State Opioid Response (SOR) Grant

State Opioid Response (SOR) Grant is sponsored by Michigan Department of Health and Human Services (MDHHS) (Federal funding from SAMHSA). This grant addresses the overdose crisis by increasing access to medications for opioid use disorder (MOUD), reducing unmet treatment needs, and reducing overdose-related deaths through prevention, treatment, harm reduction, and recovery activities for opioid use disorder and st…

# STATE OPIOID RESPONSE GRANT Overview ................................................................................................................................ ............... 3 Prepaid Inpatient Health Plans across Michigan ................................................................

................... 4 Prevention Activities ................................................................................................ ..............................

5 Youth and Family Oriented Prevention Evidence-Based Practices (EBP) ................................ ........ 5 Overdose Education and Naloxone Distribution (OEND) with Harm Reduction ................................

6 Michigan Collaborative Addiction Resources & Education System (MI CARES) .............................. 7 Older Adult Prevention Evidence Based Practices (EBP) ................................................................ .

8 Michigan Opioid Prescribing Engagement Network (MI OPEN) ................................ ........................ 9 Statewide Media Campaign ............................................................................................................

10 Syringe Service Programs (SSP) .................................................................................................... 11 Local Health Department Access to Overdose Data ....................................................................... 12 LARA Michigan Automated Prescription System (MAPS) ...............................................................

12 Treatment Activities ............................................................................................................................ 13 Peers in Federally Qualified Health Centers, Urgent Care, and Other Outpatient Settings ............. 13 Mobile Care Units ............................................................................................................................

13 Jail-Based Medication Assisted Treatment (MAT) Expansion ......................................................... 14 Opioid Use Disorder (OUD) Treatment Costs ................................................................................. 16 Telehealth to Support Rural Communities.......................................................................................

17 MISSION Michigan Reentry Program (MI-REP) Expansion ............................................................ 17 Direct Provider Support for Medication Assisted Treatment (MAT) ................................................. 18 Hope Not Handcuffs (HNH) Expansion ...........................................................................................

19 Angel Program ................................................................................................................................ 20 Opioid Health Homes ...................................................................................................................... 20 Recovery Activities ..............................................................................................................................

21 Recovery Housing ........................................................................................................................... 21 Individualized Placement and Support (IPS) ................................................................................... 21 Opioid Use Disorder (OUD) Recovery Services Costs ....................................................................

22 Peer Recovery Support in Tribal Communities ............................................................................... 22 Government Performance and Results Act (GPRA) ........................................................................... 24 Statewide Summary ........................................................................................................................

24 Intake .............................................................................................................................................. 24 Discharge ........................................................................................................................................

26 Six-Month Follow-Up ....................................................................................................................... 27 Changes across Time ..................................................................................................................... 28 Evaluation Methods ............................................................................................................................

30 Financial Overview.............................................................................................................................. 32 Program Strengths and Challenges ....................................................................................................

33 State Opioid Response – Annual Evaluation Summary – Grant Year Two 3 The rate of drug overdoses involving opioids in Michigan has significantly increased over time. From 1999 to 2017, the rate of opioid-involved overdoses was over 17 times higher (Drug Overdose Deaths in Michigan, 2020).

In 2018, over 2,500 people died from a drug overdose in Michigan and over 2,000 of these were opioid-involved overdoses (Drug Overdose Deaths in Michigan, 2017-2018). From 2017 to 2018, there was almost an 11% increase in the rate of drug overdose deaths involving synthetic opioids (e.g. fentanyl, fentanyl analogs, tramadol).

Therefore, both trends over time and current data reflect a need to address the high rate of opioids-involved overdoses and deaths. Seeking to address the rise in opioid-related deaths in Michigan, the Michigan Department of Health and Human Services (MDHHS) in 2018 applied for the State Opioid Response (SOR) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Michigan had previously been awarded the State Targeted Response to the Opioid Crisis grant by SAMHSA and was quickly able to identify existing opioid initiatives around the state that would benefit from increased funding, in addition to other areas where gaps in service delivery resulted in unmet needs from the population of focus.

Three core goals were set forth in the SOR grant application: (1) to increase access to Medication-Assisted Treatment (MAT) for the three medications approved by the United States Food and Drug Administration (FDA); (2) reduce unmet treatment need; (3) and reduce opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorders (OUD).

