Page 1


Special Edition



The national opioid epidemic is a growing crisis. In Michigan alone1: 11.4 million prescriptions for painkillers were written in 2015 — that’s 115 prescriptions per 100 people.

In 2016, drug overdoses (nearly 2,400) caused more fatalities than car accidents. 1,700 of those deaths were opioid-related — 17 times more than in 1999.

OptumRx is helping to curb Michigan’s opioid epidemic Opioid abuse is a national health care crisis. OptumRx® is committed to helping address this epidemic across the country and in the State of Michigan. That’s why we offer OptumRx Opioid Risk Management. This comprehensive solution uses advanced analytics and evidencebased clinical rules to help stop opioid abuse before it starts, prevent progression to misuse and addiction, and support individuals in their recovery. In turn, this reduces the devastating clinical, social and economic implications of opioid-related overdoses, hospitalizations and deaths — in a timely and targeted manner. What makes this solution so effective

Significant results

OptumRx Opioid Risk Management uses five key strategies to confront the opioid epidemic by identifying clinical opportunities and engaging members, prescribers and pharmacies across the care continuum.

Compliance with the Centers for Disease Control and Prevention guidelines generates proven outcomes:


1 Prevention and education

2 Minimizing early exposure

3 Reducing inappropriate supply

4 Treating at-risk and high-risk populations


compliance with CDC ‘first-fill’ dosing guidelines2


decrease in opioid prescription exposure3


reduction in total opioid prescription volume2

5 Supporting chronic populations and recovery

Visit optum.com/opioidmanagement to learn more about OptumRx Opioid Risk Management. 1. Michigan Department of Health and Human Services. Prescription Drugs and Opioids in Michigan. michigan.gov/mdhhs/0,5885,7-339-71550_2941_4871_79584---,00. html. Accessed May 2018. | 2. Results are based on June 2017 vs. December 2017 client data and short-acting opioid prescription volume and do not represent a guarantee of results. | 3. Opioid exposure refers to the quantity of opioids dispensed, represented as morphine-milligram equivalent doses (MMEs). Data represents MMEs per 100 members comparing May 2017 vs. February 2018 for all OptumRx direct commercial non-managed care organization (MCO) clients. | All Optum trademarks and logos are owned by Optum, Inc. All other trademarks are the property of their respective owners. © 2018 Optum, Inc. All rights reserved. ORX683949_180517

FEATURES & CONTENTS Reversing the Opioid Crisis: Special Edition


Michigan’s Treatment Courts: Saving Lives Through Supervision and Care BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY


MAPS Mandate







Families Against Narcotics: A Grassroots Partner for You and Your Patients BY THE HONORABLE LINDA DAVIS, 41B DISTRICT COURT

RESOURCES 04 President's Perspective


07 Michigan's New Prescribing Laws:

Timeline Summary

14 Prescribing Checklist for

Controlled Substances



michigan MEDICINE 3

perspective The light at the end of the tunnel may still be a way off, but progress is being made. This special edition of Michigan Medicine® provides an important update on Michigan’s opioid crisis, what physicians and partners like Michigan’s drug treatment courts are doing to combat it, and what the Michigan State Medical Society is doing in Lansing each and every day to support your important work.

Betty S. Chu, MD, MBA MSMS President

MICHIGAN MEDICINE® VOL. 117 / NO. 4-SE Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine 120 West Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Street East Lansing, MI 48823

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few.

Please visit msms.org/BeAWARE for up-to-date prescribing and opioid-related information and resources.

4 michigan MEDICINE


Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2018 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2018 Michigan State Medical Society

Michigan’s Treatment Courts: Saving Lives Through Supervision and Care By Nick DeLeeuw for the Michigan State Medical Society

Your spouse. Your parent. Your child. Any one of these individuals could become caught in the snare of opioid addiction.


uch has been learned through the years about appropriate and safe opioid prescriptions. We now know how addictive these powerful drugs can be—as addictive as heroin—but by the time it was realized, an epidemic had formed, spreading across Michigan and the United States, so fast and so forcefully that in October 2017, President Trump declared opioid addiction a health emergency and called it the worst drug crisis in U.S. history. Michigan ranks 7th highest in the nation for opioid related deaths, and more and more of those living with addiction are finding themselves behind bars.

Instead of locking drug offenders in prison—a tactic that’s proven ineffective— there is a better option. Through strict supervision and treatment, Michigan’s drug treatment courts are saving lives.

