Against a backdrop of steadily soaring opioid-related death rates in the U.S., state agencies and private funders are pairing up to tackle the complex problem of opioid use disorder. A new program, recently announced by the Michigan Opioid Partnership and Governor Gretchen Witmer, aims to serve as a model of best practices for other states, especially those with large rural populations, in addressing opioid addiction.
The $5 million series of grants will fund the removal of barriers to effective treatment for opioid use disorder at all levels, from training and prevention to coordination, implementation and data collection.
In particular, the initiative will underwrite evidence-based, medication-assisted treatment (MAT) programs in select Michigan hospitals and correctional facilities. These pilot programs, funders suggest, will hopefully serve as the training grounds for more widespread adoption of evidence-based MAT throughout Michigan.
Sarah Wedepohl, program officer of the Community Foundation for Southeast Michigan, says that the initiative represents a significant first for the state. “The collaborative is unique in that it’s made up of public and private funders, including philanthropy, state government and an insurance company,” she says. “So in that sense, we’re uniting for the first time around a medical issue in the state of Michigan.”
The collaborative includes the governor’s office, as well as the Michigan Opioid Partnership—the Michigan Department of Health and Human Services, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Michigan Foundation, the Community Foundation for Southeast Michigan, the Ethel and James Flinn Foundation, the Jewish Fund, the Michigan Health Endowment Fund and the Superior Health Foundation.
Wedepohl explains that the collaborative’s funding efforts will hopefully move the state toward a flexible, multimodal approach to treatment: Emphasizing a “no wrong door” approach to curbing opioid addiction, encouraging widespread adoption of medication-assisted treatment, prioritizing rural areas, and modeling a form of care that puts patients first.
A Growing Crisis
Across the U.S., opioid deaths have increased fourfold over two decades, spreading beyond concentrated rural Midwestern areas to include eastern states and both urban and suburban regions. However, opioid misuse has a specific, and especially tragic, history in Michigan and other parts of the rural Midwest.
Of Michigan, Wedepohl says, “We rank 10th among the states in prescribing opioids and 18th for opioid deaths.” She adds, “We’ve had overdoses kill more people in Michigan than traffic and gun deaths combined, as of 2017.”
In fact, drug overdoses killed almost 2,700 Michiganders in 2017, with 2,053 of those deaths attributed to opioids. Former Governor Rick Snyder declared an official Opioid Addiction Awareness Week in 2018, noting recent increases in births of opioid-dependent babies.
As in many other states, opioid addiction is particularly prevalent in Michigan’s rural communities. “Michigan has massive rural areas, especially in the Upper Peninsula, that are especially affected by opioid use disorder,” says Wedepohl. Which is why the hospital systems and other organizations targeted to receive the pilot grants serve largely rural populations.
The “No Wrong Door” Approach to Opioid Use Disorder
In adopting a “no wrong door” approach to opioid addiction treatment, says Wedepohl, the Michigan Opioid Partnership is taking its cues from similarly successful programs in California and Massachusetts. “This is a new approach for the state of Michigan,” she says.
The “no wrong door” approach to government and community services aims to be fluid rather than fixed, dynamic rather than deterministic, and responsive rather than rigid. It assumes that clients and patients might enter the “door” to treatment—whether it’s the door of a jail, emergency room, Social Security office, or otherwise—anytime, anywhere. Using the approach of “Priority, Complexity, Risk” (PCR), it also prioritizes urgent needs such as homelessness in a timely manner, rather than enmeshing clients in a web of paperwork.
Funding “no wrong door” approaches to care is particularly important in the case of opioid use disorder because it’s so often combined with other mental health conditions. The partnership is prioritizing programs in hospitals and jails that provide behavioral treatment and allow patients to continue that care when they set off on their own, says Wedepohl, in an effort to streamline and standardize best practices when it comes to opioid addiction.
“Although this is already happening in some parts of the state and in some hospitals, it’s happening in a non-coordinated way. That knowledge is not necessarily always shared with other hospitals,” Wedepohl explains—a gap in communication that the new grants seek to address.
Modeling Medication-Assisted Treatment for Hospitals and Correctional Facilities
The initiative’s grants will fund pilot programs that use evidence-based, medication-assisted treatment (MAT) to curb the potentially fatal dangers of opioid abuse and withdrawal. Medication-assisted treatment involves the use of USDA-approved medications to lessen the effects of withdrawal. It’s especially crucial in settings like emergency rooms and jails, where people suffering from opioid use disorder are overrepresented.
Over $1.3 million will fund medication-assisted treatment for people with opioid use disorder at Beaumont Hospital in southeast Michigan and Munson Medical Center in Northern Lower Michigan. The pilot emergency room MAT programs will be accompanied by outpatient behavioral treatment to ensure continuity of care, which is crucial for long-term recovery.
Meanwhile, another $1.5 million will fund select county jails and Wayne State University’s Center for Behavioral Health and Justice, which will coordinate MAT programs and therapeutic behavioral treatments for incarcerated individuals over a 16-month period.
While corrections facilities have been slow to adopt MAT, pilot programs in prisons and jails have yielded promising results in curbing opioid deaths in the high-risk periods just after intake and immediately following release. Physicians agree that these treatments are lifesaving and ethically necessary, as many incarcerated individuals are prevented from accessing MAT, even when it’s prescribed by their former clinicians.
“We know that MAT is the recommended, evidence-based treatment right now for opioid use disorder,” explains Wedepohl. “It’s safer not just for the individual, but also their community.”
“Policy and Systems Change”
The Michigan Opioid Partnership hopes that the new grants will contribute to individual healing as well as to wider “policy and systems change,” Wedepohl says. That’s why, like many of the most successful opioid treatment programs, the partnership is targeting grantees who are addressing substance abuse in ways that combine education, prevention strategies and research to implement best practices.
“These are really considered pilots,” Wedepohl says of the programs selected for initial grants. And with a multimodal approach that combines data collection, research, pain management, effective treatment and recovery services—four of the five components identified by the U.S. Department of Health and Human Services as necessary for combating the looming opioid crisis—they can hopefully serve as models for the future. Explains Wedepohl, “We have a heavy research and evaluation component. The learning from this series of grants will be spread across the state, and hopefully across the country, as we learn more about best practices.”