FSSA- Secretary Dr. Jennifer Walthall’s remarks on Indiana’s five new opioid treatment programs (OTPs) July 5, 2017
We recognize that substance use disorders are chronic disorders of the brain. We believe that it is essential to work to reduce the “shame” and stigma associated with substance use disorders. We strive to ensure that substance use disorders and other mental illnesses are covered and reimbursed appropriately. We acknowledge that most people (50-90%) with substance use disorders also experience co-occurring mental health problems. Thus, we see a need to promote treatment that takes into account both kinds of disorders. It is our belief that treatment for substance use disorders should utilize evidence-based methodologies including both medication and psychosocial interventions. Indiana’s Family and Social Services Administration works to promote increased access to and education about overdose reversal medications like naloxone for first responders, families, and persons with substance use disorder. Finally, we realize the need to grow Indiana’s treatment and recovery workforce through education and training. Therefore, we are excited to announce the addition of five Opioid Treatment Programs in Indiana authorized under Indiana Code 12-23-18-5.5. The five new OTPs have been strategically placed in locations around our state to assist with reducing driving time for individuals in need of addiction treatment for opioid use disorder and sited in or near counties with high numbers of naloxone use –the overdose reversal drug used by emergency responders. Counties include: Allen, Johnson, Monroe, Vigo and Tippecanoe. We believe that the new OTPs will allow increased access to multiple medications as part of Medication Assisted Treatment (MAT) programming and reduce use of illicit substances moving individuals toward long term recovery. Allen County – Bowen Center The Otis R. Bowen Center for Human Services, Inc. is nearing its 60th year of serving the community. Governor Bowen permitted the Center to use his name since he lived and practiced medicine in Bremen, which is in one of the counties that Bowen Center serves. Bowen Center served approximately 4,387 individuals with substance use disorder this past year and will be the license holder for the new Allen County Opioid Treatment Program (OTP) location. Bowen Center has had a clinical presence and offices in Allen County for 20 years and is a major provider of mental health and substance use services in that county. For the past 18 months, Bowen Center has had an active and robust Medication Assisted Treatment (MAT) program serving approximately 300 individuals. As the safety net provider for mental health and substance use service, the majority of Bowen Center’s clients are on Medicaid. However, Bowen Center also serves individuals with commercial insurance or no insurance at all. Since Bowen Center believes that early intervention is very important, almost half of the total number of clients served are youth. This results from being present in almost every school system in the 10 counties, having a very ambitious Student Assistance Program (SAP), and being a major provider of service to DCS clients, probation clients and gladly serve persons on the Autism Spectrum. Bowen Center also serves adults, with a strong emphasis on community based services to the chronically/persistently/severely mentally ill. Vigo County – Hamilton Center Hamilton Center is a regional behavioral health system in central and west central Indiana. Hamilton Center provides the full continuum of behavioral health and addiction treatment serving people throughout the lifespan. 13,000 clients are served a year by 550 staff including psychiatrists, nurse practitioners, psychologists, Licensed Clinical Social Workers and others. In addition to behavioral health, the organization provides primary health services in Vigo County, Terre Haute IN and is working to become an Integrated Care Entity recognized by the State of Indiana. The organization also partners with a variety of organizations to address consumer health/needs including schools, the criminal justice system, federally qualified health centers, the Department of Child Services, supportive housing and sober living organizations. Hamilton Center currently operates several programs which will complement the OTP including, residential services for those with a dual diagnosis, a diversion program for offenders, Recovery Works services, among others. Monroe and Tippecanoe Counties – Sycamore Springs Sycamore Springs is a 48-bed behavioral hospital located in Lafayette Indiana. The hospital, which opened in January 2012, is a regional leader in mental health and chemical dependency care. Sycamore Springs specializes in treating adults suffering from drug/alcohol dependency, mental health issues and co-occurring disorders. The hospital also offers quality assessment and treatment services for seniors. As part of its continued focus on the continuum of clinical behavioral health care, Sycamore Springs will be opening two outpatient Opioid Treatment Programs (OTP). These two innovative clinical programs will be located in Lafayette and Bloomington and will be named ‘Limestone Health.’ The new OTPs will feature a patient focused environment that offers immediate access to MAT services, therapy, and related addiction support services. Johnson County – Valle Vista In operation for over 30 years, Valle Vista Health System is a 132-bed facility located in Greenwood, Indiana. Ninety-eight beds are dedicated to providing acute mental health and addiction services, while 34 beds serve adolescent girls in our Residential Treatment Program. Since its inception, Valle Vista has been providing Medication Assisted Treatment for those seeking recovery. They offer a spectrum of addiction treatment programs, including Inpatient Detox, Partial Hospitalization, and Intensive Outpatient Treatment. In the upcoming months, Valle Vista is slated to also open an Ambulatory Detox Program to further facilitate long-term recovery. Valle Vista provides services to individuals both inside and outside of Johnson County. As an established substance abuse treatment provider, Valle Vista works tirelessly to promote community integration and acceptance of Medication Assisted Treatment. Valle Vista provides a wide variety of treatment options, working to identify the most appropriate option for individuals who present for treatment. Valle Vista continually seeks to build community partnerships and educate the public about viable treatment options, including Medication Assisted Treatment. The facility hosts a monthly Food for Thought event, providing continuing education opportunities to individuals in the community. Valle Vista is an active participant in several judicial systems in central and southern Indiana. These courts include various problem-solving courts, with a special emphasis on veterans and chemical dependency. Valle Vista is an active participant in the Recovery Works program and has developed plans, policies, and procedures that have been utilized with several probation departments in various counties. This facility is committed to expanding services to meet the ever-growing need for addiction treatment, and they believe that an Opioid Treatment Program is the next logical step in expanding our existing services. Methadone Policy Change Additionally, we are proud to announce an important policy change in medication assisted treatment through Indiana Medicaid. Effective August 1, 2017 – Most Indiana Medicaid members, including all Healthy Indiana Plan members, will have coverage for all services provided in an opioid treatment program (OTP), including coverage of methadone for opioid use disorder. Methadone is one of three FDAapproved medications for treating opioid use disorder. Indiana Medicaid has had coverage for buprenorphine/naloxone (Suboxone) and injectable naltrexone (Vivitrol). To date, Indiana Medicaid has not reimbursed for medication assisted treatment using the agent methadone. Access to care has been a significant barrier as this medication can only be dispensed at a certified opioid treatment program (OTP), the vast majority of whom have not participated in the Medicaid program. Studies have shown that patients receiving methadone are more likely to remain in treatment and to reduce opioid use compared with placebo or nonmedication treatment. Methadone treatment has been associated with reductions in the spread of HIV and with reduced criminal behavior. Thanks to work of the Indiana General Assembly, FSSA is confident that we can increase access to this service for Hoosiers across the State of Indiana. Senate Enrolled Act 464, passed during the 2015 session of the Indiana General Assembly, authorized DMHA to promulgate rules and add 5 new OTPs to combat the opioid epidemic. Senate Enrolled Act 297, passed during the 2016 session of the Indiana General Assembly, requires all OTPs to participate in the Medicaid program by July 1, 2017 as a condition of operating in the State of Indiana. FSSA does not prefer one medication over another, thus adding methadone maintenance treatment as a covered services gives physicians another treatment option for patients struggling with addiction. We firmly believe that any treatment plan including medication assisted treatment should be accompanied by counseling and support services. This is why we are confident in our decision to cover methadone maintenance treatment. OTPs do not simply dispense medication; they provide patient evaluation, counseling, and support programs as part of their treatment model. We are encouraged that expanding substance abuse services to include services provided by OTPs will help connect countless Hoosiers with treatment and become healthy and productive members of their community. This is how we combat an opiate epidemic – by putting people first and embracing the integration of science, data, and compassion as we make policy decisions that benefit Indiana. Thank you for being part of the solution with us to assist our fellow Hoosiers in the path to recovery.