Healing Addiction through Drug/ Sobriety Treatment Courts Led by the Michigan Association of Treatment Court Professionals (MATCP), drug treatment courts have been targeting Michigan’s opioid epidemic by providing drug offenders with the treatment needed to overcome addiction and lead fulfilling lives.

What are Drug/Sobriety Courts?

Drug/Sobriety Courts are one type of treatment courts, which are problem- solving courts designed to address an offender’s underlying problem.

Provide court-supervised treatment programs for individuals who misuse or are dependent upon any controlled substance or alcohol.

An alternative to imprisonment for nonviolent criminal offenders with substance use disorders.

Varying models to serve specific subsets of drug offenders.

A shared therapeutic approach, customized to include local program- specific components to meet the needs of participants.

A treatment court judge serves as the leader of a multi-disciplinary team of professionals, which commonly includes a program coordinator, prosecuting attorney, defense attorney, treatment representatives, and law enforcement representatives.

Michigan’s first drug court was started in Kalamazoo County Circuit Court.

MATCP Executive Director Katharine Hude says the association is dedicated to educating and training the criminal justice system on the best ways to hold participants accountable, while also treating their addiction. “MATCP is always looking for ways to improve the lives of participants in treatment courts,” said Hude. “This involves a holistic approach, and many times, addressing substance use alone is not enough. Addicted individuals may struggle with mental illness, housing insecurity, lack of employment opportunities, and a lack of a support system.” One of MATCP's biggest strengths is in its ability to collaborate with a variety of private and public partners. On a regular basis, the association meets with state government agencies and associations to discuss and work toward shared goals of access to resources, improvement of public safety, and helping individuals in their substance abuse journeys make it to, and stay on, the road to recovery. Currently, MATCP is working with the Governor's Office and the Michigan State Housing Development Authority to establish a pilot program for long-term recovery housing units in Jackson, Kalamazoo and Lansing where treatment court participants can reside in sober housing and potentially receive services on-site. “MATCP is honored to be a part of this project. We understand that when someone has a safe environment in which to reside, a major stressor—one that is likely an impediment to overcoming a substance abuse disorder—can be eliminated altogether.”

Getting Michigan Up-to-Speed Governor Rick Snyder started the Michigan Prescription Drug and Opioid Abuse Commission two years ago. With the Commission scheduled to close at the end of 2018, Judge Linda Davis is proud of how far the group has come. (continued on page 6)


michigan MEDICINE 5

(continued from page 5) As a judge for the 41B District Drug Court, Judge Davis serves as Chair of the Governor’s Opioid Commission and has been front and center as the State worked to devise and implement 56 unique initiatives to improve Michigan’s treatment of drug addicts. “We covered prevention, treatment and recovery and wanted to see wrap-around services that connected those together,” said Davis. “One of the initiatives that was huge was the implementation of a new Michigan Automated Prescription System, where doctors can track what patients are getting from other doctors, so they know what patients are taking and won’t over prescribe.” A second initiative, called Hope Not Handcuffs, has formed partnerships with 40 police departments throughout Michigan, where individuals seeking help for addiction are directed to a treatment facility instead of a jail cell. “Every treatment facility in Michigan will have to do real time data implementation so we can see where beds are available,” said Davis. “When people are ready for help, you have a really short period of time. So, you need to be able to act quickly.”

Safe Treatment of a Disease Neither the Commission’s nor the courts’ work would be possible without committed and talented physicians on the frontlines in the battle against addiction. Through her work with the drug courts, board-certified addiction medicine specialist, Sandy Dettmann, MD, DABAM, FASAM, uses an evidence-based, medication-assisted treatment program combined with psychosocial interventions to treat her patients suffering from opioid dependence. “Physicians in Michigan are becoming more aware that opioids are being overprescribed,” said Dettmann. “However, abruptly cutting patients off of their medications leaves the patient with horrific opioid withdrawal symptoms that most cannot tolerate. Their only option is to obtain the pills illegally, which frequently leads to the use of heroin, which is cheaper on the streets than opioid pills. While I do believe that people should be held accountable for their crimes, I also believe that they deserve safe, non-punishing treatment of their disease.” Judge Sue Dobrich agrees. Serving as a Judge for the Cass County Probate Court, Judge

6 michigan MEDICINE


Treatment Courts Are a Good Investment Drug Courts save as much as $27 for every $1 invested. For every dollar spent on drug courts, the state saves $2.21 in reduced criminal justice costs. Every person treated in drug treatment court saves the state between $3,000 and $13,000.

