PROJECT ECHO OPIOID USE DISORDER IN PREGNANT WOMEN

Size: px
Start display at page:

Download "PROJECT ECHO OPIOID USE DISORDER IN PREGNANT WOMEN"

Transcription

1 PROJECT ECHO OPIOID USE DISORDER IN PREGNANT WOMEN 1

2 OPIOID USE DISORDER IN WOMEN Recognition & Prevention Date: August 14 th, Time: 8 am Presenters: Deepa Nagar MD, Andria Peterson PharmD Maternal Treatment Options Date: August 28 th, Time: 8 am Presenters: Brian Iriye MD, Farzad Kamyar MD, MDA Infant Treatment Options Date: September 11 th, Time: 8 am Presenters: Deepa Nagar MD, Andria Peterson PharmD Reporting & Follow-up Date: September 25 th, Time: 8 am Presenters: Hayley Jarolimek, Kevin Schiller 2

3 RECOGNITION & PREVENTION DEEPA NAGAR, MD ANDRIA PETERSON, PHARMD 3

4 ABBREVIATIONS OUD = Opioid use disorder NAS = Neonatal abstinence syndrome SUD = Substance use disorder MAT = Medication assisted treatment SBIRT = Screening, brief intervention & referral for treatment CPS = Child protective services PDMP = Prescription drug monitoring program 4

5 BACKGROUND The United States continues to face an opioid epidemic Compromises the health of individuals, families & communities >27 million people reported concurrent use of an illicit drug or misuse of a prescription drug in past 30 days in 2015 Women continue to be a high risk population Prescription misuse & illicit drug use during pregnancy results in very poor consequences on the mother-infant dyad Infants are at risk for withdrawal, also known as neonatal abstinence syndrome (NAS) Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

6 WHAT IS THE SCOPE OF THIS PROBLEM IN NEVADA? 6

7 EPIDEMIOLOGY Nevada High Intensity Drug Trafficking Areas (HIDTA) Report: 2018 Threat Assessment US opioid prescription rate 66.5 per 100 residents Nevada opioid prescription rates 2013: 78.1 per 100 residents 2016: 87.5 per 100 residents Opioid prescription rates by select counties Clark: 84.3 per 100 residents Nye: per 100 residents Equates to more than one prescription per person!!! Office of National Drug Control Policy. Nevada high intensity drug trafficking areas p

8 CDC OPIOID PRESCRIPTION RATES BY COUNTY Office of National Drug Control Policy. Nevada high intensity drug trafficking areas p

9 EPIDEMIOLOGY Nevada High Intensity Drug Trafficking Areas (HIDTA) Report: 2018 Threat Assessment Prescription painkillers prescribed per 100,000 patients 2 nd highest state in US for hydrocodone & oxycodone 4 th highest state in US for methadone 7 th highest state in US for codeine Prescription drug overdose mortality rate 4 th highest state in US 3 out of 4 heroin users starts with prescription drugs Office of National Drug Control Policy. Nevada high intensity drug trafficking areas p

10 OVERDOSE DEATHS PER 100,000 RESIDENTS Office of National Drug Control Policy. Nevada high intensity drug trafficking areas p

11 WHAT IS THE SCOPE OF THE PROBLEM IN PREGNANT WOMEN? 11

12 EPIDEMIOLOGY : Prevalence of OUD during pregnancy doubled Increased to 4 per 1,000 deliveries : # of reproductive age women filling an opioid prescription each year according to pay source 33% enrolled in Medicaid >25% enrolled with private insurance : 31% increase in women of childbearing age (15-44 year old) reported past-month use of heroin 3 out of 4 heroin users start with Opioid prescriptions Office of National Drug Control Policy. Nevada high intensity drug trafficking areas p Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

13 EPIDEMIOLOGY Epstein RA, Bobo WV, Martin PR, Morrow JA, Wang W, Chandrasekhar R, et al. Increasing pregnancy-related use of prescribed opioid analgesics. Ann Epidemiol. 2013;23(8):

14 NEVADA PRENATAL SUBSTANCE ABUSE 14

15 DIGNITY HEALTH DATA Methadone Clinic: Maternal Toxicology Data P Value Overall ( ) # of mothers in a methadone clinic Non-Compliance Rate 13/42 (31%) 30/59 (51%) P < /101 (43%) 6/13 (46%) 16/30 (53%) P = /43 (51%) 15

