July 17, Wisconsin Health News

A nonprofit policy and research organization released more recommendations last week for improving Wisconsin's substance use disorder treatment services.

Pew Charitable Trusts has spent the last year studying the state’s treatment system. The Governor’s Task Force on Opioid Abuse adopted a series of recommendations from the organization in January, with lawmakers enacting some through executive order and others through new laws.

Andrew Whitacre, senior associate for the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts, presented more recommendations at a task force meeting in Madison Friday. He said lawmakers could accomplish them by April.

Whitacre said the recommendations aim to ensure the state is getting its “biggest bang for the buck” and building a treatment infrastructure that can address future drug epidemics. Pew tried to strike a balance between innovation and evidence-based approaches.

“There’s a lot of opportunity for states to be innovative and push the envelope,” he said. “The bottom line is an effective treatment system gets people into treatment sooner, so that people can get back to work and lead productive lives.”

Pew’s recommendations were:

• Expand opioid treatment programs. Whitacre said that Wisconsin does not have enough providers offering methadone, a medication used to treat opioid use disorder. Pew suggested allowing sites that deliver medical services to operate as methadone treatment programs. That could improve access to physical and mental health services for people with opioid use disorder.
  
• Develop a legal definition for recovery housing that would bar discrimination against those using medication-assisted treatment. Whitacre said that Pew’s interviews and focus groups in the state have confirmed that substance use disorder patients on medication-assisted treatment have been barred from some recovery housing in Wisconsin. 
  
• Ensure patients receiving medication-assisted treatment are placed in the right setting through a standardized patient placement tool. Patients seeking treatment aren’t often referred to the right care setting, leading to administrative waste and burdens on those who want help and providers, according to Whitacre. The tool could reduce costs and standardize care.
  
• Fund an expansion of buprenorphine training for providers during training programs for doctors, nurse practitioners and physician assistants, as many patients have difficulty accessing medication for opioid dependence.
  
• Use the Behavioral Health Review Committee established under recent state law to ensure that Wisconsin’s substance abuse counselor certification and licensure process align with best practices and that the number of counselors meets the state’s needs. Whitacre suggested the committee could find ways to evaluate and meet the need for counselors across the state. That could include a look at training requirements, scope of practicing, continuing education requirements and regulatory barriers.
  
• Direct the Department of Health Services to develop a plan with the Department of Corrections to pilot the availability of medication-assisted treatment in at least one prison or one jail. Part of the plan should include a review of prisons and jails to document the current availability of treatment. Whitacre suggested Rhode Island as a model, which has a correctional medication-assisted treatment program that led to a 61 percent decrease in overdose deaths among recently incarcerated people and a 12 percent decrease in overdose deaths statewide.
  
• Direct DHS to promote best practices of care for pregnant women with substance use disorder by requiring programs receiving Medicaid reimbursement and other public funding to follow guidelines that call for screening of patients and medication-assisted treatment. About 12.5 percent of treatment facilities in the state offer programs tailored to pregnant women, compared to 20.7 percent nationally.
  
• Direct DHS to incentivize healthcare providers to either offer or partner on postpartum care programs for women with substance use disorder.
  
• Direct the Medical Examining Board to establish guidelines on neonatal abstinence syndrome, a group of problems that newborns face if they're exposed to drugs in the womb. The rate of babies diagnosed with neonatal abstinence syndrome in Wisconsin more than doubled between 2009 and 2014, and treatment isn’t uniform across the state, according to Pew.
  

Whitacre said Pew is planning to wind down its work in Wisconsin, but it will help support recommendations if the state moves forward.

They’re also planning to release a final report soon, with other recommendations that could take longer than nine months. They'll include proposals targeting medication-assisted treatment in emergency rooms