Actions taken since January 2017 in response to the opioid crisis in Indiana
(Note: Governor Holcomb and state partners have taken significant steps to attack the drug epidemic. In addition, many entities from other sectors have responded to Governor Holcomb’s call for an “all hands on deck” response to the current crisis and the situations being faced in communities around the state. Selected actions taken by others in support of the overall effort to reduce substance misuse and abuse in Indiana are included in this list.)
To reduce the excess supply of prescription opioids:
- Launched the integration of INSPECT, Indiana’s prescription drug monitoring program, with electronic medical records and pharmacy management systems statewide.
- SEA 226 (2017) was enacted, placing limits on first-time prescriptions of opioids. Indiana’s Phase I Medicaid prescribing plan resulted in a 25% decrease in opioid prescriptions in its first year.
- Indiana State Department of Health (ISDH), Indiana Hospital Association (IHA), and Indiana State Medical Association (ISMA) jointly developed new Indiana Guidelines for the Management of Acute Pain to complement the existing Indiana Chronic Pain Management Prescribing Rule and Indiana Guidelines for Opioid Prescribing in the Emergency Department.
- SEA 221 (2018) was enacted. Requires certain health care professionals to check INSPECT before prescribing opioids or benzodiazepines. A phased-in approach will be completed by January 1, 2021. Also requires mandatory registration with INSPECT of prescribers of ephedrine, pseudoephedrine, or any controlled substance.
- 90 of Indiana’s 92 counties have at least one drug takeback program and there are numerous year-round takeback sites at hospitals and clinics with onsite pharmacies. Takeback kiosks are being added at numerous other pharmacies.
- Indiana State Police and the Board of Pharmacy at the Indiana Professional Licensing Agency, in partnership with the federal Drug Enforcement Agency’s National Drug Take Back Day, collected 21,480 lbs. of unused medications during a two-day statewide event in Oct. 2018, bringing the total collected since Jan. 2017 to over 54,930 lbs.
- The state is providing financial support to help Purdue Extension expand the Strengthening Families program to high needs areas of the state. Strengthening Families is an evidence-based program that has demonstrated long term impact in reducing substance abuse among young people.
- The state is also providing financial support to enable scaling and expansion and enhance sustainability of Youth First’s prevention programs. Youth First places social workers in schools to provide intervention and prevention programming for at-risk students.
- The Richard M. Fairbanks Foundation committed $12 million over a three-year period to fund evidence-based prevention programs in Marion County schools. At least two additional private foundations have also committed substantial amounts to fund prevention programs in other counties.
- The Alliance for Substance Abuse Progress (ASAP) in Bartholomew County raised over $1 million locally to fund substance abuse prevention programs.
- HEA 1438 (2017) allows municipalities to establish syringe service programs without State approval. Indiana has 9 counties approved to provide syringe services, working to prevent disease and serving as a gateway to public health and social services.
- ISDH, Family and Social Services Administration (FSSA), and Department of Homeland Security (IDHS) worked together to reorganize the state’s naloxone distribution system to ensure adequate supplies for EMS providers statewide and to maintain supplies at all Indiana State Police (ISP) posts.
- A standing order enabling anyone to purchase naloxone without a prescription remains in effect.
- Utilizing federal Cures Act dollars, first responders across Indiana have been supplied with over 8,000 naloxone kits.
- A naloxone administration heat map was launched in August, providing first responders and government partners with information to help make more informed decisions about where to place resources.
- Five new opioid treatment programs (OTPs) were opened by the first half of 2018. HEA 1007 (2018) authorizes the addition of nine more, which will raise the total to 27 and result in nearly everyone in the state being within a one-hour’s drive of an OTP. Requests for proposals have been sent out and two future locations have been confirmed in Hendricks and Knox counties. Work progresses to determine the locations for the remaining OTPs.
- Recovery Works, Indiana’s forensic treatment program, has served more than 32,000 unique individuals in the criminal justice system since its launch in 2015.
- FSSA certified an additional 44 treatment sites from Jan. 2017 through Oct. 2018, with 14 applications pending. There are now 253 certified addiction treatment providers with 428 locations around Indiana. 47 of those have in-patient or residential services. There are 1,388 total treatment beds (741 provide MAT ).
- FSSA created an interactive map for its website (also available on the Next Level Recovery website) that includes all approved treatment centers and a variety of information about each. The tool has been accessed thousands of times.
- FSSA made a policy change that enables Medicaid to pay for comprehensive treatment within an OTP, including with methadone, the only one of three drugs approved by the FDA for treating opioid use disorders that had previously not been covered.
