The recent passage of Senate Bill 600 to decriminalize fentanyl test strips is to be commended.

The only way people with substance use disorders can get to treatment is if they are alive. Fentanyl test strips work much like a home pregnancy test or rapid COVID tests. These low-cost strips provide a person deciding to use a substance immediate information about whether or not fentanyl is present. Providing fentanyl test strips to people who are at risk of overdose allows them to make informed choices about their use of any substance. With the prevalence of fentanyl in many substances (opioids, methamphetamine, “fake Adderall” and even cannabis), a single pill can kill.

To all the people who are thinking about trying something “just to feel better for a moment,” please remember that a single pill can kill.

Wisconsin is wise to pave the way to provide resources to help people be safe. Now we need a concerted effort to get fentanyl test strips to first responders and emergency departments.

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Pictured below is Dr. Ritu Bhatnagar, current WISAM President, attending and speaking at the Wisconsin Recovery Alignment Day on Tuesday, May 3 at the Wisconsin State Capitol. Recovery advocates and allies from across the state joined for the second annual day. The day included recovery and legislative speakers, meetings with the state representatives and senators, and opportunities to connect with recovery advocates. Special guest was Ryan Hampton. 

 

Back in January 2022, WISAM leaders created the attached letter which was sent to all Wisconsin Sheriffs. You can preview the letter below and access the full copy for use as needed to advocate in your own communities.

As advocates for the well-being, health and survival of our patients, the Wisconsin Society of Addiction Medicine urges County Jails, the DOC and DHS to take concrete and expedited steps to ensure that individuals incarcerated in our state’s jails and prisons have access to the standard of medical care for opioid use disorder (OUD). This means identifying both individuals currently receiving medications for opioid use disorder (MOUD) including buprenorphine, methadone, and extended release naltrexone, and individuals who would benefit from MOUD. Steps are needed to ensure that these individuals continue to receive MOUD while incarcerated. Buprenorphine and methadone, in particular, have been associated with reductions in mortality.

Access MOUD in Jails Letter Here

As the State Administering Agency for federal justice grant funds, the Wisconsin Department of Justice develops statewide strategies, determines funding priorities, and advises the Governor and legislature on justice policy issues.

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Wisconsin Health News

A state regulatory board on Friday said the Legislature will have to act to legalize kratom in Wisconsin, after lawmakers asked them to look into making the change.  

Kratom, a herbal substance with stimulant and opioid-like effects, has been illegal in Wisconsin since a 2014 law replaced the definition of synthetic drugs with a description of their chemical structures.

A bipartisan group of 11 lawmakers wrote in a letter to the Controlled Substances Board last month that two of the chemical structures included in the law are found naturally in kratom. 

“We believe this was done without adequate research and understanding of kratom in its natural form,” they wrote. “Therefore, we ask the board to review the research and provide guidance as to whether natural kratom merits scheduling.” 

The lawmakers said kratom could be an alternative to prescription drugs.

Board Chair Doug Englebert said at Friday's meeting that they heard presentations on kratom in 2015 and 2018. They opted not to take action since the Legislature scheduled the drug and they didn’t know lawmakers’ intent.

“We didn’t feel it was appropriate for the board to undo that action without going through the legislative process,” he said. 

The board unanimously voted to reiterate that position.

Mac Haddow, a senior fellow on public policy at the American Kratom Association, told board members that many of the concerns around kratom have to do with mixing the substance with more dangerous drugs. 

“We understand that kratom is controversial," he said. "Part of that is because kratom has become a popular product for adulteration."

He noted that the substance is not illegal at the federal level and that recent research has shown that kratom is “not dangerously addictive and that it’s helping people, particularly those that are dealing with opioid addictions.” 

Dr. Subhadeep Barman, a psychiatrist and board member, said the evidence that kratom is a viable product for the opioid use disorder is “just not there.” 

“It’s a dangerous product,” he said. “In clinical practice, we come across kratom routinely as a problematic substance.”

 Legislation that would have legalized kratom passed the Assembly Committee on State Affairs this spring 9-2. It didn't move beyond that and faced opposition from groups representing doctors and law enforcement. 

Wisconsin Department of Health Services

Funding Awarded to Cover Room and Board Costs for Residential Opioid Use Disorder Treatment for Medicaid Members

$2.5 million in grants removes barrier to this level of care

An estimated 1,100 Wisconsin Medicaid members with an opioid use disorder will have access to residential treatment this year, thanks to $2.5 million in grants from the Department of Health Services (DHS) awarded to agencies serving 54 counties and four tribes. The funding from opioid settlement dollars will be used to cover room and board costs for this benefit. Federal law prohibits Medicaid from reimbursing residential substance use disorder treatment providers for a client’s room and board expenses. Lack of funds to cover room and board costs is the primary reason Medicaid members do not enroll in this level of treatment.

Funding for room and board expenses was included in Governor Evers’ 2021-23 biennial budget but was not approved by the legislature. These grants awarded today are funded by Wisconsin’s share of a multistate settlement with McKinsey & Company, a global consulting firm that for years fueled the opioid epidemic nationwide through its work with the manufacturers of opioid drugs. DHS is receiving $10.4 million over five years from this settlement. The funds must be invested in strategies to address Wisconsin’s opioid epidemic.

