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.

Read more.

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.”

Read more.

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. 

Wisconsin DHS | Division of Care and Treatment Services

We are accepting applications to award a contract for a mobile narcotic treatment program/opioid treatment program to provide opioid use disorder treatment services to underserved and high-need populations. Eligible applicants include for-profit agencies and nonprofit agencies currently certified under Wis. Admin. Code § DHS 75.13 and Wis. Admin. Code § DHS 75.15. Applications are due by 2 p.m. April 20, 2022. View more information on this grant funding opportunity.

DHS Releases Findings from Statewide Listening Sessions about Opioid Settlement Funds

Feedback from public and providers from listening sessions will inform agency's strategy to address state's opioid epidemic

Following a review of public feedback from listening sessions and an online survey in January on the best uses of funding received through national settlements with opioid distributors and manufacturers, the Department of Health Services (DHS) will begin finalizing its plan to invest the funds to save lives and address Wisconsin’s opioid epidemic. DHS held 12 regional listening sessions in early 2022. Nearly 600 people living with an opioid use disorder, their families and friends, and providers of opioid prevention, treatment, and recovery support services participated in these virtual events and nearly 900 comments were submitted through the online survey.

“We listened as hundreds of Wisconsinites explained the profound impact of the opioid epidemic on their families and communities, and we appreciate everyone who took time to share their feedback with us,” said DHS Secretary-designee Karen Timberlake. “The flexibilities offered by these settlement funds will give us an opportunity to be ever more innovative in our response to the opioid epidemic so we can help people who are currently struggling with an opioid use disorder, as well as work to prevent more individual and community heartbreak over the loss of lives to opioid overdoses.”

Read full press release here.

LA CROSSE — Gov. Tony Evers today signed three bills in La Crosse to help address substance use and overdose deaths in Wisconsin.   

“Substance misuse has ravaged families and communities across our state, which has affected not only many Wisconsinites’ own health and safety but the well-being of their families and loved ones, too. Unfortunately, the pandemic has only further underscored challenges for folks working to overcome mental health crises and substance use disorders,” said Gov. Evers. “Tragically, fentanyl has played a serious role in overdose deaths across the country, and these bills are an important step toward reducing substance misuse and overdose deaths here in our state. We have to keep working to invest in getting folks and families the treatment and support they need to overcome these challenges.”   

Preliminary data of 2020 from the Centers for Disease Control and Prevention (CDC) shows the highest number of overdose deaths ever recorded in a single year in U.S. history; more than 93,000 people died, representing a 30 percent increase from the previous 12-month period. CDC data also shows that 75 percent of these overdose deaths were opioid-related, and that synthetic opioids, such as fentanyl, are the main driver of drug overdose deaths. In Wisconsin, the CDC estimates that in 2020 alone, there were more than 1,200 opioid-related overdose deaths, underscoring the importance of the governor’s action today. 

Senate Bill 352, now 2021 Wisconsin Act 179:  

• Creates a graduated penalty structure for manufacturing, distributing, or delivering fentanyl (or fentanyl analogs) or possessing it with intent to manufacture, distribute, or deliver it. 
   

Senate Bill 600, now 2021 Wisconsin Act 180:  

• Specifies that materials used to test for the presence of fentanyl or a fentanyl analog in a substance are not drug paraphernalia.
   

Senate Bill 49, now 2021 Wisconsin Act 181:  

• Requires the Department of Administration, in collaboration with the Department of Health Services (DHS) and Department of Safety and Professional Services (DSPS), to issue a request for proposal, subject to approval by the Joint Committee on Finance under a 14-day passive review, to establish and maintain a data system to collect, format, analyze, and disseminate information on opioid and methamphetamines use.

These bills will build on the work the Evers Administration is doing to combat the opioid epidemic, such as the state’s new pilot “Hub and Spoke” model of care, as well as investing approximately $47 million of American Rescue Plan Act funding to increase community-level supports for people who have been grappling with mental health and substance use challenges. Last year, Gov. Evers also signed Assembly Bill 374, now 2021 Wisconsin Act 57, into law, paving the way for much-needed funds to flow to communities throughout Wisconsin to address the opioid epidemic through a settlement with opioid manufacturers and distributors. The final settlement agreement, approved by the Joint Finance Committee in November 2021, will provide more than $294 million over 18 years to the 87 local governments involved in the litigation and $126 million, as well as $9.6 million in additional restitution, to the DHS for programs aimed at fighting the opioid epidemic and saving lives.

Additionally, last year, Wisconsin joined the Bloomberg Opioids Overdose Prevention Initiative which provided $10 million to combat the opioid epidemic in Wisconsin over the next five years. 

People looking for substance use treatment and recovery services are encouraged to use the Wisconsin Addiction Recovery Helpline, which is free and available 24/7.

An online version of this release is available here.

NASW | The Wisconsin Social Worker Journal | Winter 2021 | Pg. 15 | Ritu Bhatnagar, M.D., M.P.H.

What is Wisconsin’s Unborn Child Protection Act? Passed in 1997, Wisconsin’s “Unborn Child Protection Act” — also known as Act 292 and previously known as the “Cocaine Mom Law” — permits the jailing, forced medical treatment, or house arrest of a pregnant person on a suspicion that they have consumed or may consume alcohol or a controlled substance during their pregnancy. While the law is enforced differently across the state, according to statistics published by Wisconsin’s Department of Children & Families, each year for the past 5 years, between 400 and 500 Wisconsin women are subject state intervention under Act 292. The law was not supported by any medical organizations and has been challenged in court. In 2018, a judge found it to be unconstitutional because the language was so unclear, but the law still stands. Read more about the law and its history here. 

What role do social workers play in the enforcement of Act 292? Social workers play a unique role in the enforcement of Act 292. Often, it is the hospital-based social worker making the report to the county or local law enforcement. Social workers may report a pregnant person out of fear of losing their license, presumed obligation, or misplaced assumptions about drug use. It is important to know that the way the law is written does NOT mandate reporting while the person is pregnant. Reporting is considered “permissive” in this situation, and it is important to ensure that your decision takes into account the situation of the woman and the potential for far reaching legal consequences of reporting (see story at right).

If you have further questions about this law, please contact Afsha Malik at afm@advocatesforpregnantwomen.org. 

In 2014, Tammy Loertscher had a medical problem that caused depression if left untreated. After losing her job and consequently her health insurance, Tammy started to use methamphetamine regularly to manage her depression. Tammy made sure her drug use did not negatively affect other aspects of her life. As soon as Tammy realized she was pregnant, she stopped using methamphetamine. However, pursuant to Act 292, Tammy was ordered into drug treatment that she did not need and was incarcerated in Taylor County’s jail for 20 days for refusing that treatment, where she was held in solitary confinement, refused access to a lawyer, and denied access to her previously-scheduled prenatal care. To learn more about Tammy’s story visit us here.