Over the course of a single day, as many as 600 people may filter through this office, including perhaps a half-dozen new patients.
“It’s just nonstop,” said Diana Warrilow, lead behavioral technician for the clinic. “I wear my running shoes — it’s constantly ‘Go, go, go.’”
It may soon get even busier. A proposed new state law could send hundreds more people into the state’s addiction treatment system, and clinicians are bracing for an unknown impact.
“We’re definitely going to have capacity issues. We’re going to have management issues and we’re going to kind of need to have all hands on deck,” said Dr. Josh Blum, director of the Denver Health clinic.
The state bill is focused on fentanyl, the deadly and addictive synthetic opioid. Among other changesthe legislation would require anyone convicted of fentanyl-related charges to be assessed and potentially ordered into treatment for addiction — whether that’s at an outpatient clinic like Denver Health’s or a more intensive residential facility.
No one seems to know exactly what to expect from that change, since there is no firm statewide data on fentanyl cases.
In a cost estimate for the bill, legislative staff projected that about 300 people a year could face fentanyl possession charges, which may result in treatment orders. They reached that figure by estimating that 5 percent of annual drug possession convictions involve fentanyl.
Some advocates think the reality will be higher. In Denver County alone, prosecutors filed about 340 fentanyl-related cases in 2021. In El Paso County’s 4th Judicial District, they’ve been filing about a case per day. (Not all charges lead to conviction.)
The goal of the new state bill is to “make sure that you’re receiving the evaluation and recommendations for additional treatment if needed — because fentanyl is more addictive than any substance that we’ve ever seen before,” said House Speaker alec garnetta Democrat who is leading the bill, in an interview.
The question of pushing more people into treatment has divided clinicians, lawmakers and patients.
Some treatment providers, like Denver Health’s Dr. Blum, think an influx of new patients would ultimately be a good thing — even if it causes some temporary strains.
“I love the idea of more people being encouraged into treatment … because honestly people need this little nudge,” said Blum, who is confident his clinic can scale up to meet higher demand.
There’s some reason for optimism, especially at larger clinics. Today, about 19,000 people per month receive medication-assisted treatment in Colorado, and the state’s 30 methadone clinics are able to handle that demand without putting people on waitlists, according to state officials.
“I think it’s a good problem to have,” Blum said. “If there’s that many people seeking treatment, then it’s incumbent on us to meet people where they are.”
But those large methadone clinics only cover part of the state. The system is overloaded in other areas — especially for those seeking treatment in rural areas or residential facilities, where they may face long waits for care.
“We don’t have enough providers at any level,” said Rob Valuck, executive director of the Colorado Consortium for Prescription Drug Abuse Prevention.
“We don’t have enough primary care doctors doing this. We don’t have enough behavioral health professionals doing this. We don’t have enough addiction treatment centers and providers doing this. We don’t have enough school nurses doing this. We don’t have enough.”
Months-long waitlists for residential treatment
In total, state officials estimate that more than 43,000 people in Colorado have opiate use disorder — and a separate data source estimates that far fewer than half of people with an addiction are currently able to get treatment in Colorado.
“The state doesn’t have the ability to support what this bill is asking for, in my opinion,” said Butch Lewis, executive director of the Colorado Association of Recovery Residences.
Lewis is specifically concerned about residential services, where care is more costly and difficult to find, compared to outpatient services like methadone clinics. Facilities where patients can stay for days or weeks as they learn to manage their addictions are in short supply. Many have waitlists that are months long and include hundreds of people, advocates said.
The residential approach provides benefits that medication alone cannot, said Breeah Kinsella, executive director of the Colorado Providers Association, a trade association for substance-use treatment services.
Residential treatment “provides the connection. And for some people who have been living in addiction for a long time, they don’t know how to live anymore,” she said. “These recovery services … teach you how to live again, in recovery, without drugs, surrounded by a community of people who understand.”
The legislature isn’t doing enough to build out residential treatment capacity, she said.
“They’re mandating treatment and there’s no money for treatment,” Kinsella said. “We can hardly do what we’re being asked to do now.”
More broadly, shortages of all types of treatment are especially pronounced in rural areas. About a dozen Colorado counties are estimated to have zero or one clinicians providing addiction treatment, according to state data.