$5 million in federal grants not a lot to solve Michigan’s rural opioid crisis

As emergency room opioid overdose arrivals surge amid COVID-19, federal officials announced $5 million in additional grants last week for rural Michigan that advocates say barely scratch the surface of what’s needed in areas starved for access to treatment.

“It’s good to see we are trying to address this,” said Marianne Huff, CEO of the Mental Health Association in Michigan.

“But that’s not a lot of money. That won’t go very far at all. We have rural counties that might have one or no substance use provider. Then people have to go to a nearby county for treatment,” Huff said.

“It’s a huge issue.”

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Part of $102 million in grants nationwide, the Michigan funds are split among five $1 million grant recipients, including the Michigan Center for Rural Health. The funds will add to treatment supports in 16 rural counties in the northern Lower Peninsula.

The $5 million in rural grants come on top of larger federal opioid grants awarded earlier, including $17.5 million in funds announced in January to respond to the opioid epidemic in both rural and urban areas, by supporting medications to treat opioid disorder and to reverse opioid overdoses and expand community-based treatment. 

In September, federal officials announced $35 million in grants for Michigan including $7 million to better track opioid overdose deaths and $28 million to support medication-assisted treatment and recovery programs.

The other $1 million in rural grants will go to a hospital in Lenawee County in southern Michigan, two county health departments and Ferris State University.

While John Barnas, executive director of the Center for Rural Health, agreed with Huff’s assessment on the scope of rural funding grants, he put a more positive spin on the funding.

“It’s not a lot of money,” Barnas said. “But one thing we learn is that people in rural Michigan can take a buck a long ways.”

As Bridge has reported, there are sobering indications a resurgence of the opioid crisis is underway in Michigan, perhaps driven by months of social isolation caused by the pandemic.

In May, Michigan emergency room visits related to opioid overdoses surged 42 percent over the numbers in April — from 439 to 625, according to the Michigan Department of Health and Human Services.

From April through June, EMS runs for probable overdoses were 26 percent higher than in the same period in 2019. This increase occurred even as overall emergency runs fell in Michigan as people were afraid to enter hospitals during a pandemic.

Before the pandemic hit, Michigan’s opioid crisis seemed to finally have crested, as Michigan’s Department of Health and Human Services last year reported a slight decline in overdose deaths, from 2,686 deaths in 2017 to 2,599 in 2018.

But medical examiners representing more than a dozen Michigan counties told Bridge in July they are seeing an uptick in opioid-related deaths in early data. That squares with trends cited by the American Medical Association, which reports more than 35 states are reporting increases in opioid-related mortality.

A dozen counties on Michigan’s western edge recorded 149 opioids-related deaths this year as of late July. At the same time last year, there were 94, according to medical examiner Dr. Joyce deJong.

In five counties around Lansing, preliminary data suggest about 50 deaths in April, May and June are associated with opioid use, compared to roughly 30 over the previous 10 quarters, according to Dr. Michael Markey, medical examiner for those counties.

Well before COVID-19, it was clear much of rural Michigan lagged far behind the rest of the state in access to mental health care and substance abuse treatment.

A 2018 public health survey found the Upper Peninsula had just eight psychiatrists – and two child psychiatrists - to serve 300,000 people in an area twice the size of Massachusetts. That’s about one-third the ratio for the entire state. Seven of 15 U.P. counties have no psychiatrist.

Moreover, a 2019 analysis found that 16 rural counties do not have a substance use disorder treatment facility, and seven rural counties lack the trifecta of a psychologist, psychiatrist and substance abuse facility.

That shortage parallels broader mental health care gaps across rural Michigan, which has the lowest percentage of all types of mental health workers in the state.

In Presque Isle County in the northeast corner of the Lower Peninsula, there were 4,260 persons in 2018 to every behavioral health worker – a category that includes psychiatrists, psychologists, licensed social workers, counselors, marriage and family therapists and substance abuse providers. That’s 10 times higher than the state average of 400 persons per behavioral health worker.

Adding to the mental health challenges, many rural counties already suffer a disproportionately high suicide rate. More than one study has tied suicide to economic despair, which can also be factor in opioid abuse.

In the economic recovery that preceded the pandemic and continued into 2019,  parts of the U.P. and northern Lower Peninsula Rural Michigan posted unemployment rates nearly double the state average.

Joyce Fetrow, a project manager for the Michigan Center for Rural Health, warned that the risks to opioid overdose in rural Michigan may continue to rise.

She said that may be due in part to the closing for months of substance abuse therapy groups, which she said are “a lifeline” to many people.

“There is an opioid crisis, but there is also a death and overdose crisis. We are losing people. We are losing generations of people.”