At the 2024 Hawaii State of Reform Health Policy Conference, health leaders met to discuss the state of the substance use crisis and how they’re ensuring every Hawaiian who needs services can receive them.
Heather Lusk, executive director of Hawaii Health and Harm Reduction Center, said research is showing a growing effectiveness of harm reduction efforts. The harm reduction center does not require individuals to be abstinent from any substances in order to receive treatment.
“We see about 90 percent [who are on] Medicaid,” Lusk said. “We are one of the main pathways into residential treatment.”
While the facility does not offer residential treatment, it connects those in need of residential treatment to resources. During the past year, one of the biggest lessons learned was regarding substance overdoses.
While fentanyl continues to circulate throughout the islands, Lusk said Act 68 has been helpful at getting naloxone—an opioid anticoagulant that works to reverse overdoses—into the hands of residents. Lusk said that over the past year, 50,000 doses were delivered statewide and 2,000 doses were used to reverse overdoses. Additionally, the state has 30 different machines that hold free naloxone.
“We’re seeing fentanyl in our methamphetamine to cause both opioid overdoses, but also chronic meth-related overdoses,” Lusk said.
A stark increase in substance use became visible during the COVID-19 pandemic, where there was an increase in individuals self-medicating. Lusk noted the State Plan on Substance Abuse.
“We have a roadmap, and part of this roadmap is seeing an increase in our public safety and public health collaborations,” Lusk said.
That roadmap includes plans to train law enforcement officers on substance use and de-escalation tactics.
“We cannot arrest our way out of the substance use crisis, and [for] that we need to have a balanced public health policy approach.”
— Lusk
Since the Hawaii Health and Harm Reduction Center opened in 2017, the facility has treated over 800 individuals for substance use disorder. One issue, however, pertains to reimbursement rates.
“The Medicaid reimbursement rates are not the same as commercial rates,” said Lusk, who added how she hopes to see parity with commercial reimbursement rates.
Kimberly Fuke, clinical director at Carelon Behavioral Health, said her scope of practice focuses on utilization management, including inpatient and residential withdrawal management. She spoke about Carelon as a nationwide health services company, and noted how many inpatient units rely on detox, which creates a high risk of relapse and accidental overdoses.
“In 2020, Carelon established an inpatient/outpatient transition model to start medications for opioid use disorder in the withdrawal period,” Fuke said.
She said this model is designed to engage patients undergoing medications for opioid use disorder, and to educate patients about available treatment options. She added that the model has led to better outcomes in care.
Fuke brought up in-home treatment approaches, which have been implemented in Carelon markets on the mainland. She said a trained mobile care team, including a care coordinator, among others, support the patient in their home during the withdrawal management process.
“This is to promote family education, participant education, knowing how to address and use Narcan, a treatment plan, and really promote integration into the community. This program is intended to be long-term,” Fuke said. “There are a lot of good models out there. The question is how they can be implemented or adapted. Hawaii is a very special market.”
Both panelists agreed that the state needs to find ways to utilize and increase peer support specialists with lived experiences. Lusk said peer support specialists can be there in ways that clinicians can’t when it comes to time and resources. It’s also less costly.
She’s excited about money that will be coming from the Opioid Settlement, and hopes to take substance use disorder support and resources into the streets.
“We have millions and millions of dollars that can build detox opportunities,” Lusk said.
Lusk thinks infusing funds into the existing continuum of care to expand services, and using funds to open more brick and mortar harm reduction locations, will support Hawaii as this substance use crisis rages on.