SBIRT for Substance Use Disorders (Screening, Brief Intervention, and Referral to Treatment)

Transcription

1 SBIRT for Substance Use Disorders (Screening, Brief Intervention, and Referral to Treatment) Provider Education, Billing, and Resource Reference Guide 1/17/2018 1

2 Program Overview Screening, Brief Intervention, and Referral to Treatment (SBIRT) is designed to prevent members from developing a substance use disorder, for early detection of a suspected substance use disorder, or to refer members for treatment. These services are not intended to treat members already diagnosed with a substance use disorder or those members already receiving substance use disorder treatment services. As of January 1, 2018 Gateway Health will begin compensating providers for completing SBIRT for Substance Abuse screenings/assessment in physical healthcare settings. Gateway Health only reimburses providers for medically necessary services furnished to eligible members. The purpose of this guide is to provide education and billing guidance to providers to obtain reimbursement for SBIRT services. This guide will be updated periodically to reflect changes. Gateway reserves the right to conduct post-payment medical record audits for validation purposes and in accordance with state and federal accreditation, your provider agreement and regulatory requirements. Screening/Assessment Pre-Screen (aka Brief Screen/Assessment): A pre-screen/assessment is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as "a rapid, proactive procedure to identify individuals who may have a condition or be at risk for a condition before obvious manifestations occur." It involves short questions relating to alcohol and drug use, and must be administered prior to beginning a full screening/assessment. Pre-screens/assessments are considered part of routine medical management and are not a separately reimbursable service. When the pre-screening/assessment results do not indicate any need for a full screen/ assessment positive re-enforcement and education regarding prevention should still be provided and discussed. Full Screening/ Assessment: Full screens/ assessments are administered after a patient has answered positively to the pre-screen/ assessments questions. Full screenings/assessments entail asking patients a validated series of questions to assess the level of a patient s substance use. Full screens/assessments are only covered for members with positive brief screens/assessments and for members with signs, symptoms, and medical conditions that suggest risky or problem alcohol or drug use. Full screenings/assessments should be used as a primary method for educating members about the health effects of using alcohol and other drugs. Gateway Health covers screening/assessment services in a wide variety of settings to increase the chance of identifying individuals at risk for future substance abuse. Providers are required to use an evidence-based screening/ assessment tool to identify patients at risk for substance use problems. There are several evidence-based screening/ assessment tools including: The Alcohol Use Disorders Inventory Test (AUDIT) The Drug Abuse Screening Test (DAST) The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) The Car, Relax, Alone, Forget, Friends, Trouble Screening Test (CRAFFT), for adolescents The Problem Oriented Screening Instrument for Teenagers (POSIT) Links to these screening/assessment tools, as well as others, can be located at: Brief Intervention Brief interventions are interactions with patients that are intended to induce a change in a health-related behavior. When a Substance Use Disorder is diagnosed and appropriately added to the billing claim, up to three (3) follow-up contacts should be provided within the next 34 days (1 within 14 days and (2) additional within the remaining 34 days) to assess and promote progress and to evaluate the need for additional services. Brief interventions are typically used as a management strategy for patients with risky or problem alcohol or drug use who are not dependent. Brief substance use intervention services are covered for members who, through the use of an evidence-based screening/ assessment tool, are identified as at-risk for a substance use disorder(s). Brief intervention may be single or multiple sessions to increase insight and awareness regarding substance use and 2

3 motivation for changes in behavior. Alternatively, a brief intervention may also be used to increase motivation and acceptance of a referral for substance use treatment. Intervention services may occur on the same date of service as the screening/assessment or on a later date. Brief intervention is not covered prior to screening/ assessment. Referral to Treatment Patients who appear to be alcohol- or drug-dependent should be referred to alcohol and drug treatment programs. Patients who screen positive for a Substance Use Disorder should initiate treatment within 14 days of the substance use disorder identification/ diagnosis and engage in at least two (2) additional treatment services within 34 days of the identification/ diagnosis of the substance use disorder. Member Eligibility The SBIRT benefit is available to members ages 12 and older who are enrolled in Gateway Health. Eligible Providers The following licensed providers are eligible to be reimbursed for SBIRT as long as they have a current contract with Gateway for clinical services. Physician Psychiatrist (Medicare Only) Physician Assistant (PA) Nurse Practitioner (NP) Clinical Nurse Specialist (CNP) Clinical Psychologist (CP)- (Medicare Only) Clinical Social Worker (LCSW)- (Medicare Only) Clinical Nurse Midwife Billing Information The procedure codes used to report SBIRT services for reimbursement are consistent among all provider types. Gateway Health will reimburse for the following codes: Procedure Code G0396 G0397 Description Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes Additional Information 1. Screening Brief Intervention Treatment is not designed to address smoking and tobacco cessation services unless it is a co-occurring diagnosis with another substance such as drugs or alcohol. Tobacco-only services are not a SBIRT billable benefit. 2. Screening Brief Intervention Treatment may be provided face-to-face with the member, through telehealth/ telemedicine, or telephonically. 3. A prior authorization request is not required. 4. SBIRT screenings/ assessments are reimbursable up to two a year per member. 3

