Proposed Michigan laws would reduce hurdles, speed access to drug treatment

• A package of bills would increase access to treatment for Michiganders with addiction
• The package, in part, would decriminalize drug testing strips, require pharmacists to quickly make available medications used by individuals in drug treatment, and equip school nurses with Narcan
• The package’s sponsors include the chairman of the Senate Health Policy Committee, who collaborated with the Opioid Advisory Commission

A group of Michigan lawmakers is taking aim at a wide range of policies that treatment advocates say hinder drug treatment and recovery efforts.

“It’s a comprehensive package, and it shows a lot of creativity,” said Dr. Tom George, CEO of the Michigan State Medical Society.

A mostly-Democratic slate of senators introduced the nine-bill package last month after consulting with the Legislature-appointed Michigan Opioid Advisory Commission and the Philadelphia-based Pew Charitable Trusts, a research and advocacy nonprofit advocating, in part, for increased access to treatment.

One bill targets delays in drugs dispensed by pharmacies as part of a medication assisted treatment regimen. Senate Bill 403 would require pharmacists to make a “good-faith effort” to fill the order for the addiction medication without undue delay.

The bill has sparked concern among pharmacists that it will erode their discretion in dispensing such powerful drugs, especially if they suspect the drugs might be misused.

Other bills would do the following:

• Loosen rules around mobile treatment clinics: One bill prohibits the state from enacting rules for mobile clinics that would, for example, require a methadone treatment unit to return to the same location each night or limit the number of units a provider could offer. The bill, sponsored by Sen. Joseph Bellino, R-Monroe, also would relax some paperwork requirements by staff.
• Ease access to harm reduction programs: A bill sponsored by Sen. Jeff Irwin, D-Ann Arbor, would ensure drug testing products are not considered illegal drug paraphernalia. Such strips help a user check a drug for additives such as fentanyl.
• Ease insurance approval for certain treatments: One bill would prohibit insurers from requiring prior authorization for any prescription drug used for the treatment of opioid withdrawal symptoms management or opioid- or alcohol use disorder. A second bill would require the Michigan Department of Health and Human Services to remove prior authorization requirements in Medicaid coverage. Both were sponsored by Sen. Kevin Hertel, D-St. Clair Shores, who also chairs the Senate Health Policy Committee.
• Require doctors to offer naloxone in certain circumstances: The bill sponsored by Sen. Sylvia Santana, D-Detroit, originally required prescribing naloxone alongside opioids for all patients, but it was amended to require doctors to offer naloxone, which is often sold under the brand name Narcan, only to certain patients — those with high-dose opioids or those with a history of drug use, for example. (Narcan is available throughout Michigan without a prescription.)
• Expand treatment in street medicine services: A bill sponsored by Sen. Paul Wojno, D-Warren, would allow Medicaid to cover street medicine services, including prescribing and dispensing of medications at rural health clinics and certified community behavioral health centers.
• Expand access to medication assisted treatment: A bill sponsored by Sen. Sam Singh, D-East Lansing, would require pharmacists to make a “good faith effort” to provide, without undue delay, medications used in recovery.
• Require school nurses to carry naloxone. Two bills, introduced by Darrin Camilleri, D-Trenton, could reduce overdoses among adolescents by equipping school nurses with naloxone and shielding school personnel from liability if they administer it.

The Senate passed all but one of the bills to the House, where they have been assigned to the insurance committee. Remaining in the House is the bill that would relax rules for mobile clinics. Hertel said the legislation is stalled as lawmakers reconcile the bill with federal law.

The package tackles technical and legal hurdles that for years have stymied recovery efforts, said Hertel.

He said the package is another step in beating back a crisis that last year claimed an estimated 2,931 Michiganders. Larger solutions are more expensive: expanding infrastructure for intensive treatment programs and specialized housing for people in recovery, for example.

“For too long, what we've done is we've provided people detox, so they might have gotten a little bit of treatment,” he said. ‘Then send them right back out into the situation they were in before. That doesn't actually move the needle in most cases.”

Still, he said, the package crucially tackles “technical policy” to ease access to harm reduction and treatment programs.

Related:

• Opioid crisis cost Michigan $38 billion in 2024, new analysis finds
• Michigan may lose $93M in federal funds for drug treatment, recovery
• A steep drop in Michigan overdose deaths, thanks in part to Narcan

Among the hurdles facing people working toward recovery: Some people routinely must drive a half-hour or more for treatment providers, Andrew Whitacre, a substance use prevention and treatment expert with the Pew Charitable Trusts, told lawmakers last month.

At the pharmacy

The package gained “overwhelming, bipartisan passage” in the Senate, according to a statement emailed to Bridge Michigan by State Rep. Jamie Thompson, R-Brownstown. As vice chair of the House health policy committee, Thompson said she looks forward to considering them.

Still, at least one piece remains contentious as most of the bills move forward, and a second bill stalled in the Senate.

Some advocates say too many pharmacies don’t carry medications that help keep people from relapsing, including buprenorphine and Naltrexone.

That delays treatment and forces people to drive long distances — and many don’t have that ability, said Jonathan Stoltman, director of the Opioid Policy Institute., a Grand Rapids-based advocacy and research group.

“There are still access desserts for filling your prescription,” he said. 

Stoltman said it’s a problem fueled by stigma and denial of the problem.

But Eric Roath, director of government affairs of the Michigan Pharmacists Association, said pharmacists may not stock such medications for another reason: the red tape requirements for carrying specific ratios of brand name drug treatment medications rather than generic versions.

Whatever the reason, Roath said pharmacists worry that Senate Bill 403 doesn’t offer enough legal protection if they refuse a patient a treatment medication.

For example, a pharmacist may see evidence in the state’s prescription monitoring program — the MI Automated Prescription System or MAPS — that a patient is “doctor shopping” to obtain drugs for illegal use. The pharmacist must retain the right to refuse to fill the prescription, Roath said.

“There’s feasibly a situation where the pharmacist checks MAPS and feels … they may not be ethically able to dispense that prescription,” he said. “It says a ‘good faith effort,’ but we as the Michigan Pharmacists Association do not feel that is adequate protection to defend a pharmacist’s decision to refuse to spend a controlled substance.”

Roath is clear: The association supports the intent of the entire package.

To address the particular concerns with the single bill, Roath said the association is working with Hertel’s office to include language that would give pharmacists a role in evaluating the patients for medication assisted treatment.

“We would like the pharmacist … to be part of the success of the patient's treatment,” he said.

The view from doctors

The Michigan State Medical Society also had debated part of the package, specifically the bill that would have originally required doctors to prescribe naloxone alongside any opioid.

But not all patients are candidates for potential overdoses, including those with a very small number of opioids, or those who might be overwhelmed by the number of prescriptions, said George, at the state’s medical society.

Another prescription and another set of directions — this one about reversing overdoses — might make some patients hesitant to use the opioids for pain, he said. That, in turn, could cause other health problems, such as a racing heart.

“Untreated pain is also problematic,” he said.