Maines Opioid Epidemic: Building a Stronger, Statewide, - - PowerPoint PPT Presentation

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Maines Opioid Epidemic: Building a Stronger, Statewide, - - PowerPoint PPT Presentation

Apr 05, 2023 179 likes •388 views

Maines Opioid Epidemic: Building a Stronger, Statewide, Recovery-Oriented System of Care CCSME Lisa M. Letourneau March 2018 Why Were Here Source: Portland Press Herald reproduced with permission from Toho Soma, UNE 2 3 2017

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Maine’s Opioid Epidemic: Building a Stronger, Statewide, Recovery-Oriented System of Care

CCSME Lisa M. Letourneau March 2018

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Why We’re Here

Source: Portland Press Herald – reproduced with permission from Toho Soma, UNE

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2017 Overdose Deaths by County

25 4 109 82 <10 47 11 65 18 13 <10 <10 <10 <10 <10 Deaths proportiona l to population size Deaths higher than proportion to population size

2017 Drug Deaths Report – ME Attny Genl’s Office

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Diverse Population with SUD

Adapted with permission from Preble St. Resource Center

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Stable Trans’ng Lives in Chaos* Stable housing Employed Personal vehicle Have insurance (~5-20%) Moderately stable housing Some employment Some access to transportation Un/underinsured (~10-15%) Unstable housing or homeless Unemployed or minimally employed No or unreliable transportation Uninsured Poly-substance use, often IV use Frequent hospitalization, prior OD’s (~75-80%) Highest risk of OD death, and signif costs v/v incarceration, hosp, foster care, etc)

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Defining Systems of Care & Recovery

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Recovery Supports & Social Health Needs Medication Treatment MH/SUD Counseling Support Trauma

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MAT in Maine: State of the State

  • Maine (Jan 2017, SAMHSA): 634 buprenorphine

prescribers

– 348 docs with 30 pt limit – 145 docs with 100 pt limit – 38 docs with 275 pt limit – 88 NPs (initial 30 pt limit) – 15 PAs (initial 30 pt limit)

  • Historically…

~30% with X-waiver publicly post info on SAMHSA website ~50% providers with X-waiver ever prescribe (nationally) ~50% of those prescribe treat only 1-4 patients

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A Siloed Landscape of Care

Health Care

Mental Health Care SUD Treatment Alcohol (“Abstinence”) Opioids (+/-MAT)

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Recovery Supports?

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Maine’s MAT Landscape

  • Opioid Treatment Centers (OTCs)/methadone rx
  • Community-based SUD treatment organizations
  • Health system efforts
  • Other hospital-based efforts
  • FQHCs
  • Behavioral health organizations
  • VA system
  • Private practices (psych, addiction, primary care)
  • “Cash only” practices

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Wide Range of MAT Practices & Pts

  • Most accept insurance & offer sliding scale billing

– But growing number of “cash-only” private practices

  • Access to state funds to provide slots for uninsured

– Variable access statewide – SAMHS funds for uninsured, some through OHHs

  • Low  high barriers to access
  • Same day  days/weeks (wait list) for access
  • Widely variable orientation towards eventual

abstinence vs. promoting harm reduction

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Opioid Treatment Providers (OTPs)

  • Federal & state-recognized designation
  • 7 organizations , 11 locations
  • Offer methadone (daily dosing)
  • Most also offer buprenorphine
  • Two now MaineCare Opioid Health Homes
  • All but one (Acadia/EMHS) are for-profit
  • rganizations

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Community-Based SUD Tx / MAT Providers

  • Buprenorphine, +/- naltrexone prescribers
  • Most offer counseling on-site

– Some IOP, group, and/or individual counseling

  • Most accept insurance, MaineCare
  • May get SAMHS and/or other funds for uninsured
  • Mix of non-profit & for-profit org’s – e.g.

