Focusing on patient care can increase access without having to Recidivism of Individuals receiving Acute Treatment Services (ATS) in a Single Year add beds In 2014, 4,524 individuals utilized ATS services or more times Two individuals utilized ATS services 23 In 2014, if individuals had received ongoing treatment, at least 16,000 additional individuals could have received ATS services 7 7 6 5 4 3 2 1 464 377 337 224 183 152 328 276 295 542 498 488 1,014 861 812 1,952 1,688 1,696 2014 2013 2012 4,322 4,104 3,805 13,957 13,703 13,028 Data from DPH licensed ATS providers Finding 1: Individuals in crisis cannot access the right level of treatment at the right time 13
Studies demonstrate that youth begin to use alcohol and drugs as early as 10 years old Addiction is a Developmental Disease age group who alcohol Percentage in each begin using 35% 30% 25% 20% 15% 10% 5% 0% Age of Alcohol Use Age at first Nicotine Use Age of First Cannabis Use 5 10 15 20 25 30 35 40 45 50 Age Source: Li, Ting-Kai, Alcohol Use, Abuse, and Dependence , National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, U.S. Department of Health and Human Services, p.30, citing NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003, retrieved from: Retrieved from: www.pitt.edu/~super7/25011-26001/25521.ppt Finding 2: drug use and addiction trends must be addressed through prevention education 18
Recommendations Related to Naloxone Investigate the feasibility of having Naloxone in public spaces Improve affordability of Naloxone Through bulk purchasing agreements By eliminating all copayment requirements Encourage Naloxone to be co-prescribed with opioids Price Per Naloxone “Kit” Date 2 Naloxone Doses and 2 Atomizers November 2007 $22.98 March 2008 $31.55 January 2009 $31.87 September 2009 $31.49 June 2011 $31.77 March 2012 $32.35 May 2012 $40.56 January 2014 $42.82 July 2014 $41.69 November 2014 $74.06 May 2015 $74.06 Finding 9: Increasing access to Naloxone will save lives 32
Recommendations Related to Insurance • Require the Division of Insurance to implement guidance for commercial insurers about the implementation of chapter 258 of the acts of 2014 prior to October 1, 2015 • Eliminate insurance barriers that impede integration of addiction and mental health care into the primary care setting • Require consistent coverage and prior authorization practices and policies throughout all MassHealth programs • Bring meaning to federal and state behavioral health 2% 11% 2% 12% 2013 50% 1% 11% Opioid Related Deaths 9% in MA by Category of Insurance Commercial Insurance 14% Medicare Medicare and MassHealth (Duals) MassHealth parity laws through enforcement actions to remove inappropriate barriers to treatment • Encourage insurers to support non-opioid pain therapies 1% 14% 6% Health Safety Net Other Unknown/Uninsured • Prepare a public report on what non- pharmacological treatments for pain are covered by all private and public insurers • Encourage insurers to support recovery coaches for individuals with a substance use disorder • Encourage insurers to support new pathways to treatment 2014 54% 13% at Time of Death Data provided by the Center for Health Information and Analysis, the Department of Public Health, and MassHealth Finding 10: Insurance barriers prevent individuals from receiving treatment 33
Summary of Short-Term Action Items (6 months to 1 year) Prevention Intervention Treatment Recovery • Increase educational offerings • Improve the PMP • Develop a central statewide for prescribers and patients to • Outreach to prenatal and database of available treatment promote safe prescriber postpartum providers to services practices increase screening for women • Transfer section 35 civil • Develop targeted educational with a substance use disorder commitment responsibility materials for schools • Improve reporting of overdose from DOC to EOHHS • Appoint members to the drug death data • Increase the number of office formulary commission • Enhance data transparency, based opioid treatment • Integrate information about the including EMS data programs risks of opioid use and misuse • Encourage naloxone to be co- • Require DOI to issue bulletins into school athletic programs prescribed with opioids on chapter 258 of the Acts of • Conduct a public awareness • Amend civil commitment 2014 prior to Oct. 2015 campaign process • recovery coaches in • Identify hot spots for targeted emergency and hot spots intervention, using EMS, • Bulk purchase opioid agonist hospital, and police data and naltrexone therapies for • Promote the Good Samaritan correctional facilities law • Add 100 new ATS/CSS beds • Consider mandating testing for • Open Recovery High School in in utero exposure to alcohol and Worcester drugs at every birth • Review capacity in the treatment • Encourage and support