MiHIA and its partners are working hard on forging a path out of Michigan’s opioid crisis. Affecting all communities, all ages, and all socio-economic strata, relieving our communities of the destruction the misuse of opioids is causing is a matter of utmost importance. In 2017, MiHIA formed the regional Opioid Strategy Team comprised of community leaders, medical professionals, and mental health professionals and tasked them to produce a strategy to help combat the crisis. In 2018, the team presented the Opioid Strategy Map, after a year of significant study, community input, and data analysis.

Since the launch of the Opioid Strategy Map, there is increased coordination and momentum in our region to fight the crisis. A collaboration of physicians, physician assistants, nurse practitioners and other healthcare and subject matter experts has been remarkable, first starting with the health systems. Second, there has been a strong push for physician education regarding resources and methods for the comprehensive management of acute and chronic pain and opioid use disorders. Third, insights into both physician and patient concerns have been gathered and studied as regulatory burdens have increased. Additionally, it is noted that opioid prescribing has started to decrease both in number and in amounts.

Helping to lead the charge is Thomas Veverka, MD, a surgeon with MidMichigan Health, a member of the Board of Directors for MiHIA, former President of the Saginaw County Medical Society and the co-chair of the MiHIA Opioid Task Force. “It is important that we continue to act collaboratively to address the issues of opioid overprescribing, the needs for pain management strategies in terms of educating physicians, opening more pain specialty centers, increasing the availability of medication-assisted treatment (MAT), and coordinating ongoing care in the community. There needs to be an expansion of centers for comprehensive management of chronic pain. Insurance companies need to cover non-opioid pain medications and other interventions such as physical therapy, chiropractic care, acupuncture, regional blocks and mental health treatment. Despite our battle, there will still be a very small number of patients with intractable severe pain who will still need opioids in order to function daily. This must be allowed for.” Dr. Veverka is very passionate about addressing the opioid crisis through volunteer activities at MidMichigan Medical Center, MiHIA, and through his position on the Board of Directors of the Michigan State Medical Society as the District 8 Director where he also serves on multiple other subcommittees.

Looking ahead to 2020, Dr. Veverka would like to see more physician and provider engagement on this crisis. “Health system leadership needs to take an active role in two things: promoting physician involvement in activities that can lead to decreased opioid prescribing while simultaneously providing for effective comprehensive pain management and the treatment of opioid misuse. These can be achieved by a health system providing incentives, management infrastructure, and dedicated staff,” says Dr. Veverka.

Innovative approaches are being put into place as the crisis is fought. The effort to coordinate non-opioid services with a credentialing process will help provide insurance coverage for pain management. Academic detailing, or educating physicians within their own practice on determining issues of prescribing, pain management, screening for abuse potential, de-stigmatizing treatment of opioid use disorder, and facilitating referrals to available resources is showing promise. Other approaches showing positive results include the increase in availability of naloxone kits (overdose revival medication) through regional emergency departments and measures to help pregnant women with opioid use disorder. Finally, initiating MAT within jails and prisons has shown to sharply decrease chances of both overdose and returning to prison. Considering the opioid crisis is directly affecting people of all ages and social standing, the variety of innovative approaches is vital.

This is a complex issue and unfortunately, heroin and fentanyl continue to cost next to nothing and are too easy to obtain. MiHIA and partners will continue to operate from the demand side of the issue while law enforcement professionals can hopefully address the supply challenges. It is up to everyone in the community–health systems, mental health professionals, law enforcement, health practitioners, insurance companies, schools and universities, and families, to work together to exit out of this crisis.

For more information or to become more involved in the Regional Opioid Strategy Team please contact Shanna Hensler at s.hensler@mihia.org