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COMMENTARY | State leaders prioritize expanding access to evidence-based treatment
This analysis was originally published by The Pew Charitable Trusts and was written by Josh Rising and Andrew Whitacre.
Substance use disorder (SUD) is a serious, prevalent problem in Wisconsin. The state recorded 1,074 drug overdose deaths in 2016, double the number that occurred in 2010. And emergency department visits due to suspected opioid overdose increased more than 50 percent from 2016 to 2017.
Despite growing overdose deaths and hospital admissions, Wisconsin—like other states grappling with this epidemic—does not have the capacity to treat all individuals struggling with SUD. In fact, only 23 percent of residents who need treatment for these chronic brain disorders receive it, and too often, with therapies not backed by evidence.
To address this public health issue, the state’s Task Force on Opioid Abuse—created by Governor Scott Walker in 2016—partnered with Pew to assess ways to increase access to evidence-based treatment. Pew staff met with more than 150 stakeholders from across the state to better understand barriers to care and policy areas where reforms were most needed. The result of these efforts is a set of 18 recommendations designed to help Wisconsin build an effective, comprehensive treatment system. The recommendations are in categories deemed essential to ensuring access to high-quality and evidence-based care, including:
Treatment system transformation
Ten recommendations focus on implementing innovative ways to deliver and manage care for SUD. For example, Wisconsin is currently studying whether a care delivery model known as hub-and-spoke—where patients initiate substance use disorder treatment in “hubs,” and then focus on long-term treatment with community-based provider “spokes”—would work in the state. To ensure that enough health care providers participate with this type of model, Wisconsin should implement Medicaid payment reforms that provide incentives for providers to deliver this type of care.
The state should also allow sites that provide health care services, such as federally qualified health centers or rural health clinics, to also serve as opioid treatment programs. Such state- and federally regulated centers can dispense methadone, one of three Food and Drug Administration-approved drugs to treat opioid use disorder (OUD), which would increase access to this important medication.
The recommendations also call on Wisconsin to create a tool that would help health care providers make more informed decisions when referring patients to treatment. This referral tool should integrate with health information technology to enable providers across the state to better understand treatment capacity, where services are being used, and unmet needs. (To explore the other seven recommendations, please see the report).
Substance use disorder workforce
An effective treatment system must have enough providers to meet demand across the state. Accordingly, Wisconsin should allocate funding to expand training for physicians, nurse practitioners, and physician assistants to prescribe buprenorphine—another FDA-approved drug for OUD treatment, but one which requires a federal waiver.
The state has also faced a significant shortage of SUD counselors, which has resulted in opioid treatment programs and behavioral health clinics being unable to fill jobs. To help close these gaps, Governor Walker signed legislation in April 2018 to help ensure that the state’s substance abuse counselor certification and licensure process does not restrict qualified providers and that it instead aligns with national best practices and surrounding state standards, per the recommendations.
Finally, the state should work to ensure that health care providers—who suffer from SUD at a similar rate as the general population—have access to the same effective treatment that many of them seek to provide. Wisconsin’s physician health program should therefore incorporate national best practices to improve access to therapy for providers.
Justice-involved individuals and pregnant women may have more difficulties securing effective care than other populations. As a result, several recommendations seek to improve access in the state for these groups.
Wisconsin should institute a pilot program that offers all three medications for OUD in at least one jail or prison, and assess the medications’ availability in facilities across the state. Furthermore, Medicaid beneficiaries who enter jail or prison should have their benefits suspended instead of terminated, so that upon release individuals dealing with SUD can either seamlessly begin or continue treatment.
Wisconsin’s policies regarding substance use and misuse in pregnant women may deter them from seeking care. Since evidence-based treatment can improve health outcomes for mothers and babies, Wisconsin should revise existing policies to make it easier for pregnant women to seek and receive such care. The state should also target more health care providers, particularly obstetricians, gynecologists, and pediatricians, to provide treatment to these mothers and babies, whether through additional payments or improved training. Finally, the rate of babies diagnosed with neonatal abstinence syndrome or NAS—where infants suffer withdrawal symptoms due to opioid exposure in the womb more than doubled in Wisconsin between 2009 and 2014. In response, the state’s Medical Examining Board should establish and disseminate guidelines for treating NAS to help improve outcomes for these infants.
What’s next for Wisconsin
Wisconsin has already adopted several of the proposed recommendations. Implementing the remaining ones would help the state build an effective treatment system for SUD that is timely, comprehensive, evidence-based, and sustainable for years to come.
Josh Rising is director of The Pew Charitable Trusts’ health care programs, and Andrew Whitacre is a principal associate with Pew’s substance use prevention and treatment initiative.
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