Drug/Sobriety Court graduates achieved an average of 369 consecutive days of sobriety at the time of their discharge.

Dobrich works in family court dealing with abuse and neglect. Her focus is to determine which offenders—mothers, fathers and other caretakers—are the right fit for treatment courts. If the offender is clearly addicted, then a treatment court is often viewed as the best option. “High risk, high need individuals should be in a treatment court program because they need the attention that a program can give.” said Dobrich. “Addiction is now considered a disease, just like diabetes. So you need the proper form of treatment.” Judge Dobrich has seen tremendous improvement from graduates of the treatment court programs. “Two graduates who are mentors working in our court are really helpful because they can form the trust with the client much quicker than the system. Once they see that we’re in their corner and support their recovery, that’s really neat to see.” Most treatment court curriculums are scheduled to last from one to two years; giving participants the time necessary to complete the criteria necessary for successful discharge from the program. During this time, participants undergo random weekly drug and alcohol testing and attend frequent status hearings in court during which time the judge reviews their progress and may impose a range of consequences contingent upon their performance. To be discharged successfully, participants must comply with and complete a variety of conditions including but not limited to: participation in substance use disorder treatment and other indicated services, abstinence from illicit drugs and alcohol, remain arrest free, curfews, payment of applicable fines or fees, and community service or restitution to victims.

Learn More and Get Involved To learn more about the Michigan Association of Treatment Court Professionals visit matcp.org, call 517.253.0895, or email info@matcp.org. For information on treatment courts nationwide, visit the National Association of Drug Court Professionals’ website at nadcp.org.

To partner with your local treatment court: Check msms.org/drugsobrietycourts to find out if there is a drug court in your community.

If you have a patient who is a drug court participant: Ensure that your patient has authorized you to release his/her medical information to the drug court team. The court will have the forms for your patient to bring to his/her appointment. Provide information to the drug court team upon request (and with the above-mentioned authorization) as it is important for the drug court team to understand this participant’s medical and treatment needs, especially as they relate to the use of controlled substances. Feel free to contact the court and ask for the treatment court coordinator/probation officer, to get questions answered. Become a resource for treatment court judges by contacting the judge in your community. MATCP can also help connect you to the appropriate court and judge. Per the MATCP, all treatment court judges would welcome any assistance from physicians. If there is a FAN chapter in your area (see article on page 12), consider attending a meeting and becoming acquainted with the Board. It will likely lead to a treatment court contact.

Michigan's New Prescribing Laws: Timeline Summary March 2018 When treating patients for an opioid- related overdose, provide information on substance use disorder services. Dispensing prescribers are to report to MAPS (check exceptions). Query MAPS when prescribing/dispensing buprenorphine or methadone to a patient in a substance use disorder program. Report to MAPS when dispensing buprenorphine, or a drug containing buprenorphine, or methadone, to a patient in a substance use disorder program if permissible under federal law. Follow-up care is to be provided by the prescriber or by referral to the patients’ PCP.

June 1, 2018 Register with MAPS prior to prescribing controlled substances. Query MAPS first when prescribing/dispensing more than a 3-day supply of a controlled substance (check exceptions). When prescribing a controlled substance that is an opioid, provide information and obtain a patient signature on

MDHHS consent form (exception if prescribed for inpatient use). Minor patients – prior to prescribing a controlled substance containing an opioid, discuss the required information on danger and risks and obtain a signed “start talking consent” form (check exceptions). Note: MDHHS combined the two forms noted above into a single, one-page form which is available at: msms.org/BeAWARE

July 1, 2018 Limit prescriptions of opioids for “acute pain” to a maximum of a 7-day supply within a 7-day period. Note: “Acute pain” is defined as pain that is the normal, predicted physiological response to a noxious chemical or thermal or mechanical stimulus and is typically associated with invasive procedures, trauma, and disease and usually lasts for a limited amount of time.

March 31, 2019 Only prescribe Schedule 2-5 controlled substances if a bona fide prescriber-patient relationship exists and follow up care is established. Note: Pursuant to Public Act 101 of 2018 signed by the Governor on April 2, 2018, the effective date of this provision is March 31, 2019, or upon the promulgation of administrative rules if before March 31, 2019.

