The Opioid Epidemic - Open Door Integrated Care

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "The Opioid Epidemic - Open Door Integrated Care"

Transcription

1 The Opioid Epidemic - Open Door Integrated Care Daren Wu, M.D. Jacob Samander, M.D. Lynn Gonzalez, L.C.S.W. October 31, 2016

2 Open Door s History Founded in the basement of a church in 1972 Originally staffed by volunteer Doctors and Nurses Gained Federally Qualified Health Center recognition and Section 330 funding

3 Open Door Family Medical Centers 5 Primary Care Sites 7 School Based Health Centers Family Medicine Residency program Dental Residency program

4 Patients by Age and Sex (Under age 1) (1-19) (20-49) (50-64) (65 & Up) After childhood, we see a considerable difference between the number of men and women that we see. We attribute this trend to the high number of women that we see during child-bearing age.

5 Insurance Coverage of Open Door Patients 7% 4% 8% Uninsured Medicaid 50% CHIP 32% Medicare Private

6 Open Door Family Medical Centers At the end of 2015, we had: Over 100 Medical, Behavioral, and Dental clinicians providing care to 50,000 patients in 265,000 visits

7 Clinician Breakdown Medical clinicians (MDs, DOs, NPs, Pas, CNMs) 47 FTEs Behavioral Health clinicians (LCSWs, LMSWs) 22 FTEs Psychiatrists 1.3 FTEs

8 Addiction Over 24 Million Adults 12+ live with a SUD Only 10% or 1/10 individuals sought or received treatment for their addiction Opioid overdose is now the #1 cause of preventable death higher than car accidents higher than gun violence We are 3 times more likely to die of an opioid overdose than a car accident and most car accidents are substance related NSUDH (National Survey on Drug Use and Health), 2013

9 Addiction is Irrational Primary, chronic brain disease characterized by compulsive drug seeking and use despite harmful consequences Involves cycles of relapse and remission 40-60% genetic Without treatment addiction is progressive and can result in disability or premature death American Society of Addiction Medicine. April 12, NIDA. August,

10 Childhood Dreams and Aspirations

11 Dopamine D2 Receptors are Lower in Addiction Drugabuse.gov

12 Withdrawal Normal Euphoria Natural History of Opioid Use Disorder Acute use Tolerance & Physical Dependence Chronic use Slide courtesy of Dan Alford, 2012

13 Functional Recovery Takes Time Normal 1 month post- detox 14 months Volkow, ND et al., Journal of Neuroscience 21, , 2001

14 Addiction is Similar to Heart Disease Decreased Heart Metabolism in Coronary Artery Disease High Decreased Brain Metabolism in Addiction Healthy Heart Diseased Heart Healthy Brain Diseased Brain NIDA

15 Addiction Onset For more severely addicted individuals Course of SUD and achievement of stable recovery can take a long time Help Seeking Full Sustained Remission (1 year abstinent) Relapse Risk drops below 15% 4-5 years 8 years 5 years Opportunity for earlier detection through screening in non-specialty settings like primary care/ed Selfinitiated cessation attempts 4-5 Treatment episodes/ mutualhelp Continuing care/ mutualhelp 60% of individuals with addiction will achieve full sustained remission (White, 2013)

16 Relapse Requires Increased Support We label patients as not ready or noncompliant We ask them to seek a higher level of care on their own, when most ill We refer them for higher level of care yet many of those programs are not evidence based, and are essentially lower level of care What would we do if a cancer survivor had a lymphoma recurrence after years of remission?

17 Sources of Pain Medications

18 Medication Rx Numbers PERCOCET (Hydrocodone/ Acetaminophen) is the #1 most prescribed medication in the USA XANAX is the #1 most prescribed Psychiatric medication in the USA IMS Institute for Healthcare Informatics, 2013

19 Medication is an Effective Tool Access to medication assisted treatment can mean [the] difference between life or death. Michael Botticelli, October 23, 2014 Director, White House Office of National Drug Control Policy

20 Medication Treatment MAT = Medication PLUS counseling and behavioral therapies Opioid Agonist Therapy, medication, or treatment preferred Reduces drug use Reduces the risk of infectious disease transmission Reduces criminal activity Reduces the risk of overdose Reduces death Increases treatment retention Improves social functioning Cost-effective Safe

21 Overdoses Symptomatic of Untreated Disease A key driver of the overdose epidemic Is underlying substance-use disorder. Consequently, expanding access to addiction-treatment services is an essential component of a comprehensive response. 50% of Addiction treatment centers offer medication <38% of eligible patients are offered medications <5% of physicians are waivered to prescribe buprenorphine

22 Buprenorphine Major Paradigm Shift: DATA 2000 Partial agonist antagonist Sublingual Higher affinity for the mu opioid receptor compared to full agonists Slow to dissociate Will displace full agonists from the receptor with decreased opioid effect precipitated withdrawal Relieves cravings without producing euphoria or dangerous side effects of other opioids Naloxone to deter IV use, not active sublingually

23 Open Door and Controlled Medications 2014: Controlled meds policy - updated 2015: Tableau database - viewable controlled medication prescribing data 2016: March 16 th - new CDC guideline 2016: March 27 th - erx mandate

24 Concerning Statistics More than 40 people die every day from opioid overdoses 1:32 patients with MME > 200 die from an overdose 4.3 million Americans using prescription opioids for non-medical use

25 Enter the Cavalry! On March 18 th, 2016 the CDC released a new guideline for opioid prescribing. Expansion in funding from Feds and NYS is coming as well. Together, these aim to: Reinforce indications for opioid use Specify cautionary dosing levels for opioids (MME) Improve clinician training for medication treatment and weaning strategies Create more outpatient treatment facilities (including buprenorphine certification)

26 The Most Important Intervention Change prescribing behavior! Indication when to initiate Duration how long to Rx Patient selection dependency/addiction risks Patient monitoring (urine tox, contracts, prescription monitoring programs) Weaning suggestions

27 Are prescription opioids indicated? post-surgically? after a dental procedure? for an acute back pain, headache, sprain, or fracture presentation in the ED? Outpatient family doctors write more opioid prescriptions than any other specialty

28 Clinician Comfort with Opioid Rx Varies Physician training in residency for psychiatric conditions, including substance use and chemical dependency as well as opioid and benzodiazepine use, is very uneven PAs and NPs generally have even less training than the physicians and therefore less comfort and familiarity with pain conditions and the use of these medications

29 Unequal Burden 14 Open Door clinicians account for more than 90% of opioid Rx prescribing These are also the clinicians with the largest and most complex patient panels Open Door is concerned about the burnout risk for these clinicians

30 Organizational In-Service Series of Grand Rounds to elevate clinician familiarity and comfort level with the topics of: Depression Substance use and addiction (including Opioids) Anxiety disorders (touching on Benzodiazepines) Sleep disorders (touching on sleep hypnotics)

31 Group Conversations (a.k.a. Grand Rounds)

32 1:1 Collegial Clinician Support What the #!&$ were you thinking!? This is the last time I ask you for help Jay Daren

