would include expansion of resources geometrically, so that all those at risk of or experiencing addiction would be screened and offered treatment prior to intoxicant use negatively impacting their lives. Insurance coverage for treatment needs to be expanded, and less restrictive. Getting closer to the root of the problem, the risks of developing addiction may be reduced if prescription painkillers are far more strictly monitored through mandatory cross-referencing of prescription-drug databases by prescribers and pharmacists. Most importantly, every person who is using or is considering using any street drug (including marijuana), must assume that fentanyl is in the mix. Using street drugs today is literally like playing Russian roulette, with fentanyl as the bullet.
PBN: Former U.S. Attorney Peter Neronha noted in Warwick in April that fentanyl is now mixed with many opiate drugs, including heroin, and that drug users can no longer trust their sources. What’s driving this part of the problem?
MUMMA: This is an accurate summary of the health care industry’s experience. Essentially, the problem boils down to the basic law of supply and demand in economics. If you’re selling something, you want to create a high demand for it while reducing costs of “raw materials.” Fentanyl is many times more addictive and potent than even heroin and is much cheaper as well. Drugs that have fentanyl cut into them, with or without the user’s knowledge, create a more powerful high, a much greater addiction risk.
To a dealer, the base product stretches farther with fentanyl cut into it; the end product has the same intensity or greater, and the addiction is stronger to that dealer’s specific product. Unfortunately, there is also a much greater risk of lethality. The frightening thought is that, even if drug users believe they can trust their own sources, drugs often get passed through many hands and cut by multiple suppliers between purity and street user. Even a casual drug user can overdose from a product that was cut by many dealers prior to one they “trust.”
PBN: In October, President Donald Trump declared the opioid crisis a public emergency. How did this affect your efforts?
MUMMA: While we are encouraged by the president’s recognition of the gravity of the opioid epidemic, our efforts have always been – and always will be – directed to saving every life that we possibly can, and helping individuals battling addiction to new and healthy lives. Our country’s need is that presidential support will translate into legislative action leading to realistic funding to treat this relentless national disaster.
On the federal level, Medicare, which covers not just seniors but also those with disabilities, does not cover many types of addiction treatment at all. This must change. On the states’ level, rate improvements and relaxing policies around authorizations required for treatment would stimulate the free market to expand and enhance the existing service delivery system.
PBN: With so much of the U.S. aware of the opioid crisis, its causes and the average person’s risk so widely reported, has stigma related to addiction diminished?
MUMMA: The national move amongst health professionals to regard addiction as a real, treatable disease is being reflected in many more localized areas, such as the #StateWithoutStigMA initiative in Massachusetts. At the same time, most people know that opioid addiction is an equal-opportunity disease, affecting rich and poor, urban and suburban, and all ethnic and social groups alike.
That said, I think these efforts to destigmatize substance-use disorders will take time and continued education. Addiction is still a very misunderstood condition in the social consciousness. Physiological dependency is only the tip of the iceberg.
PBN: What is the biggest challenge you face related to the opioid crisis?
MUMMA: One enormous challenge is the shortage of adequate funding for services offered within the full continuum of care. This is further complicated by insurance company policies and procedural restrictions that come between doctors’ recommendations and their patients. Clinicians want to treat patients, not argue with insurance companies about whether or not the care is “medically necessary.”
The U.S. Health Services Research Administration has declared a national shortage of qualified behavioral health and addiction health care professionals. As a result, the expense of professional, evidence-based, quality care is increasing significantly while reimbursement rates have not.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