Be msms.org/BeAWARE




michigan MEDICINE 7 Be


Michigan Automated Prescription System (MAPS) Mandate By Christin Nohner, Director, Federal and State Government Relations, Michigan State Medical Society

On December 27, 2017 Lieutenant Governor Brian Calley signed into law several new requirements aimed at combating the opioid epidemic.


ncluded in the package of bills was a requirement for all licensed prescribers in Michigan to query the Michigan Automated Prescription System (MAPs) when prescribing any controlled substance, schedules II-V, to a patient. Exceptions to the requirement include: Prescriptions written for quantities less than or equal to a 3-day supply

Beginning June 1, 2018 a licensed prescriber must be registered with MAPS and query MAPS prior to prescribing or dispensing a controlled substance. The Michigan State Medical Society has available resources to help physicians navigate the new regulatory landscape around opioid prescribing including:

If dispensing occurs in a hospital or surgical freestanding outpatient facility and is administered in the facility

Our BeAWARE webpage (msms.org/ BeAWARE) which provides breaking news on changes and is regularly updated with information around the new laws

If the patient is an animal and the controlled substance is administered in a veteran hospital or clinic

An easy-to-read grid outlining the laws, along with a timeline summary

If the controlled substance is prescribed by a veterinarian and dispensed by a pharmacist.

A collection of FAQs directly from MSMS members and others On-demand webinars

Enforcement If the Department of Licensing and Regulatory Affairs (LARA) has reason to believe that a prescriber is in violation of the requirement, part of the enforcement of the mandate could entail the issuance of a letter to the licensee from LARA notifying the licensee that he or she may be in violation of statute. The letter does not constitute a disciplinary action. Otherwise, prescribing or dispensing a controlled substance on or after June 1, 2018, without querying MAPS and/or registering with MAPS could result in the following disciplinary actions against a physician’s license: denial, fine, reprimand, probation, limitation, suspension, revocation, or permanent revocation.

“In my opinion, MAPS is one of the best resources that Michigan state government has provided to physicians and other health care providers in the last 30 years. With just a few clicks of the mouse, I can now obtain detailed records of my ED patients' controlled substance prescriptions, from all sources, including those from out-of-state. This has changed my practice dramatically, in terms of my prescribing practice, verification of a patient's medication history, and counseling patients who are dependent on opioids and other high-risk medications. And in some cases, my MAPS queries have enlightened my patients' primary care physicians who, until I discussed the MAPS reports, were unaware of multiple opioid prescriptions written by other physicians.” JIM MITCHINER, MD, MPH (ANN ARBOR)

8 michigan MEDICINE


Conversely, according to LARA, if a practitioner requests a MAPS report and detects possible illegal activity, the practitioner can notify law enforcement and law enforcement could then open a bona-fide drug related investigation and request a MAPS report for the specific case through the state’s Bureau of Professional Licensing.

New MAPS Platform An updated and more user-friendly MAPS, powered by the Appriss PMP AWARxE software platform, went live last year with improved functionality and efficiencies including: Patient–centered alerts Recent request history Delegate activity Prescriber–specific announcements Seamless integration of interstate data sharing It’s proving, for many physicians, to be a vast improvement over the old system.

Delegate User The Department of Licensing and Regulatory Affairs (LARA) has clarified that prescribers can delegate the task of requesting a MAPS report to another authorized health care professional. If anyone in the office other than the prescriber is pulling MAPS

reports, he/she must be registered with MAPS as a delegate user for that prescriber. That staff member would need to register for MAPS under the delegate user role. The prescriber will need to give his/her approval when he/she logs in to his/her account before delegate users can begin running MAPS reports. It is also good practice for the prescribing physician to indicate on the report the date that it was reviewed and to initial. Delegate users also have the ability to batch reports.

Note that while a MAPS user can maintain a MAPS report in the EHR, the prescriber or vendor cannot pull the data from the report and upload it in a way where the data are combined with other data sets.

If a prescriber wishes to do so, they may remove a person as a delegate user. For example, in cases when a staff person leaves the office.

Visit msms.org/BeAWARE to view a tutuorial on NarxCare under the MAPS heading.