On September 19, 2018, SAMHSA awarded Michigan the SOR grant for $27,914,639 per grant year. Funding began on October 1, 2018. SAMHSA also awarded Michigan a one-time SOR supplement on June 1, 2019 for $14,571,442.

SAMHSA approved MDHHS and the SOR grant for a No Cost Extension (NCE) that will conclude September 29, 2021. MDHHS allocated SOR funding on both a statewide and regional basis. Regionally, SOR funding was allocated to Michigan’s 10 Prepaid Inpatient Health Plans (PIHPs), which serve as managed care organizations for publicly funded substance use disorder (SUD) programming.

Michigan’s 83 counties are divided among the 10 PIHPs. Each PIHP received funding to create and expand the programs that would be most impactful in their region. Prevention programming included youth and family-oriented prevention evidence-based practices (EBP) and overdose education/naloxone distribution (OEND) with harm reduction.

The 10 regions also received funding to expand treatment and recovery services.

These activities included placing peer recovery coaches in federally qualified health centers (FQHC), expanding jail-based MAT services, securing mobile care units to deliver OUD services to individuals lacking transportation, expanding and enhancing recovery housing, providing employment support, and funding the cost of OUD treatment and OUD recovery services.

Additionally, Michigan awarded funds to organizations that implement statewide initiatives in prevention, treatment, and recovery.

Grantees included: • Inter-Tribal Council of Michigan • Michigan Collaborative Addiction Resources and Education System • Michigan State University Extension • Michigan Opioid Collaborative • Michigan Opioid Prescriber Engagement Network • Michigan Opioid Partnership • Michigan Association of Recovery Residences • Michigan Department of Corrections • MDHHS Office of Communications • MDHHS Public Health Administration This report is intended to provide brief narratives, data, and highlights from the second year of the SOR grant and supplemental funding.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 4 # Prepaid Inpatient Health Plans across Michigan The following map presents the 10 PIHP regions across Michigan.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 5 SOR funded prevention activities include: • Youth and Family Oriented Prevention Evidence-Based Practices • Overdose Education and Naloxone Distribution with Harm Reduction • Michigan Collaborative Addiction Resources and Education System • Older Adult Prevention Evidence Based Practices • Michigan Opioid Prescribing Engagement Network • Statewide Media Campaign • Syringe Service Programs • Local Health Department Access to Overdose Data • LARA Michigan Automated Prescription System (MAPS) Integration # Youth and Family Oriented Prevention Evidence-Based Practices (EBP) In the second year of the SOR grant, each PIHP continued to implement youth and/or family-oriented evidence-based or promising practice programs.

Regions 3, 4, and 7 utilized the supplemental funding to implement additional programs. Due to the COVID-19 pandemic, schools in Michigan closed in March. Prevention providers swiftly adapted to online methods of facilitating the EBPs.

Northern Michigan and geographically rural sections of the state found an increase in attendance and retention with the switch to online programming. Guiding Good Choices (GGC) GGC is a family competency training program for parents of youth in middle school that gives parents the skills needed to reduce their children’s risk for using alcohol and other drugs. The program consists of five two-hour sessions.

Youth attend one of the five sessions with their parents or caregivers. GGC has demonstrated outcomes in delaying the onset of substance use in the children of participants. Regions 1, 4, 6, 8, and 10 implemented GGC.

Across these regions, 159 families participated in GGC. The distributor of GGC, the University of Washington, worked with the regions to transition the curriculum online with fidelity. All five regions successfully implemented GGC online after April.

Project Towards No Drug Abuse (PTNDA) PTNDA is a prevention program for individuals aged 14 to 19 years. The curriculum is comprised of 12 classroom-based sessions between 40 and 50 minutes in length that are delivered over a four-week period. Participants complete pre and post tests and instructors complete fidelity observation checklists.

Regions 4 and 7 implemented PTNDA. Across these regions, 960 individuals participated in PTNDA training and among these individuals, almost 400 received the PTNDA training online after April. Botvin LifeSkills Training (LST) LST is an interactive evidence-based substance abuse and violence prevention program.

LST has curricula designed for middle school, high school, and transition aged students. LST also has a specific prescription drug abuse prevention module that many facilitators have incorporated into their training. The instructor or an observer can complete fidelity checklists for each module.

Regions 2, 3, 5, and 7 implemented LST. Across these regions, 967 students participated in LST. Region 2 was able to reach more students after moving to online programming in April.

