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Illustration: Aïda Amer/Axios

Addiction treatment in the U.S. is critically necessary yet deeply flawed.

The big picture: Drug overdoses kill tens of thousands of Americans a year, but treatment is often inaccessible. The industry is also riddled with subpar care and, in some cases, fraud.

"We have a remarkably fragmented and highly strained treatment system, which has contributed to the shocking rates of overdose that we see," said Caleb Alexander of Johns Hopkins Bloomberg School of Public Health.

  • As Reuters recently reported, only 15% of patients in residential drug treatment centers received medication-assisted treatment in 2015, although it's widely agreed that anti-addiction medicines are the most effective treatment for opioid abuse.

Not only do treatment centers often lack proven treatment methods, but they also often use ineffective ones.

  • As Vox's German Lopez has reported, there's really no way for patients to know whether an addiction treatment program is any good. Insurers don't communicate well about quality, and regulators don't do a good job of monitoring it.
  • "Little in medicine is as ill defined or as anecdotal as addiction treatment. Most rehab centers are not hospitals. The counsellors are often not psychologists. The medical directors can submit instructions from a distance," Colton Wooten writes in the New Yorker, recounting his own haunting experience with rehab.
  • Fraud has also been a problem. For example, in Florida, "sober homes" for people in recovery have been caught scamming insurance companies time and again.

"There is a massive for-profit industry that operates separate and outside of established medicine, relying on group therapy, 12-steps, counseling, etc. while eschewing best medical practices," said Zach Siegel, a journalism fellow at Northeastern University School of Law.

Insurance companies are required to cover mental health on par with their physical health coverage, but have often ignored those rules.

  • That can result in families paying huge out-of-pocket costs for treatment, or people suffering from addiction simply going untreated.
  • Additionally, as Vox's Lopez writes, "insurers often don’t know what good or necessary treatment is, because they’ve remained outside the field for so long, and so much of what is out there is of uncertain quality."
  • That means high-quality treatment centers aren't necessarily the ones that are covered by insurance.

The bottom line: Providers, insurers and regulators all need to do a lot more if we're going to have a functioning addiction treatment system.

Go deeper: How to change treatment for opioid addiction

Go deeper

Senate Democrats demand answers on FBI's Kavanaugh probe

Photographer: Andrew Harrer/Bloomberg via Getty Images

Senate Democrats are demanding that the FBI hand over "all records and communications" related to the FBI tip line set up to investigate Supreme Court Justice Brett Kavanaugh when he was a nominee in 2018.

Why it matters: The ask comes after the FBI revealed it received more than 4,500 tips about Kavanaugh when he was awaiting Senate confirmation amid sexual assault allegations. Only the most "relevant" of these tips were forwarded to the Trump White House.

Chip relief on the horizon

Illustration: Sarah Grillo

Good news: The worst of the chip supply crunch might be near.

The other side: Here's the bad news... CEOs say chips totally flowing like normal is still a ways out.

Trump ally Tom Barrack pays $250 million bond to get out of jail

Tom Barrack speaking at a symposium in Tokyo in March 2019. Photo: Kiyoshi Ota/Bloomberg via Getty Images

Real estate investor Tom Barrack paid a federal court a bond of $250 million to get out of jail on Friday while awaiting trial after he was arrested and charged with acting as an unregistered foreign agent for the United Arab Emirates earlier this week, AP reports.

Driving the news: A federal judge also ordered Barrack, a longtime ally of former President Trump and chair of his inaugural committee, to wear a GPS monitoring bracelet at all times and barred him from transferring funds overseas.

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