– Catholic Charities of ME (Portland, Lewiston) – ENSO (Portland, Sanford) – Grace St (Lewiston) – 3-Key West (Lewiston, Biddeford) – Recovery Connections of ME (Lewiston) – SMART Child & Family Svcs (Windham, Biddeford) – Blue Willow – Groups (8 locations)

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Hospital-Based Health Systems

  • CMMC

– Early efforts in Family Medicine Residency – Some highly engaged primary care sites (e.g. Bridgton IM)

  • EMHS

– Acadia serves as addiction specialty treatment – EMMC Family Medicine Residency – Some other primary care maintenance providers

  • MaineGeneral

– ME-Dartmouth Family Residency – Commitment to grow number primary care providers

  • MEHlth/MBHC: developing “hub & spoke” system of specialty

& maintenance providers

  • MidCoast-Parkview

– MidCoast Addiction Resource Center – Primary care maintenance providers

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Other Hospital-Based Efforts

  • St Mary’s BH – addiction specialty inpt & OP MAT
  • Bridgton/Rumford

– Bridgton Internal Medicine/ Crooked River Counseling

  • Healthy Acadia/Downeast SU Treatment Network

– Developing “hub & spoke” system with MDI, Maine Coast Memorial, Blue Hill Hosp

  • York Hospital & York Recovery Center

– All primary care practices becoming MAT providers

  • Mayo Regional

– Several primary care maintenance providers

  • Redington Fairview General Hospital

– Early efforts to develop community capacity

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FQHCs

  • Penobscot Community Health Care

– Seaport Health Center – PCHC Brewer, Union St, Old Town, Hope House

  • HealthReach Health Centers (9 of 11)
  • Greater Portland Health
  • Health Access Network
  • Sacopee Valley Health Center
  • Lubec Regional Medical Center
  • Other?

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Maine VA System

  • All SUD dx, treatment through BH Dept
  • 6 psychiatrists see patients through consult

service

  • Provide MAT services at Togus & all CBOCs
  • No primary care MAT prescribing

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Private MAT Practices

  • Psychiatrists, addiction medicine, primary care
  • Some accept private insurance, MaineCare

– Martins Point – ME Recovery Center (Drs. Jorgensen, Landry, Manchester)

  • Many “cash-only” practices (e.g. $200-$300/visit)- e.g.

– Mark Publicker MD (Portland) – Casco Bay Medical (Drs. Lazos, Spiegel - Portland) – Sisu Health (Dr. Kozma - Portland) – Gary Ross DO (Brewer) – Be Well My Friend (Augusta) – Many, many other doc’s (esp. solo practices)…

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Behavioral Health Organizations

  • Most offer SUD counseling, but not MAT

– Of ~200 SAMHS-contracted organizations offering SUD counseling, only ~6% offer MAT

  • Some BH org’s offer MAT – e.g.

– AMHC, in partnership with Pines, other primary care providers – Kennebec Behavioral Health – Maine Behavioral Health Care, MMC McGeachee Hall – TriCounty MH – in development, partnering with community MAT prescribers

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Covering SUD Tx for Uninsured

  • DHHS/SAMHS reimburses costs for limited numbers of

uninsured thru contracts with targeted SUD/MAT providers

  • Funding comes from federal (SAMHSA) block grant & other

funds

  • Currently 18 organizations have state contracts providing

funds to provide SUD counseling & MAT meds for ~800 uninsured across state

– Health systems - e.g. MH/MBHC; MEGeneral – Independent BH/SUD org’s - e.g. AMHC, Crooked River, Key3 West – Methadone clinics -e.g. CAP Quality Care, Discovery House, Merrimac River Health Care – Other – e.g. PCHC (Penob Cnty Jail pilot), York County Shelter

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Community-Based Efforts

Several community-based across state to expand SUD treatment, MAT capacity – e.g.

  • Bangor Community Health Leadership Board
  • Downeast & Washington County Substance

Treatment Networks

  • Lakes Region Substance Abuse Coalition
  • Lewiston-Auburn collaborative
  • Greater Portland Addiction Collaborative
  • York Recovery Center

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