PFL is an evidence-based prevention and intervention program for universal, selective, and indicated audiences. It provides participants a way of understanding how alcohol and drug-related problems develop, what they can do to prevent them, and why they sometimes need help. PFL has been used for youth and adults aged 13 to 20 years old.

PFL also includes a tool for assessing instructors’ delivery and ensuring program fidelity called the Moving ForWarD Rating Scale. Regions 3, 5, 6, and 9 implemented PFL trainings. Region 6 continued their State Opioid Response – Annual Evaluation Summary – Grant Year Two 6 partnership with Eastern Michigan University to implement PFL.

Across these regions, 508 individuals participated in PFL.

Youth and Family Oriented Prevention Evidence-Based Practices Guiding Good Choices 159 families Project Towards No Drug Abuse 960 individuals Botvin LifeSkills Training 967 individuals Prime For Life 508 individuals # Overdose Education and Naloxone Distribution (OEND) with Harm Reduction The SOR grant awarded each PIHP funds for additional naloxone purchasing and training opportunities that include harm reduction activities.

Regions 1, 2, 3, and 7 utilized supplemental funding for additional OEND activities. Naloxone (Narcan®) is an opioid antagonist medication approved by the FDA to reverse an opioid overdose. The medication blocks opioid receptor sites, reversing the toxic effects of the overdose.

Naloxone can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection. Due to the COVID-19 pandemic, prevention providers moved their training curricula online and began offering virtual OEND trainings in April. Through this grant year, the regions distributed 13,917 naloxone kits and trained 13,231 individuals.

Not all naloxone usage and saves are reported to the state; however, the regions reported 437 opioid overdose reversals. PIHP regions also used funding to support local harm reduction and prevention coalitions which distributed medication lock boxes, drug disposal bags, poke resistant gloves, and other supplies to law enforcement and community members.

In January 2020 MDHHS launched the statewide online Naloxone Portal which allows community organizations, law enforcement, providers, and other agencies to request Narcan nasal spray at no charge to their organization. MDHHS rolled out the portal in stages and first opened to police departments and treatment courts in February and March.

Through September 2020, this has expanded to include local health departments, prisons/jails, academic institutions (i.e. universities and local school districts), hospitals/medical clinics, emergency services (i.e. fire departments and EMS) and faith-based institutions. The Naloxone Portal received requests for 52,032 kits from 371 different agencies.

Overdose Education and Naloxone Distribution Individuals trained 13,231 > *does not include kits distributed via the portal State Opioid Response – Annual Evaluation Summary – Grant Year Two 7 Naloxone Portal Organizations Number of Kits Requested and Shipped Community Organizations and Nonprofits 86 19,020 Law Enforcement (i.e. MSP, DNR, City, County, Township) 72 6,216 Treatment/Recovery Centers 31 4,308 Correctional Facilities/Jails/Prisons 22 1,500 District/Regional/Drug Courts 18 636 Local Health Departments 17 5,208 Hospitals and Medical Clinics 15 1,464 Behavioral Health Services 10 1,080 Academic Institutions (i.e. colleges, universities, school districts) 7 1,176 Regional Prepaid Inpatients Health Plans (PIHPs) 4 5,328 Emergency Services (i.e. Fire Departments, EMS) 3 324 Faith-Based Institutions 1 12 # Michigan Collaborative Addiction Resources & Education System (MI CARES) The mission of the MI CARES program is to address the lack of addiction medicine and addiction psychiatry specialists in Michigan.

MI CARES goals are to create a curriculum to train physicians to attain accreditation in Addiction Medicine (AM) via the American Board of Preventive Medicine (ABPM) practice pathway. This practice pathway enables physicians to use a combination of experiential hours coupled with passing a board examination to become a board-certified AM provider. The curriculum closely follows the ABPM blueprint for the subspecialty certification exam.

MI CARES continued to host the 18 modules of curriculum on the Michigan State University (MSU) learning management system, Desire2Learn (D2L). In grant year two MI CARES developed and added eight modules: alcohol, cannabis, club drugs/hallucinogens, nicotine/ tobacco, opioids, practice pathway, sedatives, and stimulants. MI CARES recruits physicians online, through medical school listservs, and at conferences.

