How Indiana Is Working to Improve Access to Opioid Treatment Programs Across the State

Douglas Huntsinger, the executive director for drug prevention, treatment, and enforcement for the state of Indiana, advises Governor Eric J. Holcomb (R) on substance use policy, coordinates the Next Level Recovery initiative, and aligns the state’s response to the drug epidemic. Huntsinger also serves as chairman of the Indiana Commission to Combat Drug Abuse.

This interview has been edited for length and clarity.

Courtesy of Douglas Huntsinger

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

A: A team comprising leadership from the Indiana Division of Mental Health and Addiction and our office starts by looking at a heat map that shows the drive times to our existing OTPs and identifies where there’s a need and a viable option for an OTP. We also look at the size of the existing clinics; we want to ensure that facilities are sized for the optimal quality of care, and some of our more populated urban areas have the ability to support more OTPs. Our goal is to place a treatment program within an hour’s drive of every Hoosier.

Q: What’s the current situation?

A: Currently, the average drive is around 16.5 miles, and there are still underserved areas an hour away or longer from an OTP—especially in rural Indiana. Regulations limit how many licenses can be issued to operate an OTP, so we must be extremely deliberate about the placement of these facilities. We use a public bid process to award the licenses, which ensures fairness and transparency in the process. 

Q: What are the most common challenges at the state level in opening an OTP?

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

Q: How do you overcome that?

We try to take a highly collaborative approach when it comes to starting a new OTP. We meet with 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 like to provide as much information as possible. For example, if we know who the provider will be in the community, we invite one of their representatives to attend the meeting with us. If locations have been identified, we share schematics or show pictures of existing clinics to help communities understand that our providers want to be good neighbors and bring value to communities.

But knowing when to walk away is important; you’re not going to win everybody over. So, if a community is opposed to an OTP, we can put the OTP in the next county over. Indiana has 92 counties, so you don’t have to go very far to end up in 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 anybody. Hopefully over time that community will come around.

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

A: The state agencies, including those who are more law enforcement-minded, were supportive because we’re increasing access to treatment. Sometimes our most vocal opponents are legislators who may not understand the plight of those who are most vulnerable in our communities. Someone coming out of treatment and entering into recovery needs housing, employment, and sometimes even identifying information like a driver’s license and birth certificate. We take many things for granted that become hurdles for some people with OUD to overcome.

Q: Would these legislators say they’re representing their constituent views?

A: Yes, I believe so. We also have to consider who writes to their representatives. People who are in the middle of treatment aren’t contacting their legislator on these issues. Oftentimes, it’s opponents in the communities who are doing that.

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

A: It’s very effective to bring people along who have lived experience. A legislator can’t argue with someone about their experience, though some have disagreed about the science behind medications for OUD.

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

Q: And who would you say 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 having another mayor vouch for a treatment provider or a type of treatment that is going well and working in their community—that just goes far and above. Likewise with law enforcement: We’ll have law enforcement officials from communities that have OTPs reach out directly to communities that are considering an OTP to help dispel some of the myths and to address their concerns.