1. MDHHS Response to the Opioid Crisis
Jared Welehodsky
Policy, Planning, and Legislative Services Administration
Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.

2. Michigan Data Summary

3. MDHHS Public Health Approach to the Opioid Crisis
MDHHS is addressing the opioid crisis from a public health approach. The focus is on prevention, early intervention, and treatment.
MAPS=Michigan Automated Prescription System, MIHIN=Michigan Health Information Network, CC360=Care Connect 360

4. Medicaid & Healthy Michigan
Medicaid funded the delivery of $41 million in substance use disorder services for 31,101 beneficiaries in fiscal year 2016
Healthy Michigan funded the delivery of $53 million in substance use disorder services for 28,850 beneficiaries in fiscal year 2016
Around half of these expenses are opioid related
Medicaid is a significant payer of opioid treatment services. Healthy Michigan significantly increased access to treatment resources.

5. Medicaid & Healthy Michigan
Medicaid funded $1,364,175 in services in the Upper Peninsula in fiscal year 2017
Healthy Michigan funded $1,779,134 in services in the Upper Peninsula in fiscal year 2017
Medicaid is a significant payer of opioid treatment services. Healthy Michigan significantly increased access to treatment resources.

6. Services Funded by Medicaid
Services funded include:
Medication Assisted Treatment
Withdrawal Management
Outpatient Services
Residential Services
Case Management
Services are modeled to include all levels of ASAM.
Medicaid provides for a variety of services in both inpatient and outpatient settings, including Medication Assisted Treatment.

7. Michigan Prescription Drug and Opioid Abuse Task Force
On June 18, 2015, Governor Rick Snyder appointed a task force to address prescription drug and opioid abuse
On October 26, 2015, the Task Force released their report
All recommendations assigned to MDHHS are complete or in progress
Director Lyon led the subcommittee on Prevention and Treatment. I served as staff on this committee in developing the recommendations.

8. Task Force Recommendations
Public Awareness Campaign
Neonatal Abstinence Syndrome
Legislation
Naloxone Standing Order
Ongoing Commission
Drop off bins are at every state police post. DEQ and U of M maintain list of drop-off bin locations.
This program looks for improper utilization of medical services, including doctor and pharmacy shopping. Medicaid can lock a beneficiary into one provider and one pharmacy. Program and technology improvements are ongoing.
MDHHS launched a statewide public awareness campaign in 2016 that will continue through 2018.

9. michigan.gov/stopoverdoses
Statewide public awareness campaign launched in 2017
This campaign will run through 2019
Campaign directs to michigan.gov/stopoverdoses
Over 100,000 page views to this website

11. Neonatal Abstinence Syndrome (NAS)Project
Remove barriers to positive postpartum outcomes for pregnant women engaged in Medication Assisted Treatment
Case Manager provides services similar to wraparound to ensure that pregnant women have knowledge of potential withdrawal of infant and infant needs, Neonatal Intensive Care Unit procedures, and potential referrals to Children’s Protective Services
Ensures engagement of all parties to promote the health and wellness of the family

12. NAS Policy Academy Priorities are:
Prevention and Wellness – Promote prevention and increased screening
Capacity – Increasing providers
Quality - Regional perinatal care system quality improvement initiative and child welfare cross-system collaboration

13. Legislation
On March 23, 2017, Governor Snyder and a bipartisan group of legislators announced a package of bills to combat opioid and prescription drug abuse
Many of these bills were Task Force recommendations
Most of these bills were signed by Lieutenant Governor Brian Calley in December 2017

14. Legislation Bona-fide doctor-patient relationship
7 day prescribing limit – For acute pain
Develop prescription drug education curriculum in schools
Greater patient education requirements – New consent form effective 6/1/18

15. Naloxone
Naloxone is a safe, non-addictive prescription drug used to treat an opioid overdose
Governor Snyder’s 2015 Prescription Drug and Opioid Abuse Task Force recommended increasing access to naloxone
Increasing access to naloxone has been a significant part of the State of Michigan's Response to the opioid crisis
Drop off bins are at every state police post. DEQ and U of M maintain list of drop-off bin locations.
This program looks for improper utilization of medical services, including doctor and pharmacy shopping. Medicaid can lock a beneficiary into one provider and one pharmacy. Program and technology improvements are ongoing.
MDHHS launched a statewide public awareness campaign in 2016 that will continue through 2018.

16. Naloxone Standing Order
In 2016, Naloxone standing order legislation signed
Allows for Naloxone to be dispensed by a pharmacist without identifying a particular patient
In May 2017, the standing order became available after administrative rules were developed
Currently, over half of all pharmacies in Michigan are participating
Drop off bins are at every state police post. DEQ and U of M maintain list of drop-off bin locations.
This program looks for improper utilization of medical services, including doctor and pharmacy shopping. Medicaid can lock a beneficiary into one provider and one pharmacy. Program and technology improvements are ongoing.
MDHHS launched a statewide public awareness campaign in 2016 that will continue through 2018.

17. Q1 2018 Naloxone Standing Order Report
(January 1, 2018 – March 31, 2018)
Number of pharmacies with controlled substance license in Michigan: 2,840
Number of pharmacies in Michigan registered for standing order: ,546
(54.4% of pharmacies with controlled substance license in Michigan)
Number of pharmacies in Michigan that did not report q1 Naloxone orders: (261)
Number of pharmacies in Michigan that reported q1 Naloxone orders: ,285
Total number of naloxone orders filled under Dr. Eden Wells’ standing order:
Total number of naloxone orders filled under any other physician:
Percentage of total naloxone orders: %
Total number of naloxone orders dispensed during Q1 2018
by registered MI pharmacies: 1,462

18. Pharmacies with Naloxone Standing Order Issued May 25, 2017

19. Prescription Drug and Opioid Abuse Commission
In June, 2016, Governor Snyder created the Prescription Drug and Opioid Abuse Commission (PDOAC)
PDOAC ensures implementation of the Task Force recommendations
Develop action plan to address new challenges in the opioid crisis

20. Opioid STR Grant
The MDHHS was awarded a 2-year State Targeted Response to the Opioid Crisis (STR) Grant from SAMHSA in April 2017 for $16,372,680 per year
This grant can be used for interventions related to:
Prevention
Treatment
Recovery

21. Opioid STR Grant Prevention
STR grant will allow Michigan to promote prevention activities as follows:
Support for improvements to Michigan’s Prescription Drug Monitoring Program (MAPS)
Statewide awareness campaign
Enhancing opioid prescribing practices for common surgical procedures
MI Open II – Training for the medical and dental practitioners

22. Opioid STR Grant Treatment
Funding from the STR grant will increase access to treatment services by:
Expanding the availability and use of Medication Assisted Treatment, including Michigan Opioid Collaborative
Providing a new model for prisoner re-entry population with co-occurring Opioid Use and Mental Health Disorders
Increasing tribal interventions
Naloxone for Michigan State Police

23. Jared Welehodsky welehodskyj@michigan.gov
Questions
Jared Welehodsky