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Gaps in insurance coverage magnify addicts' struggles in Western Pennsylvania

Brian Bowling
| Saturday, May 31, 2014, 6:13 p.m.

A lack of funding and access to effective treatment makes it difficult for people in Pennsylvania addicted to heroin and other opiates to get clean, people on the front lines of the battle say.

Part of the funding problem is that more addicts are middle-class, suburban residents who rely on private health insurance, said Kristina DelPrincipe, chief financial officer for Tadiso Inc., a methadone clinic in Manchester with about 720 clients.

“That's who is knocking on the door on a regular basis,” she said.

Medicaid or state assistance covers treatment for poorer patients, but private insurance coverage is spotty, she said. Some insurers cover counseling but not methadone or other medication-based treatment. Health insurers base their coverage on evidence of which treatments are proven safe and effective, said Susan Pisano, spokeswoman for the industry group America's Health Insurance Plans.

When 22 people died in a couple of weeks from fentanyl-laced heroin overdoses this year, Allegheny County had a rush of people seeking help, said Latika Davis-Jones, administrator of the county's Bureau of Drug and Alcohol Services.

“It was a very scary time for individuals who were using opiates,” she said.

In response, several private programs accepted more people for treatment, and U.S. Attorney David Hickton convened a special working group in April to look for ways to reduce opiate use and overdoses in the region. The group hopes to issue recommendations this summer.

Opiates include heroin and prescription painkillers, such as oxycodone. Many people become addicted while being treated for injuries or after surgery.

Regina Mollett, 63, was the traditional face of the problem, drifting into addiction as a way to escape living in the Northview Heights projects.

“I never realized I wasn't escaping. I was getting boxed in,” said Mollett, who has been clean since 2002. “I thought partying and dancing and being irresponsible was a better life.”

Now, she works as a coach helping other addicts find their way to recovery at Tadiso.

“You become desperate, close to doing anything including murder,” she said. “It's awful. An awful feeling.”

Mairead Desmond, executive director of New Directions Treatment Services in West Reading, said the key to fixing the problem is providing more accessible treatment. In particular, the state needs more programs using methadone and other medications that help people with their physical symptoms while learning to cope with their addictive behavior.

“It requires a detox because it's really difficult to stop using heroin or the pills,” she said.

Figuring out how many more treatment slots the area needs is difficult, she said, because no one really knows how many people are addicted to heroin and other opiates.

Dr. Neil Capretto, medical director at Gateway Rehabilitation Center in Beaver County, said he believes he could at least triple the number of beds dedicated to opiate addiction without worrying about finding enough people to fill them.

“It's a pretty big problem,” he said.

But private health insurance won't cover treatment or will for only a few weeks, he said.

Capretto, who is co-chairman of Hickton's working group, said the result is frequent relapses.

“It's a chronic disease like diabetes,” he said. “Unfortunately, our health system treats it like it's the flu.”

Gary Tennis, the state's secretary of drug and alcohol programs, said the resistance to providing coverage is frustrating. Studies show that insurers save money when addicts receive adequate treatment because, he said, they tend to develop fewer related problems, such as contracting hepatitis C.

Society also loses because some people commit crimes to finance their habit and ultimately end up in emergency rooms or jails, where taxpayers pick up the tabs.

“It's cheaper for all of us,” Tennis said.

Brian Bowling is a staff writer for Total Trib Media. Contact him at 412-325-4301 or

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