“Running on fumes.” That’s how Chris Hindbaugh, CEO of Traverse City’s Addiction Treatment Services (ATS), describes the state of the nonprofit right now. Two years ago, when the opioid crisis was a public health crisis, the organization was in the local limelight. But COVID-19 swept addiction matters out of the public consciousness and made it more difficult for organizations like ATS to operate. Now, as the pandemic approaches the 19-month mark in the U.S., Hindbaugh is desperate for help.

“We’re still waiting for some support from the state, around how we basically survive into the future,” Hindbaugh explains. “Because it’s costing us more right now to serve less people. The Medicaid structure [under which we operate] is fee-for-service, so we are only reimbursed when we serve somebody. And since we've had to serve fewer people because of COVID, with staffing issues and reduced census, we're getting less reimbursement. But our costs have also increased, so now, to serve 20 people costs the same as serving 50 people [before the pandemic].”

In 2019, Hindbaugh says ATS served a total of 3,145 clients. Last year, that number dropped to 2,209 – a nearly 30 percent decline. “This is despite our access department answering 24 percent more calls [from] people seeking help or information in 2020 over the previous year. In other words, the need has increased, but our ability to serve has decreased.”

Prior to the pandemic, a great deal of awareness for the opioid crisis – combined with the efforts of harm prevention organizations like ATS – seemed to be pushing trends in the right direction. After a record of 2,665 recorded overdose deaths in 2017, Michigan tracked year-over-year decreases in both 2018 (which saw 2,575 deaths from overdoses) and 2019 (2,358 deaths), per CDC statistics. Last year, though, Michigan broke its own record, with overdose deaths spiking 14 percent and claiming the lives of 2,684 residents.

COVID-19, Hindbaugh says, has created numerous unforeseen challenges that have reversed much of that progress. On one front, he thinks substance abuse issues have been “exacerbated because everyone's anxious and depressed and tired.” On another, resources like ATS have been underutilized, for a variety of reasons.

“When COVID hit back in March of 2020, we got an executive order from the governor, specific to substance use agencies, that said we were essential life-saving services,” Hindbaugh says. “So we didn’t need to close as part of the any shutdowns. But our detox facility, which is usually our busiest program from a patient admit standpoint, went to almost nothing for months. People just got scared. So we struggled as an agency [at that time] to even stay viable.”

By last summer, things had turned around: ATS was “getting bombarded again” by patients who needed help. Only by then, Hindbaugh says, other problems had set in. “We had to lower our census for social distancing,” he tells The Ticker. “And then staffing issues hit us.”

ATS has 110 beds across the organization, “split between two residential programs, our detox programs, and our recovery housing.” With current staffing insufficiencies and capacity limits to observe social distancing, Hindbaugh says the organization is “only able to utilize about 75 of those beds.”

“[Before the pandemic], we were running at 100 percent capacity, and sometimes we still ran up against needing to refer folks to other facilities,” Hindbaugh continues. “But we were meeting our community's needs, for the most part. Right now, we're not. Munson closed their residential program at the beginning of COVID, so that's left an even bigger gap. So, our community is definitely struggling right now. There are more people calling for help than we’re able to serve. And that’s part of why we see overdose deaths, because people just aren’t able to get help.”

There are a few scraps of good news. For one, in spite of a nationwide shortage of naloxone – the drug used to reverse the effects of opioid overdoses – ATS has “been able to get and distribute all that we needed here locally.” For another, Hindbaugh expects federal funding should be coming soon to help support healthcare providers like ATS – and not a moment too soon: Hindbaugh says ATS has been losing tens of thousands of dollars a month since the start of the pandemic – including some $500,000 this year alone.

But even the good news is offset by new challenges. In addition to increasing opioid overdoses, alcohol and methamphetamines have become bigger problems since the start of the pandemic, “so we are seeing a lot of people that we hadn't seen before, or that we hadn’t seen in a very long time,” Hindbaugh says.

As for meth, Hindbaugh notes that the drug world – like many other industries – has seen supply chain issues. As some opioids have gotten harder to come by, meth has become the “reliable replacement.” That uptick has created unique hurdles for ATS, given that treating meth abuse is not as well-established a process as treating opioid or alcohol addiction.

“There are no real medical protocols or treatment modalities [for meth] – especially for detox or withdrawal management” Hindbaugh explains. “If somebody has alcohol withdrawal, there's a medical protocol. There are scales that we have to monitor. We have protocols so if somebody has X score [on a certain scale], then we know to treat them with this medication. Same with opiates. With meth, there just really isn’t any of that. As a result, no insurance – including Medicaid or private insurance – covers [meth treatment], because there’s no medical intervention. And that makes it challenging for us, because we have folks that really just want a safe place [to recover], but we're not able to serve them because they're not approved to come into care.”

When asked what his “perfect plan” would be to help the most people possible, Hindbaugh points to three things. The first is more funding, which he says would help ATS and other organizations solve staffing shortages, increase capacities, and more adequately meet community needs. The second is “better integration into medical practice,” given that addiction treatments are generally considered behavioral health and therefore aren’t covered by most non-Medicaid insurance.

Finally, he says it’s time to move away from gauging addiction recovery by the barometer of sobriety.
“At this agency, we don't really talk about abstinence as a real measurement,” Hindbaugh says.

“Historically, [addiction treatment] has really been about, ‘How many days clean have you had?’ The system is designed to wait for you to lose everything, and then we'll throw you in a 30-day rehab. We won't even do aftercare; there's no other disease that you don't get any aftercare for. It’s like saying, ‘Good luck; we'll see you next time you relapse.’ So we need to pull the focus away from abstinence and put it more on healthy life domains. Things like housing, financial management, employment: Those are the life domains that exacerbate addiction. And the data shows us that supporting people in those spaces will have benefit –not just from an individual standpoint, but from a public health standpoint.”