Community of Practice Summit - May 5th, 2020
The Opioid Treatment Ecosystem Communities of Practice Virtual Summit took place on Tuesday, May 5th, 2020 from 9:00 am - 11:00 pm. Many thanks to the hundreds of attendees who participated in the summit, our partners and OTE Communities.
Q & A
We received many excellent questions from our hundreds attendees--many of which we did not have time to answer during the webinar. All questions, and the answers provided by OTE Community of Practice members, are summarized in this section.
- Medications for opioid use disorder in jails
What is the Center for Behavioral Health and Justice's model for providing medications for opioid use disorder (MOUD) in jail?
What are county jails doing to monitor and prevent withdrawal symptoms from opioids?
All county jails involved in the Opioid Treatment Ecosystem (OTE) initiative screen people at booking to assess for current and prior opioid use. The Center for Behavioral Health and Justice (CBHJ) recommends using a validated screening tool such as the Rapid Opioid Dependence Screen (RODS) or the Texas Christian University Drug Screen-V (TCUDS-V) Opioid Supplement.
Additionally, OTE-involved jails have implemented processes to assess for withdrawal from opioids and other substances once people enter the facility. This is most commonly done at booking or shortly thereafter and may involve use of the Clinical Opioid Withdrawal Scale (COWS) or other medical screening. Jail medical teams will manage opioid withdrawal as an individual's symptoms dictate until MOUD programing starts or physical symptoms subside.
To prevent withdrawal for individuals who were receiving MOUD in the community, each county jail involved in the OTE initiative has committed to continuing those medications when people enter their facility. As these jails continue to expand their treatment ecosystems, they will begin to phase in new inductions for people who have opioid use disorder but who were not receiving MOUD in the community prior to their incarceration.
Why are OTE-involved county jails partnering with community-based prescribers to provide MOUD instead of using their own healthcare providers?
The CBHJ recognizes the strong benefits that result from partnerships between county jails and MOUD prescribers in their communities. This relationship allows the MOUD prescriber to ensure continuity of care if one of their patients becomes incarcerated and, during discharge planning, facilitates connection to a community-based provider for the individual to continue their medications upon release.
Additionally, existing federal regulations enforced by the Drug Enforcement Administration (DEA) make it extremely difficult for in-jail healthcare providers to prescribe, store, and dispense buprenorphine and methadone. A special physician-level certification is required to prescribe and dispense buprenorphine – called an X-Waiver – which can be difficult to secure with a county jail's already limited budget. Other regulations altogether prevent jails from applying for facility licensure through the DEA. One of our OTE community partners has been in communication with the DEA to attempt to streamline the process and reduce certification costs for jails who wish to pursue facility licensure or physician-level certification to prescribe, store, and dispense these medications and we are hopeful that this will result in expanded treatment access in the future.
Is naltrexone (Vivitrol®) effective at reducing opioid use?
Naltrexone is an injectable medication that can block the effects of opioids for 30 days. It is not a medication of choice for everyone, both because the effects are not ideal for all and also, without a plan to continue treatment post-release, can actually increase the risk of overdose following relapse. Preliminary data in each of the six OTE counties indicate that the majority of individuals receiving jail-based MOUD are receiving methadone or buprenorphine.
- Continuity of care
What is involved in discharge planning for individuals who receive MOUD in the county jail?
Discharge planning includes connection to a community-based MOUD prescriber prior to release; Medicaid reactivation; as well as identification of basic needs including food, housing, employment, and other social supports. In most OTE communities, people who receive MOUD in the jail also receive the support of a peer support specialist who provides follow-along services for several months post-release.
Does providing naloxone (Narcan®) at release from jail encourage people to use opioids?
There is no evidence to suggest that providing naloxone increases substance use, but we do know for sure that naloxone saves lives. People who have a history of opioid use disorder and have been recently released from incarceration are up to 120 times more likely to die from an overdose. Providing naloxone at release from jail could save thousands of lives each year.
Where can I receive naloxone training and a free naloxone kit? How can I implement a naloxone distribution program at my county jail or organization?
Naloxone is often made available by local Prepaid Inpatient Health Plans, community organizations, and non-profit organizations. Individuals may also access naloxone from their local pharmacy without a prescription.
The CBHJ recommends that communities develop comprehensive protocols for sourcing, storing, and distributing naloxone. Facility and program staff should receive training on the overdose crisis, risk factors for overdose, harm reduction principles, and how naloxone can save lives. Recipients of naloxone kits must also be trained on how to use the medication safely.