EHR – MAPS Integration The State of Michigan wants to increase the utilization of MAPS data within the clinical workflows of prescribers and pharmacists, and is funding the integration of MAPS into the electronic health records (EHRs) and pharmacy dispensation systems of hospitals, medical practices, and pharmacies. This integration will enable hospitals, physicians, and pharmacists to have direct access to MAPS data without having to log out of one system and into another.

NarxCare NarxCare MAPS users also receive Appriss’ NarxCare, which is a more robust analytics and prevention tool intended to help prescribers and dispensers better assess patient risk and help prevent prescription drug and opioid abuse.

Additional Questions? Visit the MSMS BeAWARE page for questions issued by LARA and MDHHS, as well as MSMS’ own FAQs: msms.org/BeAWARE

“I feel having a searchable database like MAPS is essential to safe prescribing of controlled substances, especially Schedule II and III drugs, which can be abused and diverted. The new MAPS system is a great improvement over the old system. I delegate to support staff so they can obtain the MAPS report before I see a patient who is taking controlled substances. It’s also helpful for me to have the reports I get comparing me to others in my specialty. That way I can see if I’m prescribing more than my peers. It’s a nice self- check of my prescribing. I’m happy with the new system, just wish I didn’t have to query for Schedule IV and V drugs.” GLENN DREGANSKY, DO, FAAFP (KALAMAZOO)


michigan MEDICINE 9

EHR – MAPS Integration Grant: Frequently Asked Questions By Stacey P. Hettiger, Director, Medical and Regulatory Policy, Michigan State Medical Society and Patrick J. Haddad, JD, Kerr Russell, MSMS Legal Counsel

An updated and more user-friendly Michigan Automated Prescription System (MAPS), powered by the Appriss PMP AWARxE software platform, went live in April 2017.


hile this update offers many functionality and efficiency improvements, the State of Michigan also wants to increase the utilization of MAPS data within the clinical workflows of prescribers and pharmacists. Therefore, the State is taking advantage of additional technology available from Appriss Health by funding the integration of MAPS into the electronic health records (EHRs) and pharmacy dispensation systems of hospitals, medical practices, and pharmacies. This integration will enable hospitals, physicians, and pharmacists to have direct access to MAPS data without having to log out of one system and into another.

How do I participate? There is a simple four-step process to participate: 1. Go to the Michigan Department of Licensing and Regulatory Affairs (LARA) website at www.michigan.gov/lara where you can access the Integration Request Form and the Terms and Conditions document. 2. Fill out the one-page Integration Request Form. 3. Review and sign the Terms and Conditions. 4. Email the completed form and document to LARA at BPL-MAPS@michigan.gov. Once your application is received, the State will notify Appriss Health. Appriss Health will then connect with your EHR vendor. It is also our understanding that you will be notified when your application has been received and the LARA MAPS support team will check in to confirm that you have been contacted by Appriss Health or your EHR vendor regarding the integration.

Is there a cost to participate? The State is fully funding the cost charged by Appriss Health, the MAPS software vendor, to integrate including licensing fees through August 31, 2019. The State will not be funding any costs that may be charged by EHR vendors. However, we have been told that many of the EHR vendors will be offering this capability at no charge to their customers. We strongly recommend that you seek clarification from Appriss Health and your EHR vendor regarding potential EHR vendor costs prior to moving forward with integration.

Go to msms.org/ MAPSIntegrationGrant to apply for this exciting grant opportunity. 10 michigan MEDICINE


What if I’m not yet registered in MAPS? You and any other prescribers on your EHR must be registered in MAPS in order to take advantage of the integration. If you have not yet registered, you may do so at msms.org/ MAPSRegistration.

What do I need to know about the Terms and Conditions document? Although Appriss Health and LARA have negotiated the language in this Agreement, there are some key provisions that are important to understand. Costs – the document clearly states that the State of Michigan will cover Appriss Health’s integration and licensing costs through August 31, 2019. Any additional costs are the responsibility of the medical practice (“Subscribing Organization”).