4 Training Requirements In order to directly deliver screening, assessment and intervention services, providers are required to participate in a training that provides information about the implementation of evidence-based protocols for screening, brief interventions, and referrals to treatment. Face-to-face trainings and consultations are available through various entities. All providers are required to retain documentation confirming that staff providing SBIRT meet the training, education, and supervision requirements. Providers billing Gateway Health for SBIRT screening and assessment are required to maintain documentation of completion of an evidence based SBIRT training program. Providers may be asked by Gateway Health to present evidence of this training if an audit occurs. If appropriate documentation cannot be produced Gateway Health retains the right to void the claim payments. Training Modality Options Pennsylvania Medical Society Training by PERU Center Brief Intervention Group (BIG) Medscape SBIRT Phone application by James Bray Addiction Technology Transfer Center Network (ATTC) SAMHSA Approved SBIRT Resources Brief Description SBIRT Course offered by PERU: Negotiating Problematic Substance Use with Patients in the Primary Care Setting BIG Initiative is led by the National Opinion and Research Center (NORC) at the University of Chicago and the National SBIRT ATTC (N SBIRT ATTC). Funded by SAMHSA, the N SBIRT ATTC is housed at the Institute for Research, Education and Training in Addictions (IRETA) in Pittsburgh, PA. Offer training via online course and webinars, technical assistance, and a variety of services for SBIRT; SBIRT Course offered online by Medscape: Substance Use in Adults and Adolescents: Screening, Brief Intervention and Referral to Treatment (SBIRT) Continuing Education Offered Free course/cme's offered to physicians Education is Free Physicians: 1.75 AMA PRA Category 1 Credit (s) RNs: 1.75 Contact Hours Link: Smart Phone Application Download No Varies by Service Provider The goal of this training is to help participants develop their knowledge, skills and abilities as Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT) Trainers. No A Certificate of Completion for 6 CEs/PDH is available for purchase. ($25 for members of EAPA; $35 for nonmembers) STCUSTOM6 Resources referenced from: 4

5 Referral Resources Where Can I refer Patients who Screen Positive and agree to Treatment? Gateway Health offers the following resources for treatment: 1) Opioid Use Disorder Centers of Excellence Centers of Excellence, coordinate care for people with Medicaid. Treatment is team-based and focused on the whole person with the explicit goal of integrating behavioral health with primary care. Patients of these centers: Have an opioid use disorder May have co-occurring behavioral and physical health conditions Need help to navigate the care system Need guidance to stay engaged in treatment to avoid relapsing Centers of Excellence provide: Comprehensive Care Management Care Coordination Transitional/ Follow Up Care Patient and Family Support Referral to Community/ Social Support Services 2) The Behavioral Health Managed Care Organization For mental health and drug and alcohol services, each county contracts with a Managed Care Organization (MCO). 3) Substance Use Disorder Medical Health Homes For the most up to date listing please visit: 4) The County Single County Authority for Drug and Alcohol Services 5) Gateway Health also has other participating Medication Assisted Treatment providers. For a list of other providers please contact Gateway Health. Patients can also be referred to Case Management at Gateway Health for assistance in referrals to other resources for treatment and care coordination. To make a referral for case management: PA Medicaid: PA Medicare:

