Na#onal Trends in Addic#on Medicine. Ohio Chapter of the American Society of Addic4on Medicine 2017 Annual Mee4ng Wednesday, August 2, 2017

Transcription

1 Na#onal Trends in Addic#on Medicine Ohio Chapter of the American Society of Addic4on Medicine 2017 Annual Mee4ng Wednesday, August 2, 2017

2 Ohio Chapter of the American Society of Addic4on Medicine 2017 Annual Mee4ng Disclosure Informa4on Susan Awad No disclosures

3 Congress Overview Comprehensive Addic#on and Recovery Act (CARA) 21 st Century CURES ACA Repeal/Replace Administra#on President s Opioid Commission HHS Ac#ons

4 Sec. 103 Community-Based Coali4on Enhancement Grants CARA Preven#on& Educa#on Sec Medica4on-Assisted Treatment for Recovery from Addic4on Sec. 201 Comprehensive Opioid Abuse Grant Program Sec. 502 Veterans Treatment Courts Criminal Jus#ce Reform Treatment Access Sec Improving Access to Overdose Treatment Sec. 202 First Responder Training Law Enforcement Overdose Reversal Recovery Support Sec. 302 Building Communi4es of Recovery

5 CARA Appropria4ons Sec. 103: Community-based coali#on enhancement grants to address local drug crises Annual Authoriza4on FY17 Omnibus Funding FY18 House Mark $5 million $3 million $3 million Sec. 107: Improving access to overdose treatment $1 million $1 million Sec. 109: NASPER $10 million $14 million Sec. 110: Opioid overdose reversal medica#on access and educa#on grant program $1.67 million -- Sec. 201: Comprehensive Opioid Abuse Grant Program $ 103 million $103 million $103 million Sec. 202: First responder training $12 million $12 million $12 million Sec. 301: Evidence-based Rx opioid and heroin treatment and interven#on demonstra#on $25 million -- Sec. 302: Building communi#es of recovery $1 million $3 million $3 million Sec. 501: Improving treatment for PPW $16.9 million $19.93 million $19.93 million Sec. 601: State demonstra#on grants for comprehensive opioid abuse response $5 million -- Total $ million $ million

6 NP/PA Waivers ASAM/AANP/AAPA training numbers as of July 27 Total registra#ons: 6,370 Total comple#ons: 3,186 Latest NP/PA cer#fica#ons in by DEA through July 18. NPs: 1,685 PAs: 491 Total: 2,176

7 21 st Century CURES $500m in FY17 and FY18 to supplement SSA ac#vi#es to address the opioid epidemic, such as: o Improving prescrip#on drug monitoring programs (PDMPs) o Implemen#ng and evalua#ng preven#on ac#vi#es o Training for health care providers on safe opioid prescribing, pain management, recognizing substance use disorders, referral to treatment, and overdose preven#on o Suppor#ng access to health care services FY17 funding included in December 2016 CR FY17 State Targeted Response Grants issued April 2017

8 Opioid STR Grants Funds must be used primarily to support preven#on, treatment, and recovery support ac#vi#es Conduct needs assessment using epidemiological data Develop a comprehensive state strategic plan to address the gaps in preven#on, treatment, and recovery iden#fied in the needs assessment Design, implement, enhance, and evaluate primary and secondary preven#on Implement or expand access to evidence-based prac#ces for OUD treatment, par#cularly the use of medica#on assisted treatment (MAT) Provide treatment transi#on and coverage for pa#ents reentering communi#es from criminal jus#ce sefngs Enhance or support the provision of peer and other recovery support services

9 Ohio's response to 21st Century Cures Act Ohio will receive $26 million through the STR grants Ohio Mental Health and Addic#on Services will be issuing RFAs very soon. ASAM plans to apply to provide mul#ple waiver trainings across the Ohio. These trainings would be at no cost to physicians. Physicians will have the opportunity to be reimbursed for ahending waiver training, addi#onal educa#on, and receiving a waiver.