The MI CARES team has enrolled 224 physicians into the program. Over half of the physician specialties were family or internal medicine. Other physician specialties included addiction medicine, anesthesiology, diagnostic radiology, emergency medicine, maternal/fetal, OB/GYN, pediatrics, physical medicine rehabilitation, prevention and public health, psychiatry, and surgery.

Thirty-five participants applied to sit for the October 2020 ABPM certification State Opioid Response – Annual Evaluation Summary – Grant Year Two 8 examination. MI-CARES provided these physicians with guidance on preparing their application and documenting their patient hours.

# Older Adult Prevention Evidence Based Practices (EBP) The SOR grant funded Michigan State University Extension (MSUE) to offer evidence-based prevention programming for older adults across Michigan through the Chronic Pain and Chronic Disease Self-Management Programs (CPSMP, CDSMP), Stress Less with Mindfulness (SLM), and the Wellness Initiative for Senior Education (WISE), all with the goal of reducing the need for narcotic medications.

Stress Less with Mindfulness (SLM) SLM is a research-based and practice-tested program that provides an introduction to a variety of mindfulness techniques taught in a series of five weekly one-hour lessons. The goals of SLM include increased personal self-awareness of stress symptoms and use of mindful breathing and mindful movement to calm the body and mind.

MSUE utilized supplemental funding to implement single session mindfulness trainings. They held 46 single session mindfulness trainings for 437 individuals. MSUE staff transferred the SLM curriculum to online sessions in March.

MSUE heard from multiple participants that the mindfulness strategies were particularly useful in coping with COVID-19 related stress. In grant year two almost 250 individuals participated in the SLM program. SLM was successfully implemented online and had greater reach into the Upper Peninsula, including participants from Gogebic and Chippewa counties.

Chronic Pain and Chronic Disease Self-Management Programs CPSMP is an evidence-based program with goals to reduce pain and fatigue; increase medication adherence, quality of life, and sleep; reduce health distress and improve communication with doctors. CPSMP consists of two and a half hour sessions taught weekly over six weeks. The CPSMP curriculum includes light physical exercise.

CDSMP is also a six-week self-management workshop that is designed to help participants take an active role in managing their chronic disease(s). Adults of all ages interested in managing their chronic diseases are welcome to attend, as well as their family members and caregivers. CPSMP and CDSMP have been integrated into MSUE’s Personal Action Toward Health (PATH) programming along with diabetes management.

MSUE delivered about 25 CPSMP programs for over 185 individuals and two CDSMP programs for six individuals. MSUE hosted five and seven single sessions of CDSMP and CPSMP. MSUE facilitators successfully moved CPSMP and CDSMP to online implementation after March.

MSUE trained 12 new CPSMP trainers in grant year two. Evaluation data shows 45% of CPSMP participants experience decreased pain and 48% have an increased confidence in pain management. Wellness Initiative for Senior Education (WISE) The WISE curriculum includes information on healthy aging, alcohol and drug use, stress management, and medication management.

MSUE completed 11 WISE programs for over 50 individuals. MSUE held four single sessions of WISE for 86 individuals.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 9 ## Michigan Opioid Prescribing Engagement Network (MI OPEN) The SOR grant funded the University of Michigan’s Michigan Opioid Prescribing Engagement Network (MI OPEN) to facilitate the Optimizing Pain Management and Opioid Prescribing During Procedural Care project.

This initiative is making advances in opioid prescribing practices after surgery by developing perioperative care pathways, refining and implementing prescribing recommendations through Collaborative Quality Initiatives (CQIs), and coordinating an interprofessional network focused on improving opioid stewardship and coordinated care.

MI OPEN utilized SOR supplemental funding to distribute naloxone to emergency departments to give to patients with an SUD through collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC). Transitions of Care (TOC) MI OPEN’s TOC project seeks to optimize transitions of care for surgical patients currently using opioids, who have an OUD, or who may be at risk of new persistent opioid use.

MI OPEN developed and pilot tested a tool to screen patients preoperatively into categories of risk for poor opioid-related outcomes. To understand how physicians utilized the TOC screening tool, MI OPEN conducted semi-structured interviews with anesthesia providers, primary care physicians, and surgical providers who used the tool.

Anesthesiologists found the screening most useful, followed by surgical providers, and then primary care physicians. Providers across specialties agreed the screening tool would be best utilized with a patient early in the preoperative phase. Massive Open Online Course (MOOC) At the beginning of grant year two in October 2019, MI OPEN launched a MOOC.

