Opioid Addiction: Meeting the Need for Treatment in Michigan
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By Amy Bohnert, Jennifer Erb-Downward, and Thomas Ivacko
Introduction
More people now die of drug overdoses than car crashes in the state of Michigan. Since 2000, overdose deaths have more than tripled, increasing from 581 to 2,729 people in 2017 and impacting individuals and families across the state in rural and urban areas alike. While medication-based treatment for substance use disorders is effective, substantial barriers exist to accessing appropriate care. In Michigan, less than one-third (32%) of treatment facilities offer medication-based treatment for opiate addiction, the 12th lowest percent by state in the country. This is reflective of the ongoing reliance across the state on substance use treatment models that eschew medications that have been shown to result in better substance use mortality, and recovery outcomes. If Michigan is to see a dramatic reduction in overdose deaths and substance use related harm, ensuring access to medication-based treatment is critical.
This policy brief uses data from the Michigan Department of Health and Human Services and the Michigan Public Policy Survey (MPPS), an ongoing survey of the leaders of Michigan’s general purpose local governments (all counties, cities, townships, and villages) to examine drug treatment needs across Michigan counties and makes policy recommendations for increasing access to evidence-based care.
Key Findings
- Michigan ranks in the top third of the country for drug-related deaths. In 2016, Michigan had the eighth largest number of deaths due to drug overdose and the 14th highest death rate in the country.
- Michigan lacks access to medication-based substance use treatment programs. Only 18% of counties had access to all recommended treatment options and one-third (35%) of counties had no medication-based substance use treatment program for opioid addiction.
- Even areas of the state struggling with high substance use-related mortality rates lack access to recommended treatment. Of the top 20 counties with the highest drug overdose rates in Michigan, six had no medication-based treatment services for opioid addiction.
- Counties across the state of Michigan report a need for drug treatment programs. Officials in three-quarters (74%) of Michigan counties reported unmet need for drug treatment programs in their jurisdiction with more than one-third (36%) of counties reporting significant unmet need.
Policy Recommendations
- Incorporate information on addiction, substance use disorders and medication-based treatment into Michigan’s Automated Prescription System (MAPS). Addiction is one of the most widely misunderstood medical conditions. Due to stigma and misinformation, substance use disorders are commonly believed to be behavioral rather than medical problems. This misunderstanding of the nature of addiction is one of the leading reasons why only 12% of people with a substance use disorder receive the medically recommended care for their illness. Because all providers who prescribe or dispense controlled substances in the state are required to use MAPS in order to identify and prevent prescription misuse, incorporating information on the medical nature of addiction into the registration process, online interface and home page could help to reduce stigma among frontline providers and improve referral rates to effective addiction treatment.
- Assess the impact of changes to prior authorization requirements for Buprenorphine. Buprenorphine is an effective treatment for opiate addiction but some clinicians report that opportunities for starting patients on this medication are often missed due to requirements that clinicians obtain a prior authorization from payors. These missed opportunities are particularly true in emergency room settings where providers have a brief window of time to treat a patient and connect them to care. In these cases prior authorization requirements for Buprenorphine prevent doctors from prescribing and starting patients in need of opiate addiction treatment on medication that will help them recover. Prior authorization requirements may prevent diversion into communities, but alternative strategies may balance the benefits and potential harms. For example, Michigan CMS will allow a few days of treatment before the prior authorization must be obtained, starting in spring 2019. To answer the question and proceed with a policy that best meets the needs of residents in Michigan, Michigan CMS and other payors should collaborate with university researchers to evaluate the impact of different Buprenorphine policies.
- Implement a “Hub and Spoke” model for addiction treatment across the state. Rural areas and regions with lower population density are at particularly high risk for lacking access to evidence based addiction treatment. These same regions of Michigan have some of the highest rates of drug overdose deaths in the state. In order to meet the needs of residents
living in these areas in a cost effective manner, the state could incentivize existing regional hospitals to become certified substance use treatment centers. These centers could then provide access to medication based substance use treatment through their existing networks, connecting patients to the best treatment plan for their recovery rather than the treatment options that happen to be available in their area. To guide the development and implementation of this care model Michigan could look to other states, such as Vermont, which has seen improved health outcomes using this approach.