View full news release.

MADISON, Wis. — The Dane County Jail announced a new program Tuesday meant to help its residents fight opioid addiction.

The Medication Assistance Treatment program will allow the jail’s nurses to administer the prescription drug Subutex to those who were already being treated with the medication before they entered the jail.

“A large number of people entering our jail system are suffering from various forms of addiction,” Dane County Sheriff Kalvin Barrett said in a statement. “The ability to offer this medication program and help maintain someone’s sobriety is a huge step in reducing recidivism and improving public safety.”

Barrett said the program could expand beyond continuing care in the future. In the past, the jail has not been able to continue Subutex treatments inside the jail, leading to an interruption in recovery — and the possibility that those suffering from addiction commit more crimes in the future to support it.

“While addiction itself is not an actual crime, the criminal activity involved with supporting that addiction is where the crimes typically occur,” Barrett said during a press conference Tuesday.

If the county can help treat the addiction, it could lead to a reduction in crime by reducing the chances those people get arrested again.

“Our ultimate goal is to reduce recidivism,” Barrett said. “When we reduce recidivism, we reduce the jail population. By reducing the jail population, we decrease the crime rates. By reducing the crime rates, we increase public safety and we reduce criminal justice budgets.”

Dr. Elizabeth Salisbury-Afshar from UW-Madison says the drug has shown to be able to reduce illegal drug use and risk of death by as much as 50 percent.

“When someone with opioid addiction who is on medication is incarcerated, while they’re there, that medication is stopped,” Dr. Salisbury-Afshar said, referring to jails that do not use a Medication-Assisted Treatment program. “We know from research that this puts people at risk for multiple things: it reduces the chance that they re-enter treatment when they leave. It also increases their risk for resuming use and it increases risk for overdose death.”

Those who stop treatment while behind bars are 800 percent more likely to die from an overdose after they are released due to their tolerance being reduced, Dr. Salisbury-Afshar said.

“This is a really important first step and I commend Sheriff Barrett and the Dane County Jail for committing to continued efforts to continue to expand access to care beyond continuation of care, but eventually to be able to screen everyone coming in and even be able to initiate care and link people to treatment in the community,” Dr. Salisbury-Afshar said. “This is the right thing to do.”

Read article.

Wisconsin Department of Health Services

You spoke, we listened

In January 2022, we listened to Wisconsinites explain the profound impact of the opioid epidemic and potential strategies to save lives. Our goal was to gather input from a broad group of stakeholders to inform our use of future opioid settlement funds.

• 598 people attended one of our 12 listening sessions.
• 897 comments submitted through our input survey.

We heard from substance use services providers, family and friends of people with a substance use disorder, and people living with a substance use disorder.

Summary: Invest across the continuum from prevention to recovery

We heard that supporting policy and systems change is essential to success. The remainder of the feedback falls into one of the areas listed below.

• Address root causes. Address the social determinants of health. Improve access to mental health services. Bolster family stability. Reduce people's exposure to trauma and the impact of trauma.
• Prevent proactively. Provide evidence-based substance use prevention education, especially in K-12 schools, as well as in communities. Consider including voices of those with lived experience to reduce stigma in communities.
• Enhance harm reduction. Maintain and expand harm reduction strategies, including needle exchange, safe use sites, increased access and use of naloxone/NARCAN®, and fentanyl test strips.
• Expand treatment options. Increase the accessibility and availability of all forms of treatment that follow best practices. Ensure equity in the location and delivery of treatment options.
• Support recovery. Support individuals in recovery with targeted wraparound services. Provide direct support to families with a loved one with substance use disorder.

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On March 23, 2022, the DEA announced a new option for DEA-registered practitioners working in hospitals, clinics, or emergency rooms, and for  DEA-registered hospitals/clinics that allow practitioners to operate under their registration number. Per this new option, the DEA will grant requests for an exception to the one-day supply limitation in 21 CFR 1306.07(b) to allow for the dispensing of up to a three-day supply of narcotic drugs, including buprenorphine and methadone, “to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment.” Consistent with Pub. L. 116-215, the DEA will grant such exception requests while it works to amend 21 CFR 1306.07(b) as directed by said law.

As part of this effort to save lives in the opioid overdose crisis, the DEA also announced that it is working to make permanent its COVID-19 public health emergency temporary regulations allowing for the initiation of buprenorphine for opioid use disorder by telemedicine.

Finally, the DEA said it is, in partnership with HHS, “engaging in regular outreach with pharmacists and practitioners to express support for the use of medication-assisted treatment for those suffering from substance use disorder.”

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Wisconsin DHS | Division of Care and Treatment Services

This year's Opioids, Stimulants, and Trauma Summit is scheduled for May 10-12, 2022. You are invited to join us for this event in person or virtually.

View the agenda for each day and information on how to register to attend. 

Continuing education units are available for people who attend the live event either in person or virtually.