MOA Strategy for Combating the Opioid Crisis

The Michigan Osteopathic Association has developed a strategy for combating the opioid crisis facing our state. The following "MOA 5 Strategic Pillars" were developed based on recommendations from the MOA Presidential Task Force on Safe Opioid Us, the Michigan Governors Task Force and The Office of the White House. The pillars include actions for Providers and for our Health System

Our goal is to reduce opioid-related deaths and morbidity, while we treat patients with pain and/or addiction with compassion and expertise.

1. First things first - Prevent Death with Naloxone 
2. Stabilize Addiction with Medical-Assisted Treatment (MAT)
3. Establish Long-term Person-Centered Treatment Goals for Successful Recovery 
4. Change Opioid Prescribing Habits 
5. Shrink the Supply of and Demand of Illicit Drugs

1. First things first - Prevent Deaths with Naloxone

Evaluate risk for overdose at each visit
Prescribe naloxone to patients at high risk
Ensure availability of naloxone for lay first responders 
Ensure orientation of  patients, friends and family on how to use naloxone and begin CPR
Be prepared to manage carfentanil cases with appropriate dosing and supplies of naloxone

Health System
Update legislation to grant access to naloxone and allow friends and family to use it 
Update legislation to hold first responders harmless when providing assistance
Fund & train police, fire and EMS 1st responders across the state
Educate first responders how to use naloxone and begin CPR
Be prepared to handle carfentanil cases

2. Stabilize Addiction with Medication-Assisted Treatment (MAT)
Offer MAT to patients with opioid addiction
Buprenorphine +/- naloxone (providers with xDEA waiver)
Naltrexone (any office) 
Methadone (SAMHSA certified Opioid Treatment Program – OTP)

Health System
Increase the number of MI providers with xDEA licenses to Rx buprenorphine
Establish an appropriate number of integrated centers of excellence for treating pain and opioid addiction
Use a spoke and hub network referral system to manage complex cases similar to the ECHO project

3. Establish Long-term Person-Centered Treatment Goals for Successful Recovery

Assess for addiction and co-existing behavior diagnoses, ie, depression, bipolar disorder
Use evidence-based behavioral therapies including mindfulness training
Coordinate care with the patient and entire care team
Monitor for continued single or multi substance abuse
Utilize recovery support programs

Health System
Improve coordination of care
Address access to critical information barriers for care coordination team members
For complex cases, establish integrated multidisciplinary pain and addiction centers throughout the state
Improve reimbursement for sustained coordinated care

4. Change Opioid Prescribing Habits
Leverage 2016 CDC Opioid Guidelines for Chronic Pain Mgt. 
Minimize opioids past 3-7 days for acute pain
Maximize non-opioid based therapies
Avoid daily Morphine Equivalent Doses ≥ 90 mg/day
Avoid concomitant use of benzodiazepines and sedatives/hypnotics 
Review MAPS reports looking for misuse or abuse
Utilize Urine Drug Screens
Initiate Patient Contracts

Health System
Focus on Maximizing Non-Opioid Pain Management Strategies
Establish appropriate expectations by highlighting risk vs. benefits of opioid use to all stakeholders
Update and Enhance Professional Education – CME/CE, Medical Professional School Training
Improve patient education and level-set expectations
Set standards for Palliative Care Practices

5. Shrink the Supply of and Demand of Illicit Drugs
Limit prescription dose and quantities to limit supply
Treat addiction to minimize demand for illicit drugs off the street
Encourage patients to clean out medicine cabinets and safely dispose of medications
Encourage patients to keep controlled medications under lock an key
Warn patients not to sell, give away or allow others to steal their medication

Health System
Initiate local/regional planning boards with law enforcement and health systems working together to develop community action plans 
Increase community prevention education programs to shrink demand – schools (grades 5-12), colleges and adult ed programs
Support community outreach programs such as Teen Challenge International, etc. to shrink demand
Community drug take-back programs to shrink supply
Identify and address diversion and illicit drug trafficking patterns


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