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Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Opioid Treatment Ecosystem Update
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Drug Overdose Death in Michigan
9th largest number of deaths17th highest death rate
Wave 1: Prescription Opioids Wave 3: FentanylWave 2: Heroin
1429 1394 13861308
1553
1762
1980
2347
26942591
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
0
500
1000
1500
2000
2500
3000
*Data Source: CDC WONDER
Synthetic Opioids (Fentanyl)
Heroin
Prescription Opioids
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
CBHJ OTE Initiative Goals
Project Start: August 2019
Goals:
• Transform the attitudes of criminal/legal stakeholders and the culture in correctional facilities as we implement sustainable evidence-based behavioral health treatment
• Develop a continuity of care for those entering jail
• REDUCE DRUG OVERDOSE DEATHS IN MICHIGAN!
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Approximately 20% of incarcerated individuals meet the criteria for opioid use disorder. (Binswanger et al., 2013)
Less than 11% of these individuals receive treatment. (NIDA, 2017)
Death from a drug overdose is 129 times more likely for individuals within the first two weeks of release from incarceration than it is for the general population. (Binswanger et al., 2007)
Criminal/Legal Systems as a Touchpoint
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Following lawsuits in Maine, Massachusetts, and Washington Federal Courts ruled that withholding treatment is a violation of the 8th
Amendment and the ADA (Arnold, 2019; Taylor, 2018; Associated Press, 2019)
ADA defines OUD as a disability (DHHS, 2018)
Best practices allow participants to utilize all three forms of medications for OUD
Courts Mandate Jails to Provide MOUD
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Medications for Opioid Use Disorder
Source: The Pew Charitable Trusts, 2016
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
• Reduces drug use, opioid use, criminal behavior, and injecting behaviors.
• Each MOUD modality should be provided in addition to psychosocial or behavioral therapy.
• Recent research suggests that buprenorphine and methadone are the most effective medications for reducing the use and of illicit opioids.
Evidence on Medications for Opioid Use Disorder
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Opioid Treatment EcosystemImplementation Strategy
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Exploration Preparation Implementation Sustainability
CBHJ Implementation Framework
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Exploration Preparation Implementation Sustainability
CBHJ Implementation Framework
Needs assessment
Access to training and resources
Process mapping
Activities include:
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Exploration Preparation Implementation Sustainability
CBHJ Implementation Framework
“Change Team” facilitation
Program evaluation
Sustainability planning
Activities include:
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
County-Level Change Teams
• Developed out of the NIH Network for the Improvement of Addiction Treatment (NIATx) Model
• Includes jail admin and health, CMH and community providers
• Meet at least once a month
• Some are integrated into existing groups
• Data review, barriers, shared learning
Change Team
Executive Sponsor
Data Analyst
Project Coordinator
Change Team
Member
Change Leader
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
County-Level Change Teams
• Developed out of the NIH Network for the Improvement of Addiction Treatment (NIATx) Model
• Includes jail admin and health, CMH and community providers
• Meet at least once a month
• Some are integrated into existing groups
• Data review, barriers, shared learning
Center for Behavioral Health and Justice staff
Change Team
Executive Sponsor
Data Analyst
Project Coordinator
Change Team
Member
Change Leader
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Community of Practice
Change Team
Change Team
Change Team
Change Team
Change Team
Change Team
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Implementation of a Validated Screening Tool
RODS
TCUDSwith opioid supplement
Access to all forms of MOUD
Methadone
Buprenorphine
Naltrexone
Psychosocial Services
Group/Individualized
Therapy
OUD Targeted Offerings
Relapse prevention, MRT Class, etc.
Continuity of Care
Discharge Planning
Transportation, housing, etc.
Coordination with Community MOUD Provider
Medicaid Reactivation
The CBHJ MOUD in Jail Model
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
91 deaths Kent
10 deathsJackson
48 deathsMonroe
50 deathsMuskegon
82 deathsWashtenaw
775 deathsWayne
Current CBHJ OTE Initiative Counties
41% of overdose deaths in 2018 occurred in these counties
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Attitudes and Readiness
I am comfortable serving people with substance use disorder
I treat people with substance use disorder in the criminal/ legal system the same as others
Landlords shouldn’t be able to deny housing because of substance use disorder
Employers shouldn’t be able to deny work because of substance use disorder
57%
72%
71%
86%
63%
88%
87%
100%
89%
89%
89%
100%
100%
80%
100%
100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage of Respondents Who Agree
Agreeability Regarding Social Distance & Self Efficacy*County A
County B
County C
County D
Knowledge of Medications for Opioid Use Disorder:
Attitudes Towards Substance Use Disorder
Familiar with Medications for Opioid Use Disorder*
Have Attended a Medications for Opioid Use Disorder Training or Workshop*
County A80%
* Data collected from four Opioid Treatment Ecosystem counties
County B100% County C88% County D100%
County B89%County A60% County D71%County C50%
Data Source: Community Readiness Survey (November 2019)
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Community of Practice
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Community of Practice Summit
September 2020*East Lansing Hannah Community Center
• Convening of current and prospective OTE community stakeholders, funders, and State of Michigan partners
• Keynote address on making sustainable change• Panel presentations by jail staff, MOUD
prescribers, behavioral health providers, and first responders
• Discussion on where we go from here
*dependent on accepted public health protocols.
