Best Practices and Next Steps in the Opioid Epidemic

Health Update

Editor’s Note: With the number of opioid deaths six times higher in 2017 than in 1999, the opioid epidemic is continuing its rampage across the country. What can be done to solve the epidemic? What steps have states taken that are showing meaningful progress? What needs to come next? To uncover the answers, Manatt Health and the American Medical Association (AMA) performed an in-depth “spotlight” analysis of how four hard-hit states—Pennsylvania, Colorado, North Carolina and Mississippi—are addressing the epidemic. We shared summaries of our Pennsylvania, Colorado and North Carolina spotlights in previous “Health Updates,” and round out our series below with an overview of how Mississippi is responding to the epidemic.

Click here to download all of our analyses.

We also shared the findings from our full spotlight program in a recent webinar. Click here to view the webinar free, on demand—and here to download a free copy of the presentation.

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Mississippi’s opioid epidemic is following national trends. Even as the number of opioid prescriptions dispensed in the state has steadily dropped, deaths due to opioid-related overdoses have continued to increase. Governor Phil Bryant has led state efforts to address the epidemic through an August 2017 executive order that encouraged the use of naloxone by law enforcement officers. Governor Bryant also convened an Opioid and Heroin Study Task Force with representatives from state agencies, medical and dental boards, providers, and counties. Mississippi has not been as active as some other states in expanding access to medication-assisted treatment (MAT) and other substance use disorder (SUD) treatments, but it does have promising public- and private-sector initiatives that offer building blocks toward ending Mississippi’s—and the nation’s—opioid epidemic.

The spotlight analysis of Mississippi primarily highlights the work of two agencies—the Mississippi Division of Medicaid (housed within the Office of the Governor) and the Mississippi Insurance Department (MID). These two agencies address coverage issues that determine what care is accessible and affordable to the 24% of Mississippians covered by Medicaid and the Children’s Health Insurance Program (CHIP), as well as the 48% with fully insured individual or group insurance coverage. The analysis also describes work being done by the Department of Mental Health (DMH) and some leading private-sector institutions.

Where Mississippi Is Succeeding

Expanding naloxone access. The state’s efforts to expand naloxone access, including a standing order and a Good Samaritan law, have saved lives. Over 2,000 lives were saved by emergency medical services using naloxone in 2017.

Expanding coverage of opioid alternatives. Medicaid covers non-opioid pain management options, including some non-opioid pharmaceuticals and topical analgesics, though Medicaid also has a monthly limit on prescription drugs that reduces the impact of this coverage.

Advancing community engagement. StandUp Mississippi was designed to help reduce stigma and promote overdose prevention across multiple agencies, including the Mississippi DMH, the Department of Public Safety, the Mississippi Bureau of Narcotics, the Mississippi Board of Pharmacy, the Federal Bureau of Investigation, the Mississippi Department of Human Services and the Drug Enforcement Agency.

Where Mississippi Is Making Progress

Increasing access to opioid alternatives. The University of Mississippi Medical Center’s initiatives to treat pain with acupuncture, physical therapy, biofeedback and other non-opioid alternatives could be promoted across other leading state institutions and used to expand Medicaid and commercial coverage of non-opioid pain management strategies.

Reviewing parity compliance. The MID is conducting a comprehensive review of health insurer policy forms to assess compliance with mental health and SUD parity laws and is developing materials for future regulatory reviews, as well as for insurers and consumers, on parity requirements.

Where Mississippi Can Take Steps to End the Epidemic

Expanding access to MAT and other treatment options. Mississippi’s decision not to expand Medicaid leaves many people affected by the epidemic without coverage, making it critical that the state maximize its remaining options by strategically using other sources of federal opioid funding, covering the cost of training to encourage more providers to become waivered, developing outreach programs to connect individuals to existing treatment options, and covering all clinically appropriate forms of MAT without prior authorization.

Enforcing parity requirements. The MID will be able to use new materials that come out of its current parity assessment work to more closely scrutinize benefits packages, prior authorization policies and cost-sharing obligations to ensure ongoing parity. Where compliance problems emerge, the MID can use its regulatory authority to perform market conduct exams similar to the parity exams currently underway in Pennsylvania and Colorado.

Tracking metrics to assess impacts. The data clearinghouse being established at Mississippi State University could become a forum for state agencies to track key indicators of the epidemic on a regular basis to assess whether policies, programs and other efforts in the state are working to impact patient care and reduce opioid-related harms. Greater collaboration with MID, Medicaid and public health experts could be helpful.