2020 OPIOID USE DISORDER AND TREATMENT NEEDS +777V 32 16 +860V Michigan Current 2.3 % Estimate ℞ Projection* of state residents have Opioid Use Disorder 156,024 120,362 0% |||| 5% patients patients without without access to treatment if existing access to ℞ ℞ treatment providers patients more treat 20,1804 patients 32,568 receiving 65,864 buprenorphine patients receiving buprenorphine state residents ℞ 13,218 patients receiving methadone 16,523 patients receiving methadone with Opioid Use Disorder total access to 45,780 patients with treatment 82,386 total patients with access to treatment ℞ *Projection assumes buprenorphine prescribers double their number of patients or the county adds 10 new prescribers if there are no active prescribers and opioid treatment programs operate at full capacity. Treatment Driving Time to Nearest ℞ 9,996 ℞ overdose total deaths; 29 per 100K (2016-2019) Buprenorphine: 8 minute state average 7,568 opioid-related overdose deaths; 22 per 100K (2016-2019) car 0 1 hr. ℞ 2% of the population speaks limited English; 3% of the population speaks Spanish; state Methadone: 1 hour, 42 minute ℞average 2% population of the speaks another language car 0 9 hr. ℞ 44 opioid ℞ 13,218 treatment programs (OTPs) with patients; 154 per 100K residents methadone Prescribers in Michigan, 2020 48,373 747 509 229 total prescribers in the state; 4% have a buprenorphine waiver ℞ active* buprenorphine prescribers with a active* buprenorphine prescribers with a active* buprenorphine prescribers with a (2% in 2018) 30-patient limit 100-patient limit 275-patient limit *An active prescriber is defined as the primary buprenorphine prescriber for at least one patient episode during the year. Strategies to Meet Demand for Treatment Increase prescribers: Adding 1,964 new waivered prescribers would more than double the active prescribers and fill 3% of the current treatment gap of 156,024 people, if new prescribers treat 2.6 patients each (the state average for 30-waivers). One potential source of new prescribers is the 370 inactive prescribers that already have a waiver to prescribe buprenorphine. Increase prescribers and treat more patients: Active prescribers would have to treat 6 times as many patients to fill the treatment gap. If active prescribers doubled their number of patients, adding 1,708 new waivered prescribers would fill 7% of the projected treatment gap of 120,362 people, if new prescribers treat 5.2 patients each (twice the state average for 30-waivers). Other promising strategies: Engage health plans and regional PIHP in prescriber outreach; expand medication for OUD (MOUD) in health centers, jails, prisons, EDs, hospitals, primary care, addiction treatment programs and SSPs, expand telehealth; coordinate with community partners and health workers; remove state regulatory barriers to MOUD prescribing; ensure pharmacies stock MOUD. SUMMARY OF METHODS See the methodological appendix for more details Data sources. We used 2016–19 county drug overdose death data (for people ages 12 and older) from all drugs and from opioids from the CDC WONDER Multiple Cause of Death data. Data on languages spoken are from the Agency for Healthcare Research and Quality's Social Determinants of Health database. Driving estimates show the estimated driving time from 2016 county population–weighted centroids (published by the Missouri Census Data Center) and DC ward centroids (estimated from DC block centroids from Open Data DC) to the nearest opioid treatment program (OTP) and buprenorphine-waivered prescriber from the Drug Enforcement Administration (DEA) Active Controlled Substances Act Registrants Database. Opioid use disorder (OUD) estimates. To estimate the demand for treatment, we calculated county OUD rates by averaging two estimates based on different methodological approaches. For the first, we started with substate estimates of past-year pain reliever use disorder (PUD) and heroin use for people 12 and older from the combined 2016 to 2018 National Survey on Drug Use and Health (NSDUH) substate data. We adjusted these estimates for recent trends and the share of people who have heroin use only but not PUD. We then used regression models to predict county-level rates as a function of explanatory variables that have an empirical relationship with OUD (Alzeer et al. 2017; Paulozzi et al. 2017). For the second OUD estimates, we multiplied the estimated NSDUH-based county estimates by a scalar representing the relationship between an NSDUH-based OUD rate, known to be biased downward, and a more accurate OUD rate based on a capture-recapture analysis of seven linked Massachusetts administrative databases (Barocas et al. 2018). We averaged these two estimates to compute county OUD rates and counts. Treatment capacity and gap estimates. To estimate buprenorphine treatment capacity, we drew on 2018 IQVIA Real-World Longitudinal Prescription data, analyzed and published by the RAND Corporation's Opioid Policy Tools and Information Center. These data contain information on active buprenorphine prescribers, defined as the primary buprenorphine prescriber for at least one patient episode during the year, and buprenorphine patients by prescriber county. We also use the Drug Enforcement Administration's Active Controlled Substances Act Registrants Database, which includes information on all prescribers with a waiver to prescribe buprenorphine and their patient limit (30, 100, or 275). We calculated a lower bound of county treatment capacity as the number of patients currently receiving any buprenorphine treatment in the past year plus the current number of methadone patients at OTPs. We computed an upper-bound estimate based on a projected increase if all buprenorphine prescribers doubled their number of patients, or if counties with no active prescribers added 10 new prescribers, and OTPs operated at full capacity, assuming they currently operate at 80 percent capacity. To compute the number of people with OUD who do not have access to buprenorphine or methadone treatment in their county, we subtracted the treatment capacity in each county from the estimated number of people with OUD, with separate estimates for low and high treatment capacity. We assumed that all people with OUD seek treatment. Strategies to meet demand for treatment. We computed the estimated number of additional 30-waivered buprenorphine prescribers needed per county to achieve capacity to fill the lower- and upper-bound estimates of the treatment gap, assuming new prescribers treat the estimated state average number of patients per 30-waivered prescriber for the lower bound and twice that for the upper bound. We present strategies to meet demand for treatment, showing a range using the lower and upper estimates of the treatment gap and the treatment capacity. In cases where the number of new prescribers needed would be more than double the number of current buprenorphine prescribers, we present an alternative, more feasible strategy of doubling the number of active prescribers or adding 10 new prescribers. In these cases, we present the share of the treatment gap that would be filled. Authors. Lisa Clemans-Cope, Douglas A. Wissoker, and Marni Epstein. Corresponding author: Lisa Clemans-Cope, lclemans@urban.org. This fact sheet builds on previous work for California in 2019. This report was written for Johns Hopkins Bloomberg School of Public Health, with funding from Bloomberg Philanthropies. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Further information on the Urban Institute's funding principles is available at urban.org/fundingprinciples. Copyright © July 2021. Urban Institute. 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