6 Adams Allegheny Armstrong Beaver Bedford Community Care Behavioral Health (CCBH) York Adams Drug and Alcohol Commission West Market Street, Suite B04, York, PA BH MCO Community Care Behavioral Health (CCBH) BH MCO Allegheny County Department of Human Services / Office of Behavioral Health/ Bureau of Drug and Alcohol Services One Smithfield Street, 3rd Floor, Pittsburgh, PA Gateway Rehabilitation Center Rouser Road, Moon Township, PA COE West Penn Allegheny Health System Federal Street, Floor 1, Suite B110, Pittsburgh PA COE Tadiso Inc Beaver Avenue, Pittsburgh, Pa COE WPIC of UPMCPS O'Hara Street, Pittsburgh, PA COE University of Pittsburgh Physicians: General Internal Medicine Clinic-Oakland Lothrop Street, Pittsburgh PA COE Magee-Women s Hospital of UPMC Halket Street, Pittsburgh, PA COE Accessible Recovery Services McKnight Rd, Suite 103, Pittsburgh, PA SUD MHH Accessible Recovery Services Brookline Blvd, Suite 2, Pittsburgh, PA SUD MHH Accessible Recovery Services Northern Pike Suite, 101, Monroeville, P A SUD MHH Accessible Recovery Services Evans Ave, McKeesport, Pa SUD MHH Accessible Recovery Services Dallas Ave, Natrona Heights, PA SUD MHH Accessible Recovery Services Stanton Ave, Pittsburgh, PA SUD MHH Beacon Health Options BH MCO Armstrong-Indiana-Clarion Drug and Alcohol Commission, Inc US Route 422, PO Box 238, Shelocta, PA Beacon Health Options BH MCO Beaver County Behavioral Health Drug and Alcohol Program Eighth Street, Beaver Falls, PA Accessible Recovery Services rd Street, Beaver, PA SUD MHH Opioid Addiction Recovery Services Hospital Drive, Aliquippa, PA SUD MHH PerformCare BH MCO Personal Solutions Inc Clark Building, Suite 5,Bedford, PA Community Care Behavioral Health (CCBH) BH MCO Berks Berks County Council on Chemical Abuse Penn Street, Suite 600, Reading,PA Reading Hospital and Health System th Avenue and Spruce Street, West Reading, Pa COE New Directions Treatment Services North 6th Avenue, West Reading, PA COE 6

7 Community Care Behavioral Health (CCBH) BH MCO Blair Blair County Drug and Alcohol Program, Inc Fairway Drive, Suite D, Altoona, PA Pyramid Healthcare, Inc Plank Road, PO Box 967,Duncansville, PA COE Bradford Bradford/Sullivan Drug and Alcohol Programs Main Street, Unit 1, Towanda, PA CASA of Livingston County, Inc./Trinity Henry Street, Sayre, PA COE Magellan BH MCO Bucks Bucks County Drug & Alcohol Commission, Inc Louis Drive, Suite 102A, Warminster, PA Family Service Association of Bucks County Cornerstone Drive, Langhorne, PA COE Penn Foundation, Inc Lawn Ave., Sellersville, PA COE Butler Beacon Health Options BH MCO Butler County MH/MR Drug and Alcohol West Diamond Street, PO Box 1208, Butler, PA Butler Memorial Hospital One Hospital Way, Butler, PA COE Accessible Recovery Services Smith Dr, Unit 1, Cranberry Twp, PA SUD MHH Accessible Recovery Services South Main Street, Plaza Level Suite C, Butler, PA SUD MHH Opioid Addiction Recovery Services Liberty St, Butler, PA SUD MHH Magellan BH MCO Cambria Cameron Carbon Centre Chester Cambria County MH/MR Drug and Alcohol Program Central Park Complex, 110 Franklin Street, Suite 200, Johnstown, PA Alliance Medical Services- Johnstown Scalp Ave, Suite 175, Johnstown, PA COE Accessible Recovery Services Walnut St, 1st Floor Suite A, Johnstown PA SUD MHH Cameron Elk McKean Counties Alcohol and Drug Abuse Services Inc Chestnut Street, Port Allegheny, PA Community Care Behavioral Health (CCBH) BH MCO Carbon Monroe Pike Drug and Alcohol Commission Phillips Street, Suite 203, Stroudsburg, PA Centre County Office MH/MR Drug and Alcohol East College Avenue, Suite 1200, State College, PA Crossroads Counseling, Inc East College Avenue, Suite 460, State College, PA COE Community Care Behavioral Health (CCBH) BH MCO Chester County Department of D&A Services Government Services Center Suite 325, 601 Westtown Road, PO Box 2747, West Chester, PA