33 Case Management = Team Work Case conferencing around complex cases BH, Patient Advocate, PCP, Psychiatry Frequent BHIS and LCSW touchpoints and visits Ad hoc (but documented!) consultations tracked in ecw Telephone Encounters, including treatment recommendations and modifications

34 Case Study: NK 65 yo gentleman with: Hep C HTN DM Lumbar disc herniation Spinal stenosis Cirrhosis h/o IVDA h/o alcohol abuse Anxiety disorder Depression

35 Case Study: NK More than 20 years of chronic opioid and benzodiazepine use, and as of a few months ago he was on: 40 mg of hydromorphone daily 2 mg of clonazepam daily

36 Case Study: NK Psychiatry and Family Medicine co-management With weekly follow-up visits (either with psychiatry, LCSW) and also with family physician PCP, the team was able to help NK get off entirely from clonazepam use within 4 weeks, and reduced his hydromorphone use from 40 mg/day to 8 mg/day over the space of 5 weeks

37 And if at first you don t succeed Try and try again! Because over time the impact can be huge!

38 From Awareness Action! Improved Opioid Prescribing Substance use Grand Rounds Opioid Addiction Grand Rounds

39 From Awareness Action! Improved SSRI prescribing

40 Steep Drop-off in Rx written

41 Integrated Behavioral Health Approach To Treatment Primary Care BHIS Patient Behavioral Therapist Psychiatrist

42 Chronic Pain Affects Many Dimensions of Patient s Life Psychological Anxiety/ Depression Anger/ Fear Function Activities of daily living Sleep/rest Physical Social Relationships Ability to show affection/ sexual function Isolation Borneman T, et al. Oncol Nurs Forum. 2003; 30:

43 Assess Risk to Determine Treatment Options

44

45 Pain and Psychiatric Disorder Recent estimates suggest that pain and depressive disorder co-occur 30-60% of the time Anxiety disorders may be present 35% of the time among persons with chronic pain Pain and PTSD co-occur; 20-34% of persons with chronic pain meet criteria for PTSD; chronic pain is present in 45-87% of persons with PTSD Pain is present in 37-61% of patients seeking substance use disorders treatment Pain undermines effective treatment for depression, anxiety disorders, PTSD, and substance use disorders Robert D. Kerns, Ph.D. Director, Pain Research, Informatics, medical comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System

46 what is at stake is that patient s very ability to become a full person without the shadow of always needing something. -Friedman

47 Personal Narrative When I think about the day I was injured I can feel the pain in my back flare up right where I was hurt. My whole day seems to be spent waiting for the time to take my next pain pill. I know they don t help that much, but it s all I have. 36 year old male veteran with chronic back and leg pain Robert D. Kerns, Ph.D. Director, Pain Research, Informatics, medical comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System

48 Goals of Psychological Pain Treatment

49 Chronic Pain Treatment Resources

50 Summary 1. Have (or adopt) guidelines 2. Actually follow the guidelines chosen 3. Support your clinicians Increase knowledge and comfort level with pain conditions and treatment parameters Team-based care Case conferencing 4. Support the patient(s) which includes limit setting, following care plans, and not enabling pathologies 5. Repeat steps 2-4, constantly

51 Questions???

52

53 Naloxone: Preventing Opioid Overdose in the Community Sharon Stancliff, MD Medical Director Harm Reduction Coalition

54 DISCLOSURES No conflicts to disclose The off-label use of injectable naloxone intranasally will be discussed

55 LEARNING OBJECTIVES:. Discuss the epidemiology of opioid overdose including recent shifts to heroin and illicit fentanyl. Identify how to avoid, recognize, and act on opioid overdoses Discuss the role and safety of prescribing and distributing naloxone in the community.

56 Deaths related to prescription opioids and heroin drug poisoning United States, *Age-Adjusted Rates Compton et al. NEJM 2016;374:154-63

57 March 24, 2016 Opioid-Related Deaths in NYS Opioid-Related Deaths in NYS LIMITATIONS OF THESE DATA Known underreporting Data only as good as certificates Variability among counties in thoroughness of tox screens and reporting

58 Other Opioid³ 47% Fentanyl & Heroin Related 4 9% Fentanyl Related² 22% Heroin Related¹ 22% Other Opioid³ 26% Fentanyl & Heroin Related 4 19% Heroin Related¹ 12% Fentanyl Related² 43% ¹ No fentanyl; possible other drugs involved ² No heroin; possible other drugs involved ³ No fentanyl or Heroin; possible other drugs involved 4 Possible other drugs involved

59

60 Age-Adjusted Rate per 100,000 Rate of unintentional drug poisoning deaths by drug type, NYC * (Drugs not mutually exclusive) Opioids Opioid Analgesics *Data for 2014 are preliminary and subject to change. Source: New York City Office of the Chief Medical Examiner & New York City Department of Health and Mental Hygiene *

61 Fentanyl & Overdose Deaths Fentanyl was relatively uncommon in overdose in NYC with fewer than 3% of deaths involving fentanyl in the past ten years Of the 886 drug overdose deaths in 2015, 136 (15%) involved fentanyl

62 Strategies to address overdose Increase access to naloxone Good Samaritan laws Prescription monitoring programs Prescription drug take back events Safe opioid prescribing education Supervised injection facilities Expansion of opioid agonist treatment

63 Opioid Overdose Opioid receptors are in the respiratory center in the medulla White JM, Irvine RJ. Mechanism of fatal opioid overdose. Addiction Jul;94(7): Opioid Overdose Characteristics Reduced sensitivity to changes in O 2 and CO 2 outside of normal ranges Decreased tidal volume and respiratory frequency Respiratory failure and death due to hypoventilation Opioid Overdose Toxidrome Develops Over Minutes to Hours Decreased respiratory rate, Unresponsiveness Blue/gray lips and nails

64 Naloxone Reverses overdose and prevents fatalities Mu opioid receptor antagonist No clinical effect in absence of opioid agonists Displaces opioids from receptors Takes effect in 2-5 minutes May cause withdrawal Lasts for minutes (longer for newest formulation) Hepatic metabolism; renal excretion

65 Formulations

66 Risk Factors for Opioid Overdose Reduced Tolerance Mixing Drugs Using Alone Changes in the Drug (risk factor for fatal OD) Supply Illness History of previous Depression overdose Unstable housing Doses 100 mg morphine-equivalent doses

67 Lowered tolerance Tolerance- repeated use of a substance may lead to the need for increased amounts to product the same effect Abstinence decreases tolerance increasing overdose risk Incarceration Hospitalization Drug treatment/ Detox/ Therapeutic communities Sporadic patterns of drug use Sporer 2007, Binswanger

68 Overdose deaths in New York City involve multiple drugs: % of overdose deaths involved more than one substance. Approximately eight in ten (79%) overdose deaths involved an opioid. Benzodiazepines were found in 54% of overdose deaths involving opioid analgesics, 41% of deaths involving heroin, and 55% of deaths involving methadone NYCDOHMH 2015

69 Context of Opioid Overdose The majority of heroin overdoses are witnessed (gives an opportunity for intervention) The circumstances of prescription drug overdoses are less well characterized Fear of police may prevent calling 911 Witnesses may try ineffectual things Myths and lack of proper training Abandonment not uncommon Tracy

70 NYS Public Health Law 2006 Allows the medical provider to provide naloxone for secondary administration. Naloxone must be prescribed by MD, DO, PA, or NP either in person Offers some liability protection 2014 amendments to the PHL made naloxone accessible through non-patient specific prescriptions ( standing order )

71 Training Essentials What does naloxone do? Overdose recognition Sternal rub/grind Action Call EMS and administer naloxone Recovery position

72 Training recommendations in most settings Risk factors for overdose/overdose death Loss of tolerance Mixing drugs Using alone Good Samaritan Law Hands on practice with device Resuscitation Rescue breathing and/or Chest compressions

73 Shake and shout Sternal rub/grind

74 Call AND Naloxone 22 Tell the dispatcher, I think someone has overdosed. Give the address and location AND Give the Naloxone DO FIRST, whichever is closer at hand

75 Give naloxone

76 Give naloxone

77 Rescue breathing or full CPR or chest compressions

78 Second dose 26 If the person does not respond in 2-3 minutes, give a second dose of naloxone. Do not wait more than 5 minutes to give a second dose.

