New Horizons Substance Use Recovery Network

Description

According to a previous Michigan's Department of Health and Human Services report, from 1999 to 2016 total opioid overdose deaths increased from 99 to 1,699, a 17-fold increase. Additional data from that time, Michigan's Automated Prescription System (MAPS) showed that 11.4 million prescriptions for painkillers in 2015 were written, or about 115 opioid prescriptions per 100 people. Public health efforts dealing with this situation involve a framework of prevention, treatment, and recovery. According to the Substance Abuse and Mental Health Service Administration (SAMHSA), medication-assisted treatment, or MAT, is a well-vetted integrated treatment for opioid use disorder (OUD) using medications in addition to counseling.

A rural Michigan effort to address the issues behind the statistics involved three partners: Alcona Health Center, the FQHC; Freedom Recovery Center, the program's original waivered-provider group; and Catholic Human Services, Inc., the behavioral health group. Their goal is providing established FQHC patients with all of their medication-assisted treatment needs within the FQHC itself. As of 2019-2020, MAT treatment is provided by the FQHC providers, eliminating the need for outsourcing the service.

Their approach includes a process that begins after an initial in-house medical provider referral. The referral is followed by an intake assessment performed by the program's clinic-based nursing care coordinator. The care coordinator also arranges appointments with the on-site Freedom Recovery Center consultants who have the required training for prescribing MAT medications. The referral process also includes appointing with on-site Catholic Human Services team members for the behavioral health counseling that is part of the whole-patient OUD treatment.

The program is also designed to accommodate more urgent needs if patients are actively withdrawing from opioids, other substances, or having urgent mental health needs.

Prompted by the Centers for Disease Prevention and Control (CDC) reports of high per capita rates opioid overdoses and high prevalence of addiction-related infectious disease in area this program serves, Michigan Medicaid implemented a waiver program in the state's region the 3 partners serve. The program, called the Opioid Health Home, uses a hub and spoke referral model similar to that used in Vermont and accomplishes two objectives: increases access to OUD treatment for Medicaid patients and allows care coordination- and case management-like services to be billed.

The program's initial funding came through a 2015-2017 HRSA/SAMHSA grant awarded to the FQHC in order to expand MAT for substance use disorders, with special attention for OUD. Revenue generated from services performed within the program is early signs of service sustainability.

Services offered

• Level one substance use treatment (Based on American Society of Addiction Medicine's Substance Use Disorder Treatment)
• Individualized treatment plans which include general medical needs, medications for opioid use disorder, and counseling needs
• Nursing care coordinator providing both intake care processing and ongoing care coordination
• Five (increased from the initial 2) licensed master's level behavioral health clinicians/addiction counselors for the behavioral health portion of MAT
• Five (increased from the initial 3) rotating MAT medication prescribers
• Multidisciplinary team meetings every two weeks to review individual treatment plans, adjusting care when needed
• "Curbside, warm handoff referrals" in addition to formal referral process
• Urgent consultation to manage active withdrawal symptoms or urgent behavioral health needs
• Coordinated referral to outside psychiatric services when needed
• Coordinated referral to the Local Coordinating Agency, Michigan's state-funded entity that assists with residential treatment or detoxification programs when needed
  • (Note: Participants with opioid use disorder may also have co-existing alcohol use disorder or benzodiazepine use disorder. Though opioid withdrawal is extremely uncomfortable, in contrast, alcohol or benzodiazepine withdrawal are both life-threatening conditions which require a higher level of substance use treatment.)
• Coordination with recovery program transitions
• Integration with community services providing the additional social determinants of health interventions (for example, economics, education, employment, housing)

Results

From the initial grant cycle, data from patients enrolled May 2016 through final report:

• Current caseload:
  • 32% of patients have been in the program for 18 months or more
  • Many patients stabilized on maintenance
  • 3 buprenorphine-treated pregnant patients had safe deliveries
  • Many patients have remained employed/found new employment
  • Some patients have returned to college or completed GED

Additional in-house observations:

• Increased primary care provider referrals
• Increased medical provider awareness of opioid addiction risks

Additional impact: community-collaborations

• Program now linked with community partners; for example, collaboration with focus on a Family Recovery Team to impact parental rights terminations often associated with substance use disorders
• Community integration with educational programs on issues leading to opioid and substance use disorders such as building capacity for addressing adverse traumatic events

For more information, see the 2018 Rural Monitor article, What's MAT Got to Do with It? Medication-Assisted Treatment for Opioid Use Disorder in Rural America.

Challenges

• Initial buy-in from primary care providers
• Workforce scarcity issues for recruitment and retention of qualified behavioral health and substance use treatment providers
• Sustainability
• With initial grant program, patient numbers precluded additional enrollees due to unanticipated high participant retention
• Ensuring transition to local recovery services

Replication

To reproduce this program in other areas:

• Acknowledge that identifying a common goal brings motivated partners to the planning table
• Acknowledge medication-assisted treatment as an integrated treatment that must include overall medical care, counseling, and coordination with other agencies attending to the associated social determinants of health impacting the participants' overall quality of life

Contact Information

Dan Oliver, CMA, Substance Use Program Coordinator
Alcona Health Center - Alpena Services
989.358.3905
doliver@alconahc.org