8 Clarion Clearfield Armstrong-Indiana-Clarion Drug and Alcohol Commission, Inc US Route 422, PO Box 238, Shelocta, PA Clearfield Jefferson Drug and Alcohol Commission Midway Drive, Suite A,DuBois, PA Clearfield-Jefferson Drug and Alcohol Commission Midway Drive, DuBois, PA COE Clinton Columbia Crawford Cumberland Community Care Behavioral Health (CCBH) BH MCO Lycoming Clinton West Branch Drug and Alcohol Abuse Commission West Fourth Street, Williamsport, PA Crossroads Counseling, Inc North Grove Street, Suite 4, Lock Haven, PA COE Columbia Montour Snyder Union Drug and Alcohol Program Behavioral Health Base Service Unit 603 East Market Street, Suite 200, Danville, PA Beacon Health Options BH MCO Crawford County D&A Executive Commission, Inc Water Street, Downtown Mall, Meadville, PA Accessible Recovery Services Conneaut Lake Rd, Unit 6, Meadville, PA SUD MHH PerformCare BH MCO Cumberland Perry Drug and Alcohol Commission Human Services Building, 16 West High Street, Suite 302, Carlisle, PA PerformCare BH MCO Dauphin Dauphin County Department of Drug and Alcohol Services South Cameron Street, Harrisburg, PA Pennsylvania Counseling Services - Allison Hill South 17th Street, Harrisburg, PA COE Hamilton Health Center S 17th Street, Harrisburg, PA COE Accessible Recovery Services South Progress Ave, Suite 3B, Harrisburg, PA SUD MHH Magellan BH MCO Delaware Elk Delaware County Office of Behavioral Health South 69th Street, Third floor, Upper Darby, PA AIDS Care Group/Sharon Hill Medical Edgemont Avenue, Chester, PA COE Crozer-Chester Medical Center - Community Hospital West 9th Street, Chester, PA COE Cameron Elk McKean Counties Alcohol and Drug Abuse Services Inc Chestnut Street, Port Allegheny, PA

9 Community Care Behavioral Health (CCBH) BH MCO Erie Fayette Forest Franklin Fulton Greene Huntington Indiana Erie County Office of Drug and Alcohol Abuse West 8th Street, Suite 418, Erie, PA Esper Treatment Center West 18th Street, Erie, PA COE Accessible Recovery Services Peach St, Erie, PA SUD MHH Beacon Health Options BH MCO Fayette County Drug and Alcohol Commission Inc New Salem Road, Suite 106, Fayette County Health Center Building, Uniontown, PA Highland Hospital East Murphy Avenue, Connellsville, PA COE Accessible Recovery Services S Arch St Connellsville, PA SUD MHH Forest -Warren Human Services D&A Program Hospital Drive, North Warren, PA PerformCare BH MCO Franklin Fulton County Drug and Alcohol Program Franklin Farm Lane, Chambersburg, PA PerformCare BH MCO Franklin Fulton County Drug and Alcohol Program Franklin Farm Lane, Chambersburg, PA Beacon Health Options BH MCO Greene County Human Services Program Fort Jackson Building, Third Floor 19 South Washington Street, Waynesburg, PA Juniata Valley Tri-County Drug and Alcohol Abuse Commission S. Dorcas St., Suite D, Lewistown, PA Beacon Health Options BH MCO Armstrong-Indiana-Clarion Drug and Alcohol Commission, Inc US Route 422, PO Box 238, Shelocta, PA Accessible Recovery Services Church St., Indiana, PA SUD MHH Jefferson Clearfield Jefferson Drug and Alcohol Commission Midway Drive, Suite A, DuBois PA Clearfield-Jefferson Drug and Alcohol Commission Midway Drive, DuBois, PA COE Juniata Juniata Valley Tri-County Drug and Alcohol Abuse Commission S. Dorcas St., Suite D, Lewistown, PA