- FSSA applied for and received from the Centers for Medicare and Medicaid Services (CMS) an extension to the state’s 1115 Medicaid demonstration waiver that extends Medicaid/HIP coverage for a full-range of services, including short-term residential treatment and recovery support services. This is expected to result in up to an additional $80 million a year for such services in Indiana and has resulted in the addition of more than 200 beds statewide for residential treatment. Approximately 2,400 more Hoosiers per year can receive treatment as a result of these additional beds. Funding through this waiver has already covered the cost of treatment for more than 42,000 Hoosiers who were previously not covered.
- Funds from a 21st Century Cures Act grant received in 2017 have been used as follows:
o $7.6 million to expand/enhance residential treatment
o $600,000 to fund recovery coaches in emergency departments. 10 peer recovery coach programs are operating in emergency departments throughout the state. These programs pay for certified peer recovery coaches in the emergency departments of local hospitals to help people suffering from an ailment related to substance use disorder get connected to treatment.
o $600,000 to support mobile crisis teams. Mobile response teams are working with first responder agencies in the southern part of the state to identify individuals who have experienced an overdose and bring the treatment directly to them at their homes. Two teams are spread out over 14 rural counties stretching from Monroe, Switzerland and Dearborn counties. One of the teams has already served 107 clients.
o $300,000 to provide web-based training using Project ECHO. Tracks have been launched to train doctors in the clinical management of opioid use disorders as well as for health workers/peer recovery coaches, and professionals working with pregnant women.
- Indiana has received second-year federal funding of $10.9 million from the 21s Century Cures Act and first year funding of $18.9 million from a federal State Opioid Response grant.
- FSSA worked to modify the Open Beds platform and link it to the statewide 211 system to enable quick and easy identification of available treatment beds anywhere in the state, thus increasing timely access to treatment and making fuller use of existing capacity. The program has made more than 4,000 referrals for treatment services and support groups.
- The Department of Correction (DOC) is transforming treatment in state prisons. “Recovery while Incarcerated” changes include screening at intake to identify mental health and substance abuse issues, evaluate the need for treatment, and improve treatment planning. MAT is being initiated prior to release, and DOC and FSSA are working together to connect those about to be released with treatment providers in the community.
- DOC has added over 700 residential-style treatment beds across their facilities since September 2017, utilizing updated evidence-based clinical treatment models (38% increase).
- In the last year, more than 520 inmates have been treated utilizing medication assisted treatment, with more than 75 people released on MAT as part of their re-entry strategy.
- Parole has implemented a substance use matrix that provides a graduated correctional response to people with substance use disorders who have setbacks. This includes support for all three evidence-based forms of MAT.
- Recovery While Incarcerated includes a comprehensive screening and assessment process that identifies substance use disorders, motivation for treatment, and co-morbid criminogenic risk factors.
- Indiana is providing financial support for expansion of the Fresh Start Recovery Program operated by VOA. Authorized by SEA 446 (2017), the program provides inpatient treatment for women who have been using opioids while pregnant and allows mothers and babies to stay together. After-care and other wraparound services are also available after the mother leaves the recovery facility.
- Financial support is being provided or reserved for other pilot programs authorized by the General Assembly in 2017:
o SEA 243 – a maternal neonatal addiction project operated by Community Health Network (CHN). Provides screening, treatment, and care for mother and baby when the mother tests positive for substance abuse. Develops a Maternal and Neonatal Center of Excellence for the Treatment of Drug Use Symptoms at CHN.
o SEA 510 – a treatment diversion project in Allen County. Enables persons entering the criminal justice system with substance use disorder to receive treatment rather than go to jail. Creates a full spectrum of care including recovery supports. Partners include Allen County Commissioners, Allen County Sheriff’s Department, Ft. Wayne Police Department, and Lutheran Foundation.
o SEA 499 – This legislation allows for involuntary commitment programs to be piloted in Wayne and Tippecanoe Counties for persons who have been revived with naloxone and who are deemed to be particularly vulnerable to repeat overdoses.
- ISP formed and trained “all crimes” policing units in all ISP districts statewide.
- ISP works closely with federal and local law enforcement agencies on drug interdiction actions and coordinates approaches with neighboring states.
- In 2017 ISP’s Drug Enforcement Section seized 35.5 kg of heroin, 2.5 kg of fentanyl, 4 kg of other synthetic drugs, 78.5 kg of crystal methamphetamine, and 852 dosage units of prescription drugs.
- HEA 1359 (2018) increases the penalties for those who manufacture or distribute drugs that result in an overdose death.
- Twenty state agencies signed data sharing agreements with the state’s Management Performance Hub, which is working to improve access to accurate, timely, actionable information.