The MOOC, called Impacting the Opioid Crisis: Prevention, Education, And Practice for Non-Prescribing Providers, consists of six modules on the epidemiology of the opioid crisis, understanding pain and drug targeting, prevention, clinical care and population health, and addiction treatment. Course participants have the opportunity to obtain continuing education hours.

The modules are non-sequential and self-paced and are provided through Coursera and EdX. At the end of grant year two, there were 4,258 participants. Collaborative Quality Initiatives (CQIs) Much of the work collaborating with CQIs was put on hold due to COVID-19.

However, the Obstetrics Initiative (OBI) was able to move forward with planning a hospital training program for both prescribers and non-prescribing healthcare professionals on alternatives to opioids during and after childbirth.

The OBI selected four labor support skill development programs and one doula program to educate over 400 staff members at 16 hospitals on the proper use, education, and promotion of alternatives to opioids during and after childbirth. The team is working on the logistics of implementing trainings virtually.

Michigan Emergency Department Improvement Collaborative (MEDIC) Collaboration Michigan OPEN partnered with MEDIC to increase the distribution of naloxone to patients in emergency departments that are treated for opioid overdose and patients who are at high risk of future overdose. MI OPEN established contracts with nine emergency departments: Ascension St.

John Hospital, Detroit Medical Center Receiving, Detroit Medical Center Sinai-Grace, Hurley Medical Center, Michigan Medicine, Munson Medical Center, Sparrow Hospital, Spectrum Health Butterworth Hospital, and St. Joseph Mercy Hospital. Over 884 naloxone kits were distributed to patients among the hospitals.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 10 # Statewide Media Campaign MDHHS contracted with Brogan & Partners in Project Year 1 to create an opioid anti-stigma media campaign. The campaign advertisements continued into Project Year 2. The objective of the media campaign is to start a conversation that reworks the narrative, helps end the stigma of OUD, and leads to healing.

The primary target audience for the campaign is individuals aged 25 to 44 who misuse opioids, and their peers and family. The campaign is a statewide effort with emphasis on Genesee, Lapeer, Macomb, Sanilac, St. Clair, and Wayne Counties.

More information about the campaign can be found at michigan. gov/opioids . The End the Stigma campaign included advertisements on radio, cable television, billboards, transit, Google search, Facebook, Instagram, YouTube, and Michigan Chronicle.

The advertisements ran from November 2019 through April 2020. The number of impressions of each element of the media campaign are in the table to the right. The End the Stigma campaign website also includes information about stigmatizing language and preferred language when discussing OUD, concrete suggestions for reducing stigma, and tips for talking to a loved one with SUD.

The Project Year 2 media campaign targets individuals who are actively using and provides resources for harm reduction such as Syringe Service Programs, HIV and Hep A/B/C testing, and Naloxone. The ads have been completed and the media campaign will be implemented in the new year. The campaign seeks to reduce health disparities in harm reduction services with the ads and will be focused on Southeast Michigan and Northern Michigan.

In addition, a portion of the Michigan. gov website has been devoted to the campaign and resources for treatment, recovery supports and harm reduction. A sample of the ads appears below.

Media Campaign Impressions Cross -Screen Digital 16,751,831 Minority D igital 8,107,284 Cable/Connected TV 2,770,292 Michigan Chronicle 363,129 Paid Search 60,170 State Opioid Response – Annual Evaluation Summary – Grant Year Two 11 # Syringe Service Programs (SSP) Syringe Service Programs (SSP) are an essential harm reduction approach to reduce the risk of using substances to both the individual and the community.

Across the state of Michigan, there are a total of 65 SSP. SSP connect marginalized individuals to their communities and empower them to make positive changes. These programs focus on building relationships and linking individuals to services like substance use treatment.

SSPs offer a variety of other services including naloxone distribution; human immunodeficiency virus (HIV) and hepatitis C (HCV) testing; hepatitis A (HAV) and B (HBV) vaccinations; as well as various trainings. SSP also provides items like needle disposal boxes, gloves, alcohol wipes, and personal hygiene kits.

In the second year of the SOR grant beginning in April 2020, funds were dispersed across 16 SSP provided by health departments and social service organizations. SSP conducted outreach and provided trainings on stigma reduction with SOR funds. SSP also utilized funds to provide referrals to SUD treatment and distribute naloxone, as shown in the table below.

