Governor Steve Bullock and public health leaders from around the state today announced that Montana has been bucking national trends with a decrease in the opioid overdose death rate since peaking in 2009 and presented new resources, information, and progress that is being made in the fight against prescription opioid abuse in Montana.
“There is simply too much at stake not to address the invisible epidemic that Montana – and much of the rest of the nation – faces,” Governor Bullock said. “In Montana, we refused to let the challenges be used as an excuse for inaction and have made significant progress in addressing opioid abuse and saving lives. This report confirms we’re on the right path and informs future steps as we continue to ensure that opioid use trends downward.”
As part of the event, Governor Bullock released a new report showing improvements in several key areas regarding the use of prescription opioids in Montana, including a decrease in the number and strength of opioids prescribed to patients over six years.
This newly-released report, called “Opioid Prescribing Practices in Montana, 2012-2017” is the result of a DPHHS partnership with the Montana Board of Pharmacy in 2018 to analyze data from the Montana Prescription Drug Registry (MPDR).
The key findings from the report indicate that between 2012 and 2017, there was a 4% overall decrease in the opioid prescription rates in Montana. The average daily dose of prescription opiates decreased by nearly 23% during this time. Additionally, the proportion of Montana residents prescribed high (≥90 morphine milliequivalents (MME) and very high (≥180 MME) doses decreased by 35% and 40%, respectively.
The report shows that Montana health care providers and health systems are working to find a balance between the appropriate prescribing of these medications, and ensuring their patients are receiving the care they need. State officials plan to utilize the data to routinely monitor opioid prescribing practices and trends in the state.
DPHHS State Medical Officer Dr. Greg Holzman is optimistic about the report results. He said it is important to view this data within the context of the overall goal of caring for patients with pain, decreasing the risk of misuse and addiction, and preventing overdose deaths.
“We need to make sure individuals who are addicted have access to treatment, individuals who are on high dose opioid are weaned slowly with compassion and care, and for those individuals on opioids where the benefit of the medication outweighs the risk, we want to make sure they use the medication in the safest way for themselves and their community,” Holzman said.
The use of naloxone to save lives:
Some of the key strategies to prevent overdose deaths in Montana include increasing access to care through Medicaid expansion, increasing access to evidence-based treatment services, and increasing the availability of naloxone – the opioid overdose reversal medication. This medication can help prevent an acute opioid overdose and can be administered to get an individual to an emergency room for more definitive care and on to substance use disorder treatment.
The state has had a Standing Order for naloxone since Governor Bullock signed legislation into law in 2017, meaning any Montanan can get the opioid reversal medication from their local participating pharmacy without a prescription. Since 2018, DPHHS has distributed 2,100 units of naloxone, with a majority of the units going to law enforcement and first responders around the state, and 419 individuals have been trained as master trainers on how to administer the life-saving drug.
Thus far in 2019, DPHHS records indicate that naloxone has been administered over 500 times in Montana by first responders.
Montana implements Medication Assisted Treatment (MAT):
In 2017, Montana launched the use of Medication-Assisted Treatment (MAT), which involves the use of medications, behavioral health, and peer support services and team coordinated care to treat substance use disorders and prevent opioid overdose effectively.
Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. MAT increases treatment retention, reduces relapse, improves social functioning, reduces transmission of infectious diseases such as hepatitis C and HIV, reduces criminal activity, and reduces overdose deaths.
Treatment services are currently available in Hardin, Ashland, Miles City, Helena, Missoula, Hamilton, Havre, and Polson.
As of August 2019, a total of 757 patients were offered MAT, behavioral health counseling, and recovering support services. Most patients were between ages 25 to 44.
Another important statewide effort has been to increase the number of practitioners to deliver MAT services. Practitioners are required to obtain a waiver to prescribe and dispense medications like buprenorphine, in settings other than opioid treatment programs. The Montana Primary Care Association has provided training throughout the state. At this time, Montana now has over 130 MAT providers. When this effort began in January 2017, Montana had just over 20 providers.
More drop off locations than ever before:
There is more prescription drop off locations today in Montana than ever before with over 165 boxes in 55 counties. This increase in the number of locations is a direct result of a grant announced by Governor Bullock in August 2018 to distribute collection boxes to local pharmacies. Dropbox locations can be found at this link: https://dphhs.mt.gov/amdd/substanceabuse/dropboxlocations
PSAs now airing; new educational resources available:
DPHHS worked with various partners to create TV Public Service Announcements about how to help Montanans who are struggling with addiction.
The PSAs are airing now and posted here: https://www.youtube.com/user/MontanaDPHHS
Additionally, 18 new educational videos are now available to the Montana medical community to be used for continuing medical education. The videos focus on how to reach special populations, law enforcement efforts, and information on Medicated Assisted Treatment, the Montana Prescription Drug Registry, and more.
Much of this work has been done under the framework of the Addressing Substance Use Disorder in Montana strategic plan that is still being implemented: https://dphhs.mt.gov/Portals/85/Documents/SUDStrategicPlan.pdf.