By Alison Knopf
Healthy Women, a group that has been active for 30 years, is expanding its work around policy and advocacy, and recently released a toolkit for female state legislators to use in getting support for legislation to address the opioid epidemic.
“The toolkit was designed as a way to get resources and insights to women legislators,” explained Michael D. Miller, MD, HealthyWomen’s senior policy advisor, in an interview with AT Forum. Healthy Women, joined by the Legal Action Center, presented the toolkit at the Women in Government conference in Washington in early October.
The toolkit is primarily for state, not federal, legislators. While the huge 660-page opioid package (H.R. 6) has been signed, there are still initiatives that need to take place on state levels.
“States are very different, and legislators are very different, and each have their own needs and areas of focus” said Dr. Miller. The toolkit gives a broad array of information, which is a useful reference piece, regardless of the state. Some states have much easier rules than others.
Legal Action Center
“We’ve seen states like Indiana—one of the states we identified—that changed their policies to allow the opening of new OTPs [opioid treatment programs],” said Gabrielle de la Gueronniere, director of policy for the Legal Action Center. The Center is working on an additional toolkit on state strategies, along with HealthyWomen. “It’s a matter of the patient community being really active, and also the provider community,” she said.
West Virginia and Indiana are two states that had moratoriums on new OTPs. In Indiana, the moratorium was lifted; in West Virginia, advances have been made as well.
A notable example of a state doing cutting-edge work is Vermont, which almost 10 years ago initiated the hub-and-spoke model, noted Ms. de la Gueronniere. The hubs are OTPs, which do all of the assessments and provide treatment with methadone (and other medications) for patients who need it in that setting. The spokes are buprenorphine prescribers. “When you look at the hub-and-spoke model and the role of OTPs, you see this is a real positive that helps people have better health outcomes,” she told AT Forum.
The focus is on medication-assisted treatment (MAT) for opioid addiction. “MAT has been shown to work—it’s the gold standard,” said Dr. Miller. This message, along with the fact that opioid use disorder is a disease, is a key point for legislators to get across. Legislators sometimes have an uphill battle when it comes to promoting legislation that supports MAT, and the toolkit is hoped to help.
“HealthyWomen’s perspective is to reduce barriers to access to treatment,” said Dr. Miller. “One way to do this is to help dispel the stigma.”
The problem—that many people (voters and legislators) think methadone and buprenorphine are “replacing one addiction with another”—can be combatted only with education and information. The toolkit will help to do that.
An example was the Medicare bill, included in the opioid package, which allows coverage for treatment with methadone in an OTP. When federal lawmakers heard that methadone was involved, some were confused. “They say, ‘We get it,’ but they didn’t really get it,” noted Dr. Miller. This is where the role of the Legal Action Center was essential. “It’s a great resource when it comes to looking at what states have done that works well,” he said. OTPs are a particularly good example of how to treat opioid use disorders.
Dr. Miller knows that if you’ve seen one state, you’ve seen one state. “While working at the National Governor’s Association I saw how each state is unique,” he said. “Every state has different challenges, in terms of drug issues infrastructure (such as OTPs), regulations, and of course politics.”
Part of the challenge is the terminology, said Dr. Miller. “People being treated with methadone are not addicts,” he said. “There is a clinical difference between dependence and addiction.” These facts are well known to OTPs, but not to most lawmakers. “We’re really trying to guide them,” he said. “People who have opioid use disorder have a disease. The word addiction shouldn’t be used except in a purely clinical sense, and not in public discussion of this disease.”
The Legal Action Center’s toolkit is expected to be released shortly, but is just awaiting final approval. In the meantime, the HealthyWomen toolkit is essential as well.
One of the reasons HealthyWomen got involved in this issue—and why Women in Government was interested – is that women are the primary health care decision makers, both in buying insurance and in care decisions, said Dr. Miller. “When it comes to an impact on the family member, it’s often the woman in the family who is responsible for the care,” he said. “They’re mothers, wives, sisters, aunts.” He recalled the old aphorism about the group that provides the more health care than any other. The answer is: “moms.”
Finally, Dr. Miller noted that the Centers for Medicare and Medicaid Services will be providing funding for states to develop demonstrations—small-scale projects testing out protocols—for treating pregnant women who have opioid use disorders. “This is the type of program/opportunity that Women in Government members might take advantage of, for improving OUD treatment and access in their states, since states will have to apply for this program/demonstration in partnership with a care-delivery organization.”
The opioid epidemic has many components and causes. To address it requires multiple approaches and collaborations. Each region, state, and community must consider its own situation in developing and implementing plans and actions. The HealthyWomen toolkit is intended to support these efforts; the toolkit is organized into the following sections:
For the toolkit, go to https://www.healthywomen.org/policy-center/legislator-toolkit