10 Lackawanna Lancaster Community Care Behavioral Health (CCBH) BH MCO Lackawanna/Susquehanna Office of Drug and Alcohol Programs Scranton Electric Building 507 Linden Street, Fifth Floor, Scranton, PA The Wright Medical Group, PC Madison Avenue, Lackawanna, PA COE Habit OPCO Dunmore Comprehensive Treatment Center Monahan Avenue, Dunmore, PA COE Total Wellness Center, LLC West Lackawanna Avenue, Scranton, PA COE PerformCare BH MCO Lancaster County Drug and Alcohol Commission North Queen Street, Suite 410, Lancaster,PA Lancaster General Hospital N. Duke Street, Lancaster PA COE TW Ponessa & Associates Counseling Services, Inc North Prince Street, Lancaster, PA COE Beacon Health Options BH MCO Lawrence Lebanon Lehigh Lawrence County Drug and Alcohol Commission Inc E. Washington Street, 2nd Floor, New Castle PA Accessible Recovery Services East North St, Suite 123A, New Castle, PA SUD MHH PerformCare BH MCO Lebanon County Commission on Drug and Alcohol Abuse East Lehman Street, Lebanon, PA Magellan BH MCO Lehigh County Drug & Alcohol Services Government Center, 17 South Seventh Street, Allentown, PA Neighborhood Health Centers of Lehigh Valley West Union Street, Allentown, PA COE Treatment Trends, Inc South Fifth St., PO Box 685, Allentown, PA COE Community Care Behavioral Health (CCBH) BH MCO Luzerne Luzerne Wyoming Counties Drug and Alcohol Program Penn Place Building, 20 N. Pennsylvania Ave., Suite 218, Wilkes-Barre, PA Total Wellness Center, LLC E. Market Street, Wilkes-Barre, PA COE Pennsylvania Care LLC DBA Miners Medical Main Street,Ashley, PA COE Lycoming Community Care Behavioral Health (CCBH) BH MCO Lycoming Clinton West Branch Drug and Alcohol Abuse Commission West Fourth Street, Williamsport, PA Crossroads Counseling, Inc East Third Street, Williamsport, PA COE Total Wellness Center, LLC Pine Street, Williamsport, PA COE McKean Cameron Elk McKean Counties Alcohol and Drug Abuse Services Inc Chestnut Street, Port Allegheny, PA

11 Beacon Health Options BH MCO Mercer Mifflin Mercer County Behavioral Health Commission Inc Sharon Mercer Road, Mercer, PA Accessible Recovery Services Main Street, Greenville, PA SUD MHH Juniata Valley Tri-County Drug and Alcohol Abuse Commission S. Dorcas St., Suite D, Lewistown, PA Community Care Behavioral Health (CCBH) BH MCO Monroe Carbon Monroe Pike Drug and Alcohol Commission Phillips Street, Suite 203, Stroudsburg, PA Mt. Pocono Medical Pocono Blvd., Mt. Pocono, PA COE Montgomery Magellan BH MCO Montgomery County Department of Behavioral Health and Developmental Disabilities Resources for Human Development, Inc. Montgomery County Methadone Center Montgomery County Human Services Center 1430 Dekalb Street, PO Box 311, Norristown, PA DeKalb Street, Norristown, PA COE Community Health and Dental Care Inc Heritage Drive, Pottstown, PA COE Montour Northampton Northumberland Perry Columbia Montour Snyder Union Drug and Alcohol Program Behavioral Health Base Service Unit 603 East Market Street, Suite 200, Danville, PA Geisinger Clinic/GIM Danville North Academy Avenue, Danville, PA COE Community Care Behavioral Health (CCBH) BH MCO Northampton County D&A Division Northampton County Human Services Building 2801 Emrick Boulevard - 3rd Floor, Bethlehem, PA Neighborhood Health Centers of Lehigh Valley North Second Street, Allentown, PA COE New Directions Treatment Services & 2456 Brodhead Road, Bethlehem, PA COE Northumberland County BH/IDS Human Senior & Social Services Building 217 North Center Stree,t Sunbury, PA PerformCare BH MCO Cumberland Perry Drug and Alcohol Commission Human Services Building 16 West High Street, Suite 302, Carlisle, PA