As mentioned previously, for most users there should not be any additional costs. However, unless and until your EHR vendor commits to providing this capability at no charge, there can be no guarantee that there will not be any additional costs. The State intends that health systems, physician organizations, medical practices, and pharmacies will work directly with Appriss Health for continued licensing privileges beyond August 31, 2019. At this time, there is no commitment from the State to continue funding after August 31, 2019, for any integration or licensing costs. Authorized Users – are validly licensed prescribers who are registered with MAPS, authorized by their Subscribing Organization (i.e., medical practice) to use MAPS data, and acting pursuant to applicable requirements and law. Access and Use of Appriss Health’s Gateway Service – practices will need to have policies and procedures in place to ensure appropriate access, use, and security. (Note: MSMS Legal Counsel is drafting model template language for practices to use as a guide to comply with this requirement.) Unauthorized or Inappropriate Use of Gateway Service – the Subscribing Organization is compelled to investigate and report to LARA complaints of unauthorized or inappropriate use. Unauthorized Disclosures – the Subscribing Organization is required to investigate and report any known privacy or security breach incidents involving the unauthorized use or disclosure of PHI which is not in compliance with the terms of the Agreement or with applicable law. Indemnification – the Agreement indemnifies and holds harmless the State, Appriss Health, and the National Association of Boards of Pharmacy from inappropriate actions of the Subscribing Organization. However, there is no indemnification provision for Subscribing Organizations. Although one-sided indemnification claus-

es are not unusual in these types of Agreements, MSMS and MAFP have raised this concern with the State. Ownership of Information – states that PHI and any related information created or received from or on behalf of the State is the property of the State. The intention is that the information not be used for purposes other than intended. Termination or Expiration – if the Agreement is terminated or expires, the Subscribing Organization can no longer use the Gateway Service and must destroy and certify destruction of proprietary information (i.e., Gateway Service documentation).

How long will it take after I sign up to integrate my EHR with MAPS? It depends on the readiness of your EHR vendor and the timing of scheduled updates that may be required for the version of software you are currently using. If your EHR vendor is one that has the capability in place, you could be up and running in the near future. However, if your vendor still needs to develop those capabilities or is waiting to offer it in the next update release, it may take more time. Also, in order to make this integration initiative available to as many prescribers as possible, the State is prioritizing those EHR vendors that have a greater presence in Michigan.

Do I need to contact my EHR vendor? No, not to register to participate. However, it is important that you include the name of your EHR vendor and your contact with that vendor on the Integration Request form. Appriss Health will follow-up with your EHR vendor to coordinate the integration.

Where can I get more information? Appriss Technical Support 844-364-4767 LARA MAPS Support Team 517-373-1737 or BPL-MAPS@michigan.gov Stacey P. Hettiger, MSMS Director, Medical and Regulatory Policy 517-336-5766 or shettiger@msms.org Dara Barrera, MSMS Manager, Practice Management and Health Information Technology 517-336-5770 or djbarrera@msms.org

If my EHR vendor doesn’t currently have the capability to integrate with MAPS, or if I'm unsure of the costs, should I wait to sign up? No. It is important that you get in the queue. Also, by signing up, the State and Appriss Health have more leverage when working with the EHR vendors whose customers are asking for the ability to integrate with MAPS.


michigan MEDICINE 11

Families Against Narcotics: A Grassroots Partner for You and Your Patients By The Honorable Linda Davis, 41B District Court

Families Against Narcotics is a non-profit organization that has been involved in the fight against the opiate epidemic for over 12 years. FAN was working at a grassroots level before this epidemic was even publicly acknowledged as a crisis.


welve years ago, several young adults died of an opiate overdose in our community. These were good kids from good families. At first, we thought this was a local problem, but as we began meeting and talking, we discovered that every community was facing the same issue. As a result, a community effort was formed called Families Against Narcotics (FAN), an organization that provides support and education to thousands of families in Michigan. Over the last 12 years, FAN has developed into a movement with over 20 chapters and 34 monthly meetings in the state of Michigan. Last year FAN launched their first national chapter in North Carolina.


12 michigan MEDICINE


This organization has partnered with organizations all over Michigan including medical schools, the University of Michigan Research Team (creating educational programs to be used in schools), four major hospitals, over 40 police departments, 350 treatment facilities, the Michigan Department of Health and Human Services, doctors, pharmacists, dentists, and Blue Cross Blue Shield of Michigan in an effort to implement programs that will ensure the safety and well-being of our community and erase the stigma associated with addiction. FAN was also responsible for initiating Operation Rx which brought together over 16 sectors of the community touched by addiction together in an effort to connect and

“Over the last 12 years, FAN has developed into a movement with over 20 chapters and 34 monthly meetings in the state of Michigan. Last year FAN launched their first national chapter in North Carolina.”

fill the gap between prevention, treatment and recovery. FAN has been called “the gold standard” organization in Michigan. The areas we service can be found on the map on page 12.