79 After You Give Naloxone Explain what happened. Tell them not to take any more drugs because that could cause another overdose. Naloxone wears off in 30 to 90 minutes. Stay with the person until they go to the hospital, or until the naloxone wears off, to make sure they do not overdose again. If you do not seek medical care, stay with the person for at least 3 hours Call 911 if the person is not OK when they wake up or take them to the emergency Room yourself. When the ambulance arrives, tell them that naloxone has been given. 27

80 New York State s Good Samaritan law Protects: Individual who experience an overdose and Person who summons EMS (calls 9-1-1) Sept. 18, 2011 Prevents prosecution for: Possession of up to 8 Oz of a controlled substance Alcohol (for underage drinkers) marijuana (any amount) Paraphernalia offenses Sharing of drugs (in NY sharing can be a sales offense) 28

81 Evaluations of Overdose Education and Naloxone Distribution Programs Feasibility Increased knowledge and skills Piper et al. Subst Use Misuse 2008: 43; Doe-Simkins et al. Am J Public Health 2009: 99: Enteen et al. J Urban Health 2010:87: Bennett et al. J Urban Health. 2011: 88; Walley et al. JSAT 2013; 44: (Methadone and detox programs) Green et al. Addiction 2008: 103; Tobin et al. Int J Drug Policy 2009: 20; Wagner et al. Int J Drug Policy 2010: 21: No increase in use, increase in drug treatment Seal et al. J Urban Health 2005:82: Doe-Simkins et al. BMC Public Health :297. Reduction in overdose in communities Maxwell et al. J Addict Dis 2006:25; Evans et al. Am J Epidemiol 2012; 174: Walley et al. BMJ 2013; 346: f174. Cost-effective $438 (best) $14,000 (worst ) per quality-adjusted life year gained Coffin and Sullivan. Ann Intern Med Jan 1;158(1):1-9.

82 Massachusetts Massachusetts compared interrupted time series of towns by enrollment in Opioid Education and Naloxone Distribution programs 2912 kits distributed 327 rescues, 87% by drug users; 98% effective EMS revived the other 3 Walley et al BMJ 2013

83 Community results Fatal opioid OD rates compared no implementation Program enrollment per 100k population (ARR: 0.73) Program enrollment >100 per 100,000 (ARR:0.54) No differences were found in nonfatal opioid OD rates. Walley et al BMJ 2013

84 Increase drug use? Of the 325 with 2 points of data on drug use: No increase in reported use of opioids, alcohol, cocaine or number of substances used Significant increase in reported use of benzodiazepines: 30% increased use 23% decreased use Doe-Simkins et al BMC Public Health 2014

85 New York City Longitudinal Cohort Study Recruitment at trainings provided by 6 syringe exchange programs and 2 methadone programs June January 2014 Interviewed at baseline, 3 months, 6 months and 12 months 398 were recruited, 80% of whom reported use of an opioid, 33% reported injection in the past year 342 (86%) were interviewed at least once in the follow up period (Sept Dec 2014) Huxley-Reicher Z. 2016

86 Results 135 (39%) study participants witnessed at least one opioid overdose, with 63% of these participants witnessing more than one overdose A total of 338 overdoses were observed Naloxone was administered by the study participant in 189 (57%) of cases and by another lay person in an additional 57 (17%) of cases In 12 months, of 398 trained individuals, 87 used naloxone and 2 had their naloxone used on them (22 reversals for every 100 trained) Huxley-Reicher Z NYC Department of Health and Mental Hygiene

87 Implementation in NY State Over 300 sites have registered to distribute free kits provided by the New York State Department of Health Syringe exchange/syringe access providers Drug treatment providers Agencies focused on homeless populations Law enforcement agencies Local health departments Educational institutions School Districts NYS Department of Corrections and Community Supervision Primary care HIV services

88 September 2016 Expanding Community Program Basic Life Support Law enforcement Firefighters Corrections School Settings Pharmacy Special Focuses Nearly 300 programs currently active or recently registered 185 in 2014 & 2015; Permissible scope of practice now includes IN naloxone. Frequently first on the scene of an OD. As with police, firefighters are often first on the scene Pilot in 10 State prison facilities being expanded to others Began in August 2015 with changes in Public Health and Education laws Pharmacy dispensing pursuant to standing orders is now underway. Patient specific prescriptions as well

89 Pharmacy Pharmacies are now carrying naloxone Dispense with a patient specific order Dispense per an non-patient specific (standing) order Work with registered opioid overdose programs Register as an opioid prevention program

90 Pharmacy 1,983 pharmacies throughout New York State able to dispense naloxone under standing orders including 111 independents 713 in New York City 1,270 in rest of state All chains with greater than 20 stores are required to dispense

91 Insurance coverage All Medicaid plans must cover at least one formulation of naloxone for people at risk of overdose Medicaid Fee for Service covers naloxone under standing orders at pharmacies- awaiting word from Managed Care No information on private insurance If a patient cannot afford the naloxone and/or co-pay, they should be directed to listing of NYS Opioid Overdose Prevention Programs

92 Opioid-Related ED Visits by Receipt of Naloxone Prescription Among Primary Care Patients with Chronic Pain Coffin et al., Annals of Internal Medicine 2016 In a population with a rate of opioid-related emergency department visits of 7/100 person-years, prescribing naloxone to 29 patients would avert 1 opioid-related visit in the subsequent year.

93 Participate! Prescribe to patients: Higher doses of opioids Using opioids illicitly or with a history of use Patients at risk of witnessing an overdose Insurance issues less clear Can also refer to community agencies Enroll your agency as a community program Particularly if serving high risk patients

94 Opioid Maintenance & Mortality In Baltimore, researchers found: Statistically significant inverse relationship between heroin OD deaths and patients treated with buprenorphine (P =.002) (Adjusting for heroin purity and # of methadone patients) Schwartz et al AJPH 2013

95 Conclusions Provision of naloxone to patients and community members is feasible and efficacious Physicians can train, prescribe, refer to programs depending and local resources An addition to, not a replacement for evidence based treatment!

