October 17, 2018; Bridge Michigan

Michigan’s Department of Licensing and Regulatory Affairs, or LARA, has proposed new rules for opioid clinics that threaten to shut or reduce the work of facilities across the state, according to several clinic directors.

LARA’s Bureau of Community and Health Systems director Larry Horvath told Bridge Magazine that “the proposed regulations were developed over months with widespread input from substance abuse officials and agencies,” though we note that doctors are not on this list. LARA also came under fire this summer, when Michigan passed new laws regulating opioid prescription that created administrative headaches for doctors.

One change that most directly threatens clinics’ ability to operate is the requirement to have a medical staff person like a doctor or a physician’s assistant on site 24 hours a day. Many clinic offer what’s known as “social detoxification,” which the Colorado Health Partnership defines as follows:

“Social detoxification” is a detoxification program delivered in an organized, residential, non-medical setting. Services are administered by appropriately trained personnel who provide 24-hour monitoring, observation, and support in a supervised environment for a client to achieve initial recovery from the effects of alcohol or another drug. Social detoxification is characterized by its emphasis on peer and social support, and it provides care for clients whose intoxication or withdrawal signs and symptoms are sufficiently severe to require 24-hour structure and support, but the full resources of a medically monitored inpatient detoxification are not necessary.

Jason Schwartz, clinical director at Dawn Farm, said that adding round-the-clock medical personnel would cost $400,000, or half of his annual budget for serving 600 people. “One way or another, we would have to cut service,” he said. Other officials say the requirement could lead to the layoff of up to 1,400 treatment staff in Michigan.

Sam Price, CEO of a Midland-based treatment network, said, “Our doctor is on call. Our nurse is on call. If we have a situation where a person who is medically compromised, we are on the phone with them. We have had very good outcomes doing it this way for over 10 years.”

The requirement doesn’t address the difficulty of finding the doctors. Bridge Magazine reported just a couple of weeks ago that Michigan has a shortage of doctors certified to prescribe buprenorphine, a drug that is used to combat withdrawal and help patients wean themselves off opioids. Some areas of Michigan have a shortage of doctors, period, whether buprenorphine-certified or not. Reporter Ted Roelofs was unable to find a single emergency room in the state that prescribed the drug. Naloxone, the drug used to reverse an overdose and save someone’s life, doesn’t require a doctor; it can be obtained through a pharmacy without a prescription and administered by almost anyone.

Staff would also be eliminated by other proposed requirements, such as that all treatment workers be certified (perhaps a reasonable expectation) or have a master’s degree in social work (a more extreme requirement). Kristie Schmiege, chair of the Michigan Certification Board of Addiction Professionals, said this requirement would eliminate another 1,400 workers and, due to the rising rate of opioid deaths in Michigan, “The best thing to do is certainly not eliminate significant numbers of people in the substance abuse workforce.”

Structurally, the regulations punish those suffering from addiction; they include requirements that would restrict counseling from recovered addicts, which is often the most effective avenue for help, and a standard search of clients when they come through the doors.

“This program is an extension of the healthcare system, not the correctional system,” said Price. “To incorporate such a protocol would convey a repeated message of mistrust and reinforce criminogenic thinking patterns that the program is trying to address.”

The imposition of burdensome regulations that makes it difficult to operate a center recalls the regulations imposed upon abortion clinics in many states. Though states cannot legally forbid abortion, they can make it difficult for clinics and doctors to offer the procedure, effectively eliminating the option for most women. Requiring abortion providers to have hospital privileges or direct relationships with nearby hospitals is marketed as a safety measure for women but is in fact an additional hurdle for clinic operation.

Several experts said they were confused why these regulations on opioid clinics would be imposed, considering the crisis faced by the state.—Erin Rubin