SOR funds supported HIV and HCV testing. The tables below present the number of tests administered and the number of positive tests. Overall, SSP engaged with over 4,000 clients and 35 were referred to SUD treatment.

Over 20,000 naloxone kits were distributed and over 250 overdoses were reversed by these kits. Additionally, over 250 HIV and HCV tests were conducted.

Clients and Referrals Naloxone & Overdose Reversals > Clients Seen Clients Referred to Treatment > Naloxone Kits Distributed > Tests Conducted Positive Tests Tests Conducted Positive Tests 119 0 138 36 State Opioid Response – Annual Evaluation Summary – Grant Year Two 12 # Local Health Department Access to Overdose Data The System for Opioid Surveillance (SOS) was created through a partnership between the University of Michigan Injury Prevention Center and the Michigan High Intensity Drug Trafficking Areas.

The SOS provides close to real-time mapping of fatal and non-fatal overdoses. The public can access county-level data, while authorized public health and safety officials can access more detailed data and demographic information. The SOS is a data-driven tool to inform prevention efforts and reduce overdose injuries and fatalities.

In year two of the SOR grant, funds were utilized to develop statements of work for local health departments and guide local health departments in developing an evaluation process. The MDHHS technical assistance team worked with local health departments to use the SOS to determine high risk areas and identify naloxone distribution sites. This information was used to inform statements of work.

COVID-19 however redirected the focus of local health departments and transitioned staff to address the pandemic. This delayed the development of statements of work and corresponding evaluation processes. # LARA Michigan Automated Prescription System (MAPS) The Licensing and Regulatory Affairs Michigan Automated Prescription System (MAPS) is Michigan’s prescription drug monitoring program.

Prescribers and pharmacists utilize MAPS to determine if patients are receiving controlled substances from other providers and to assist in the prevention of prescription drug abuse. SOR funds are used to cover the cost for integration of MAPS into existing electronic medical records and pharmacy dispensation systems.

MAPS provides MDHHS with data that includes the numbers of health systems, hospitals, physician’s offices, and pharmacies that are integrated with MAPS and the number of each that are pending integration with MAPS. Data also includes the number of registered MAPS users by prescribers, pharmacists, as well as the number of users that are utilizing MAPS.

Since implementation and through September 2020, 395 health systems, hospitals, pharmacies, and physician’s offices, integrated with MAPS, and another 343 were pending integration (e.g. in talks, received request). Physician’s offices utilize MAPS most frequently, followed by pharmacies, health systems, and hospitals.

There are a total of 83,741 online registered MAPS users, which are most frequently prescribers, followed by delegates, and pharmacists. During each quarter of the second year of the SOR grant, there was an average of over 36,000 users actively utilizing MAPS.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 13 SOR funded treatment activities include: • Peers in Federally Qualified Health Centers (FQHCs), Urgent Care, and Other Out-Patient Settings for Screening, Brief Intervention, and Referral to Treatment (SBIRT) • Jail-Based Medication Assisted Treatment (MAT) Expansion • Opioid Use Disorder (OUD) Treatment Costs • Telehealth to Support Rural Communities • MISSION Michigan Reentry Program (MI-REP) Expansion • Direct Provider Support for Medication Assisted Treatment (MAT) • Hope Not Handcuffs (HNH) Expansion # Peers in Federally Qualified Health Centers, Urgent Care, and Other Outpatient Settings Nine PIHP regions received funding to support peer support specialists in outpatient settings such as Urgent Care or Federally Qualified Health Centers (FQHC).

Peers are individuals with lived experience of SUD recovery who can connect with individuals currently struggling in a meaningful, empowering way. Through this initiative, agencies placed peers placed in outpatient treatment settings to conduct Screening, Brief Intervention, and Referral to Treatment (SBIRT) for individuals at risk of OUD.

Peers work with clinicians collaboratively and are essential to support and enhance the work of fully integrated behavioral health delivery systems. In the second year of the SOR grant, peer support specialists from nine regions made 2,821 initial contacts with individuals at risk of OUD, and 5,540 follow-up contacts with the same individuals. Peer programming was implemented in 23 different locations across Michigan.