96 Acknowledgments New York State Department of Health New York City Department of Health and Mental Hygiene Opioid Safety with Naloxone Network Injection Drug Users Health Alliance

97 Resources NYSDOH: List of programs; registration information; calendar of trainings and more NYCDOH&MH List of NYC pharmacies and more HRC: Updates, videos, soon lists of independent pharmacies in NYS

98 QUESTIONS?

Naloxone: Preventing Opioid Overdose in the Community. Sharon Stancliff, MD Medical Director Harm Reduction Coalition

Naloxone: Preventing Opioid Overdose in the Community. Sharon Stancliff, MD Medical Director Harm Reduction Coalition Naloxone: Preventing Opioid Overdose in the Community Sharon Stancliff, MD Medical Director Harm Reduction Coalition DISCLOSURES Sharon Stancliff MD has nothing to disclose LEARNING OBJECTIVES 1. Discuss

More information

Opportunities for Opioid Safety and Community-Based Overdose Management

Opportunities for Opioid Safety and Community-Based Overdose Management Opportunities for Opioid Safety and Community-Based Overdose Management DANTE COLLINS ERICA C. ERNST MAYA DOE-SIMKINS SEPTEMBER 13, 2013 Overview Prevalence & data Overdose prevention Making an overdose

More information

Mainstreaming naloxone rescue kits from harm reduction programs to pharmacies, police and fire responders

Mainstreaming naloxone rescue kits from harm reduction programs to pharmacies, police and fire responders Mainstreaming naloxone rescue kits from harm reduction programs to pharmacies, police and fire responders Alexander Y. Walley, MD, MSc Boston University School of Medicine ThINC Bergen 2015 Conference

More information

TREATING OPIOID ADDICTION IN HOMELESS POPULATIONS

TREATING OPIOID ADDICTION IN HOMELESS POPULATIONS TREATING OPIOID ADDICTION IN HOMELESS POPULATIONS Challenges and Opportunities Providing Medication Assisted Treatment (Buprenorphine) August 18, 2016 SPEAKERS TODAY Nilesh Kalyanaraman, MD, Chief Health

More information

Naloxone for Emergency Administration: A 2017 Update On FDA Guidance

Naloxone for Emergency Administration: A 2017 Update On FDA Guidance Naloxone for Emergency Administration: A 2017 Update On FDA Guidance Nathan A. Painter, PharmD, CDE Associate Clinical Professor University of California San Diego Skaggs School of Pharmacy and Pharmaceutical

More information

Opioids and Overdose 2017

Opioids and Overdose 2017 Opioids and Overdose 2017 This presentation is an introduction to: 1. Opioids, overdose and naloxone 2. How you can help A partnership of: Opioids A class of drugs taken for pain relief or euphoria. Prescribed

More information

The Opioid Epidemic: The State of the State

The Opioid Epidemic: The State of the State JOINT LEGISLATIVE COMMITTEE ON HEALTH AND HUMAN SERVICES The Opioid Epidemic: The State of the State Dr. Mandy Cohen, Dr. Susan Kansagra Department of Health and Human Services Nov. 14, 2017 3 PEOPLE DIE

More information

The Chronic Disease of Addiction Evidence and Lessons from Practice

The Chronic Disease of Addiction Evidence and Lessons from Practice The Chronic Disease of Addiction Evidence and Lessons from Practice Laura G. Kehoe, MD, MPH Medical Director, MGH Substance Use Disorders Unit Bridge Clinic Massachusetts General Hospital Assistant Professor

More information

Opiate Use Disorder and Opiate Overdose

Opiate Use Disorder and Opiate Overdose Opiate Use Disorder and Opiate Overdose Irene Ortiz, MD Medical Director Molina Healthcare of New Mexico and South Carolina Clinical Professor University of New Mexico School of Medicine Objectives DSM-5

More information

Evaluations. Viewer Call-In. Guest Speakers. What s New in AIDS/HIV? Phone: Fax: Thank You to our Sponsors

Evaluations. Viewer Call-In. Guest Speakers. What s New in AIDS/HIV? Phone: Fax: Thank You to our Sponsors What s New in AIDS/HIV? December 16, 2010 Guest Speakers Dr. Amneris Luque Director, AIDS Center at Strong Memorial Hospital Alma Candelas Director, Division of HIV Prevention, AIDS Institute Dan O Connell

More information

Take Home Naloxone: What Pharmacists Need to Know

Take Home Naloxone: What Pharmacists Need to Know Take Home Naloxone: What Pharmacists Need to Know Sheri L. Fandrey, BSP, PhD Knowledge Exchange Lead Manitoba Addictions Knowledge Exchange Conflict of Interest/Disclosure Dr. Sheri Fandrey Has no conflicts

More information

October 20, 2016 Scott K. Proescholdbell, MPH. Opioid Overdose and North Carolina s Public Health and Prevention Strategies

October 20, 2016 Scott K. Proescholdbell, MPH. Opioid Overdose and North Carolina s Public Health and Prevention Strategies October 20, 2016 Scott K. Proescholdbell, MPH Opioid Overdose and North Carolina s Public Health and Prevention Strategies Deaths per 100,000 population Death Rates* for Three Selected Causes of Injury,

More information

Medication Assisted Treatment of an Opioid Use Disorder. J. Craig Allen, MD. Medical Director, Rushford

Medication Assisted Treatment of an Opioid Use Disorder. J. Craig Allen, MD. Medical Director, Rushford Medication Assisted Treatment of an Opioid Use Disorder J. Craig Allen, MD. Medical Director, Rushford Learning objectives At the conclusion of this activity, participants will be able to: Understand

More information

SC MAT ACCESS. Medication Assisted Treatment Academic Community Capacity Expansion for Sustainable Success Kathleen Brady, MD, PhD, VPR, MUSC

SC MAT ACCESS. Medication Assisted Treatment Academic Community Capacity Expansion for Sustainable Success Kathleen Brady, MD, PhD, VPR, MUSC SC MAT ACCESS Medication Assisted Treatment Academic Community Capacity Expansion for Sustainable Success Kathleen Brady, MD, PhD, VPR, MUSC Overdose Death Rates from Opiates Most important sign of a

More information

Opioid Overdose Education and Naloxone Distribution

Opioid Overdose Education and Naloxone Distribution Opioid Overdose Education and Naloxone Distribution Emily Stoukides, PharmD PGY-2 Ambulatory Care Pharmacy Resident Nicole Brunet, PharmD, BCPP Clinical Pharmacy Specialist, Mental Health Disclosures Emily

More information

QUARTERLY PROVIDER MEETING MARCH 9, 2017 SUZANNE BORYS, ED.D.