10 ACA Repeal/Replace: Expected Impact on Opioid Epidemic ACA repeal would cause an es#mated 2.8 million Americans with SUD, including about 222,000 with OUD, to lose some or all of their insurance coverage AHCA/BCRA would go further: Repeals Medicaid Expansion Converts federal Medicaid funding to per-capita caps or block grants Allow states to waive Essen#al Health Benefits

11 ACA REPEAL UPDATE 7/25: Senate opened debate on House bill (AHCA) by vote of /25: Senate rejected Senate repeal/replace bill (BCRA w/ Cruz & Portman amendments) /28: Senate rejected skinny repeal amendment McConnell pulled reconcilia#on bill alerward Hearings on stabilizing the individual market expected aler recess

12 President s Commission on Comba#ng Drug Addic#on and the Opioid Crisis Gov. Chris Chris#e (R-NJ) Gov. Roy Cooper (D-NC) Gov. Charlie Baker (R-MA) Bertha Madras, PhD Harvard Hon. Patrick Kennedy

13 President s Commission on Comba#ng Drug Addic#on and the Opioid Crisis First public mee#ng on June 16 Public Conference Call on July 31 Final report due October 1

14 HHS Ac#ons: FDA May: Public Mee#ng on mandatory prescriber educa#on; open comment period on ER/LA REMS Blueprint June: FDA asked Endo Interna#onal Plc to pull Opana ER from the market July: Announced updated REMS program will include immediate release (IR) opioids and be available to non-physicians; Scien#fic Workshop on abuse-deterrent formula#ons September: Commissioner Gohlieb to meet with health insurers and PBMs to discuss ways to limit opioid exposure

15 HHS Ac#ons: CMS The Summit will convene providers, payers, community health organiza#ons, medical socie#es, pa#ent advocacy groups, government and non-government organiza#ons to discuss behavioral health payment and care delivery. There will be four panels with subject maher experts to discuss the following topics: Substance use disorders Mental health and medical comorbidi#es Alzheimer s disease and related demen#as Behavioral health workforce challenges The purpose of the Summit is to discuss ideas for a poten#al behavioral health model to improve access, quality, and cost of care for beneficiaries with behavioral health condi#ons.

16 HHS Ac#ons: NIH Public-Private Ini#a#ve to Address the Opioid Crisis Medica4ons Development for Opioid Use Disorders and for Overdose Preven4on and Reversal (June 5) Discussion: S#mulate innova#ve direc#ons in preven#ng and trea#ng opioid use disorders and overdoses Development of Safe, Effec4ve, Non-Addic4ve Pain Treatments (June 16) Discussion: Expedite the screening and development of promising agents to treat chronic pain with lihle or no poten#al for misuse or addic#on. Understanding the Neurobiological Mechanisms of Pain (July 7) Discussion: Enhance our understanding of the complex neurobiological mechanisms of pain and accelerate the development of novel pain treatments.

17 Ohio Chapter of the American Society of Addic4on Medicine 2017 Annual Mee4ng Disclosure Informa4on R. Jeffrey Goldsmith, MD, DLFAPA, DFASAM No Disclosures

18 Marijuana Overview Na#onal Perspec#ves Ohio Medical Marijuana Control Program ASAM Criteria New Ohio MHAS Requirement CONTINUUM ABPM Cer#fica#on

19 Medical Marijuana Na#onal Perspec#ves ASAM, AMA, APA, and AAP agree: No clinical evidence to support marijuana legaliza#on for medical or recrea#onal use Support more research and funding to determine the clinical benefits of marijuana and cannabinoid-based medicines for the purposes of treatment Recommend a removal of barriers for research of marijuana and cannabinoid-based medicines If scien#fic evidence supports the use of cannabis-derived substances for the purpose of treatment, the medica#on should be subject to the approval process of the FDA

20 Marijuana Resources hhp:// hhps://learnaboutsam.org/ hhps://drugfree.org/ar#cle/how-to-talk-about-marijuana/

21 Medical Marijuana in Ohio h[p://

22 OH Regulatory Changes & the ASAM Criteria Ohio Department of Medicaid Rule : (A) For the purpose of medicaid reimbursement, substance use disorder treatment services shall be defined by and shall be provided according to the american society of addicaon medicine also known as the ASAM Treatment Criteria for AddicAve, Substance Related and Co-occurring CondiAons for admission, conanued stay, discharge, or referral to each level of care (LOC).

