Published in Health Care

Treatment options for opioid addiction expand; ‘legitimate concerns’ from physicians remain

BY Sunday, October 27, 2019 12:11pm

In 2017, Gov. Rick Snyder’s administration proposed and later signed into law a 10-bill package meant to be an “all-hands-on deck approach” to the opioid crisis, as former Lt. Gov. Brian Calley described it at the time. 

Key aspects of the bills required providers to check patients’ prescription histories in the Michigan Automated Prescription System (MAPS), limited initial supplies of opioids for patients, and expanded opioid addiction treatment options for Medicaid recipients, to name a few.

Dr. Joneigh Khaldun COURTESY PHOTO

It followed a series of reforms — such as a standing order for pharmacies to provide the overdose-reversing drug Naloxone and expanding the state’s Good Samaritan law to encourage overdose reporting to authorities — and task forces created under Snyder as the opioid problem proliferated in Michigan and nationally.

Health care experts and advocates say expanding treatment options covered under Medicaid, including inpatient care, will have a broad effect on people facing opioid addiction. Often, evidence-based behavioral therapy combined with opioid maintenance (such as scheduled doses of methadone) remains the best treatment option. 

Treatment availability dates back to the Obama administration’s Affordable Care Act, which created parity for mental health coverage and allowed for Michigan’s Medicaid expansion known as the Healthy Michigan Plan.

“In relation to the opioid epidemic, the (Affordable Care Act) and Healthy Michigan’s mental health parity component has ensured adequate insurance coverage for mental health needs as well as physical health,” said Alex Rossman, external affairs director for the Michigan League for Public Policy. “Putting mental health care on the same footing as other medical care not only ensures these services are affordable, it also helps reduce the stigma associated with these challenges by recognizing that they are just as serious and important to address as any other health needs.”

Also over the past two years, the Michigan Department of Health and Human Services (DHHS) has encouraged greater use of medication-assisted treatment, including funding more than $7 million in additional training. On Oct. 22, DHHS announced it will use a $3.4 million grant from the Centers for Medicare and Medicaid to do a needs assessment on where and how substance use disorder treatment and recovery is needed.

“This will further our state’s proactive response to the opioid crisis that focuses on prevention, treatment and recovery,” Dr. Joneigh Khaldun, chief medical executive and chief deputy for health at DHHS, said in a statement.

Physician input

The University of Michigan’s Center for Health and Research Transformation (CHRT) notes the effect of the 2017 policy changes will depend partly on support from primary care physicians.

In July, the Center published its recent Michigan Physician Survey that measured physicians’ reactions to the reforms. While 60 percent said the changes would be useful to better manage opioid prescribing and help address the epidemic, 70 percent were concerned the policies could create “unnecessary administrative burden.” About half thought the changes would limit the ability to treat chronic and acute pain while also negatively affecting patient satisfaction.

Physicians “see (the new policies) as holding promise, but they don’t want to see it inhibit their ability to treat their patients or do what they need to do to provide good care,” said Melissa Riba, CHRT’s research and evaluation director. “From the practice perspective, there are still some legitimate concerns we’re still sorting out in terms of their long-term impact.”

The survey also found that only one in five Michigan physicians provide medication-assisted treatment — like using methadone to treat addiction — and only 16 percent said they would be interested in training on the issue. Nearly two-thirds of physicians surveyed said they have no interest in medication-assisted treatment.

Supporters of medication-assisted treatment say the results show the stigma still surrounds the topic of treating opioid addiction with other drugs. However, survey responses show the tide may be shifting among physicians who began practicing in the past 10 years.

“There’s a good deal of stigma and lack of understanding about what medication-assisted treatment is,” Riba said.

CHRT monitors changes in federal and state policy and shares information with communities and organizations that receive grant funding for programs and services. It partners with local health departments, law enforcement, schools and treatment centers to find the best ways to direct funding to address the opioid crisis.

Riba said the 2017 state laws “brought the topic (of opioids) to the forefront even stronger in Michigan.” Survey results also suggest providers have begun to change their prescribing practices.

‘Tip of the iceberg’

Meanwhile, focus on the opioid epidemic has carried over under Gov. Gretchen Whitmer, who during her election campaign called it the “greatest health crisis of our lifetime.” In August, Whitmer signed an executive order creating an opioids task force to help improve access to treatment and help meet people with addiction “where they are,” including supporting them if they are still using. Whitmer has also announced a $10 million partnership with Bloomberg Philanthropies to stem Michigan’s increasing opioid death rate.

The state has budgeted about $30 million in the next fiscal year from a federal opioid response grant, although Whitmer drew criticism recently for vetoing $750,000 in spending approved by the Legislature for an opioid recovery center. The center is in Senate Majority Leader Mike Shirkey’s district.

In the state Legislature, several bills are pending that would expand the availability of overdose-reversing drugs like Naloxone.

Whether the 2017 laws left open policy gaps remains to be seen, Riba said, but there still needs to be a shift in the understanding and availability of treatment options, as well as stable funding. An “infrastructure” change is also needed to move away from a process that historically placed individuals in the criminal justice system instead of treatment programs.

“The policy changes are almost the tip of the iceberg,” Riba said. “What’s needed is a system change to really help address opioid use disorder.” 

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