QUARTERLY PROVIDER MEETING MARCH 9, 2017 SUZANNE BORYS, ED.D. 2017 State Targeted Response to the Opioid Crisis Grants QUARTERLY PROVIDER MEETING MARCH 9, 2017 SUZANNE BORYS, ED.D. H.R.6-21st Century Cures Act The 21st Century Cures Act is a United States law enacted

More information

Responding to the Opioid Epidemic

Responding to the Opioid Epidemic Responding to the Opioid Epidemic Jessica Gray, MD Addiction Medicine Fellow Boston Medical Center ROME New England August 17, 2017 Disclosures for Jessica Gray, MD No conflicts Learning Objectives Describe

More information

Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction

Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction Andrew Kolodny, MD Co-Director, Opioid Policy Research Collaborative Heller School for Social Policy and Management Brandeis

More information

Braintree Public Schools

Braintree Public Schools Braintree Public Schools Policy and Procedures for School Nurse, Athletic Director and Athletic Trainer Management of Potential Life Threatening Opioid Overdose Program Policy In order to recognize and

More information

September 1, The Honorable Tom Price, MD Secretary Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201

September 1, The Honorable Tom Price, MD Secretary Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201 September 1, 2017 The Honorable Tom Price, MD Secretary Department of Health and Human Services 200 Independence Avenue SW Washington, DC 20201 Dear Secretary Price: The National Association of County

More information

Addressing the Opioid Epidemic in Tennessee

Addressing the Opioid Epidemic in Tennessee Addressing the Opioid Epidemic in Tennessee A Multidisciplinary Approach Melissa McPheeters, PhD, MPH Director, Informatics and Public Health Analytics 26 108 733 *Source: CDC References Centers for

More information

Overdose Prevention and Response and Relay, a post-overdose initiative

Overdose Prevention and Response and Relay, a post-overdose initiative Overdose Prevention and Response and Relay, a post-overdose initiative Emily Winkelstein, Community Engagement Manager Bureau of Alcohol and Drug Use Prevention, Care and Treatment Agenda How overdose

More information

BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY SUMMIT Turning the Curve on Opioid Abuse in Bernalillo County

BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY SUMMIT Turning the Curve on Opioid Abuse in Bernalillo County BERNALILLO COUNTY OPIOID ABUSE ACCOUNTABILITY SUMMIT Turning the Curve on Opioid Abuse in Bernalillo County NMPHA Annual Conference April 2, 2014 Marsha McMurray-Avila Coordinator, Bernalillo County Community

More information

Law Enforcement Naloxone Training Florida Department of Children and Families. Office of Substance Abuse and Mental Health

Law Enforcement Naloxone Training Florida Department of Children and Families. Office of Substance Abuse and Mental Health Protecting, Leading, Uniting Since 1893 Law Enforcement Naloxone Training Florida Department of Children and Families Office of Substance Abuse and Mental Health 1. Learn how to recognize and respond to

More information

Opioid Management of Chronic (Non- Cancer) Pain

Opioid Management of Chronic (Non- Cancer) Pain Optima Health Opioid Management of Chronic (Non- Cancer) Pain Guideline History Original Approve Date 5/08 Review/Revise Dates 11/09, 9/11, 9/13, 09/15, 9/17 Next Review Date 9/19 These Guidelines are

More information

VIRGINIA S OPIOID & HEROIN OVERDOSE EPIDEMIC

VIRGINIA S OPIOID & HEROIN OVERDOSE EPIDEMIC 1 VIRGINIA S OPIOID & HEROIN OVERDOSE EPIDEMIC Virginia Association of Counties November 14, 2016 The Honorable William A. Hazel, Jr., M.D. Secretary of Health and Human Resources 1999 - Estimated drug

More information

Opioid Task Force Kick-Off Meeting. February 29, 2016

Opioid Task Force Kick-Off Meeting. February 29, 2016 Opioid Task Force Kick-Off Meeting February 29, 2016 Scope of the Opioid Problem and Data Review Olivia Kasirye, MD, MS County Public Health Officer OVERVIEW The Opioid Epidemic Opioid Task Force Development

More information

Steve Alsum. The Grand Rapids Red Project. (616)

Steve Alsum. The Grand Rapids Red Project. (616) Steve Alsum The Grand Rapids Red Project steve@redproject.org (616) 456-9063 Red Project Basics Overdose Epidemiology Naloxone Distribution Overview Locally And In Michigan Innovative National Models A

More information

Prescription Opioids

Prescription Opioids What are prescription opioids? Prescription Opioids Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made

More information

Prescription Drug Abuse Task Force Rx Report Card

Prescription Drug Abuse Task Force Rx Report Card San Diego County Prescription Drug Abuse Task Force 2016 Rx Report Card October 2016 Key Measures of Prescription Drug and Heroin Problems in San Diego County. Visit www.sandiegorxabusetaskforce.org for

More information

FY17 SCOPE OF WORK TEMPLATE. Name of Program/Services: Medication-Assisted Treatment: Buprenorphine

FY17 SCOPE OF WORK TEMPLATE. Name of Program/Services: Medication-Assisted Treatment: Buprenorphine FY17 SCOPE OF WORK TEMPLATE Name of Program/Services: Medication-Assisted Treatment: Buprenorphine Procedure Code: Modification of 99212, 99213 and 99214: 99212 22 99213 22 99214 22 Definitions: Buprenorphine

More information

Rural Prevention and Treatment of Substance Abuse Toolkit

Rural Prevention and Treatment of Substance Abuse Toolkit Rural Prevention and Treatment of Substance Abuse Toolkit September 18, 2017 Tricia Stauffer, MPH NORC Walsh Center for Rural Health Analysis Rural Health Outreach Tracking and Evaluation Program Funded

More information

Presenters. Session Objectives. Session Overview. Cluster Investigations in Rural Wisconsin

Presenters. Session Objectives. Session Overview. Cluster Investigations in Rural Wisconsin Public Health Nurses, Hepatitis C, Injection Drug Use and Heroin Sheila Guilfoyle Viral Hepatitis Prevention Coordinator Division of Public Health Wisconsin Department of Health Services Wisconsin Public

More information

PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE

PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE PRESCRIPTION DRUG ABUSE: THE NATIONAL PERSPECTIVE September 20, 2013 Association of State and Territorial Health Officials Annual Meeting R. Gil Kerlikowske Director of National Drug Control Policy National

More information

Appendix F Federation of State Medical Boards

Appendix F Federation of State Medical Boards Appendix F Federation of State Medical Boards Model Policy Guidelines for Opioid Addiction Treatment in the Medical Office SECTION I: PREAMBLE The (name of board) recognizes that the prevalence of addiction

More information

Serious Mental Illness and Opioid Use Disorder

Serious Mental Illness and Opioid Use Disorder Serious Mental Illness and Opioid Use Disorder Serious Mental Illness and Opioid Use Disorders Arthur Robin Williams, MD MBE Columbia University, Department of Psychiatry Nick Szubiak, MSW, LCSW Director,

More information

GOALS AND OBJECTIVES

GOALS AND OBJECTIVES SUBOXONE AND VIVITROL: ARE THERE DISPARITIES SURFACING IN MEDICATION ASSISTED TREATMENTS? P R E S E N T E D B Y D R. K I AM E M AH A N I A H & D R. M Y E C H I A M I N T E R - J O R D AN GOALS AND OBJECTIVES

More information

Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction

Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction Responding to the Prescription Opioid and Heroin Crisis: An Epidemic of Addiction Andrew Kolodny, MD Co-Director, Opioid Policy Research Collaborative Heller School for Social Policy and Management Brandeis

