Every day, more than 130 people die in the United States as a result of opioid overdose. The opioid abuse epidemic has become a national public health crisis with devastating economic, societal and human costs.
People with mental illnesses served in the public mental health system have significant rates of Opioid Use Disorder (OUD). In fact, mental illness is a risk factor for OUD and adverse outcomes, including overdose. And while some patients in the public mental health system with co-occurring OUD may express interest in receiving treatment, they may experience difficulty going to treatment at an additional clinic setting. Evidence shows that integrated treatment, or “one‐stop shopping”, improves outcomes for people with mental illness and OUD.
Medication-Assisted Treatment (MAT) is the use of FDA-approved medications, such as long-acting naltrexone (Vivitrol), buprenorphine (Suboxone) or methadone, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders.
At the NYS Office of Mental Health, our goal is to ensure that people living with mental illness as well as opioid use disorder get the help they need on their road to recovery. We are working with our providers statewide to enhance the capacity of the 486 licensed mental health clinics to respond to the opioid epidemic. Clinics are required to participate in educational webinars and to adopt new best practices, including:
- Implement and use validated, standardized, opioid-specific screening tools for all new patients at intake.
- Prescribe or dispense naloxone to all individuals with opioid use disorder and others identified as having risk of opioid overdose. Provide education on how to use naloxone to patient, friends, and family.
- Improve referral process for individuals who need more specialized addiction treatment by developing relationships with specialized substance use programs, scheduling appointments within two weeks of identification and following up to make sure appointments were kept.
- Increase the number of buprenorphine-waivered physicians and nurse practitioners on clinic staff.
- Provide MAT induction and maintenance services for OUD at the clinic
We have also made enhancements to PSYCKES, a web-based platform developed by OMH to improve clinical decision-making and quality improvement. PSYCKES allows clinicians to identify their patients with increased opioid overdose risk, including those with a history of opioid overdose and those co-prescribed opioids and benzodiazepines. In addition, PSYCKES can identify patient history of OUD diagnoses and level of engagement in counseling and medication services.
OMH is also working within its state-operated clinic and residence programs to stock naloxone kits. Non-medical staff such as social workers, mental health therapy aides and psychologists are being trained to become Overdose Prevention Responders so that they can administer potentially-life saving naloxone in an overdose emergency. We are also developing protocols to equip our safety officers to carry naloxone on their person and cars as they patrol our campuses. So far, over two thousand staff members have been trained throughout our residences and clinics.
Another step we have taken to battle to opioid epidemic is to enhance OUD resources and training available through our Center for Practice Innovations (CPI), a collaboration between OMHs New York State Psychiatric Institute and Columbia University to support training and implementation on evidence-based practices statewide. In addition to disseminating resources on OUD, CPI launched in 2009 its Focus on Integrated Treatment (FIT) to offer training and implementation supports for providers to enhance their ability to offer integrated treatment. As of October 2019, over 32 thousand people completed more than 376 thousand online integrated treatment education modules. Nearly five thousand people earned CPI’s Integrated Mental Health and Addictions Treatment Training Certificate.
Under the leadership of Governor Cuomo, New York has also enacted new laws that prohibit insurers from requiring prior authorization to receive medication-assisted treatment for substance use disorders. Another measure limits patient co-payments for outpatient mental health services and substance use disorder treatment to the equivalent cost of a primary care visit.
New York is also fighting the opioid epidemic by ensuring that people have access to treatment services. Last year, Governor Cuomo and members of the State Legislature created the Community Health Access to Addiction and Mental Healthcare Project (CHAMP) an ombudsman program developed in partnership with the Community Service Society, the New York State Council for Community Behavioral Healthcare, The Legal Aid Society, the Medicare Rights Center, and the Legal Action Center.
CHAMP assists individuals and families in obtaining their legal rights to insurance coverage, helps them to access treatment and services, and resolve complaints regarding denial of health insurance coverage.
OMH is working closely with other state agencies, especially the Office of Addiction Services and Supports and the Department of Health, and with many other stakeholders to provide strategies and resources to help health care providers, communities, and local governments develop practices and policies to help treat opioid addiction and prevent opioid-related overdoses and deaths. Our goal is to ensure that people living with mental illness as well as opioid use disorder get the help they need on their road to recovery.