State reveals its opioid strategy


Michigan is heightening its efforts to prevent and treat opioid addiction. 

Its effort is based on a three-prong approach Gov. Gretchen Whitmer, the Michigan Department of Health and Human Services (MDHHS) and the Michigan Opioids Task Force revealed in November. 

The strategy is focused on three steps: media campaign, which is designed to eliminate the stigma that is associated with the disorder, increase access to medication and harm reduction. 

The first step involves a $1 million statewide media campaign that is funded by the State Opioid Response federal grant funds to inform individuals about the opioid addiction and eliminate the stigma that is associated with it. The campaign will feature advertisements in television, radio, billboards, social media, paid search and on mobile devices, which will run through April. The ads will provide information about programs and resources that are provided by the state. The state also will be releasing toolkits for medical providers on safer opioid prescribing practices.

The second is removing prior authorization requirements for Medicaid recipients who use specific medications to treat their disorders, such as buprenorphine, methadone and naltrexone, starting Dec. 2.

Dr. Cara Poland, a physician at Spectrum Health’s outpatient clinic, said insurance companies do not readily cover some medications that treat opioid addiction without further explanation. 

“If your doctor says, ‘I think you should have this medical test or this medication,’ your insurance can say, ‘No, if you need that test, you need to give me the rationale for why you need or want that test,’ and sometimes the process can take multiple days to go through,” she said. “Historically, Michigan Medicaid had prior authorization processes for some of the medication to treat individuals with an opioid addiction disorder. This could, because there is a turnaround time for that, lead to a delay in treatment, which means that we can lose some of our patients to follow-up. 

“So, they come in and say they want treatment, we try to get them the medication, we have this delay and the patient doesn’t come back, so we don’t get them the medication they need. (As a result,) they’ll remove that barrier so if I say, ‘My patient needs this medication,’ my patient can go from my office to the pharmacy and pick up the medication.”

Along with eliminating prior authorization requirements for Medicaid patients, inmates who are suffering from opioid addiction disorder also will be a priority in the state’s three-prong approach. They represent more than 20% of individuals who are incarcerated in Michigan and are 40 to 120 times more likely to die of an overdose within two weeks of release. 

“We know that the prison population is at a higher risk of having a substance use disorder,” Poland said. “These medications help to stabilize the brain so people can engage in healthier thought processes. By having access to these medications during incarceration and strong linkage to care after incarceration, one of the goals is to reduce the risk of someone being re-incarcerated after release. 

“We know that after people are released after incarceration, they are at higher risk of opioid overdose, which may or may not be fatal because they haven’t had that opioid for a while and the brain reacclimates to not having as much. So, when they are released from incarceration, if they do use again, their tolerance isn’t what it once was, so they are at a higher risk of overdose as a result of that. If we can get people on and engage in medication and transition them to continue that medication upon release in the community, we are supporting their health and wellness.”

The Michigan Department of Corrections will pilot its medication-assisted treatment programs starting with three facilities — Central Michigan Correctional Facility, Carson City Correctional Facility and Charles Egeler Reception and Guidance Center. 

The final step is harm reduction. The MDHHS will be expanding its syringe service programs to 25 agencies, which is an increase of 13 from the previous year. Some of the agencies are in Kalamazoo, Ionia, Kent and Muskegon counties. 

According to Poland, the syringe service program allows for individuals who have an opioid disorder and would like treatment to exchange the items they are using to inject drugs to get further treatment. The syringe service program also provides ambulatory care such as HIV and hepatitis C treatment. 

Rachel Jantz is the public health epidemiologist for the Kent County Health Department and the co-chair of the Kent County Opioid Task Force. She said the state’s new three-prong approach to address the opioid addiction disorder resembles much of what the county is doing to combat the addiction. 

“Our strategies are really in line with the strategies that the state has come out with, and in fact, their three groupings — prevention, treatment and harm reduction — align with our subcommittees,” she said. “Our intervention subcommittee is more focused on harm reduction. We really try to apply a harm reduction lens to all the work that we are doing, but I would say that our intervention sub-committee is specifically for harm reduction.”

Jantz said the statewide media campaign is beneficial to the Kent County Opioid Task Force because the county task force does not have the funding to do a large media campaign. Some of the projects they do to bring awareness, as part of the task force, is align with community efforts or pursuing grants, Jantz said. 

According to the Opioid Surveillance report for October 2019 by the Kent County Health Department, there have been 122 opioid-related overdose deaths of Kent County residents from January 2018 to October 2019. Eighty-two were males and 40 were females, and 42 of those deaths were between the ages of 25-34 years old. 

Between January 2019 to October 2019, there have been 56 opioid-related deaths in Kent County. The average age was 37. Fentanyl was involved in 68% of those deaths.

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