More information

The Connecticut Opioid REsponse Initiative. October 5, 2016

The Connecticut Opioid REsponse Initiative. October 5, 2016 October 5, 2016 The Connecticut Opioid REsponse Initiative October 5, 2016 The genesis of this strategic plan was Governor Dannel P. Malloy s charge to the Alcohol and Drug Policy Council (ADPC), a statewide

More information

Skills and Knowledge on Overdose Prevention. Bill Matthews, RPA-C Bethany Medley, MSW Bruce Trigg, MD

Skills and Knowledge on Overdose Prevention. Bill Matthews, RPA-C Bethany Medley, MSW Bruce Trigg, MD Skills and Knowledge on Overdose Prevention Bill Matthews, RPA-C Bethany Medley, MSW Bruce Trigg, MD Harm Reduction Coalition POLICY & ADVOCACY TRAINING & CAPACITY BUILDING OVERDOSE PREVENTION & ADVOCACY

More information

Public Policy Statement on the Regulation of Office-Based Opioid Treatment

Public Policy Statement on the Regulation of Office-Based Opioid Treatment Public Policy Statement on the Regulation of Office-Based Opioid Treatment Background Office-based opioid treatment (OBOT) commonly refers to outpatient treatment services provided outside of licensed

More information

Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse

Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse Jay Butler, MD, President of ASTHO, Chief Medical Officer, Alaska Department of Health

More information

Opioid Antagonist Act

Opioid Antagonist Act Opioid Antagonist Act Intranasal Naloxone Administration Training Module for Initial Responders Public Service Training Session Public Training Session Provided By: West Virginia Office of EMS Endorsed

More information

The Nova Scotia Take Home Naloxone Program. Amanda Hudson-Frigault, MA NS THN Coordinator

The Nova Scotia Take Home Naloxone Program. Amanda Hudson-Frigault, MA NS THN Coordinator The Nova Scotia Take Home Naloxone Program Amanda Hudson-Frigault, MA NS THN Coordinator Amanda.Hudson@nshealth.ca nsnaloxone@nshealth.ca Who are the Health Promoters in your Neighborhood? Background The

More information

NALOXONE LEARNING ABOUT NALOXONE COULD SAVE A LIFE

NALOXONE LEARNING ABOUT NALOXONE COULD SAVE A LIFE NALOXONE LEARNING ABOUT NALOXONE COULD SAVE A LIFE WHAT IT IS WHAT IT IS NARCAN (naloxone HCl) Nasal Spray is the first and only FDA-approved nasal form of naloxone for the emergency treatment of a known

More information

The Role of Primary Care Teams and the Medical Neighborhood in Addressing the Opioid Crisis in Maine. March 10, 2016

The Role of Primary Care Teams and the Medical Neighborhood in Addressing the Opioid Crisis in Maine. March 10, 2016 The Role of Primary Care Teams and the Medical Neighborhood in Addressing the Opioid Crisis in Maine March 10, 2016 Objectives Review current state of opioid crisis in Maine Briefly review physiology of

More information

Maryland s Good Samaritan Law

Maryland s Good Samaritan Law Maryland s Good Samaritan Law Annotated Code of Maryland, Criminal Procedure 1-210 Effective October 1, 2015 1 Maryland Public Opinion Survey (MPOS) Administered online February 20 - March 15, 2015 to

More information

Addressing the Opioid Epidemic through a Public Health Lens

Addressing the Opioid Epidemic through a Public Health Lens Addressing the Opioid Epidemic through a Public Health Lens MONICA BHAREL, MD, MPH MASSACHUSETTS COMMISSIONER OF PUBLIC HEALTH VISION Optimal health and well-being for all people in Massachusetts, supported

More information

Reducing Opioid Deaths: Arizona s Emergency Declaration & Response

Reducing Opioid Deaths: Arizona s Emergency Declaration & Response Reducing Opioid Deaths: Arizona s Emergency Declaration & Response September 15, 2017 Sheila Sjolander, Assistant Director Arizona Department of Health Services Emergency Declaration On June 5, 2017, Arizona

More information

Recommendations in Opioid Prescribing Guidelines for Chronic Pain

Recommendations in Opioid Prescribing Guidelines for Chronic Pain Recommendations in Opioid Prescribing Guidelines for Chronic Pain The use of opioids for treating chronic pain has been increasing. 1 In 2010, an estimated 20% of patients presenting to physician offices

More information

Division of Mental Health and Addiction Services

Division of Mental Health and Addiction Services Division of Mental Health and Addiction Services A DAM BUCON, LSW DMHAS Mission DMHAS, in partnership with consumers, family members, providers and other stakeholders, promotes wellness and recovery for

More information

Opioid Abuse in Iowa Rx to Heroin. Iowa Governor s Office of Drug Control Policy March 2016

Opioid Abuse in Iowa Rx to Heroin. Iowa Governor s Office of Drug Control Policy March 2016 1 Opioid Abuse in Iowa Rx to Heroin Iowa Governor s Office of Drug Control Policy March 2016 2 National Rx Painkiller Trends CDC, 2013 3 National Rx-Heroin Trends NIH, 2015 4 National Rx-Heroin Trends

More information

Prepublication Requirements

Prepublication Requirements Issued Prepublication Requirements The Joint Commission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals

More information

Topics of today s training

Topics of today s training Extended Release Naltrexone Vivitrol Christopher J Davis D.O. CAADC, FASAM Medical Director, Brightwater Landing Medical Director, Pyramid Healthcare Diplomate of The American Board of Addition Medicine

More information

Opioid Use and Other Trends

Opioid Use and Other Trends Opioid Use and Other Trends National Overview Across the nation communities are struggling with a devastating increase in the number of people misusing opioid drugs, leading many to identify the current

More information

The Prescription Drug Overdose Epidemic

The Prescription Drug Overdose Epidemic The Prescription Drug Overdose Epidemic Rita Noonan, PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division

More information

Overdose Fatality Review Presentation of Annual Reports. Erin Haas and Laura Bartolomei-Hill Maryland Department of Health

Overdose Fatality Review Presentation of Annual Reports. Erin Haas and Laura Bartolomei-Hill Maryland Department of Health Overdose Fatality Review Presentation of Annual Reports Erin Haas and Laura Bartolomei-Hill Maryland Department of Health 5/23/2017 Agenda Introductions Overview of Overdose Fatality Review in Maryland

More information

Good Samaritan. State with this law in place: New Mexico, Washington, New York, Connecticut, Illinois (to be enforced June 1, 2012)

Good Samaritan. State with this law in place: New Mexico, Washington, New York, Connecticut, Illinois (to be enforced June 1, 2012) Good Samaritan Immunity Laws that provide protection from prosecution for calling 911 if seeking medical attention for self or another experiencing an overdose The US Conference of Mayors 2008 unanimously

More information

1 HB By Representative Williams (JD) 4 RFD: Health. 5 First Read: 09-JAN-18 6 PFD: 11/28/2017. Page 0

1 HB By Representative Williams (JD) 4 RFD: Health. 5 First Read: 09-JAN-18 6 PFD: 11/28/2017. Page 0 1 HB37 2 188862-1 3 By Representative Williams (JD) 4 RFD: Health 5 First Read: 09-JAN-18 6 PFD: 11/28/2017 Page 0 1 188862-1:n:11/16/2017:PMG/tj LSA2017-3516 2 3 4 5 6 7 8 SYNOPSIS: This bill would establish