Access to free resources related to naloxone access, virtual trainings, and crisis support can be conveniently accessed through NEXT Naloxone. Learn more
- Proactive Response to Overdose and Appropriate Connection to Treatment (PROACT)
What is the PROACT model?
Opioid-related overdose events often require an emergency first response to administer naloxone, and research suggests that individuals who use illicit opioids are at high risk for a repeated non-fatal overdose and fatal overdose. An interface with a first responder presents an opportunity for a public health response; however, there is rarely an attempt to link these individuals into subsequent treatment or services, even when there is a suspected substance use disorder or opioid use disorder.
To address this potential opportunity many jurisdictions have developed a post-overdose response within law enforcement and EMS protocols. The CBHJ is helping bridge the gap to treatment and other potentially life-saving programs following a non-fatal overdose event by outlining, implementing, and evaluating community-based post-overdose response programs. These post-overdose response programs are intended to be customized to the resources, stakeholders, and needs of the community.
For more details about how Kent and Monroe counties are implementing
the PROACT initiative, read the Developing Pathways to Treatment report.
- COVID-19 Response
What are the OTE communities doing to ensure access to treatment in light of COVID-19?
To support OTE communities in light of COVID-19, the CBHJ sought out grant dollars to equip interested jails with tablets to establish remote facilitation of discharge planning, continuity of care, jail-based behavioral health services and jail-based MOUD
The recent loosening of restrictions on telehealth in favor of other emergent technologies to facilitate remote access, as well as the current relaxed restrictions on consent, provide a new opportunity to improve and expand remote access during this time of crisis and beyond.
In addition to the equipment needs, the grant will entail costs for protective cases, WiFi accessibility, and assistance in the development in best practices and policies around the use of these technologies for remote access to care.
The CBHJ has developed a repository of policy briefs and resources to help local jails and behavioral health providers respond to COVID-19. Learn more
- Funding and sustainability
Which communities are involved in the Opioid Treatment Ecosystem (OTE) initiative?
Jackson, Kent, Monroe, Muskegon, Washtenaw, and Wayne counties are currently involved in the OTE initiative. However, the CBHJ works with many other counties throughout Michigan to provide evaluation, support, and technical assistance. Learn more
How is the OTE initiative funded? Are there plans for sustainability?
In Kent and Monroe counties, the Michigan Health Endowment Fund (MHEF) has provided grant funding to implement MOUD in the county jails and ensure continuity of care. Additionally, MHEF has supported implementation of PROACT initiatives in these two counties, strengthening their community-based post-overdose response plans. Support from MHEF has also made it possible for the Center for Behavioral Health and Justice to convene county-level Change Teams which feed into a larger, statewide Community of Practice focused on enhancing the Opioid Treatment Ecosystem. Through this framework, the CBHJ serves as an external facilitator to provide technical assistance, support, and shared learning opportunities including the Summit that was presented on May 5th.
In Jackson, Muskegon, Washtenaw, and Wayne counties, grant funding is provided by the Community Foundation for Southeast Michigan through the Michigan Opioid Partnership. This grant funding is allocated toward implementation of MOUD in the county jails.
Project coordinators from the CBHJ are currently working with key stakeholders in each county to develop sustainability plans. This is accomplished by providing technical assistance to identify future grant opportunities and assisting with the grant writing process.
- Monroe county
How many people have received medications for opioid use disorder in Monroe County as part of the OTE initiative?
The MOUD portion of the OTE initiative is expected to launch in May 2020. Prior to its official launch, four people were able to continue receiving their medications that they were taking in the community (buprenorphine: 2 people, methadone: 2 people). Monroe County previously provided naltrexone to some participants of the Michigan Re-Entry Program (MIREP II).
Who provides discharge planning and case coordination for the OTE initiative in Monroe County?
The Monroe Community Mental Health Authority provides these services through a master's level clinician who is based in the jail and a certified peer support specialist. Follow-along services are provided for at least three months post-release.
- Kent county
What is the Red Project?
Red Project is a harm reduction agency in Kent County that uses a community health approach to responding to substance use and overdose. Red Project's role in the OTE initiative in Kent County is to facilitate PROACT by connecting people to peer support specialists following an overdose in the community, as well as by providing discharge planning and follow-along services for people who receive MOUD in the Kent County Jail.
Which agencies are involved in Kent County's OTE initiative?
Kent County's OTE is comprised of a number of agencies including community mental health, jail medical, community MOUD providers, first responders and the sheriff's office.
Family Outreach Center Kent County Correctional Facility Red Project Network 180 Corizon Health Emergency Medical Services: Life EMS, American Medical Response, Rockford Ambulance, Kent County EMS Community MOUD Providers: Cherry Health, NuPoint, WMi Treatment