Battling the opioid epidemic

Nonopioid directive now available in Michigan

A patient consults with her doctor. In Michigan, a nonopioid directive recently became available as part of a new law that aims to address the opioid epidemic. Officials said the directive allows individuals to state they do not want to be treated with opioids by health care providers or emergency services personnel. The directive can be helpful for those who may be at risk for an opioid substance abuse disorder, relapse or overdose, officials said. The form is available online through the Michigan Department of Health and Human Services and interested parties should start by talking to their doctor about the directive, MDHHS officials said. (Photo courtesy of Bob Nichols, U.S. Department of Agriculture)

MARQUETTE — Opioid-related overdose deaths have increased by more than three times in Michigan since 2011, rising from 622 to over 2,000 deaths annually.

In response to this, a recent amendment to Michigan’s Public Health Code is aiming to address the opioid epidemic in Michigan in a number of ways, including making a nonopioid directive form available.

Through the nonopioid directive, individuals or their legal guardian can formally state that they do not want to be treated with opioids by healthcare professionals or emergency medical services personnel, as the nonopioid directive will be included in the person’s medical records once signed.

“This law helps ensure nonopioid options to pain management are considered in the medical treatment of Michigan patients,” said Dr. Debra Pinals, MDHHS medical director of Behavioral Health and Forensic Programs. “Providing this supportive tool for patients to notify their health professionals that they are seeking alternatives for pain treatment is critically important for those who are most at-risk of misusing opioids, including those with a history of an opioid disorder.”

Because “opioids are commonly prescribed without understanding the substance use disorder risk for patients,” it’s important to provide additional information and options for pain management, Pinals said in an email.

“Prevention is a key element of reducing the opioid epidemic,” Pinals said. “This will help change the focus on the treatment of pain to more than just writing opioid prescriptions. This is critically important for high-risk patients.”

For those who have struggled with substance use disorders involving opioids, the nonopioid directive can provide another tool to avoid relapse and/or overdose.

“We are encouraged to see that the state continues to take proactive steps to ensure the safe and responsible use of opioids,” Great Lakes Recovery Centers CEO Greg Toutant said. “Providing a mechanism to ensure the voice of clients to decline the use of opioids is another step in helping manage the overall utilization of opioids and reduce the over-use of opioids.”

It’s especially important for those with a history of substance abuse disorders to talk with a doctor about the directive and alternative pain management methods, Pinals said.

“Once an individual has had challenges with opioid use disorder, they are at risk for relapse with excessive or unmonitored use of opioids,” Pinals said. “Individuals that are on other medications, such as benzodiazepines, may have additional risks.”

For those who are interested in pursuing a nonopioid directive, Pinals recommends they start by talking to their health care provider.

“Patients can print the forms from the MDHHS website or ask their providers to print one. They should then take it to their medical provider, who will scan this into their electronic health records or place it in a paper medical record.”

Pinals advises patients to discuss their risk factors with their physicians to determine if a nonopioid directive could be appropriate for them.

“They should discuss the risks of opioids and if they are high risks for developing a substance use disorder or at risk of an overdose because of other medication they take,” Pinals said.

Overall, Pinals said the nonopioid directive is “another tool to address the opioid epidemic from a prevention perspective,” as MDHHS is “working to address the opioid epidemic with prevention, early intervention and treatment.”

It is important to note there are exceptions in the law about the directive, such as the provision that a “prescriber or a nurse under the order of a prescriber may administer an opioid if it is deemed medically necessary for treatment,” officials said.

Additional information, resources and a link to the directive form can be found under “Additional Resources” at the bottom of the “Find Help Page” on Michigan’s Opioid Addiction Resources website, which can be found at www.michigan.gov/opioids.


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