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Doctor Day 2018 has been set for Tuesday, January 30. The event will again be held at the Monona Terrace in Madison and is hosted by over 20 medical societies.
The event provides physicians an opportunity to meet with their legislators, and have input on important health care issues. The day will conclude with a reception in downtown Madison.
Registration is available online (link).
Kim Krisberg
Confronting an opioid overdose epidemic that kills nearly 100 Americans every day takes a combination of interventions across sectors. But a common thread throughout, says Andrew Kolodny, MD, should be viewing the problem not as an epidemic of abuse, but as an epidemic of addiction.
Jennifer Stepp and her daughter, Audrey, 8, hand out trainer boxes of a Naloxone auto-injector that can help with opioid overdoses after a November 2015 training class in Louisville, Kentucky. As the number of Americans with opioid addictions has grown, CDC has created new tools that support prevention.
“If you refer to it as an abuse problem, it leads people to believe the problem is a lot of folks behaving badly and abusing drugs,” said Kolodny, co-director of opioid policy research at Brandeis University. “But that’s not at all what’s going on. The majority of deaths happen in people suffering from opioid addiction — these are people who aren’t taking opioids for fun but to avoid feeling the agonizing pain of withdrawal.”
In fact, Kolodny sees the opioid addiction crisis as similar to a disease outbreak — “you have to contain the outbreak by preventing new people from becoming infected and make sure everyone already infected gets the best possible care so they don’t die from infection,” he told The Nation’s Health.
Preventing further “infection,” or new cases of opioid addiction, he said, boils down to one overarching strategy: more cautious prescribing.
“For a while now, CDC has been pointing out that the rise in deaths has corresponded with a rise in prescribing,”said Kolodny, who also serves as executive director of Physicians for Responsible Opioid Prescribing. “And now we see much greater recognition that it’s overprescribing that’s driving this epidemic.”
The Centers for Disease Control and Prevention reports that drug and opioid-related overdose deaths keep rising in the U.S., with rates up among men and women and among all racial and age groups. In the U.S., more than three of every five drug overdoses involve an opioid, with overdose deaths due to both prescription opioids and heroin quadrupling since 1999. According to data published last year in CDC’s Morbidity and Mortality Weekly Report, opioid-related overdose deaths increased by 14 percent between 2013 and 2014, including a sharp increase in deaths associated with the synthetic opioid fentanyl. Such findings, the researchers wrote, “indicate that the opioid overdose epidemic is worsening.”
CDC guidelines tell clinicians to discuss the risks of opioids when prescribing them, and to start patients on the lowest dose.
At public health departments nationwide, prevention is guiding work to stem the overdose epidemic, with efforts focused on both avoiding addiction in the first place and preventing fatal overdoses in people already addicted. On the addiction side, changing the way medical professionals prescribe highly addictive opioid painkillers is a key intervention point, with CDC releasing its “Guideline for Prescribing Opioids for Chronic Pain” in 2016. Noting that opioid prescriptions went up 7.3 percent per capita from 2007 to 2012, the evidence-based guidelines recommend prescribers consider nonpharmacologic and nonopioid therapy for chronic pain, concluding the “clinical evidence review found insufficient evidence to determine whether pain relief is sustained and whether function or quality of life improves with long-term opioid therapy.”
The guidelines recommend prescribers fully discuss the risks and benefits of opioids with patients, start patients on the lowest effective dose if opioids are needed and assess a patient’s risk of opioid-related harm, among other measures. In an article accompanying the new guidelines and published in the Journal of the American Medical Association, researchers with CDC’s National Center for Injury Prevention and Control concluded that “of primary importance, nonopioid therapy is preferred for treatment of chronic pain.” Kolodny said the CDC guidelines marked a substantial shift in how to address the role of prescribing in rising opioid addiction.
