Chronic Pain and Addiction Treatment in Montana

How is chronic pain treated when someone also has a substance use disorder?

When someone in Montana has chronic pain and a substance use disorder, coordinated care means a pain clinician and an addiction clinician work from one shared plan, deciding medication, therapy and dose changes together. That can be a single program covering both, or two providers who share records with your consent and agree on who prescribes what.

A care team may talk through non-opioid medicines, physical therapy, cognitive behavioral therapy and other psychological approaches. Which mix fits is a decision for you and your clinicians, and no listing can settle it. Any taper of a long-term opioid or benzodiazepine prescription should be planned with the prescriber, since sudden cuts can bring withdrawal and uncontrolled pain.

Physical dependence and a substance use disorder are different things. A person who has taken opioids for pain over many years can have withdrawal symptoms when the dose drops without having a use disorder, which involves craving, loss of control and continued use despite harm. Programs on our pain and addiction pages serve people with either or both.

Where depression, trauma or anxiety are also part of the picture, the dual diagnosis listings in Montana may be worth a look. Montana Medicaid covers telehealth by video or phone when medically necessary, a real help across the eastern plains, where state-authorized providers are sparse.

Is it safe to stop or reduce pain medication on my own?

Stopping or sharply cutting a long-term opioid or benzodiazepine prescription on your own is not considered safe. Any taper should be planned with the prescriber. Sudden changes can bring withdrawal and uncontrolled pain, and stopping a benzodiazepine abruptly can cause seizures. Taking a benzodiazepine with an opioid or a gabapentinoid raises the risk of slowed breathing, so tell every prescriber about every medicine you use. Montana programs that work with benzodiazepine use are on the benzo rehab page.

Naloxone is easy to get in Montana. A statewide standing order from the state medical officer lets pharmacies dispense it without an individual prescription. The Department of Public Health and Human Services (DPHHS) also distributes naloxone and fentanyl test strips. The Help Save Lives from Overdose Act of 2017 offers certain legal protections to people who seek help during an overdose. A 2019 amendment extended protection to pregnant women seeking evaluation or treatment for a substance use disorder.

Can I keep getting pain treatment while in addiction treatment in Montana?

Many people continue pain care during addiction treatment, but policies differ from program to program, so ask before intake. Buprenorphine and methadone are the two main medications for opioid use disorder. Buprenorphine also has pain-relieving effects, which some clinicians weigh when a person has both conditions. Methadone for opioid use disorder is dispensed through opioid treatment programs, listed on our Montana methadone clinics page. Buprenorphine can be prescribed in offices and clinics, and the federal X-waiver requirement ended in 2023. See Suboxone clinics in Montana and the wider opioid rehab listings.

Distance is a real factor across the eastern plains, where state-approved providers are sparse. Montana Medicaid covers telehealth by live video and by telephone when medically necessary and clinically appropriate. Programs offering remote care appear under telehealth rehab in Montana.

How do I pay for pain and addiction treatment in Montana?

Montana Medicaid is the main public payer for substance use treatment in the state. DPHHS administers it as Montana Healthcare Programs, and expansion under the HELP Act began on January 1, 2016. Montana does not use Medicaid managed care plans. Most members are enrolled in Passport to Health, a primary care case management program. The Medicaid fee schedule includes rates for levels of care from intensive outpatient through medically monitored intensive inpatient. The HEART waiver lets Medicaid pay for short-term residential stays in larger treatment settings. Ask each program whether it bills Montana Medicaid for medication for opioid use disorder. Programs accepting it are gathered on the Medicaid page.

Private health plans generally have to cover substance use and mental health care on terms comparable to medical care under federal parity law. People without coverage can ask state-approved programs about funding through the Behavioral Health and Developmental Disabilities Division (BHDD) of DPHHS, which administers federal block grant money for treatment. Two good starting points are state-funded rehab in Montana and sliding scale options.

What should I ask a Montana program before starting?

Does the program treat pain and substance use together? Can it continue or start medication for opioid use disorder? Will it coordinate with your current pain prescriber? You can also ask whether staff check the state prescription monitoring program when reviewing your medicines, and how they plan any dose changes. On each listing, compare chronic pain services, medication options, levels of care, payment types and insurers, accreditation, languages, populations served and location.

Some 84 percent of Montana’s pain and addiction listings are within 25 miles of a river, a median of 8.7 miles away, most often the Clarks Fork Yellowstone River. Billings Logan International is the most common nearest airport, and the median distance to the nearest airport is 4.1 miles. Program sites range in elevation from 2,560 to 5,710 feet, with a median of 3,840. More Montana pages are on the Montana locations hub.

Call or text 988 for a mental health or substance use crisis. The national treatment referral line can point you to programs and payment options at no cost.