How Virginia is seeking to reframe the discussion around ‘deaths of despair’

The rise in “deaths of despair”—including overdoses, suicides, alcohol-related diseases—is driving a national decline in life expectancy.

And policymakers in Virginia say it's time to reframe the discussion about the problem around its true cause: Economics.

“They track each other,” Marvin Figueroa, the state’s deputy secretary of Health and Human Resources said about Virginia's death rates as compared with the rates of poverty, low educational attainment and unemployment.  He was one of several speakers at a panel on the issue hosted Wednesday by the Alliance for Health Policy. 

State leaders found counties in Virginia with the highest rates of deaths of despair—or, from overdoses, suicides or alcohol-related conditions—were among those with the highest number of people in poverty or with lowest high school graduation rates.

These are not deaths of despair, Figueroa said, but “deaths of disparity.” 

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Whatever they're called, these deaths nationwide are a growing problem, increasing by 50% over the past decade. They are the only cause of death on a significant upward trajectory in that window, The Commonwealth Fund found.

These rates increased in every U.S. state: By 2016, 18 states and the District of Columbia saw at least 50 deaths per 100,000 residents, with the rate peaking at 83 deaths per 100,000 people in West Virginia. 

Figueroa said having a clear understanding of some of the underlying issues that could contribute to deaths of despair was crucial in building a response, especially as Virginia rolls out Medicaid expansion in tandem with addressing the problem. 

The state launched a Medicaid benefit last year for substance abuse disorder and behavioral health treatment, which will be accessible by more people now that Virginia’s expanded the program, Figueroa said.

Addiction and Recovery Treatment Services (ARTS) became available in April 2017 to Medicaid patients and includes coverage for inpatient detox, residential treatment, outpatient programs, care management and peer recovery, among others.

The program has led directly to more people accessing recovery care. In 2016, 67% of people in the state’s far southwest region—one of these hit hardest by the opioid crisis, poverty and unemployment—had received some kind of treatment for opioid abuse.

By April 2018, that number rose to 73%. 

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The state also relies on community service boards, which connect people in need to public behavioral health services. These boards are specialized to meet the needs of the specific region they serve, Figueroa said, and types of services vary. 

“If you’ve seen one’ve seen one CSB,” he said. 

These boards either directly provide or work with private providers to offer outpatient services—including medication-assisted treatment—primary care, detox, psychological treatment and specialized veterans services.

Through these programs, Figueroa said the state is hoping to reach patients with the most immediate social needs that could also be addressed simultaneously.

“If you are a substance abuser, you will find a drug to abuse,” he said. “We need to find a way, not to react to the drug itself, but to address the underlying cause that led an individual to seek those drugs.”