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Governor Scott Walker's Task Force on Opioid Abuse meets on Friday to continue its work toward ending the opioid crisis in Wisconsin.
WHO: Among the presentations to the task force will be a discussion on Trauma-Informed Care presented by Wisconsin First Lady Tonette Walker, Elizabeth Hudson of the Office of Children's Mental Health, and Dr. Michael Tkach of Hazelden Betty Ford.
WHEN: Friday, September 22, 2017 from 9:00 AM to 12:00 PM
WHERE: Sauk County Human Services Building,505 Broadway Street, Baraboo, Wi.
Conference B-30 (Basement). Parking available behind the building. Credentialed members of the media are invited to attend.
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).
The Centers for Disease Control and Prevention awarded Wisconsin additional funding to beef up its efforts to curb opioid abuse, according to a Tuesday statement.
Wisconsin received roughly $752,000 in supplemental funding that can be used to scale up prevention efforts, like increasing the use of prescription drug monitoring programs and expanding the reach of messages about opioid risks. Wisconsin is now receiving $2.6 million from the same program.
The state also received an additional $131,000 to better track and prevent opioid-involved overdoses. The state is now receiving $460,000 through the program.
CDC announced $28.6 million in funding to 44 states and the District of Columbia Tuesday.
Due to a lack of guideline-based direction for the management of chronic pain, selection of treatment is often based on institutional protocols, provider experience, and fear of legal issues, according to results of study presented at Pain Week 2017.
Online surveys were distributed nationally to US-practicing clinicians in different specialties actively managing ≥10 chronic pain patients per week. Data from 402 clinicians was collected and compiled for both descriptive and inferential analysis. Each respondent was presented with case vignettes, predominately centered on patients suffering from chronic pain due to osteoarthritis and low back pain. “These patient scenarios were designed to assess how clinicians prefer to manage, and case continuations were set up to progress the patient in pain severity,” the study authors explained.
In the first vignette, a 52-year-old patient presented with a 4-month progression of moderate-to-severe right hip pain due to osteoarthritis. For this patient, most clinicians chose to prescribe an NSAID, corticosteroid injection, or non-pharmaceutical therapy followed by surgical referral as the patient progressed. The second case involved a 50-year-old patient suffering from chronic low back pain with inadequate relief from NSAIDs, muscle relaxants, or physical therapy. Results found that clinicians generally did not agree on the best treatment option for this patient, and a variety of NSAIDs and therapy involving short-acting opioids were generally recommended. In the third vignette, a 75-year-old patient presented with well-controlled hip osteoarthritis and was receiving oxycodone for the past 6 months. Results found that only a few clinicians recommended continuing opioid-based therapy instead of initiating a different treatment.
“Many clinicians, particularly orthopedic surgeons and rheumatologists, use standardized screening tools for opioid risk assessment,” the study authors commented. They added, “Of all clinicians included in the study, orthopedic surgeons and rheumatologists are least confident in their ability to assess patient risk and to assess a patient's level of pain.”
Results of this analysis found that guideline-based direction for management of chronic pain is lacking. The study authors added, “Continued studies are needed to understand practice change and allow refinement of educational messages.”
Read more of MPR's coverage of PAINWeek 2017 by visiting the conference page.
Annual Wisconsin Society of Addiction Medicine Conference:
Advancing the Art and Science of Addiction Prevention and Treatment in Wisconsin
September 14-16, 2017 (Thursday-Saturday), Pyle Center, Madison, WI
This conference is open to individuals working in addiction prevention and treatment across disciplines, including clinicians, social workers, recovery coaches, individuals in recovery, law enforcement and public health officials.
This year's conference will feature a number of workshops, lectures, and a special presentation by Joseph LMS Green (poet. performer. educator.).
Our post-conference workshop options on Saturday, September 16th, 2017 are:
Click here to download the conference brochure.
Click here to register for the conference.
Fulfill your 2 hour opioid prescribing education requirement by attending the Saturday PM workshop "Mitigating the Risk of Prescription Drug Abuse: The Wisconsin Medical Examining Board Opioid Prescribing Guidelines." This activity has been approved by the Wisconsin Medical Examining Board (MEB) as an educational course (MED-1035) related to the opioid prescribing guidelines issued by the board under s. 440.035 (2m), Stats. For Wisconsin-licensed physicians with a DEA number, this activity meets the requirement under s. Med 13.02 (1g) a) and 1r) as minimum of 2 hours related to the guidelines of 30 hours of continuing medical education required for licensure every two years.
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.
Wisconsin Society of Addiction Medicine563 Carter Court, Suite B,Kimberly, WI 54136
