Opioid Archives

Results from the opioid settlement prioritization survey 2021–22

Dollars and data charts under a magnifying glass

In 2019, Michigan and many of its districts filed lawsuits against numerous companies in the opioid industry. Settlement negotiations regarding some of these lawsuits are ongoing; however, the State of Michigan is currently drafting legislation that would establish a fund for these resources–$766 million–that would be used to support Michigan-based substance use treatment services and to address the harm created by the opioid epidemic.

Consequently, The Opioid Settlement Prioritization Survey 2021-22 sought to gather data to understand priorities for settlement funding among individuals across Michigan, including those with lived experience, to inform strategies to address the opioid crisis across the state. Then, in late 2021, the Michigan Department of Health and Human Services (MDHHS) worked with the Center for Health and Research Transformation (CHRT) to analyze results from that survey.

Specifically, CHRT’s team worked with state partners to analyze survey results, and reported back to MDHHS to share its analysis, which is the first step toward offering advice to support policymakers’ decision process.

Key Findings

Respondents’ primary desires for the use of settlement funds included:

Recovery support services, including peer support and wrap-around services for individuals with substance use disorder and multiple mental health diagnoses.
Prevention programs.
Expanding access to medications used to treat opioid use disorder (MOUD) and other opioid-related treatment.

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Michigan Physician Survey–perspectives on opioid prescribing policies, medication assisted treatment

Whether opioid policy reforms and additional resources will have an impact on opioid use depends in part on physician support. Physicians need to be key partners in the implementation of changes in opioid prescribing and in providing supportive treatment approaches. In order to understand the likelihood that these policies will succeed, CHRT’s latest Michigan Physician Survey asked physicians about their views on recent opioid initiatives.

Over the last decade, there has been a startling increase in the number of deaths attributed to opioid overdose. Between 1999 and 2016, the number of overdose deaths in Michigan increased seventeen fold—from 99 to 1,699. In 2017, more deaths were due to overdose than car accidents State of Michigan (2019).

In 2017, Michigan enacted legislation intended to deter over prescribing. Key provisions include a seven-day limit on opioid prescriptions for acute pain and mandatory use of the Michigan Automated Prescription System (MAPS). The seven-day limit was put in place to both reduce the supply of prescription opioids in circulation, as well as require more oversight of patients receiving opioids for acute pain. The MAP system was mandated in order to track all opioid prescriptions to individual patients, regardless of source.[footnote]Department of Licensing and Regulatory Affairs and the Michigan Department of Health and Human Services (2019).

In 2017 and 2018, the Michigan Department of Health and Human Services (MDHHS) encouraged expansion of Medication-Assisted Treatment (MAT) programs. Specifically, MDHHS provided more than $7 million for MAT training, rate incentives, and program expansions in rural areas. Additionally, MDHHS recently announced a tuition reimbursement program for training physicians who become waivered to provide buprenorphine.

CHRT analyzed results from the latest Michigan Physician Survey to determine the opinions of primary care providers (PCPs) on these opioid initiatives.

In general, PCPs think the new prescribing policies will help to address the opioid epidemic, but are concerned about administrative burden and patient care.
Just one in five physicians offer Medication-Assisted Treatment (MAT) in their practices, and even less are interested in being trained.
Physicians who are newer-practicing and serving higher volumes of Medicaid patients are more likely to be currently providing or interested in providing MAT.

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Quick Facts: Chronic Pain in Michigan

Not everyone suffers from chronic pain in Michigan, but many people do. Our Cover Michigan Survey found that more than 35 percent of the state’s residents say they experienced chronic pain which limited their lives or work within the last year. This is similar result to research finding at least 30% of Americans report suffering from chronic pain.

These infographics from the Center for Health and Research Transformation are based on consumer response, and show how many people report suffering from chronic pain, along with who is most affected.

Some of the key information includes:

One in three people reported pain that limited their lives or work in the past year, and one in five were prescribed a pain medication.
Of those suffering pain in the past year, four in five people had chronic pain some or most days.
Chronic pain affects adults of all ages.
Women and men experience chronic pain equally.
African Americans were significantly more likely to suffer from chronic pain compared with all other groups.
Medicaid beneficiaries report chronic pain at a higher rate than adults with other kinds of insurance.

In the context of the opioid epidemic and the utilization of prescription pain medication, these findings demonstrate the need for providers to remain vigilant and become well-versed in alternative treatments for chronic pain.

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Uncoordinated prescription opioid use in Michigan

Prescription opioids such as morphine, oxycodone, and hydrocodone provide pain relief to patients with chronic pain. However, these drugs also pose safety risks to patients. Opioid use can cause respiratory depression, resulting in overdose or death.

As prescription opioids have been used more extensively for pain control in the past two decades due to changing practice guidelines, overdose deaths surged in both Michigan and the United States. Notably, the majority of opioid-related disabilities and deaths result from patients taking opioids as prescribed, rather than from deliberate abuse or misuse. Furthermore, opioid-related deaths are frequently associated with concurrent use of prescribed antidepressants or benzodiazepines like Valium and Zanax.

Pain control is an essential part of patient care, and opioids are one of the primary pain treatments available. While most opioids are used and prescribed appropriately, a small number of patients receive numerous prescriptions from separate prescribers within a short period of time. This lack of coordination increases patients’ risk of accidental overdose and death. This issue brief analyzes accidental deaths from opioid overdoses in Michigan, uncoordinated opioid prescribing among privately insured Michigan patients in 2013, and policy options to improve safe prescribing in the state.

Key findings include:

Uncoordinated opioid prescribing is a critical patient safety issue in Michigan, particularly for patients who receive a large volume of opioids from multiple prescribers. It is essential that patients receive appropriate pain control, which may include the use of opioids, but pain treatment should not jeopardize patient safety.
Accidental overdose deaths involving opioids (including prescription drugs and heroin) increased sixfold in Michigan between 1999 and 2013 (from 81 to 519 deaths). These opioid-related deaths represented 38 percent of all accidental drug deaths in 2013, up from 23 percent in 1999.
Accidental overdose deaths involving prescription opioids represented 43 percent of total opioid deaths in 2013. The remaining 57 percent of deaths were from heroin, which is noteworthy since some patients first become addicted to prescription drugs and then turn to heroin, the strongest form of opioid.
In 2013, over 600 privately insured Michigan patients in the study group were defined as having uncoordinated opioid prescriptions (0.3 percent of all patients using prescription opioids). These patients filled at least ten opioid prescriptions from four or more providers within three months. As a result, they ran a higher risk of accidental overdose and death because their providers may not have been aware of all their opioid prescriptions.
In October 2015, the Michigan Prescription Drug and Opioid Abuse Task Force released its findings and recommendations.

Key recommendations to address these issues include:

Expanding provider education on safe opioid prescribing;
Requiring providers to have a bona-fide relationship with patients before prescribing controlled substances;
Launching a public awareness campaign;
Increasing access to the lifesaving overdose reversal drug naloxone;
Exploring the possibility of limiting criminal penalties for people who report or seek medical attention for overdoses; and
Improving the state’s database of controlled substance prescriptions and increasing its use by providers and pharmacists.

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Publications

Key Findings