Since their release last year, the CDC guidelines have become a frontline tool in public health efforts to stem opioid addiction and overdose risk. Also on the frontline are prescription drug monitoring systems, which are often administered by health departments and allow prescribers to view a patient’s prescription drug history. In fact, the CDC guidelines recommend prescribers use such systems when prescribing opioids. The systems, which can serve as an early warning of addiction and risky drug behaviors as well as highlight signs of drug sharing, operate in every state and Washington, D.C., except Missouri, though the state’s legislature was considering a bill to create such a system earlier this year.
Research finds that prescription drug monitoring programs can impact opioid prescribing. For example, a 2015 report prepared for the Kentucky Cabinet for Health and Family Services found that since the state began requiring prescribers to register with and use such systems in 2012, opioid prescriptions have decreased with no negative impact on patients who need opioids for chronic cancer pain. Findings from Pennsylvania’s monitoring system, which began in 2016, showed that doctor-shopping, in which patients visit multiple doctors to procure medications, fell by 94 percent.
“Prescription drug monitoring systems have emerged as a very useful tool (in confronting the opioid epidemic),” said Peter Kreiner, PhD, principal investigator of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, which assists local officials in implementing and enhancing their monitoring systems. “And because they’re run at the state level, it fosters a lot of innovation and allow states to specifically respond to what’s happening in their own communities.”
Besides shifting prescribing practices, Kreiner said monitoring system data also let public health practitioners track trends and patterns over time, which helps officials know where and when to deploy proactive prevention efforts. For instance, he said, the data can reveal areas of a state where providers need more education on the latest prescribing guidelines or communities where expanded access to naloxone could stem fatal overdose rates. Naloxone is a prescription medicine that can reverse an overdose.
Kreiner said work is underway in many states to make the systems easier for prescribers to use, such as connecting the data to electronic health records and generating daily opioid dosages across a patient’s multiple prescriptions. He also noted that in communities without access to addiction treatment services, monitoring systems data may be particularly useful in identifying patients who need greater engagement with their medical providers.
“These programs are a major public health asset,” Kreiner told The Nation’s Health.
In addition to better linking public health and physicians, the monitoring systems also connect public health to pharmacists. Heather Free, PharmD, a practicing pharmacist in Washington, D.C., and spokesperson for the American Pharmacists Association, emphasized that the systems are not for “policing” patients, but for identifying those who need help. The data, she said, alert her to patients who need more information on nonopioid therapies and those who should have naloxone on hand as a precaution.
Free noted that many states allow pharmacies to have a standing order to dispense naloxone, which is nonaddictive, as part of efforts to reduce fatal overdoses. Pharmacists can also help with the diversion of opioids for nonmedical use, such as partnering with law enforcement to install secure take-back boxes outside of pharmacies. Free said she recently began dispensing a new tool to prevent diversion: a small, biodegradable bag that neutralizes painkillers’ active ingredients when water is added and allows for the safe disposal of opioid medication at home.
Of course, because the opioid epidemic is such a complex problem, one of public health’s greatest tools is its expertise in convening multisector solutions. In 2016, the Los Angeles County Department of Public Health helped convene and launch Safe Med LA, a cross-sector coalition that includes local health and law enforcement agencies, health insurers and health care providers and organizations. An overarching mission of the coalition is to carry out the public health agency’s five-year plan to reduce prescription drug overdose deaths by 20 percent by 2020.
Gary Tsai, MD, medical officer and science officer in the agency’s Substance Abuse Prevention and Control program, said Safe Med LA allows for a more coordinated response to the problem.
“One of public health’s real strengths is seeing things from a population perspective,” he said. “So when we have complicated problems like this, we know the solutions needs to be similarly sophisticated.”
For more information, including links to opioid-related prevention tools, visit www.cdc.gov/drugoverdose/epidemic.
NIDAMED has just updated its webpage, streamlining the content into categories such as, For Your Practice, Health Professions Education, and Patient Resources.