16 DIGNITY HEALTH DATA Methadone Clinic: Infant Toxicology Data P Value Overall ( ) # of infants with mothers in a methadone clinic Non-Compliance Rate 13/42 (31%) 30/59 (51%) P < /101 (43%) 11/13 (85%) 22/30 (73%) P = /43 (77%) 16

17 DIGNITY HEALTH DATA Infant Toxicology Data of Mothers in a Methadone Clinic: Illicit vs Controlled vs Polysubstance Use P Value Overall ( ) Infants of mothers in a methadone clinic positive for > 1 substance (polysubstance use) 11/13 (85%) 22/30 (73%) P = /43 (77%) 17

18 DIGNITY HEALTH DATA Infant Toxicology Data: Illicit vs Controlled vs Polysubstance Use P Value Overall ( ) Infants positive for an illicit substance Infants positive for a controlled substance Infants positive for > 1 substance (polysubstance use) 20/42 (48%) 43/59 (73%) P = /101 (62%) 22/42 (52%) 39/59 (66%) P = /101 (60%) 23/42 (55%) 48/59 (81%) P = /101 (70%) 18

19 DIGNITY HEALTH DATA Infant Toxicology Results: Specific Substances P Value Overall ( ) Opiates 20/42 (48%) 34/59 (58%) P = /101 (54%) Benzodiazepines 3/42 (7%) 13/59 (22%) P = /101 (16%) Methamphetamine 14/42 (33%) 31/59 (53%) P = /101 (45%) Marijuana 11/42 (26%) 18/59 (31%) P = /101 (29%) Cocaine 0/42 (0%) 2/59 (3%) P = /101 (2%) 19

20 DIGNITY HEALTH DATA Prenatal Care/Discharge Information Overall ( ) Infants admitted for NAS with no prenatal care Infants discharged with someone other then parents 11/42 (26%) 11/59 (19%) 22/101 (22%) 12/42 (29%) 22/59 (37%) 34/101 (34%) 20

21 UNDERSTANDING BARRIERS TO TREATMENT FOR PREGNANT WOMEN 21

22 BARRIERS TO TREATMENT DURING PREGNANCY Shame Misinformation Legal consequences implemented by several states Goal: Protect the infant from opioid exposure Consequence: Drives women away from seeking or continuing care leading to worse outcomes for infant & the mother Healthcare professionals & systems are often reluctant to provide care Typically due to misunderstanding & lack of experience in treating pregnant women Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

23 BARRIERS TO TREATMENT DURING PREGNANCY Multiple policies exist on screening, treatment, reporting of substance use during pregnancy/postpartum period & involvement of child protective services (CPS) which can be confusing American Academy of Addiction Psychiatry American Society of Addiction Medicine Committee on Healthcare for Underserved Women American College of Obstetricians & Gynecologists American Academy of Pediatrics Substance Abuse & Mental Health Services Administration Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

24 BARRIERS TO TREATMENT DURING PREGNANCY Take home point: Without treatment, pregnant women with OUD face increased risks of preterm delivery, low infant birth weight & have an increased risk for transmitting HIV to their infants Effective interventions, including medication-assisted treatment (MAT), can lead to healthy outcomes for mother & infant Requires recognition by health care professionals!!!! Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

25 WHAT WOMEN SHOULD I SCREEN FOR SUBSTANCE USE DISORDER (SUD)? 25

26 RECOGNITION World Health Organization (WHO) recommendations Who? Healthcare professionals should ask ALL pregnant women about their use of alcohol & other substances Universal screening Ask about past, present, prescribed, licit & illicit use How often? As early as possible in pregnancy & at every follow-up visit 2017 American College of Obstetricians & Gynecologists (ACOG) recommendations: Screening for SUD should be part of comprehensive OB care & should be done at the 1 st prenatal visit Screening based only on factors, such as poor adherence to prenatal care or prior adverse pregnancy outcome, can lead to missed cases & may add to stereotyping/stigma It is ESSENTIAL that screening be UNIVERSAL Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

27 HOW DO I SCREEN? 27

28 WHAT IS SBIRT? SBIRT: Screening, Brief Intervention, & Referral for Treatment Evidence-based practice to identify, reduce & prevent problematic use, abuse & dependence on alcohol & illicit drugs 3 major components Screening Brief intervention Referral to treatment Substance abuse and mental health services administration. Integration.samhsa.gov. Accessed August 9,