While COVID-19 limited the ability of peers to engage new clients and expand programming to new locations, many were able to connect with clients virtually. Mobile care units are retrofitted RV’s and health vans that provide SUD screening, referral to treatment, SUD counseling, peer supports, overdose education, naloxone distribution, drug screening, and basic primary care supports.

Transportation is consistently a barrier for individuals seeking resources and health care services for OUD. Mobile care units help address this barrier by bringing prevention and treatment services directly to the individuals that require them. Providers place mobile care units strategically throughout the community to reach individuals in rural areas and underserved populations.

Through community partnerships, mobile care units are also able to offer ancillary services such as referrals to housing, clothing, and food support. In the first year of the SOR grant, Region 5 established a mobile care unit and in year two, they began serving clients in Arenac, Bay, Eaton, Gladwin, Isabella, and Midland counties.

This unit provided over 65 services to more than 25 individuals, as well as providing two Vivitrol ® injections. Routine service delivery was severely impacted by COVID-19. Region 7 received funding to support two existing mobile care units in Detroit and throughout Wayne County.

In the second grant year, these units provided over 7,100 services to more than 3,100 individuals and had 34 reported naloxone saves. Due to COVID-19, the mobile care unit adapted services to include basic needs for the community like hygiene and personal protective equipment.

State Opioid Response – Annual Evaluation Summary – Grant Year Two 14 Through SOR carryforward funding, the Michigan Primary Care Association also received funding to partner with a local health center to implement mobile MAT services. During the second grant year, MPCA contracted with Great Lakes Bay Health Center, developed a treatment model, and accepted bids for a provider to build the mobile unit.

The table presents the types and numbers of services provided by Regions 5 and 7. Both Regions 5 and 7 implemented COVID-19 testing on their mobile care units. Region 10 experienced numerous delays due to COVID-19.

However, they were able to obtain a vehicle, establish MOUs with health care partners, and hire staff. They began providing COVID-19 testing and telehealth services in September 2020. # Jail-Based Medication Assisted Treatment (MAT) Expansion Medication assisted treatment (MAT) is the use of FDA-approved medications, in combination with counseling, to treat alcohol, opioid, or tobacco addiction.

For addressing OUD, medications bind or block opioid receptors in the brain to address craving and withdrawal symptoms. This helps manage symptoms and alter brain chemistry to fight the opioid addiction. Research shows MAT can successfully treat OUD and help maintain recovery by decreasing opioid use and overdose deaths, while increasing treatment retention.

There are three types of medications specific to OUD: buprenorphine, methadone, and naltrexone. • Buprenorphine (Suboxone ®, Sublocade ®) is a partial opioid agonist that binds with brain receptors to limit the euphoric effects of other opioids, which reduces craving and withdrawal symptoms. Only authorized prescribers with special training can provide buprenorphine.

It can be dispensed daily in a dissolving tablet or cheek film, or a six-month implant under the skin. • Methadone is a full opioid agonist that binds with brain receptors to limit the euphoric effects of other opioids, which reduces craving and withdrawal symptoms. Only specially licensed clinics can provide methadone, and it is dispensed daily in liquid form.

• Naltrexone (Vivitrol ®) is an opioid antagonist that blocks opioid receptors to eliminate the euphoric effects of other opioids, but it does not address craving or withdrawal symptoms. Any health professional who is licensed to prescribe medication can prescribe naltrexone, and it is taken through a daily pill or monthly injection.

Mobile Care Unit Services Number of Services Provided Referral to SUD Treatment 620 Referral to Ancillary Services 462 OEND and Harm Reduction 926 Basic Primary Care Supports 232 State Opioid Response – Annual Evaluation Summary – Grant Year Two 15 In the second year of the SOR grant, nine regions either continued existing jail-based MAT programming and/or expanded programming to new jails.

Eleven facilities across Michigan implemented jail-based MAT through SOR and supplemental funds and an additional six facilities were in talks to implement jail-based MAT, as shown in the table below. In partnership with the Wayne State University Center for Behavioral Health and Justice (CBHJ), the Michigan Opioid Partnership (MOP) utilized SOR supplemental funds for an Opioid Treatment Ecosystem Jail Initiative.

During this year, MOP and CHBJ were able to provide funding, develop memoranda of understanding, and facilitate the implementation of OUD screening and the provision of MAT in the Jackson County and Muskegon County Jails. The Jackson County Jail enrolled 15 individuals. Muskegon County Jail enrolled 47