Content incudes resources on:
Please encourage your members to visit the updated webpage and browse for resources to help them fight drug abuse and addiction—and ultimately improve individual, community, and public health.
If you have suggestions for improvements to the NIDAMED webpage, please contact the NIDAMED coordinator, Michelle Corbin: michelle.corbin@nih.gov.
Kind regards,
As a partner working to fight opioid and heroin abuse, Senator Baldwin wanted to make sure you were aware of new federal grant funding for critical treatment initiatives to help address this epidemic:
Improving Access to Overdose Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is accepting applications for fiscal year (FY) 2017 Improving Access to Overdose Treatment (Short Title: OD Treatment Access). SAMHSA will award OD Treatment Access funds to a Federally Qualified Health Center (FQHC), Opioid Treatment Program, or practitioner who has a waiver to prescribe buprenorphine to expand access to Food and Drug Administration (FDA)-approved drugs or devices for emergency treatment of known or suspected opioid overdose. The grantee will partner with other prescribers at the community level to develop best practices for prescribing and co-prescribing FDA-approved overdose reversal drugs. Click here for more information regarding OD Treatment Access grants and note applications are due by July 31, 2017.
Rural Health Opioid Program
The Health Resources and Services Administration is currently accepting applications for the Rural Health Opioid Program (RHOP), which seeks to promote rural health care services outreach by expanding the delivery of opioid related health care services to rural communities. The program will reduce the morbidity and mortality related to opioid overdoses in rural communities through the development of broad community consortiums to prepare individuals with opioid-use disorder (OUD) to start treatment, implement care coordination practices to organize patient care activities, and support individuals in recovery through the enhancement of behavioral counselling and peer support activities. The program supports three years of funding. Click here for more information regarding the Rural Health Opioid Program and note applications are due by July 21, 2017.
First Responders – Comprehensive Addiction and Recovery Act Cooperative Agreement
The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is now accepting applications for fiscal year (FY) 2017 First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Cooperative Agreements. The purpose of this program is to allow first responders and members of other key community sectors to administer a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose. Click here for more information regarding FR-CARA grants and note applications are due by July 31, 2017.
If you would like to request a letter of support from Senator Baldwin to include with your application(s), please contact Grants & Special Projects staff in the Senator’s Madison office. You can also visit Senator Baldwin’s website to learn more about additional federal resources and funding opportunities that may be available to your community.
Sincerely, The Office of US Senator Tammy Baldwin
The Rhode Island health insurance commissioner says the state's four major health insurers will end a practice that has been criticized for delaying treatment for patients with opioid dependency disorders.
Read full article here.
Communities in northeast Ohio are affected daily by the rising incidence of opioid overdoses. The Cuyahoga Medical Examiner’s Office reported at least 61 heroin- or fentanyl-related deaths in a single month earlier this year. The alarming death rate brings the gravity of the situation home to physicians in the area.
“There’s no more playing around with this,” said Jason Jerry, MD, until recently an addiction psychiatrist at the Cleveland Clinic’s Alcohol and Drug Recovery Center. Dr. Jerry, now with FirstHealth Moore Regional Hospital in Pinehurst, N.C., is a recognized leader in efforts to curb opioid abuse and misuse, and he and his colleagues use medication-assisted treatment (MAT) to help patients with substance-use disorders through recovery. They have cared for patients with opioid substance issues since the mid-1990s.
Dr. Jerry told AMA Wire® that it is important for medical students and residents to think about the state of the opioid crisis and consider joining the specialty of addiction medicine “because there is no end in sight. ... We’re trying to teach the next wave so they can have an impact going forward.”
To that end, Dr. Jerry and other physicians at the center were joined on their rounds by medical residents, who rotate on the center’s inpatient detox unit. He served as a mentor to one resident each year, in addition to teaching medical students interested in addiction medicine.