- ISDH has added to its website an interactive map of Indiana that provides access to opioid-related information such as mortality reports, non-fatal ED visits, counties that provide syringe services, and more.
- SEA 139 (2018) requires coroners to obtain and report additional data on deaths where an overdose is suspected.
- Indiana University responded to Governor Holcomb’s emphasis on attacking the opioid epidemic by launching “Responding to the Addictions Crisis” as the university’s third Grand Challenge. IU has committed $50 million over the next five years to this initiative. The first sixteen projects funded as part of this Grand Challenge were launched in January 2018 and focus on five key areas:
o Data sciences and analytics
o Education, training, and certification
o Policy analysis, economics, and law
o Basic, applied, and translational science
o Community and workforce development.
A second round of projects was announced in Oct. 2018.
- At the invitation of the Governor’s Office, Pew Charitable Trusts launched a substance use prevention and treatment initiative to develop recommendations for a treatment system that provides timely access to comprehensive, evidence-based, and sustainable care. That work was done at no cost to the state.
- Indiana Chamber of Commerce and its affiliate, the Wellness Council of Indiana, has developed the Indiana Workforce Recovery Initiative to help employers respond more effectively to the opioid crisis and to help persons in recovery reengage with the workforce.
- IHA and ISMA are developing Continuing Medical Education modules on topics related to substance use disorder.
- Numerous faith-based organizations have created volunteer recovery support groups. A Better Life – Brianna’s Hope, an organization based in Portland, Indiana, has formed 28 such groups – mostly, but not exclusively in churches around the state.
- Several communities and counties have begun developing and implementing local cross-sector coalitions – systems of care – focused on prevention, treatment and recovery. FSSA is supporting Recovery Oriented Systems of Care and has also established an Office of Social Determinants to enhance a more holistic approach to prevention, treatment and recovery.
Public Education and Stigma Reduction:
- FSSA launched Know the O Facts, a “humanizing” campaign designed to educate, inform, and reduce stigma. Tens of thousands of Hoosiers have been reached.
- The Governor’s Office developed and launched the Next Level Recovery website, in.gov/recovery, to provide a convenient, user-friendly source of information on prevention, treatment, and enforcement and to serve as a resource for those wanting information related to opioids.
- ISDH and ISP have held two Public Health/Public Safety conferences to foster understanding of the different perspectives common among public health and public safety professionals.
Governor Holcomb’s Agenda
Governor Eric J. Holcomb made attacking the drug epidemic one of the five pillars on his agenda. His first action in office was to create a position to tackle the drug crisis, appointing Jim McClelland as Indiana’s first Executive Director for Drug Prevention, Treatment and Enforcement, which is a cabinet position that reports directly to Governor Holcomb. Executive Director McClelland is carrying out the strategic approach he formulated after months of listening to the concerns of the community and researching best practices to overcome the crisis in Indiana.
2017 General Assembly Legislation
Establishes a pilot project to pay for OB/GYN doctors to be trained in prescribing drugs such as buprenorphine for medication-assisted treatment.
Limits prescriptions to first-time patients and children. Provides an option for patients to accept less pills than prescribed.
Sets up a pilot project to provide opioid treatment to pregnant women and mothers of newborns at three locations in Indiana: Indianapolis, Winchester and southern Indiana.
Creates a plan by 2018 to house and treat homeless Hoosiers who have a drug addiction, mental illness or combination of the two.
Supplies the framework for mobile treatment units to expand care in underserved parts of the state.
Develops a plan by January 1, 2018 to increase the number of inpatient and residential beds for detox and drug treatment in Indiana.
Allows municipalities to establish the syringe exchange programs without state approval.
Provides that Allen County may enter into an agreement with an entity to administer a residential substance abuse pilot program.
Requires prescribers to indicate when a patient has entered into a pain management agreement.
Audits the amount of money being spent to integrate INSPECT with electronic health record systems and asks a committee to study improvements to INSPECT.
Establishes a three year opioid treatment pilot program (pilot program) for opioid abuse disorder in Tippecanoe, Marion, and Wayne counties.
Ensures residences for residential care and supported housing for chronic addiction are certified and meet standards determined by the division of mental health and addiction.
Cures Act provides Indiana with federal funding.
The 21st Century Cures Act provides Indiana with $10.9 million in funding. Health and Human Services prioritized five specific strategies to combat the ongoing opioid crisis: strengthening public health surveillance, advancing the practice of pain management, improving access to treatment and recovery services, targeting availability and distribution of overdose-reversing drugs, and supporting cutting-edge research.