Here’s how Michigan should spend Bloomberg’s $10 million to fight opioids

Billionaire Michael Bloomberg’s philanthropy is donating $10 million to Michigan to fight the opioid epidemic that is rattling the state.

As Michigan continues to battle an opioid epidemic, billionaire and former New York Mayor Michael Bloomberg's charity is investing $10 million to broaden state access to treatment and improve prevention.

As Bridge Magazine has reported, health and law enforcement experts say the state needs to invest in several areas to reduce deaths, among them: Expanding distribution of naloxone and medications for opioid use disorder and improving data collection to help speed response, .

“Michigan can certainly use the money,” said Molly Welch-Marahar, program manager for the University of Michigan’s Center for Healthcare Research & Transformation. “But it will be important to align the investment with the work that is already being done to expand treatment and naloxone access to decrease fragmentation and increase better coordination of care and resources statewide.”

She said she also hopes to see more investment in rural telemedicine and community services tailored to tribal communities, “who are disproportionately impacted by the opioid epidemic in Michigan.”

Opioids were responsible for more than three-quarters of Michigan's nearly 2,700 drug overdose deaths in 2017.

Michigan becomes the second state in Bloomberg Philanthropies’ $50 million opioid initiative, following a similar $10 million grant awarded Pennsylvania in November.

Bloomberg said in a statement that combating the epidemic requires “bold leadership and big ideas,” and expressed confidence in Michigan’s new governor to invest the money wisely.

“Governor Whitmer is committed to reversing the epidemic, and our goal is to support her administration with resources and expertise that can help them save more lives,” Bloomberg said.

The statement said funding is to support "high-impact, state-based interventions."

That presumably includes broader access to naloxone, which is used to reverse the effect of overdose.

Since 2017, pharmacies in Michigan are authorized to distribute naloxone to those at risk of overdose as well as family and friends. A growing number of Michigan schools now stock naloxone as well.

"The opioid epidemic is one of the greatest health crises of our lifetime, and we need to marshal all forces necessary to fight back," Whitmer said in the release. "The opioid crisis affects nearly every county in Michigan."

Meanwhile, the toll of the opioid epidemic continues to mount as the state’s opiate death rate ranked 10th worst among states in 2016, at 18.5 deaths per 100,000 people. That same year, 1,762 people died from an opioid overdose in Michigan – more than triple the number in 2007, and far more than the number of traffic fatalities.

The rise in deaths initially followed a rise in prescriptions for opiates such as Oxycodone and fentanyl, with 11 million opiate prescriptions filled in 2016 – more scripts than Michigan has people.

Gov. Gretchen Whitmer: “We need to marshal all forces necessary to fight back” against the opioid epidemic.

But in recent years, deadly illegal street versions of fentanyl have overtaken prescription opiates as cause of overdose death. It’s often mixed with heroin or cocaine, or sold as a pill, streaming in from labs in China, through the mail or smuggled into the country through Mexico.

In 2017, according to preliminary calculations, about three-quarters of fatal overdoses in Wayne County were tied to fentanyl, an eightfold increase in three years. The statewide share of overdose deaths tied to synthetic opioids also has risen sharply, from 5.6 percent to 39 percent between 2013 and 2015.

Substance abuse experts say that highlights the need for better access to medically assisted treatment, which includes the use of an opioid substitute called buprenorphine.

Multiple studies have found that buprenorphine, as part of a broader treatment plan, can indeed save lives. And yet a recent report found Michigan suffers a critical shortage of doctors certified to prescribe the drug.

According to an analysis by Avalere Health, a Washington, D.C., healthcare consulting firm, Michigan ranks in the bottom 10 states in the ratio of certified doctors compared to opiate deaths.

Launched in 2017 with $1.5 million in federal funds, the Michigan Opiate Collaborative is aimed at helping more physicians get certification for buprenorphine treatment and offering expert guidance for patient care. It’s part of  $16.4 million in federal funds to help Michigan combat opioid addiction.

Experts say Michigan can also learn from states like California, New York and Maine, where emergency rooms are becoming a life-saving front line in the opioid crisis.

Armed with evidence that addicts given an opiate substitute called buprenorphine in the ER are more likely to remain in treatment, California is committing $78 million over two years to ensure greater access to buprenorphine and two other addiction medications in ERs and beyond.

A groundbreaking 2015 Connecticut study found patients given buprenorphine in the ER were twice as likely to remain in treatment a month later compared with patients who were released with a referral to community-based treatment. Addicts, experts say, often need months of sustained treatment to kick their habit, while users referred to community treatment or abstinence programs are more likely to relapse.

As far as Bridge Magazine could determine, no Michigan emergency rooms offer buprenorphine treatment.