Dr. Jerry offers this advice based on what he taught those who rounded with him every day in the detox unit. It includes:
“I think we need to get away from writing blanket prescriptions for one-month supplies because what’s happening is people are abusing them, or we’re having supplies of opioids that are sitting idle in patient’s medicine cabinets at home that are getting swiped by loved ones or by people that visit their houses,” Dr. Jerry said. “It’s a big source of diversion so I think that’s one of the major steps that we can make in terms of moving in the right direction.”
Before they leave the Cleveland Clinic, many patients also benefit from Project DAWN, an opioid overdose education and naloxone-distribution program that was founded by Cleveland emergency physician Joan Papp, MD, an assistant professor at Case Western Reserve University’s medical school.
“Many have already enrolled in DAWN and so they have their naloxone kits,” Dr. Jerry said. “They’re readily available if you’re around the Cleveland area.”
The AMA Opioid Task Force has been working for several years to increase access to naloxone, the life-saving opioid overdose antidote, increase access to MAT for patients struggling with substance-use disorder, encourage physicians to register for and use prescription drug monitoring programs (PDMP), reduce the stigma of substance-use disorder and educate patients and physicians on the matter.
Two new educational modules on what every physician needs to know and on chronic pain management are available in the AMA Education Center. They can help physicians in their efforts to battle against opioid abuse and misuse in their practices.
The American Board of Preventive Medicine now offers physicians who are certified by a member board of the American Board of Medical Specialties the opportunity to become certified in the subspecialty of addiction medicine. During the next five years following the date of the first exam, physicians are eligible to become board certified in addiction medicine without completing an addiction-medicine fellowship.
Physicians interested in taking the exam and becoming certified in addiction medicine need to complete the application on the ABPM website by June 30. The exam takes place in several locations Oct. 16–28. Learn more.
Full article
Journal of Addiction Medicine - Read more
Objectives: We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of nonmedical prescription opioid (NMPO) use among young adults.
Methods: Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study, we identified associations between physical pain in the past 6 months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression.
Results: Of 199 participants, the mean age was 24.6, and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (P < 0.001) and reporting greater physical pain (P = 0.002). Among females, older age (P = 0.002) and monthly or greater nonmedical benzodiazepine use (P = 0.001) were independently associated with weekly NMPO use.
Conclusions: Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use to improve harm reduction and pain management interventions.
(C) 2017 American Society of Addiction Medicine
WI Health News
The Controlled Substances Board modified rules regarding the use of the Prescription Drug Monitoring Program to align with a recently approved change to the state budget, but rejected other proposals from health systems and doctors.
The proposed rule and emergency rule involve the implementation of laws that recently went into effect, including a requirement that prescribers review patient records before prescribing a controlled substance.
The board approved changes Friday clarifying that prescribers can delegate review of a patient's record and that the board would only refer prescribers to an appropriate law enforcement agency if it determines a criminal violation occurred.
Both changes square with a motion approved by the Legislature's Joint Finance Committee last week. They were also requested by the Wisconsin Medical Society and Wisconsin Hospital Association at the public hearing.
"There's always room for improvement," Mark Grapentine, the society's vice president of government relations, told board members.
But the board pushed back against recommendations to provide more specifics on what has to be contained in a record to satisfy the review requirement.
Matthew Stanford, the hospital association's general counsel, said they've heard from members who are concerned there isn't a list of information that is required to be in a record that has to be reviewed.
"It's both an issue of regulatory clarity but then where that ultimately becomes a bigger issue is when you start thinking about integrations and options for integration," he said. Having more clarity could help electronic health record vendors connect with the program, he said.
Board member Dr. Tim Westlake said that, as a prescriber, he didn't want "a checklist of all this."
"I could see this as becoming burdensome," he said. The board decided not to change its current definition of review.
Other speakers at the public hearing raised concerns about the integration of electronic health records with the program.
Wisconsin Statewide Health Information Network CEO Joe Kachelski said the process to connect with the updated Prescription Drug Monitoring Program, which was launched in January, has been "a little bit bumpy."
