opioid treatment ecosystem update · opioid treatment ecosystem | february 2020 •reduces drug...

Wayne State University Center for Behavioral Health and Justice

Opioid Treatment Ecosystem | February 2020

Opioid Treatment Ecosystem Update



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



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!



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



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



Medications for Opioid Use Disorder

Source: The Pew Charitable Trusts, 2016



• 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



Opioid Treatment EcosystemImplementation Strategy



Exploration Preparation Implementation Sustainability

CBHJ Implementation Framework





Needs assessment

Access to training and resources

Process mapping

Activities include:





“Change Team” facilitation

Program evaluation

Sustainability planning

Activities include:



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



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



Community of Practice

Change Team

Change Team

Change Team

Change Team

Change Team

Change Team



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



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



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)



Community of Practice



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.



• 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



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



Sheriff’s AssociationSurvey Results

January 7, 2020



Sample Sizes

44 All Counties (Full Sample)

6 Opioid Treatment Ecosystem (OTE) Counties6 6 Other (Non-OTE)

Counties38



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



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%).



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



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%).



OTE Next Steps



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


31IUPUI TRIP Community Showcase – November 4, 2019

opioid treatment ecosystem update · opioid treatment ecosystem | february 2020 •reduces drug...

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