Connecting to Treatment FAN implemented a program in 2017 called Hope Not Handcuffs (HNH). A person struggling with any drug addiction can come to any of the participating police agencies and ask for help. They will be greeted with support, compassion and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement. If a person is uninsured or has Medicaid, we will work directly with the local Office of Substance Abuse Services for placement. If a person has private insurance, we will provide them with treatment options covered by their plan. Regardless, our team will work to get them into treatment as soon as possible. Over 200 volunteer Angels will help with paperwork and provide compassionate support until a treatment option is found. HNH is now in eight counties and working with over 40 police departments. Since the launch of this program on Feb. 1, 2017, over 1200 people have been placed into treatment. Recently, many hospitals and doctors have begun to use HNH to place patients that have been identified with substance use disorder and to provide them with information about how they might utilize this program. We continue to expand HNH throughout the state and hope to be statewide by 2019. Visit hopenothandcuffs.org to learn more.

Education FAN has educated thousands of students in over 15 counties in Michigan on the dangers of opiate use, and has developed a video to be used in athletic programs in schools throughout Michigan. FAN has educated hundreds of doctors, dentists, and nurses on the dangers of prescribing opiates, and lectures in numerous hospitals across the state to reduce the stigma of addiction. FAN has provided speakers for hundreds of venues throughout Michigan and has also presented nationally through webinars and at National Drug Court conventions. Several of our speakers have appeared as experts on every major television and radio station in the Detroit area. Judge Linda Davis, President of FAN, has been asked on several occasions to do media events with the Governor and the Lt. Governor.


Advocacy FAN’s work has also received national attention. Judge Davis has been invited to the White House, on five different occasions, to participate in round-table discussions with the President and First Lady, and to give testimony to the National Commission on Opiate Addiction. Katie Donovan the vice-president of FAN has given testimony in Washington DC to both the DEA and the Senate. As a result of FAN’s efforts, Governor Snyder invited Judge Davis to serve on his Prescription Drug & Opioid Abuse Task Force. Judge Davis was asked to, and currently serves as, Chair of Michigan’s Prescription Drug and Opioid Addiction Commission.

Your connection to information, resources, and support. To partner with FAN, help your patients access their network of support and resources, and/or request a presentation, visit FamiliesAgainstNarcotics.org.


michigan MEDICINE 13

Prescribing Checklist for Controlled Substances June 2018 BEFORE PRESCRIBING Obtain a valid Michigan Controlled Substance License (physicians and physician assistants).

Obtain a valid DEA Registration (All health professionals). If dispensing controlled substance, obtain a valid Michigan Drug Control License (unless exception applies, e.g., dispensing within emergency department, etc.)

Register with MAPS. If delegating prescribing authority to an eligible APRN, execute a collaborative agreement or other written authorization; written practice agreement if a physician’s assistant will be prescribing. Have a bona fide prescriber-patient relationship (effective the earliest of March 31, 2019 or when LARA promulgates rules addressing this requirement.

Conduct at least one in-person medical examination if prescribing through the Internet as required by federal law*.

Ask the patient about other controlled substances the patient may be using. Record the patient’s response in the patient’s medical record.

If prescribing buprenorphine or a drug containing buprenorphine or methadone to a patient in a substance abuse disorder program, obtain and review the patient’s MAPS report.

Obtain and review patient’s MAPS report if prescribing a quantity that exceeds a 3-day supply, unless dispensing and administering to patient within hospital or freestanding surgical outpatient facility.

If prescribing an opioid, provide the patient with statutorily required information (e.g., dangers of opioid addiction, etc.) and obtain signed acknowledgment on the MDHHS Opioid Start Talking form** and include the signed form in the patient’s medical record.





If prescribing an opioid to a minor and the start talking consent form is signed by another adult authorized to consent to the minor’s medical treatment, must limit prescription to no more than 72-hour supply.

If dispensing controlled substances, MAPS reporting is required unless an exception applies (.e.g., dispensing to inpatient at hospital, etc.).

2 If treating a patient for acute pain, must not prescribe patient more than a 7-day supply of an opioid within a 7-day period. 3

2 If prescribing a controlled substance, provide follow-up care to patient (e.g., schedule a follow-up appointment) or refer patient to his or her primary care provider or another geographically accessible provider if the patient does not have a primary care provider for such follow-up care.

