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CENSORED: IN OREGON, MANAGED HEALTHCARE BANS AN APPROVED OPIOID CONFERENCE PRESENTATION IN REACTION TO EXPOSURE OF MISUSE OF PUBLIC HEALTHCARE FUNDS

By Clark Miller

Published July 23, 2018

Updated April 1, 2021

In rural Oregon hard-hit by the opioid crisis, the managed care insurance industry using public healthcare funds to control clinical healthcare practices rejects evidence-based practice and clinical expertise, supports with public funds invalidated practices with no predicted benefit including coerced religious programming, and banned an invited, reviewed and approved professional presentation challenging effectiveness of those practices.

The presentation (Reducing Harm: Toward a Validated and Integrated Practice Theory and Treatment Model for Problem Substance Use) is a research-based critique of clinical models and practices that have led to the opioid crisis and drive increasingly lethal national substance use epidemics, with synthesis of most recent primary research toward models for effective treatment, including 37 references and links to primary research and other sources. Two Oregon managed care insurance companies – Columbia Pacific Coordinated Care Organization working with Care Oregon under Oregon Health Authority – invited, reviewed, and approved the presentation, then banned it weeks later only directly (days) after public release by me of documentation of their misuse of public healthcare funds (see copy of letter from CPCCO legal counsel below).

The material was censored from a conference organized by Care Oregon and CPCCO to address the opioid crisis and worsening substance use problems, consequences of those epidemics in Oregon among the most dire nationwide, with the rural counties of NW Coastal Oregon – where use of public healthcare funds for Affordable Care Act (ACA) patients is overseen by Columbia Pacific CCO – ranking high as problematic among counties in Oregon, where the problem is described as a “public health crisis” and “epidemic”, historically with more prescription opioid pills (280 million) prescribed than in any other state and 150 deaths annually attributed to overdose by prescribed opioids.

 More recent findings identify Oregon with the highest rate of older adults hospitalized for opioid use problems . Tillamook County is fifth among counties for continued prescription of opioids, with Clatsop County, also in the region, in the top ten. Annual opioid overdose deaths in the three counties in this rural Oregon region exceed national rates by up to 40% (source of date and graphic here).

Map of Oregon with counties most affected by opioid crisis

But there are problems – 

big ones – with how Care Oregon, Columbia Pacific and other managed care organizations are using public healthcare funds to fund clinical practices to address the opioid crisis, substance use, and other behavioral health problems, something the public, trapped in those epidemics, has a right to know.

In Oregon, use of Medicaid funds under the ACA to address the opioid crisis by selectively funding treatment approaches – including inextricably linked mental health (MH), primary care (PC) and substance use (SU) services – is controlled by regional Coordinated Care Organizations (CCO) acting as insurance companies and driven by business and medical models of operation. In rural Oregon most hard-hit by the opioid crisis those insurance payers include Care Oregon (CO), Columbia Pacific CCO (CPCCO) and Greater Oregon Behavioral Health Inc. (GOBHI, for mental health funds), each taking a central role in determination and dissemination of clinical treatment direction to treatment providers and control of practices through allocation and withholding of public funds for selected treatment models for ACA Medicaid patients.

Columbia Pacific determined that Medication-Assisted Treatment (MAT) with the prescribed substitute opioid Suboxone as the Assisted component of MAT will be the focus of treatment response to the crisis, developing and naming a MAT program at the OHSU  (Oregon Health Sciences University) primary care clinic in Scappoose, Oregon as a model program, a “hub” and “center of excellence” for opioid crisis response.

A second MAT program at Rinehart Clinic in Wheeler, Oregon has begun providing partial agonist (Suboxone) MAT under the clinical guidance and support of the CCOs. Rinehart Clinic in Oregon was a focus of scrutiny for alleged over-prescription of opioid pain medications.

Hand holding Suboxone

But as described in detail in posts here and here

citing and discussing the most current research, the evidence for effectiveness of MAT is at best mixed, with recent studies showing treatment failure. More importantly and troubling, constituting apparent abuse of public healthcare funds, under medical models and management and direction provided by Columbia Pacific CCO, none of the behavioral health services planned and provided at either of these MAT programs constitutes evidence-based treatments for opioid abuse or substance use disorders – none predict benefit for the problem of opioid dependence.  For example, at Rinehart Clinic, patients on Suboxone were placed in AA-style support group meetings as part of the programming.

Instead of therapies supported by research as effective (“evidence-based practice”)  these programs substitute and bill public (Medicaid) healthcare funds for: self-help groups, “check-in” groups, and “process groups”, none of which constitute a form of treatment for a substance use disorder and constituting apparent Medicaid abuse and perpetuating public harm in the opioid crisis. At Rinehart, there are no qualified mental health professionals (QMHPs) with credentialing or background in substance use treatment providing treatment services.

As described in the related post “OREGON PUBLIC MEDICAID FUNDS MISSPENT FOR HEALTHCARE THAT HARMS”, additional malfeasant use of public funds by Columbia Pacific has included and involved:

  • a consistent pattern of CPCCO misuse of public healthcare funds, comprising apparent Medicaid abuse, for practices clearly unsupported by research as predicting benefit for vulnerable patients affected by the opioid crisis and problem substance use in Oregon
  • gross clinical and ethical incompetence in directing clinical practices (for example for tobacco cessation practices without review of the research)
  • systematic violation of patient constitutional rights and coerced religious programming by programs supported by CPCCO
  • misrepresentation of research by CPCCO staff, for example in attempting to promote an invalidated New Age “treatment” approach for a life-threatening substance use disorder

 

These types of concerns and others were made public on or around March 26, 2018. Description and documentation of the range of malfeasant use of public healthcare funds by regional CCOs required a 29-page press release to expose practices a public trapped in opioid and addiction epidemics has a right to know. Directly following the release, in apparent censorship and retaliation for the release Columbia Pacific CCO blocked the presentation.

The stated reason for blocking the presentation from the Summit is disingenuous and illegitimate –

Although CPCCO may have formalized “standards of service and expectations” for clinical practices of providers it contracts with, it would not have formalized standards and expectations for the “treatment philosophy” or “statements” of such providers, overtly pointing to the real intent and motivation driven by intended censorship and avoidance of accountability, and posing threat to freedom of expression and open public and scientific discourse.

Blocking of the presentation overtly constitutes retaliation and intimidation for the press release. The invited presentation (Power Point file) was made available 2/5/18 to CPCCO, on their request for review for Continuing Medical Education (CME) accreditation for the Summit, with no concerns raised. “Concerns” and censorship arose only directly after CPCCO became aware (late March or early April) of the press release to media describing grossly inadequate clinical practices and misuse of public health funds.

Letter from legal counsel for Columbia Pacific Coordinated Care Organization:

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

Pierre Bourdieu - Outline of a Theory of Practice 1972

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