Gateway to Better Health, a health care program for poor and uninsured people in St. Louis, will soon cover treatment for people addicted to opioids and other substances, its leaders announced Tuesday.
Gateway to Better Health is a state-sponsored program that provides health care to nearly 20,000 St. Louis and St. Louis County residents who often can’t afford health insurance but don’t qualify for the state’s Medicaid program. It provides primary, specialty and urgent care at the region’s five federally qualified health centers and at St. Louis County-run health clinics.
“The safety net clinic network is the primary location for services,” said Angela Brown, acting CEO of the Regional Health Commission, which administers the program. “And we see a growing increase in the population that’s showing up in emergency departments and our community health centers that have a need for substance use services.”
There were 306 overdose deaths in St. Louis County in 2018, according to county health officials. That’s a 28 percent increase from the year before. For every one of those overdose deaths, there were 300 other drug overdoses that weren’t fatal, said Spring Schmidt, acting director at the St. Louis County Department of Public Health.
“We’re not at the peak of this crisis, and we have no time to take our foot off the gas,” she said.
People served by the Gateway program are particularly at risk for overdoses, because they’ve been locked out of traditional health care and haven’t been able to receive treatment for their addiction, she said.
“They don’t have insurance through their employers, they are significantly disenfranchised from a lot of different services,” she said. “It is the uninsured, high-need disenfranchised population of both the city and the county.”
The St. Louis County Council gave $750,000 to the county health department to help administer the program’s addiction treatment. The county's contribution helped officials acquire $1.4 million in federal funds from the Centers for Medicare and Medicaid Services designated for substance abuse disorder therapy.
The new treatment offered by Gateway will include access to 10 medications doctors use to treat substance abuse, including buprenorphine, an opioid that helps ease withdrawal symptoms without getting people high. Experts consider such medications, along with counseling, as the gold standard for treating opioid addiction.
The program won’t offer methadone — another opioid used to treat addition — because of the stringent federal standards required of providers to dispense it, Schmidt says.
In addition to generic medications, Gateway also will pay for office visits and counseling.
Until people go through treatment to help control their addiction, it is nearly impossible to treat them for other dangerous health conditions, Brown said. Treating substance use disorder is just the beginning.
“When we start to see people getting substance abuse treatment, they’re able to stabilize,” she said. “Now that they’re at their primary care home, they’re also getting their primary care treatment, so we can start looking at chronic disease, their asthma and other heart-related issues they may be dealing with.”
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