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
• Stakeholder attitudes/knowledge around SUD, evidence-based practices, & MOUD
• Stakeholder perceptions about OTE programs
• Number of bookings, RODS administered, positive RODS screens, persons eligible for MOUD, persons enrolled in MOUD
• MOUD history, type of MOUD, first/last doses, MOUD referral source, successful/unsuccessful program completion, reason for non-enrollment
• Prevalence of opioid & MOUD use
Data Collection
What Data Do We Collect? Why Do We Collect It?
OUD Screening Data
Process Data
Individual Data for MOUD Participants
Organizational Data
To assess need for MOUD and OTE programming
To describe individuals referred to programming and how they are
referred and processed through the program
To illustrate how a sample processes through booking to
MOUD enrollment and to evaluate implementation
To evaluate community readiness and assist with OTE
implementation & development
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Preliminary OUD Prevalence
13% 13%
18%
14%
Jackson+ Kent+ Monroe* Muskegon+
Data Source: Baseline Rapid Opioid Dependence Screen + 30 day collection period* 10 month collection period
Note. Results presented in chart are preliminary findings
14.5% of those booked into jail may have OUD
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Sheriff’s AssociationSurvey Results
January 7, 2020
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Sample Sizes
44 All Counties (Full Sample)
6 Opioid Treatment Ecosystem (OTE) Counties6 6 Other (Non-OTE)
Counties38
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Assessing Opioid Withdrawal Using Standardized Tool
• 46% of all counties reportedusing a standardized tool to assess opioid withdrawal.
• OTE counties are significantly more likely (100%) to report using a standardized tool to assess opioid withdrawal than other counties (37%).
*Difference statistically significantData Source: Sheriff’s Association Survey
46%
100%
37%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Perc
enta
ge o
f C
ou
nti
esU
sin
g St
and
ard
ized
To
ol
OTE Counties*
Other Counties
All Counties
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Types of MOUD Offered In-Jail
*Difference statistically significant
43%
100%
34%
0%
20%
40%
60%
80%
100%
All OTE* Other
Naltrexone
Methadone
36%
100%
26%
0%
20%
40%
60%
80%
100%
All OTE* Other
34%
100%
24%
0%
20%
40%
60%
80%
100%
Buprenorphine
All OTE* Other
Data Source: Sheriff’s Association Survey
None Reported
58%
24%18%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Other Counties
OTECounties*
1-2 3 3
All Counties
Number of MOUD Forms Offered In Jail
330%
1-220%
None Reported
50%
• 30% of all counties reported offering all three forms of MOUD in jail.
• OTE counties are significantly more likely (100%) to report offering all three forms of MOUD in jail than other counties (18%).
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Behavioral Health Services
• OTE counties are significantly more likely (100%) to report offering behavioral health services, such as peer support, counseling, and 12-step programs, than other counties (47%)
*Difference statistically significantData Source: Sheriff’s Association Survey
55%
100%
47%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
OTE Counties*
Other Counties
All Counties
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
36%
83%
29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Naloxone and Medicaid Assistance Upon Jail Release
18%
67%
11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
OTE Counties*
Other Counties
*Difference statistically significant
All Counties
OTE Counties*
Other Counties
Data Source: Sheriff’s Association Survey
Offering Naloxone Upon ReleaseOffering Assistance with Medicaid
Upon or Prior to Release
All Counties
• OTE counties are significantly more likely (67%) to report offering naloxone upon release than other counties (11%).
• OTE counties (83%) are significantly more likely to report offering assistance with Medicaid upon/prior to release than other counties (29%).
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
OTE Next Steps
Wayne State University Center for Behavioral Health and Justice
Opioid Treatment Ecosystem | February 2020
Implementation of a Validated Screening Tool
RODS
TCUDSwith opioid supplement
Access to all forms of MOUD
Methadone
Buprenorphine
Naltrexone
Psychosocial Services
Group/
Individualized Therapy
OUD Targeted Offerings
Relapse prevention, MRT Class, etc.
Continuity of Care
Discharge Planning
Transportation, housing, etc.
Coordination with Community MOUD Provider
Medicaid Reactivation
New Inductions
Po
st O
verd
ose
Re
spo
nse
Nalo
xon
e at R
ele
aseTreatment | Peer-Recovery | Harm Reduction
Wayne State University Center for Behavioral Health and Justice
31IUPUI TRIP Community Showcase – November 4, 2019
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