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National Heroin Epidemic: NY State Proposes Insurance Legislation

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Although it appears to be a national trend, the resurgence of national heroin epidemic and opioid addiction hit few states as hard as New York. A governmental focus to stop pain pill abuse yielded promising results, but it has also spurred a disturbing counter effect – increased heroin use. According to New York’s Newsday, more than 220 heroin deaths have been reported on Long Island alone in the last two years. That’s more than double those reported in the entire state of Florida over the same time period.

National Heroin Epidemic

The national heroin epidemic is becoming more problematic. In Western New York’s Monroe County, heroin deaths have increased almost 600 percent since 2011. Travel east and you will find Onondaga County, which has the highest percentage of infants born with heroin addiction in the entire state.

In an effort to help alleviate the throngs of addiction, New York State legislators began focusing their newest proposition not on those who need help, but on those who are unwilling to finance it.

New bill seeks mandatory coverage of drug abuse treatment

Senate Bill S4623’s broad intent to curb drug addiction in New York is not unique to the senate, but the specific course of action it proposes certainly is. Its fundamental change is to require insurance providers to cover drug and alcohol abuse and dependency treatment. While most insurance companies already include addiction treatment in their offerings, they routinely deny coverage of inpatient programs that are considered necessary by doctors. That is why this bill also seeks to change the dynamic of decision-making in regards to a patient’s addiction treatment. It will give qualified medical professionals, not the insurance company, the final say as to the type of care necessary and the duration of the treatment program.

Issues with insurance under the current format

If it passes, Senate Bill S4623 has the potential to exponentially increase treatment options for heroin and opioid pill addicts by eradicating many of the issues addicts and their loved ones face on the road to recovery in New York State battling insurance companies. Again, under the state’s current format, insurers can refuse coverage for any rehabilitation program THEY deem unnecessary.

Numerous addicts seeking help across the state have commonly been met with a similar response from insurance providers: the patient must show evidence of unsuccessfully attempting one or more outpatient programs before they will consider covering the cost of an inpatient program. Those few providers who are willing to pay for inpatient care often limit the stay to seven days; a fraction of the typical duration of an inpatient program a generation ago. 

Changing demographics of today’s heroin addicts

An alarming demographic shift in those addicted to heroin only furthers the complications many face when it comes time to deal with insurance companies. Aside from looking for failed attempts in outpatient programs before considering funding for inpatient care, many insurance companies also look for individuals with little to no outside support from family or friends, or those plagued by a health condition that would make inpatient treatment imperative.

The problem is that some of the most prevalent users today don’t fit those old stereotypes of a severe heroin addict. Many of today’s addicts come from stable homes and have loving families, strong support systems, good health and bright futures Not only are these addicts appearing more “normal” by societal standards, they’re also getting hooked younger than ever. According to an article on, from 2008-10, “drug poisoning deaths involving heroin” only increased in the youngest of the four age groups analyzed, ages 15 to 24. Counselors in New York state have even cited seeing patients as young as 12-years-old.

National Heroin Epidemic Solution

The message insurance companies are subliminally sending through their current pattern of evaluation and decision-making is that in order to receive inpatient care, you must first hit rock bottom. Fortunately, certain New York State legislators are hoping to flip the script. If you or someone you love is struggling with pills, heroin, alcohol or other substance abuse issues, please don’t let the fear of insurance constraints prevent you from seeking help. Contact The Watershed today. Our hotline is always open: 1-800-861-1768.

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