system for women/families alternatives to arrest • Analyze treatment spending in • Expand availability of Naloxone correctional facilities • Increase the number of Promulgate chapter 257 rates for recovery homes effective July 2015 Establish a single point of accountability for addiction recovery policy at EOHHS Suspend rather than terminate MassHealth during incarceration Certify alcohol and drug free housing Enforce the requirement that BSAS treatment programs accept patients on an opioid agonist therapy Strengthen connections between law enforcement and community providers for individuals upon release Explore issuing certificates of recovery Review and revise discharge/court notification policies for section 35 36
Summary of Mid-Term Action Items (1 year to 3 years) Prevention Intervention Treatment Recovery Support substance use prevention curricula in schools Mandate pain management, safe prescribing and addiction training for all prescribers Partner with federal government regarding graduate medical education Require manufacturers and pharmacies to dispose of unused prescription medication Require prescribers to discuss opioid side effects at point of prescription partial refills across all payers Eliminate prescription refills by mail for schedule II medications the curriculum for teachers as state universities to include training on screening and intervention techniques Have state universities develop substance use prevention curricula for schools Improve the PMP to ensure data compatibility with other states Develop training on neonatal abstinence syndrome and addiction for DCF staff Improve affordability of Naloxone Increase access to beds for section 35 patients Implement electronic prescribing for opioids Increase screening for substance use at all points of contact in the medical system Increase the use of screenings in schools to identify at-risk youth for behavioral health issues Create a consistent public behavioral health policy through licensing reforms Pilot providing patients with access to an emergent/urgent addiction assessment by a trained clinician and direct referral to the appropriate level of care Increase points of entry to treatment Ensure section 35 patients receive a continuum of care Enhance provider accountability by requiring treatment programs to report on outcomes Reform purchasing of substance use disorder treatment services Require DPH to advance standards of care by establishing industry benchmarks Add new treatment beds Fund patient and case managers Leverage coalitions to address Ensure all infants with referred to early by time of hospital Increase drug specialty court capacity Expand peer/family Partner with businesses remove employment that recovering experience 37
Summary of Long-Term Action Items (3+ years) Prevention Intervention Treatment Recovery Support alternate pain therapies through commercial and public insurers & prepare a public report on what treatments for pain are covered by all private and public insurers Improve the PMP by interfacing the PMP with electronic health records Establish and promote a longitudinally based system of addiction care Integrate primary care into substance use treatment programs Reduce stigma and treatment professionals 38
Organizations that Submitted Information to the Working Group Massachusetts Division of Insurance Massachusetts Health Council Massachusetts Hospital Association Massachusetts Medical Society Massachusetts Organization for Addiction Recovery Massachusetts Pain Initiative Mass Society for the Prevention of Cruelty to Children Mass Technical Assistance Partnership for Prevention Massachusetts Court MassHealth MCI-Norfolk Project Youth Program Medford Substance Abuse Task Force Melrose Substance Abuse Prevention Coalition Meridian House Merrimack Valley Prevention and Substance Abuse Project Middlesex County Opioid Task Force Middlesex District Attorney’s Office Monson Mystic Valley Public Health Coalition’s Opioid Prevention Collaborative Narcotics Anonymous Never Another Death New Beginnings Peer Recovery Center Norfolk County Sheriff’s Office Norfolk District Attorney’s Office North Adams Mayor’s Office Northern Berkshire Community Coalition Northwestern District Attorney’s Office Number 16 Opioid Task Force of Franklin County and North Quabbin Ostiguy School Partnership for Drug-Free Kids Peabody Police Department Pfizer Phoenix Multisport Pioneer Valley Regional School District Plymouth County Correctional Facility Plymouth Fire Department Plymouth Police Department Plymouth Public Schools Project Cope Project NESST (Newborns Exposed to Substances: Support Therapy) Project Youth Quaboag Hills Community Coalition Quincy Community Action Programs, Inc. Real You Revolution Recovery Homes Collaborative RW Massage Therapy SAS Solutions