More information

Medication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment

Medication Assisted Treatment. MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Medication Assisted Treatment MAT Opioid dependence/addiction Opioid treatment programs OTP Regulation of OTP Office Based Treatment Opioid Drugs Opium Morphine Heroin Codeine Oxycodone Roxycodone Oxycontin

More information

Substance Use Disorders in Primary Care

Substance Use Disorders in Primary Care Substance Use Disorders in Primary Care Jin Hee Yoon-Hudman, MD Assistant Vice President, Medical Director, Behavioral Health Healthfirst Fall Symposium Prevention as a Priority in Value-Based Healthcare,

More information

Treatment Alternatives for Substance Use Disorders

Treatment Alternatives for Substance Use Disorders Treatment Alternatives for Substance Use Disorders Dean Drosnes, MD, FASAM Associate Medical Director Director, Chronic Pain and SUD Program Caron Treatment Centers 1 Disclosure The speaker has no conflict

More information

Good Samaritan and Naloxone Bill Status Report Carryover 2016 and Special Sessions

Good Samaritan and Naloxone Bill Status Report Carryover 2016 and Special Sessions Good Samaritan and Naloxone Bill Status Report Carryover 2016 and Special Sessions Research current through April 8, 2016 This project was supported by Grant No. G15599ONDCP03A awarded by the Office of

More information

The STOP Measure. Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018

The STOP Measure. Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018 The STOP Measure Safe and Transparent Opioid Prescribing to Promote Patient Safety and Reduced Risk of Opioid Misuse FEBRUARY 2018 AHIP s Safe, Transparent Opioid Prescribing (STOP) Initiative Methodology

More information

Maternal Substance Abuse: Challenges & Opportunities for Perinatal Nurses Catherine H. Ivory, PhD, RNC-OB October, 2015

Maternal Substance Abuse: Challenges & Opportunities for Perinatal Nurses Catherine H. Ivory, PhD, RNC-OB October, 2015 Maternal Substance Abuse: Challenges & Opportunities for Perinatal Nurses Catherine H. Ivory, PhD, RNC-OB October, 2015 Objectives Discuss the current scope of maternal substance use and abuse List examples

More information

Pharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco

Pharmacotherapy for opioid addiction. Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Pharmacotherapy for opioid addiction Judith Martin, MD Medical Director BAART Turk Street Clinic San Francisco Disclosure slide No commercial conflicts to disclose. Gaps in current treatment of opioid

More information

Best Practices in Prescribing Opioids for Chronic Non-cancer Pain

Best Practices in Prescribing Opioids for Chronic Non-cancer Pain Best Practices in Prescribing Opioids for Chronic Non-cancer Pain Disclosures S C O T T S T E I G E R, M D, F A C P, D A B A M A S S I S T A N T C L I N I C A L P R O F E S S O R D I V I S I O N O F G

More information

Talking with your doctor

Talking with your doctor SUBOXONE (buprenorphine and naloxone) Sublingual Film (CIII) Talking with your doctor Opioid dependence can be treated. Talking with your healthcare team keeps them aware of your situation so they may

More information

SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program

SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets. Risk Evaluation and Mitigation Strategy (REMS) Program SUBOXONE Film, SUBOXONE Tablets, and SUBUTEX Tablets Risk Evaluation and Mitigation Strategy (REMS) Program Office-Based Buprenorphine Therapy for Opioid Dependence: Important Information for Prescribers

More information

Disclosures. Objectives 2/5/2018. Women and opioid use disorder: Optimizing care during pregnancy and beyond

Disclosures. Objectives 2/5/2018. Women and opioid use disorder: Optimizing care during pregnancy and beyond Women and opioid use disorder: Optimizing care during pregnancy and beyond Susanne Astrab Fogger, DNP, PMHNP-BC, CARN-AP, FAANP Ashley L. Hodges, PhD, CRNP, WHNP-BC Disclosures Dr. Fogger has nothing to

More information

Stark County Opiate Task Force

Stark County Opiate Task Force Stark County Opiate Task Force Allison Esber, MSSA, LSW, OCPSA Systems Initiative Manager April 10, 2017 Partner Solutions Informatics Forum for Next Gen Users in Behavioral Health What does StarkMHAR

More information

Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in 5 New England States

Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in 5 New England States Facing the Opioid Epidemic (FOE): Assessing and Responding to Prescription and Illicit Opioid Use and Misuse in 5 New England States T h o m a s J. S t o p k a, P h D, M H S L e o B e l e t s k y, J D,

More information

Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx

Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx Role of PMPs in Preventing Substance Abuse National Conference of State Legislatures December 6, 2006 San Antonio, Tx Nick Reuter Division of Pharmacologic Therapy Substance Abuse and Mental Health Services

More information

Dear DEA. Howard A. Heit, MD, FACP, FASAM,* Edward Covington, MD, and Patricia M. Good

Dear DEA. Howard A. Heit, MD, FACP, FASAM,* Edward Covington, MD, and Patricia M. Good PAIN MEDICINE Volume 5 Number 3 2004,* Edward Covington, MD, and Patricia M. Good *Georgetown University, Washington, District of Columbia; Cleveland Clinic Foundation, Cleveland, Ohio; Office of Diversion

More information

Heroin What You Need to Know

Heroin What You Need to Know Heroin What You Need to Know More People Died from Drug Overdoses than Car Crashes and Gun Deaths in 2015 52,404 people died from drug overdoses (33,091 involved an opioid including heroin) 37,757 people

More information

Treatment Approaches for Drug Addiction

Treatment Approaches for Drug Addiction Treatment Approaches for Drug Addiction NOTE: This fact sheet discusses research findings on effective treatment approaches for drug abuse and addiction. If you re seeking treatment, you can call the Substance

More information

Prescription Drug Monitoring Program Update. Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017

Prescription Drug Monitoring Program Update. Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017 Prescription Drug Monitoring Program Update Rebecca R. Poston, BPharm., MHL Program Manager August 26, 2017 Objectives Brief historical overview of opioids Review of PDMP information Discuss ideas from

More information

Injectable naltrexone (XR-NTX) A RETROSPECTIVE STUDY OF ITS ACCEPTANCE IN A COMMUNITY RECOVERY SETTING BRIANNE FITZGERALD MSN, PMHNP, CARN-AP

Injectable naltrexone (XR-NTX) A RETROSPECTIVE STUDY OF ITS ACCEPTANCE IN A COMMUNITY RECOVERY SETTING BRIANNE FITZGERALD MSN, PMHNP, CARN-AP Injectable naltrexone (XR-NTX) A RETROSPECTIVE STUDY OF ITS ACCEPTANCE IN A COMMUNITY RECOVERY SETTING BRIANNE FITZGERALD MSN, PMHNP, CARN-AP Overview Gavin Foundation Injectable naltrexone Community report

More information

Practical Tools to Successfully Taper Prescription Opioids. Melissa Weimer, DO, MCR

Practical Tools to Successfully Taper Prescription Opioids. Melissa Weimer, DO, MCR Practical Tools to Successfully Taper Prescription Opioids Melissa Weimer, DO, MCR Objectives Understand how to calculate morphine equivalents per day Understand the steps necessary to plan a successful

