How Indiana is working to improve access to opioid treatment programs statewide?

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Douglas Huntsinger, Indiana’s Executive Director for Drug Prevention, Treatment, and Enforcement, advises Governor Eric J. Holcomb (R) on substance use policy, coordinates the Next level recovery initiative, and fine-tune the state’s response to the drug epidemic. Huntsinger is also chairman of the Indiana Commission to Combat Drug Abuse.

This interview has been edited for length and clarity.
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Douglas Huntsinger

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Q: Indiana recently expanded the number of opioid treatment programs, or OTPs, allowed in the state. That is no small feat. How do you determine where to find one?

A: A team made up of the Indiana Division of Mental Health and Addiction leadership and our office begins by reviewing a heat map showing drive times to our existing OTPs and identifying where there is a need for and a viable option for an OTP . We also look at the size of the existing clinics; we want to ensure that the facilities provide the optimal quality of care, and that some of our more populous urban areas have the opportunity to support more OTPs. Our goal is to place a treatment program within an hour’s drive of every Hoosier.

Q: What is the current situation?

A: Currently, the average drive is about 16.5 miles, and there are still underserved areas an hour or more from an OTP, especially in rural Indiana. Regulations limit the number of permits that can be issued to operate an OTP, so we need to be extremely conscious about the placement of these facilities. We use a public bidding process to award the licenses, ensuring fairness and transparency in the process.

Q: What are the most common state-level challenges when opening an OTP?

Stigma is the biggest challenge. We’ve seen it play on so many zoning venues; one community put a one-year moratorium on substance use treatment facilities when we called to schedule a community meeting. Other places have the “not in my backyard” mentality. Residents may think that a treatment center will lead to higher crime rates, homelessness and a drop in property values. Some people do not understand or believe that treating opioid use disorder (OLD) with medication is the right answer, or that addiction is a disease that needs to be treated.

Q: How do you overcome that?

We try to take a very collaborative approach when it comes to starting a new OTP. We meet our stakeholders [i.e., local officials, medical providers, funders] to explain the needs of the new facility and the process for opening, and the OTP provider explains how the facility will operate. We are happy to provide as much information as possible. For example, if we know who will be the provider in the community, we invite one of their representatives to attend the meeting with us. Once locations are identified, we share schedules or show photos of existing clinics to help communities understand that our healthcare providers want to be good neighbors and add value to communities.

But knowing when to walk away is important; you’re not going to win everyone over. So if a community is against an OTP, we can put the OTP in the next province. Indiana has 92 counties, so you don’t have to go far to get to another county. We want OTPs to be embraced by communities; we don’t want to create them in a hostile situation because that’s not good for anyone. Hopefully that community will come in time.

Q: Who were the most vocal groups when it came to expanding the number of OTPs?

A: The government agencies, including those more focused on law enforcement, have been supportive as we increase access to treatment. Sometimes our most outspoken opponents are lawmakers who fail to understand the plight of the most vulnerable in our communities. A person coming out of treatment and recovering will need housing, employment, and sometimes even identification information such as a driver’s license and birth certificate. We take many things for granted that become a hurdle for some people with OLD to overcome.

Q: Would these lawmakers say they represent their constituent positions?

A: Yes, I believe so. We also need to think about who writes their representatives. People who are in the midst of treatment do not contact their legislators about these issues. Often it is adversaries in the communities who do this.

Q: What arguments have you seen work best in addressing societal resistance?

A: It is very effective to bring people who have gained experience. A legislator cannot argue with anyone about their experience, although some disagree on the science behind medicine for OLD.

If we can help get opponents to OTPs to a point where they stop voicing their opposition, that’s a win. We’ve seen that in many communities; people may have concerns, but after the program opens, their concerns are not realized.

Q: And who do you think are the most effective and trusted messengers to talk to opponents of OTPs?

A: peers. “I’m from the state, I’m here to help” often falls on deaf ears. But conversations between mayors, for example, are effective because they face similar challenges, and another mayor vouches for a practitioner or some kind of treatment that goes well and works in their community — that just goes way above and beyond. The same goes for law enforcement: we will have law enforcement officers from communities with OTPs contacting communities considering an OTP directly to help dispel some of the myths and allay their concerns.

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