Failure to effectively use public healthcare funds to treat compulsive use of tobacco – smoking – has extremely high costs and drives broader epidemics because public health and social harms of tobacco use eclipse those of opioids and illicit substances combined, and because tobacco use is directly worsening the opioid crisis by contributing to the causes of chronic pain conditions and to worsened perception of chronic pain.

In rural Oregon hard-hit by the Opioid Crisis, response by the business-model Managed Healthcare system (Coordinated Care Organization) rejects evidence-based practice and clinical expertise, instead supports with public funds invalidated practices with no predicted benefit including New Age remedies for smoking. Columbia Pacific CCO continued to attempt to recruit smokers to the group sessions – termed “Practice of Health” (POH), without a curriculum and without evidence-based interventions – and to use public healthcare (Medicaid) funds to reimburse unqualified group leaders, after three clinical programs withdrew support based on concerns.

The Columbia Pacific staff member promoting the POH group practices compared them favorably to the invalidated practices of a religious subculture (Alcoholics Anonymous) for substance use problems, those practices not constituting treatment or providing benefit  for substance use problems. That staff member expressed personal positive orientation to practices of religious self-help groups, citing personal life experience with them. She misrepresented herself as having a background in research in a clinical meeting about the group sessions, and misrepresented evidence about effectiveness of the group activities. That’s not good.

In the context of a lethal opioid crisis and national substance use epidemic, the public has a right to accountability and to know whether use of public healthcare funds is being driven by research and evidence, or the religious allegiances of insurance company staff.

Practice of Health (POH) is a proposed group session “treatment program”, without curriculum or elements registered or supported by research as evidence-based (as beneficial)  – not found under the Substance Abuse and Mental Health Services Agency (SAMHSA) registry of evidence-based practices.

Instead, POH as envisioned is made up of elements of New Age spiritualism and Integral Transformative Practice from the Esalen Institute with “long-term, positive activities” like the Kata,  “movements [which] are intended to articulate all the muscle groups and joints in the body and to offer an opportunity for deep rhythmic breathing, relaxation, transformational imaging and meditation”. POH was advertised to Medicaid patients by Columbia Pacific CCO as treatment for tobacco use disorder with public (Medicaid) funds allocated for payment by Columbia Pacific CCO. There is no evidence that the practices serve as treatment whatsoever for lethal compulsive substance use, mood disturbance, or any other issue.

To protect patients in our clinic from ineffective treatments and the public from abuse of Medicaid funds, I evaluated Practice of Health and found no basis in evidence for any beneficial effects, moreover evidence of harm to patients who would be encouraged to believe and continue to act on the beliefs that the components of POH constitute treatment of some type for life-threatening substance use problems.

The stated plan for the POH group sessions was to have the licensed clinical social worker proposing the series, based on his past experiences with the Esalen Institute and Integral Transformative Practice, pass on the role of providing group treatment for the life-threatening condition of tobacco dependence to a non-professional, a community member with no credentialing, training, or competence in behavioral health or substance use treatment, Columbia Pacific dedicating Medicaid funds for payment.

For a copy of email exchanges that include evaluation of (lack of) evidence base for POH, a copy of the flyer recruiting Medicaid patitents, and documentation of misrepresentation of research by CPCCO staff promoting POH, send a request here.

I shared findings with my clinic, which then declined to refer patients to the program, as had been requested by Columbia Pacific. Two additional area treatment programs then also withdrew support for POH. Columbia Pacific has continued to advertise, advocate for, and commit public (Medicaid) funds to the fictional “treatment” program.

Practice of Health is not an isolated example.

Columbia Pacific has supported (paid staff members arranging and facilitating the presentations) healthcare presentations and treatment advice to local communities, with themes similar to those represented by Practice of Health – personal journey and spiritual or personal growth experience as treatment for life-threatening conditions – in this case symptoms of trauma or PTSD that often include increased risk of depressed mood, suicidal behavior, and substance use problems.

The invited speaker was Elaine Waters of the Trauma Healing Project based in Eugene, Oregon. Ms. Waters advised audiences that she is “not a clinician” then went ahead and offered recommendations for “healing” from traumatic experiences throughout her presentations to vulnerable Oregonians, also alluded to her “work with” young people and adults living with trauma-related symptoms.