12 Community Behavioral Health BH MCO Office of Addiction Services Market Street, Eighth Floor, Philadelphia, PA Pathways to Housing PA Old York Road, Philadelphia, PA COE Public Health Management Corporation Market Street, Philadelphia, PA COE Philadelphia Pike Potter Penn Presbyterian Medical Center N 39th Street, Philadelphia, PA COE Maternal Addiction Treatment, Education, and Research (MATER) Temple University Of the Commonwealth System of Higher Education Locust Street, Philadelphia, PA COE North Broad Street, Philadelphia, PA COE Wedge Medical Center, Inc Old York Road, Philadelphia, PA COE Community Care Behavioral Health (CCBH) BH MCO Carbon Monroe Pike Drug and Alcohol Commission Phillips Street, Suite 203, Stroudsburg, PA Potter County Drug and Alcohol North Street, P.O. Box 241, Roulette, PA Schuylkill Schuylkill County Drug and Alcohol South Claude A Lord Boulevard, 2nd Floor, Pottsville, PA Clinical Outcomes Group, Inc North Centre Street, Pottsville, PA COE Snyder Somerset Sullivan Susquehanna Tioga Union Columbia- Montour- Snyder- Union Drug and Alcohol Program Behavioral Health Base Service Unit 603 East Market Street, Suite 200 Danville PA PerformCare BH MCO Somerset County Drug and Alcohol Commission North Center Avenue, Suite 360, Somerset, PA Bradford/Sullivan Drug and Alcohol Programs Main Street, Unit 1, Towanda, PA Community Care Behavioral Health (CCBH) BH MCO Lackawanna/Susquehanna Office of Drug and Alcohol Programs Scranton Electric Building 507 Linden Street, Fifth Floor, Scranton, PA Tioga County Department of Human Services Shumway Hill Road, Wellsboro, PA Crossroads Counseling, Inc Shumway Hill Road, Wellsboro, PA COE Columbia Montour Snyder Union Drug and Alcohol Program Behavioral Health Base Service Unit 603 East Market Street, Suite 200, Danville, PA

13 Beacon Health Options BH MCO Venango Warren Venango County Substance Abuse Program One Dale Avenue, Franklin, PA Accessible Recovery Services Prospect Ave, Suite 303, Franklin, PA SUD MHH Forest -Warren Human Services D&A Program Hospital Drive,North Warren, PA Beacon Health Options BH MCO Washington Wayne Westmoreland Wyoming York Washington D&A Commission, Inc West Chestnut Street, Suite 310 T, Washington, PA The CARE Center, Inc East Maiden Street, Washington, PA COE Accessible Recovery Services Pike Street, Canonsburg, PA SUD MHH Wayne County Drug and Alcohol Commission Tenth Street, Honesdale, PA Beacon Health Options BH MCO Westmoreland Drug and Alcohol Commission, Inc Monessen Municipal Complex 1 Wendell Ramey Ln, Suite 120, Monessen, PA Mon Valley Health Services Inc Eastgate Avenue, Monessen, PA COE Accessible Recovery Services Kensington Square, New Kensington, PA SUD MHH Accessible Recovery Services East Otterman St, 2nd Floor Back Entrance, Greensburg Pa SUD MHH Community Care Behavioral Health (CCBH) BH MCO Luzerne Wyoming Counties Drug and Alcohol Program Penn Place Building, 20 N. Pennsylvania Ave., Suite 218, Wilkes-Barre, PA Community Care Behavioral Health (CCBH) BH MCO York Adams Drug and Alcohol Commission West Market Street, Suite B04, York, PA Family First Health Corporation South George Street, York, PA COE Pennsylvania Counseling Services - York Psychiatric North George Street, York, PA COE 13

14 Patient Education Opportunities While not all patients will require brief intervention and referral to treatment for substance abuse when screened, opportunities will present themselves to provide prevention education to lessen the likelihood that a substance use disorder will develop in the future: Opportunity Talking Points Adolescent Populations Addressing Peer Pressure Predisposition to develop an addiction Adult Populations who admit to social drinking Signs that social drinking is progressing to problematic drinking Binge drinking Long- term health effects of alcohol Impact of alcohol use on chronic physical health conditions Alcohol interactions with prescription medications Child bearing Age/ Pregnancy Risk to unborn child related to alcohol or substance use Risk of use of opioids during pregnancy When prescribing a new medication that has a The potential for misuse or addiction to the medication likelihood to develop a misuse/ abuse Importance of proper drug disposal/ drug take back programs (Opioids, benzodiazepines, stimulants) Use of Narcan when high dosages of opioids are prescribed Family member or friend of someone with a Community Supports (Al-Anon, Nar-anon) substance use disorder Use of Narcan 14

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