By Amy Bohnert, Jennifer Erb-Downward, Thomas Ivacko
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, 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 percentage by state in the country. This is reflective of the ongoing reliance across the state on substance use treatment models that eschew medications 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.
- 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 roughly 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.
Access To Treatment
More than seven people die every day of a drug overdose in Michigan. What is most striking about the high mortality in the state is the lack of access to treatments needed to turn these trends around.
- Overall roughly one-third (35%) of counties had no medication-based substance use treatment program and only 18% of counties had access to all of the recommended treatment options.
- By type of treatment, 19% of Michigan counties had at least one opioid treatment program, and just over half had any Vivitrol and Buprenorphine prescribers actively prescribing in Medicaid. While positive efforts are underway to expand the number of long-acting Natrexone (Vivitrol) and Buprenorphine prescribers across the state, it’s critical to ensure those new prescribers accept Medicaid and that patients struggling with addiction are appropriately referred to care.
- Geographically, lack of access to substance use treatment is concentrated in Michigan’s northern and primarily rural jurisdictions. All but four of the 29 counties with no medication-based substance use treatment options are located in the northern region of the state. Of the remaining four counties, three are rural and the fourth has significant rural geography. Three are located in the central region of the state and one in the western region.
- While the largest number of drug overdose deaths occurred in the state’s densest population centers, the top 20 drug overdose death rates per capita by county were distributed across the state. Six of these counties—including Clare, Eaton, Iosco, Iron, Manistee, and Roscommon—had no access to medication-based substance use treatment within the county.