From the Top
The United States is in the midst of an opioid epidemic, and no state, city, or town seems to be immune to the deadly wave. Michigan is no exception. Overdose deaths related to heroin, synthetic opioids, or prescription painkillers like fentanyl and oxycodone rose from around 130 in 1999 to more than 2,000 in 2018—a 1,438.5 percent increase. On the frontlines of the crisis are emergency departments, which play a pivotal role in assessing and treating opioid use disorders (OUDs) or referring people struggling with one to the resource that could help them toward recovery. But not every emergency department approaches the issue in the same way. After two decades of pushing back against the opioid crisis, efforts to get Michigan emergency departments on the same page about policy and process best practices have multiplied.
The Cast and Crew
The Michigan Department of Health and Human Services (MDHHS) Bureau of EMS, Trauma, and Preparedness (BETP)—a combination of the former Office of Public Health Preparedness and EMS and Trauma Services sections—approached PSC in 2019 on the heels of an opportunity. With federal funding available, the BETP’s mission to better protect the health and well-being of Michigan residents was financially supported to address the ever-growing opioid epidemic. Having a strong and long-term relationship with the MDHHS, PSC was ready to step in and assist.
The Plot Thickens
In Michigan, there is at least one emergency department in 71 of the state’s 83 counties, with one county alone hosting 16—each of which has a different set of rules, regulations, and practices when it comes to OUDs. These EDs are often the frontlines of the epidemic, seeing firsthand the results of opioid influence in communities. With this responsibility also came the opportunity to do more than releasing patients after simply providing Narcan (a medicine that rapidly stops the effects of an opioid) or other drugs that can ease withdrawal symptoms. However, without a clear understanding of the extent to which emergency departments were providing or referring patients out to different and/or longer-term support, it was difficult for Michigan’s health leaders to assess what kinds of help emergency departments in this position needed and how they could ensure that the state was approaching the epidemic in a cohesive way.
With PSC’s expertise in large population survey work and data analytics, this grainy picture would become much clearer in a matter of 76 survey responses.
Research, Innovate, Action
To create a clear picture of Michigan emergency departments’ response to the opioid epidemic, PSC sent surveys to all 135 emergency departments in the state, which serve between fewer than 1,000 to more than 200,000 patients every year. Due to the severity of the crisis and the finite number of emergency departments operating in Michigan, the goal was to ensure the highest response rate possible, and PSC worked with the BETP to employ unique tactics to maximize the amount of information collected, including:
- Receiving an appeal from the chief medical executive and chief deputy director for the MDHHS, with a letter signed by Dr. Joneigh Khaldun
- Monitoring of survey completion and outreach from PSC offering assistance in completing the survey
- Engaging the Michigan Health and Hospital Association for more outreach
- Offering a monetary incentive to cover the cost of survey completion
The survey collected information about emergency department experiences; policies; screening, treatment, and referral practices; education offerings; and support needs. To go even deeper, PSC conducted face-to-face interviews with seven emergency department leaders as well. The environment this work detailed had three major aspects, including a hierarchy of opioid-related response efforts, from least to most intensive; a lack of standard policies and procedures; and varied methods and rates of collecting data on opioid-related efforts. These findings were paramount in the next steps of the BETP’s response to Michigan’s opioid issue.
The first round of surveys included a letter signed by Dr. Joneigh Khaldun, known for her roles in Michigan public health and her station as Gov. Gretchen Whitmer’s public health adviser for the state’s response to the COVID-19 pandemic.
For Michigan and Beyond
PSC developed a set of informal recommendations that could be used across the state to solidify a response to the epidemic. These recommendations included sharing best practices and community resources between EDs and developing standardized reporting tools and educational modules to support consistent adoption of these best practices. Work in these areas continued, as the MDHHS engaged PSC further to create well-designed issue briefs to provide an even deeper understanding of the survey’s key findings. This additional effort explores urban and rural differences in opioid response efforts, initiation of medication-assisted treatment, and emergency departments’ use of opioid screening tools. PSC also developed a presentation that was delivered via webinar for key stakeholders, including staff from emergency departments, universities, and research and advocacy organizations engaged in opioid-related work and can be used by the MDHHS to share findings into the future. While the daunting work of addressing the nation’s opioid crisis starts with compassion, it can’t move forward without informed analysis. PSC’s guidance in this measure goes hand in hand with cementing Michigan’s forward-thinking and long-term response to the crisis.