Ms. Waters contrasted professional, evidence-based practice (EBP) therapies for trauma-related symptoms and conditions, warning that they are often “not very effective” and can often be traumatizing themselves, versus “the healing and recovery part” offered by the practices she provides “at my center” based on her personal journey recovering from trauma, “I have wisdom about it”. Those practices include:

 – “energy work”
– “group movement work”
– “acupuncture healing circle”
– “cognitive emotional wellness acupuncture”
– “support groups”
– “healing arts program”
– “acupuncture”
– “massage”

None of those activities constitute EBP for trauma effects and in any case are not substitutes for EBP therapies.

If Ms. Waters had been addressing a somewhat different chronic health condition with associated life-threatening conditions and effects when unmanaged by professional care – like Type 2 Diabetes – would she provide the same types of warnings against use of professional health care services, and the same recommendations for substitute, unvalidated practices like “energy work” and “acupuncture healing circle” ?

Her messages to vulnerable Oregonians struggling with life-threatening conditions were promoted, supported and tacitly endorsed by Columbia Pacific CCO, using public healthcare funds.

Is it possible that POH and the Trauma Healing Center are flukes – that misuse of public funds for unsupported practices like those described are exceptional incidents, corrected and not repeated by Columbia Pacific in its public duty and responsibility to manage those funds competently, supporting effective clinical practices ?

On examination, it becomes apparent that examples like POH and other New Age healing practices were driven by personal religious allegiances and lack of clinical and ethical competence and orientation of CP CCO staff who are in positions to influence the way public funds are used to address lethal substance use including opioid epidemics. It appears critically important to evaluate and provide accountability for potentially malfeasant use of public funds by examining Columbia Pacific CCO staff scope of competence in:

  • ability to understand and evaluate research

 

  • planning appropriate evidence-based practices for specific behavioral health problems

 

  • capacity to understand the nature and treatment needs for mental health and substance use problems.

A review of Columbia Pacific funding and clinical guidance practices generated a 29-page press release that documented:

  – Medication-Assisted Treatment (MAT) for the opioid crisis

Columbia Pacific CCO clinical oversight and support for two clinics where no EBP treatments are used for opioid dependence, at one clinic for example, patients placed in self-help group sessions and billed for those sessions.

 

 

 – Bridges to Pathways detoxification center

Endorsed and supported with public funds by Greater Oregon Behavioral Health Inc. (GOBHI) and Columbia Pacific, and where a patient in detox was sent to a program of faith healing, Mountain Ministries Religious Center Church in Rainier, Oregon, where she found she would need to commit to a year-long program of religious indoctrination, with only the Christian Bible allowed as reading material, and strict rules of conduct, experienced by her as programing aimed at her being “brainwashed” and “pretty much a cult . . . I left”.

  – Helping Hands (HH) homeless shelter, Tillamook County

Supported with public funds by Columbia Pacific, and where residents and their children are evicted back to homelessness if they do not comply with mandatory participation in religious programming, a violation of their constitutional rights as Americans and the opposite of “trauma-informed care”.

  – Columbia Pacific CCO clinical trainings to disseminate “best practice” clinical practices by experts to clinical professionals.

The Columbia Pacific CCO “experts” lack credentialing, training, and competence in evaluation of research and in EBP for substance use disorders, neglecting to review research and disseminating false information about effectiveness of nicotine replacement therapy (NRT) for smoking.

  – Clinical Oversight and Direction for addressing the opioid crisis and substance use epidemic: Columbia Pacific’s Northwest Regional Substance Use Steering Committee (NRSUSC)

None of the committee members, charged with providing clinical guidance to CPCCO for prevention and treatment of substance use disorders, has expertise in those areas or in evaluation of research-informed EBP. Request related documents here.

So –

Practice of Health and Columbia Pacific CCO’s promotion to communities of “energy work” and other unvalidated activities for chronic PTSD are not flukes, exceptions, but represent systematic malfeasance and profound clinical ignorance in the management of public healthcare funds by Columbia Pacific and other Oregon business-model managed care organizations, including coerced religious programming.

That failed responsibility to vulnerable Oregonians trapped in lethal opioid and substance use epidemics represents an abdication of critical thought and critical discourse, an abdication of evidential, scientific and ethical reasoning.

An expression of social pathology.

For detailed description of those problems and others, request the 29-page press release here.

 

See Columbia Pacific’s flyer recruiting Medicaid patients to POH, below.

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