A physician may not authorize an APRN to issue a prescription for a schedule 2 controlled substance with a quantity greater than a 30 day supply. 4 Comply with all applicable state and federal laws regarding contents and transmission of prescription.

If prescribing opioid to a minor, discuss additional statutorily required information (e.g., risks of addiction and overdose associated with a controlled substance, etc.) with the minor and the minor’s parent, guardian or another adult authorized to consent to the minor’s medical treatment, and obtain the signature of the minor’s parent, guardian or authorized adult on a start talking consent form.** Include the signed form in the minor patient’s medical record.



* Federal law requires an in-person medical examination before prescribing a controlled substance by means of the Internet. Notwithstanding, federal guidance suggests that the lack of an in-person medical examination before prescribing a controlled substance (even by written prescription) raises a “red flag” for potential diversion. MSMS recommends that Be (e.g., e-prescribing or non-covering practitioners perform at least one in-person medical examination on a non-covering practitioner regardless of the means of prescribing written prescription). ** MDHHS has combined these requirements into one form which is available at msms.org/BeAWARE.

14 michigan MEDICINE





MAPS The Michigan Automated Prescription System (MAPS) is the state’s Prescription Drug Monitoring Program. MAPS provides prescribers with a user-friendly portal to obtain information of Schedules 2 through 5 controlled substances that have been dispensed. MAPS utilizes Appriss Health’s PMP AWARxE and NarxCare software tools, which puts Michigan at the forefront of prescription drug monitoring technology. A dashboard provides patient alerts, recent request history and the ability to maintain delegate user activity within the prescriber’s main account. Patient report requests include seamless interstate data sharing, prescription history, including prescriber and dispenser information that can all be provided in a complete summary. As of June 1, 2018, licensed prescribers are required to register to MAPS before prescribing a controlled substance to patients.

MAPS helps detect overprescribing, over dispensing and possible drug diversion. The system is used by providers to assess patient risk to highly abused and addictive drugs and assists with maintaining patient safety. michigan.gov/mimapsinfo BPL-MAPS@michigan.gov

To figh t a pres opioid abu s c e r i , p t w i e o The op n h a o ioid cr f v e h i sis is w o and ra p e idespr ces all for Mic ead. It across epide ’s affe the co mic w h igan. cting p untry. ith a u thes e n T o

e reso ified t he sta ple of eam. Y urces t all age e o f stop o Michig and p o s, gen u c verdo a rogram n help an is fi ders ses. ghting by bei s with ng aw friend this are of s and and sh family aring . Toge ther w e can

The Michigan Department of Health and Human Services is committed to building awareness of the growing opioid problem by running a statewide educational campaign and supporting local treatment services. Michigan families affected by this crisis can find treatment options, resources and support all across the state. The Michigan State Police Angel Program allows an individual struggling with drug addiction to walk into a state police post during regular business hours and ask for assistance. If accepted into the program, an “Angel” volunteer will support the person during the process and provide transportation to a treatment facility. The Michigan Department of Environmental Quality Drug Take Back Program educates and promotes proper drug disposal to the public and healthcare providers. Find drug disposal resources, residential take back locations and educational materials such as shareable videos at www.michigan.gov/deqdrugdisposal. The Michigan Department of Licensing and Regulatory Affairs administers the Michigan Automated Prescription System (MAPS). MAPS is a software tool that provides prescribers and dispensers with real-time prescription data and analytics to help clinicians make informed decisions and also provides additional resources to better assess a patient’s risk for substance use disorder. The Prescription Drug and Opioid Abuse Commission – made up of health professionals, law enforcement officers, substance abuse treatment providers, government officials and citizens – advises state agencies and the governor’s office on prevention, treatment and policy related to the opioid crisis. Learn what you can do at Michigan.gov/stopoverdoses.

Profile for Michigan State Medical Society

Michigan Medicine®, Volume 117, No. 4-SE  

In a special edition of Michigan Medicine®, the award-winning magazine of the Michigan State Medical Society: http://msms.org, the July/Augu...

Michigan Medicine®, Volume 117, No. 4-SE  

In a special edition of Michigan Medicine®, the award-winning magazine of the Michigan State Medical Society: http://msms.org, the July/Augu...