29 SCREENING SBIRT: Screening A healthcare professional assesses a patient for risky substance use behaviors using standardized tools Screening can occur in any healthcare setting Tools for screening: Prescription Drug Monitoring Program (PDMP) Interviews & instruments Toxicology Substance abuse and mental health services administration. Integration.samhsa.gov. Accessed August 9,

30 SCREENING State-based PDMPs Collects data from pharmacies on prescriptions of controlled substances Confirms patients seeing multiple physicians for controlled prescriptions Also helpful in identifying use of any other prescription medications that can be harmful during pregnancy Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

31 Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P SCREENING Interviews & instruments A complete history is essential to establishing a safe & appropriate treatment plan Measure Problem Screened # of items Method Training necessary? Validation Sample 4P s Plus & Integrated 5Ps Violence, mental health, tobacco, alcohol, illicit substances 5 Paper & pencil No Inpatient/ Outpatient Substance Use Risk Profile-Pregnancy (SURP-P) Tolerance, Annoyed, Cut-down, Eye-opener (T-ACE) Tolerance, worried, eyeopener, amnesia, K(c)ut-down (TWEAK) Alcohol & substances 3 Paper & pencil No Prenatal clinic Alcohol 4 Paper & pencil No Prenatal clinic Alcohol 5 Paper & pencil No Prenatal clinic 31

32 SCREENING Maternal toxicology What can be used? Urine, blood or saliva Do I need informed consent? Oral informed consent may be used, but a signed paper or electronic form is preferred Ask the pregnant woman what, if anything, she expects might be detected in the test Give her an opportunity to describe her substance use patterns & behavior Toxicology testing should still be obtained when there is self-reported use Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

33 SCREENING Maternal toxicology Additional laboratory tests to order in women with SUD: HIV Hepatitis B & C Sexually transmitted infections (STIs) Liver enzymes & serum bilirubin Detection for liver disease Serum creatinine Detection for silent renal disease Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

34 Moeller, K. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008;83(1): COMMON SCREENING QUESTIONS: LENGTH OF TIME DRUGS CAN BE DETECTED IN URINE Drug Alcohol Methamphetamine Barbiturates Short-acting (pentobarbital) Long-acting (phenobarbital) Benzodiazepines Short-acting (lorazepam) Long-acting (diazepam) Cocaine metabolites Marijuana Single user Moderate user (4 times/wk) Daily user Long-term heavy smoker Opioids Codeine Heroin (morphine) Hydromorphone Methadone Morphine Oxycodone Propoxyphene Phencyclidine Time 7-12 h 48 h 24 h 3 wk 3 d 30d 2-4d 3 d 5-7 d d 30 d 48 h 48 h 2-4 d 3 d h 2-4 d 6-48 h 8 d 34

35 COMMON SCREENING QUESTIONS: AGENTS CONTRIBUTING TO FALSE POSITIVES Substance Potential agent causing false-positive result Substance Potential agent causing false-positive result Alcohol Short-chain alcohols (isopropyl alcohol) Cocaine Coca leaf tea Topical anesthetics containing cocaine Amphetamines Amantadine Buproprion Chlorpromazine Desipramine Dextroamphetamine Ephedrine Isometheptene Labetalol Methylphenidate Phentermine Phenylephrine Promethazine Pseudoephedrine Ranitidine Trazodone Opioids & heroin Dextromethorphan Diphenhydramine Poppy seeds Rifampin Verapamil Benzodiazepines Oxprazosin Sertraline Phencyclidine Dextromethorphan Diphenhydramine Doxylamine Ibuprofen Imipramine Ketamine Meperidine Thioridazine Tramadol Venlafaxine Cannabinoids Dronabinol Efavirenz NSAIDS Proton pump inhibitors Moeller, K. Urine drug screening: practical guide for clinicians. Mayo Clin Proc. 2008;83(1): Tricyclic antidepressants Carbamazepine Cyclobenzaprine Cyproheptadine Diphenhydramine Hydroxyzine Quetiapine 35