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Mark Kilgore
Fri, 03/15/2019 - 9:50am

We need to make sure that recovery support services are funded to help people achieve long term recovery. Treatment and MAT alone are not enough. Treatment lays the foundation for which to build recovery upon it is not the cure. Recovery support services are way underfunded.

Sandra Russo
Mon, 03/18/2019 - 10:45am

Spot on Mark Kilgore. I think if more people wo are concerned about this epidemic spent any time in an AA meeting they would begin to see the light!

Fri, 03/15/2019 - 4:50pm

The last two paragraphs of this article should tell us we need buprenorphine treatment NOW in Michigan. According to the article a program was launched in 2017, it's 2019!
I have been to the ER three times for my daughter with an overdose. Each time after the patient was stabilized she was discharge and told don't do it again or else. Heroin addiction is so strong it takes a lot to break it, the users mentally have a hard time breaking from it. In fact, some addicts become pissed off that the Narcan was administered, even when it saved their life. It doesn't make sense, I know, but their brains have been so changed by these chemicals they crave it. My daughter is now in a full recovery but it has taken seven trips, yes 7, to detox programs to save her.

Anon Ymous
Sun, 03/17/2019 - 2:03am

I have zero problems with helping those suffering from addiction. AS LONG AS it's not at the expense of the stable chronic pain patient that has tried PT, injections, etc.. and has finally found some relief and quality of live by taking prescription opioids.

Unfortunately, that's not been the case. Chronic pain patients don't take opioids for recreation. And they don't take doses that get them high. However, since the CDC's "guidelines" came out, we are now harming the millions of people that never asked for their chronic pain, by forcefully taking the opioids that help them. This is causing large numbers of chronic pain patients to have to quit their jobs, and many to commit suicide, because they cannot handle the pain!

On the other hand, we are giving those addicted to ILLEGAL opioids, just another form of opioid in buprenorphine and suboxone! Read their own testimonies: yes, they "might" stay off of heroin, and other drugs, but they are still getting HIGH. This doesn't make them productive members of society!

How can this possibly be considered fair in anyone's thinking?

Sun, 03/17/2019 - 10:45am

AnonYmous: Do you realize that Suboxone has naltrexone added to it? This makes it difficult to get high unless one takes multiple doses at once. Suboxone does not interfere with psychomotor skills as much as methadone so these people CAN work. I'm undecided about people who work in sensitive positions (healthcare, public transportation drivers, etc) . Chronic pain patients aren't getting the education or treatment they need because it's a labor intensive, expensive process and it's easier to just write a prescription or do an injection. You'll have to show me your source for your claim that the suicide rate for chronic pain patients is rising because I have not seen this in the literature and don't believe this to be the case. Since it's all about cutting taxes, I doubt that people will be getting the skills they need to manage their own chronic pain.

Mon, 03/18/2019 - 11:00am

Diner, When you’re using naltrexone or Suboxone for pain management you do have to take large doses I’m here to tell you I’ve been on that medication after many surgeries and it’s debilitating no one should be driving around let alone working on that drug you do get high on it it has different effects with different people so it is a very dangerous drug I would not advise anyone to go on Suboxone the detox is the hardest I’ve ever experienced .
I’ve said this before and I’ll say it again the pharmaceutical companies should be responsible for creating some type of recovery programs at a very high-end not the 30 day program as we have here in Michigan .

Sandra Russo
Mon, 03/18/2019 - 10:57am

I agree, addiction is a “thinking” disease. Often trauma is associated with drug use. To all that are making important decisions I suggest you stay in a long term treatment center of quality. (Missing here in our state). Go to AA mtgs. Get familiar with this fellowship and you will see why there is a great success if you stick close to the program.

I am in recovery and I have chronic pain issues. In the last 1 1/2 yrs I have had 5 surgeries. Many more in the last decade. I disclose my addiction to health care and I have experienced horrific treatment or should I say lack of treatment because health care industry don’t understand it. I truly believe that Health Care industry should be required to participate in a residency recovery program. Refusing opiates to a person dealing with chronic pain is abusive and offers no compassion.
Do the research, using pain meds for chronic pain is very different than recreational use. I believe Pharma should be paying for better treatment centers.

John S.
Sun, 03/17/2019 - 10:56am

I recall many years ago discussion on the Michigan Commission on Death and Dying of the need for better physician training on pain management. Plainly, too many scripts are being written for opioid pain medications. There's not 10x as much pain today as 15 years ago. Why are sales of these drugs 10x higher? I think it has something to do with profits (e.g., Purdue Pharma). It is important to look at upstream solutions, not just downstream ones.