"Our validation processes have revealed some substantial data quality completeness issues," he said. "Although we have worked through many of them, some of them do remain."
The board requested the Department of Safety and Professional Services work on ways to better facilitate health system and user adoption of the new version of the program.
May 12, Wisconsin Health News
The state added an additional opioid-addiction treatment to its preferred list for Medicaid patients Wednesday, after law enforcement and legislators raised concerns about a current preferred drug that they say is being smuggled into jails.
The Medicaid Pharmacy Prior Authorization Advisory Committee classified the medication Zubsolv, which comes in a tablet, as a preferred drug for treating opioids. The committee also kept Suboxone, a film strip that dissolves under the tongue, on its preferred list.
In April, two associations representing sheriffs in Wisconsin wrote Medicaid Director Michael Heifetz that the "thin and malleable" strips have become "leading contraband" in jail, as inmates can abuse the drug. The associations suspected Medicaid-eligible families were "partially responsible" given jail demographics.
Rachel Currans-Henry, director of the Bureau of Benefits Management in the department's Division of Medicaid Services, said Wednesday that adding Zubsolv gives providers and members another option.
"There is an increased cost of this for the department," she said. "But in the interest of ensuring that we are addressing a public health epidemic in the state and the country, we believe that the benefits outweigh the costs."
Heifetz said they have "to balance all these things."
"We cannot just look through one lens," he said. "We have to look through a number of lenses, the taxpayer lens, the clinical lens and in this situation the law enforcement lens as well, which is a rarity for us."
Marquette County Sheriff Kim Gaffney, president of the Badger State Sheriffs' Association, hoped the decision would make a difference.
"On behalf of sheriffs across the state, we are hopeful that more opioid treatment options in the Medicaid program will reduce the prevalence of film strips and them being smuggled into jails," he said in a statement.
At a public hearing before the committee took its vote, Assembly Committee on Corrections Chair Mike Schraa, R-Oshkosh, demonstrated how the strip could be concealed under a stamp.
The strip is easier to "sneak into" jails than pills, cigarettes and other contraband, sometimes coming in through children's artwork or Bibles, he said.
"There's no good reason for the government to fuel the black market with this product," he said.
He was also concerned because Wisconsin Attorney General Brad Schimel has joined more than 40 other states to sue Indivior, the maker of Suboxone, alleging that the company switched from a tablet to a film to ensure patent protection and discourage the development of generics.
William Mullen, managed care clinical advisor for medical affairs at Indivior, encouraged the committee to "open the formulary for all" medication-assisted treatments approved by the Food and Drug Administration for opioid addiction.
That would allow doctors to choose what works best for their patients, he said. But Mullen cautioned that all drugs that contain buprenorphine, like Suboxone and Zubsolv, have a potential for abuse, misuse and diversion.
"The company will continue work with the FDA to address misuse, abuse and diversion," he said.
Lawmakers approve bills targeting opioid addiction
The Senate and Assembly passed a number of bills that are part of Gov. Scott Walker's special session targeting opioid addiction Tuesday.
The proposals originated from a preliminary report issued in January by a task force co-chaired by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch.
"With the nine special session bills advanced today, the Senate has taken several great strides towards helping to combat our state's ongoing opioid crisis," Senate Majority Leader Scott Fitzgerald, R-Juneau, said in a statement.
But Democrats questioned whether the bills go far enough.
"After years of struggles, we're taking baby steps when we should be making major strides to improve outcomes and strengthen community safety," Senate Democratic Leader Jennifer Shilling, D-La Crosse, said in a statement.
The Senate approved proposals that would:
The Assembly approved the bills last month, so they now head to Walker's desk for his approval.
The chamber also approved two additional bills Tuesday that are part of the package but haven't been taken up by the Senate. Those measures would:
Wisconsin Society of Addiction Medicine563 Carter Court, Suite B,Kimberly, WI 54136