23 ASAM Dimensions

24 ASAM Criteria Levels of Care

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28 Streamlined Assessment CONTINUUM gives you: DSM-5 Substance Use Disorders: Diagnoses & Criteria CIWA-Ar & CINA withdrawal scores (alcohol/bzs, opioids) Addic#on Severity Index (ASI) Composite Scores Imminent Risk Considera#ons Access & Support Needs/Capabili#es ASAM Level of Care recommenda#ons All adult admission levels and sub-levels Including Withdrawal Management Including Biomedically Enhanced Sub-level Including Co-occurring Disorder Sub-levels (Capable, Enhanced) If actual placement disagrees with solware, the clinician gets to jus#fy the discrepancy TM

29 ABMS Recogni#on of Addic#on Medicine American Board of Medical Special#es (ABMS) recognized addic#on medicine as mul#specialty subspecialty under American Board of Preven#ve Medicine (ABPM) in March 2016, realizing decades-long ASAM goal ABPM announced addic#on medicine subspecialty exams from October 16-28, applica#on period closed June 30, ,723 physicians applied to take the exam! 697 used the ABAM Pathway 1,026 used the Prac4ce Pathway First 5 years examina#on given (un#l 2022), individuals are NOT required to complete addic#on medicine fellowship. Aler that, 1 year addic#on medicine fellowship required

30 ABMS Recogni#on of Addic#on Medicine Exam Eligibility Requirements: Hold current medical degree and medical license Hold cer#fica#on from any 24 ABMS Member Boards and one of the following: o Clinical involvement in subspecialty-level prac#ce of addic#on medicine (1920 hours over last 5 years, among other specifics) o Full-#me ACGME accredited fellowship in subspecialty area within 12 months o Reference leher from ABMS cer#fied physician if 24 months past fellowship comple#on

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32 Backup Slides

33 American Health Care Act (AHCA) March 6: House leadership introduces H.R. 1628, the American Health Care Act April 25: MacArthur- Meadows amendment introduced May 3: Upton amendment introduced May 24: CBO releases score of AHCA March 24: Leadership/WH introduce Manager s Amendment Bill pulled from House floor minutes before expected vote May 4: House passes AHCA by a vote of

34 1980s: The ASAM Criteria 1990s: Research founda#on & clinical algorithm 2006+: 30+ states require ASAM s Criteria 2016: CONTINUUM LoC Recogni#on Training

35 The ASAM Criteria Logic: hundreds of decision rules Screening Diagnosis Severity Readiness & Relapse Potential Patient Placement Criteria DIMENSIONS Intoxication Biomedical Emotional Withdrawal Behavioral Relapse Potential Treatment Acceptance/ Resistance Recovery Environment Decision Rules LEVEL OF CARE 1. Outpatient 2. Intensive Outpatient 3. Medically Monitored Intensive Inpatient 4. Medically Managed Intensive Inpatient 2016 American Society of Addic#on Medicine

36 CONTINUUM & the Opioid Epidemic Determine if the pa#ent has used any opioid agents prescribed or illicit Guides assessment of opioid use recency, frequency, dura#on & prior treatment Yields DSM-5 Opioid Use Disorder (OUD) diagnosis, symptom count & severity Guides interviewer through quan#ta#ve withdrawal symptom scoring (CINA) Generates Addic#on Severity Index (ASI) drug severity composite score Decision logic generates detailed recommenda#ons for withdrawal management, opioid treatment services (e.g., medica#on) & needed Level of Care Streamlines re-assessment to detect con#nuing needs & change over #me Evidence-based, standardized, quan#ta#ve & comprehensive