When Gary Mendell’s son Brian needed addiction treatment, money was never an object. A graduate of Cornell and Wharton, Mendell co-founded HEI Hotels and Resorts of Norwalk, Conn., a prosperous hotel investment and management firm. So, over a nearly ten-year span, Brian was enrolled in eight different addiction treatment programs.
Seven of them didn’t offer any of the three FDA-approved treatment medications, Mendell told Opioid Watch in a recent interview. And though one did, he continued, “the next one took him off it.”
Brian committed suicide in 2011, at age 25. Mendell, now 61, founded Shatterproof in 2012. It’s a nonprofit intent on reframing addiction as a medical condition no different from, say, diabetes. Through Shatterproof Mendell, of Easton, Conn., wants to strip opioid addiction of its stigma and increase the availability of medication-assisted treatment, or MAT, for those in recovery. Under MAT regimens, the patient is prescribed one of three medications that quell cravings—buprenorphine, methadone, or naltrexone—on a long-term basis, often for life, in much the way that diabetics take insulin. (Buprenorphine and methadone are themselves opioids—but opioids that can be administered without causing euphoria or disruption to a productive, normal life.)
Despite ample empirical data establishing that medication increases an opioid user’s chances of survival and recovery, 70 percent of treatment programs listed on the federal Substance Abuse and Mental Health Services Administration website don’t offer any of the three. Fewer than two percent of them offer all three (which is preferable, because each medication has its strengths and weaknesses).
To address this situation, Mendell has multiple projects underway, of which two are taking center stage at the moment. One enlists insurance companies to incentivize healthcare providers to offer MAT, by having them commit to reimbursing such providers appropriately and listing them in their preferred networks.
Mendell granted Opioid Watch a recent interview about his son, Shatterproof, and its current projects. The following is an edited, condensed interview.
Why is treatment reform a focus for Shatterproof?
It’s a fact that addiction treatment is extremely poor today. On the whole, treatment is being delivered without the use of evidence-based practices. Which is in contradiction to what happens with any other disease within our healthcare system. So that’s the key point.
What’s wrong specifically?
The 2016 Surgeon General’s Report on Alcohol, Drugs and Health recommends that a patient be offered three medications—buprenorphine, Vivitrol [an injectable form of naltrexone], and methadone. Yet I hear stories literally every week: just like with my son, you go into treatment and the program does not believe in medication.
Why hasn’t behavioral health caught up with the medical research?
Without any doubt it’s been stigmatized: Why should we worry about these people who can’t make good decisions? And I think it’s finally starting to be understood: a substance use disorder, where someone is addicted to either drugs or alcohol, is a chronic illness and needs to be managed within our healthcare system, not our criminal justice system.
“Dad, my wish is that some day people will realize I’m not a bad person. I’m a good person with a bad disease.”
How do you fight this stigma?
One way is for people to really understand what happens inside someone’s brain when they’re addicted. How they lose control. For my son it started with pot and beer. Then he had anxiety and he was prescribed Xanax, but way too much. Then he moved to Vicodin [a combination of the opioid hydrocodone and acetaminophen]. He would always do well in treatment, but when he got out he would relapse pretty quickly. The last residential treatment program he went to, they put him on Suboxone [a preparation of buprenorphine]. But then the outpatient program didn’t believe in it, and they took him off. He spiraled, and took his own life without ever using again.
The last time my son came home for a visit we sat on the back porch and he looked at me and said, “Dad, my wish is that some day people will realize I’m not a bad person. I’m a good person with a bad disease. And I’m trying my absolute hardest.”
So Shatterproof is a response to his experience?
For every disease in the country there is one well-funded organization, from Autism Speaks to the Susan G. Komen Organization for breast cancer. I put in $5 million of my own money in to start it, and we raised another $15 million from foundations: the Helmsley Foundation, the Arnold Foundation, the United Healthcare Foundation, others. The name was originally Brian’s Wish, after my son. Then we did some consumer research and the name Shatterproof tested really well in terms of, it’s a shatterproof coating on our children. Many will not become addicted because of our work. And with those who are, it’s a protective coating of treatment based on science, without shame or stigma.
How are you hoping to get healthcare providers to change their ways?
We spent six months last year working with Tom McClellan, who’s the lead author of the 2016 Surgeon General’s Report, and Pew Charitable Trusts, and we distilled from all the research eight principles of care that relate to the highest outcomes for patients [including access to FDA-approved medications and universal screening for substance use disorders across medical settings]. And then once we had those finalized we presented them to the six largest health insurers in the country related to behavioral health in a meeting in Washington on September 19. Two months later we announced an agreement with 16 insurers [including Aetna, Anthem, UnitedHealth Group and WellCare] in support of those principles, and a commitment by each insurer to incentivize payment toward treatment providers that deliver this care.
How will these incentives work?
A lot of insurance companies don’t reimburse efficiently for these substance use medications. Many require the provider to go through a prior authorization process. If you’re a treatment program, that’s a disincentive to prescribing the medication, on top of stigma.
Now insurance companies can start paying a little more for the programs that deliver better care. Treatment programs with better care can also go into a higher level of a network. If you are in the top network, the insurer can eliminate paperwork. They can also publicize their higher-level network more.
How will you hold insurers to their pledge?
We’re working on a grant with the Arnold Foundation to collect data on how addiction is paid for. Which plans have prior authorizations? Which plans reimburse at what rate? Which plans have a large enough network of providers that provide treatment? Which plans have a network of providers that are following evidence-based practices? We’re just starting to go through the process. It’s at least a year away.
And how can you measure the impact these incentives have on providers?
We’re in the process of finalizing funding to build out a rating system of each of the providers in the country. This is already done for healthcare specialities, but it’s the first time it will be done for addiction. Health insurers can use that data to make decisions on who’s in network and who’s out of network. It’s also for consumers, so they know where to send their loved ones. It’s for state licensors, so they can license the providers who hit a certain benchmark. And it’s for providers themselves, so they can learn from each other.
You’ve clearly focused your advocacy on the private sector.
I have a 30-year career running businesses. We put together a business plan that can move quickly and save a lot of lives.
Do you have a position on abstinence? Research suggests it can increase the chances of a fatal overdose.
Imagine you’re sitting with your doctor and the doctor says, “You’ve just been diagnosed with a bad heart valve. Here’s option A, B, and C and here’s the pluses and minuses of each.”
It should be the same thing for this disease. You sit with a doctor who informs you, “Here’s option one: medications. Here’s option two: medications with behavioral therapy. Here’s option three: abstinence. If you chose option one or two, here are the different medications. Here’s the pluses and minuses of everything.” If you as a patient, fully informed, want to try abstinence, that’s totally fine.
How has the Trump Administration impacted your work on treatment access?
All the federal government has to do—and they could do this tomorrow—is say that if states want their share of the $3 billion going out this year, then we have a condition: Starting January 1, 2019, any treatment program licensed in your state has to offer two of the three medications. To do this privately, we need to pilot and then start to expand this over the country. The federal government could do this within six months.