More information

End the Epidemic. Miami-Dade County COMPREHENSIVE COMMUNITY PREVENTION ACTION PLAN

End the Epidemic. Miami-Dade County COMPREHENSIVE COMMUNITY PREVENTION ACTION PLAN End the Epidemic Miami-Dade County COMPREHENSIVE COMMUNITY PREVENTION ACTION PLAN 2018 2021 Miami-Dade County along with the State of Florida and the Nation are dramatically impacted by an Opioid Epidemic

More information

Maine s Response to the Opiate Crisis. Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016

Maine s Response to the Opiate Crisis. Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016 Maine s Response to the Opiate Crisis Christopher Pezzullo, DO State Health Officer Maine DHHS Maine CDC November 12, 2016 Required Disclosure Text Font typically Times New Roman at least 20 point Try

More information

SUBSTANCE USE DISORDER TREATMENT AND REFERRAL PROCESS

SUBSTANCE USE DISORDER TREATMENT AND REFERRAL PROCESS SUBSTANCE USE DISORDER TREATMENT AND REFERRAL PROCESS Presented by: John M. Connolly, Ph.D. Acting Deputy Director Los Angeles County Health Agency Department of Public Health Substance Abuse Prevention

More information

Overview of Medication Assisted Treatment Methadone, Buprenorphine and Naltrexone

Overview of Medication Assisted Treatment Methadone, Buprenorphine and Naltrexone Overview of Medication Assisted Treatment Methadone, Buprenorphine and Naltrexone Alexander Y. Walley, MD, MSc Associate Professor of Medicine Director, Addiction Medicine Fellowship Boston University

More information

What do we mean by the opioid crisis? Painkiller prescriptions per 100 North Carolinians Source: CDC US Prescribing Rate Maps (2016)

What do we mean by the opioid crisis? Painkiller prescriptions per 100 North Carolinians Source: CDC US Prescribing Rate Maps (2016) What do we mean by the opioid crisis? 83 Painkiller prescriptions per 100 North Carolinians Source: CDC US Prescribing Rate Maps (2016) 675,315,375 Opioid pills dispensed in North Carolina in 2016 SOURCE:

More information

Pharmacist Directed Opioid Antagonist Dispensing

Pharmacist Directed Opioid Antagonist Dispensing Pharmacist Directed Opioid Antagonist Dispensing MARK BOESEN, PHARM.D., J.D. CHAIRMAN AND CEO GENRX PHARMACY C0-CHAIRMAN ARIZONA PHARMACY ASSN. LEGISLATIVE COMMITTEE DECEMBER 15, 2016 Opioid Substance

More information

A Different Kind of Drug War. CINDY SANDERS Posted: Thursday, April 5, :07 pm. Providers Focus on Prescription Drug Addiction, Abuse

A Different Kind of Drug War. CINDY SANDERS Posted: Thursday, April 5, :07 pm. Providers Focus on Prescription Drug Addiction, Abuse A Different Kind of Drug War CINDY SANDERS Posted: Thursday, April 5, 2012 4:07 pm Dr. Roland Gray recording the latest online prescribing class curriculum for the Prescription Safety Program. Providers

More information

Prescription Opioid Policies (22 March 2016)

Prescription Opioid Policies (22 March 2016) Prescription Opioid Policies (22 March 2016) Prescription opioid misuse and abuse has become problematic in the United States and internationally in economically developed countries. Increased use of opioids

More information

THE UNSTABLE BUPRENORPHINE- NALOXONE PATIENT

THE UNSTABLE BUPRENORPHINE- NALOXONE PATIENT Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences THE UNSTABLE BUPRENORPHINE- NALOXONE PATIENT MARK DUNCAN MD UNIVERSITY OF WASHINGTON SPEAKER DISCLOSURES Any conflicts

More information

Federal and State Controlled Substance Laws and Guidelines. Good Medicine for Prescribers and Patients

Federal and State Controlled Substance Laws and Guidelines. Good Medicine for Prescribers and Patients Federal and State Controlled Substance Laws and Guidelines Good Medicine for Prescribers and Patients Tennessee Chapter of the American College of Physicians Nashville, Tennessee 28 October 2017 Disclosure

More information

Prescription for Disaster: Impact of Drugs in our Society

Prescription for Disaster: Impact of Drugs in our Society Prescription for Disaster: Impact of Drugs in our Society What you can do about the epidemic of drug abuse in our communities 1 Florida Poison Information Center-Tampa 10/26/2012 Cynthia R. Lewis-Younger,

More information

OPIOID PRESCRIBING RULES. May 17, 2017 Webinar

OPIOID PRESCRIBING RULES. May 17, 2017 Webinar OPIOID PRESCRIBING RULES May 17, 2017 Webinar Outline Introduction and Universal Precautions Dr. Levine, Commissioner, Health Department 15 Minutes Acute Pain Dr. Patti Fisher, UVMMC 20 Minutes Chronic

More information

Substance Use Disorders: A Path Forward for Michigan

Substance Use Disorders: A Path Forward for Michigan Substance Use Disorders: A Path Forward for Michigan DEBRA A. PINALS, M.D. MEDICAL DIRECTOR BEHAVIORAL HEALTH AND FORENSIC PROGRAMS MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES Tackling the opiate

More information

Dutchess County Substance Abuse Prevention Initiative

Dutchess County Substance Abuse Prevention Initiative Dutchess County Substance Abuse Prevention Initiative Prevention Agenda Priority Promote Mental Health and Prevent Substance Abuse Latham, NY Wednesday, November 12, 2014 Background Justification: a) Mortality

More information

Naloxone for opioid safety

Naloxone for opioid safety SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH Naloxone for opioid safety A provider s guide to prescribing naloxone to patients who use opioids 1 NALOXONE FOR OPIOID SAFETY Overdose is the leading cause of

More information

U.S. Counties Vulnerability to Rapid Dissemination of HIV/HCV Infections Among People Who Inject Drugs

U.S. Counties Vulnerability to Rapid Dissemination of HIV/HCV Infections Among People Who Inject Drugs U.S. Counties Vulnerability to Rapid Dissemination of HIV/HCV Infections Among People Who Inject Drugs Michelle Van Handel, MPH Health Scientist National Center for HIV/AIDS, Viral Hepatitis, STDs and

More information

NALOXONE RISK ASSESSMENT

NALOXONE RISK ASSESSMENT NALOXONE RISK ASSESSMENT Intended audience: Non-public sector organizations. Introduction: BC is currently experiencing a public health emergency related to the unprecedented increase in opioid overdoses

More information

NM DRUG OVERDOSE PREVENTION QUARTERLY MEASURES REPORT THIRD QUARTER OF 2017 (2017Q3)

NM DRUG OVERDOSE PREVENTION QUARTERLY MEASURES REPORT THIRD QUARTER OF 2017 (2017Q3) NM DRUG OVERDOSE PREVENTION QUARTERLY MEASURES REPORT THIRD QUARTER OF 217 () Substance Abuse Epidemiology Section Prescription Drug Overdose Prevention Program Injury and Behavioral Epidemiology Bureau

More information