36 MY PATIENT HAS A POSITIVE TOXICOLOGY RESULT. NOW WHAT DO I DO? 36

37 BRIEF INTERVENTION SBIRT: Brief intervention Pregnancy is a time of great potential for positive change A woman with OUD may be motivated to enter treatment out of concern for herself & health of the fetus She can envision a different future for herself & her child 5 basic steps to intervention: 1) Feedback is given to the mother about risks 2) Responsibility of change is placed on the mother 3) Advise to change is given by the provider 4) Menu of treatment options are offered 5) Empathic style is used in counseling 6) Self-efficacy or optimistic empowerment provided to the mother Substance abuse and mental health services administration. Integration.samhsa.gov. Accessed August 9,

38 WHERE CAN I REFER MY PATIENT AFTER A BRIEF INTERVENTION? 38

39 REFERRAL OPTIONS Tune in August 28 th at 8am for detailed information regarding maternal treatment options Nevada Division of Public & Behavioral Health (DPBH) certified providers SAPTAProviders/ 39

40 DIGNITY HEALTH EMPOWERED PROGRAM 40

41 WHAT ABOUT INFANT TOXICOLOGY? 41

42 INFANT TOXICOLOGY Matrix Benefits Drawbacks Urine Cord Tissue -Sample can be difficult to collect -Results are readily available -Exempt from maternal consent procedures -Sample is easily collected -Accurate results -Exempt from maternal consent procedures -Only reflects recent exposure *Not completing confirmatory urine testing can be disastrous, as false positive results may lead to loss of custody & legal prosecution -Collection -Storage -Policy must be in place Meconium Hair -Sample is easily collected -Relatively wide collection range -Exempt from maternal consent procedures -Sample is easily collected -Exempt from maternal procedures -Sample appears to form at 12 weeks. Volume of meconium increases throughout gestation, with most being produced in the last 2 months of gestation, focusing detection on last 2 months in utero. -Sample may be contaminated by urine -Does not reflect periods of abstinence -Fetal hair only reflects exposure during 3 rd trimester -Accuracy is limited by chemical composition of hair (dark hair vs light) Substance abuse and mental health services administration. Clinical Guidance for treating pregnant and parenting women with opioid use disorder and their infants. P

43 WHAT IS NEONATAL ABSTINENCE SYNDROME (NAS)? 43

44 NEONATAL ABSTINENCE SYNDROME (NAS) Tune in September 11 th at 8am to learn more!!! 44

45 QUESTIONS??? 45

Urine Drug Testing Methods 3-5

Urine Drug Testing Methods 3-5 Urine Drug Testing Methods 3-5 Type of Test Logistics Pearls Initial Screening Test: Immunoassay Confirmatory Test: Gas chromatography-mass spectrometry (GCMS) + or Liquid chromatography-mass spectrometry

More information

Controlled Substances Evidence-based Tips for Improved Workflow: Diagnosis, Screening & Drug Testing

Controlled Substances Evidence-based Tips for Improved Workflow: Diagnosis, Screening & Drug Testing Controlled Substances Evidence-based Tips for Improved Workflow: Diagnosis, Screening & Drug Testing Mississippi Primary Health Care Association Pearl, MS March 7, 2018 Scott Hambleton, MD, DFASAM Medical

More information

Screening Pregnant and Postpartum Women for Substance Use Disorder. MPQC Fall Summit November 14, 2018

Screening Pregnant and Postpartum Women for Substance Use Disorder. MPQC Fall Summit November 14, 2018 Screening Pregnant and Postpartum Women for Substance Use Disorder MPQC Fall Summit November 14, 2018 Disclosures No relevant financial or non-financial relafonships Screening Pregnant and Postpartum Women

More information

Linking Opioid Treatment in Primary Care. Roxanne Lewin M.D.

Linking Opioid Treatment in Primary Care. Roxanne Lewin M.D. Roxanne Lewin M.D. The Facts Fewer than 10 percent of individuals with an alcohol use disorder and only about 20 percent of individuals with an opioid use disorder receive specialty treatment. Many individuals

More information

Controlled Substance Monitoring in the Age of the Opioid Epidemic

Controlled Substance Monitoring in the Age of the Opioid Epidemic Controlled Substance Monitoring in the Age of the Opioid Epidemic Paul E. Hilliard, MS, MD Hospital Pain Committee Chair Department of Anesthesiology CME housekeeping I have no financial disclosures AKA,

More information

10/16/2017. Objectives. Drug Testing Interpretation in Addiction Care. Background. Which is Nonadherent?

10/16/2017. Objectives. Drug Testing Interpretation in Addiction Care. Background. Which is Nonadherent? Objectives Drug Testing Interpretation in Addiction Care Brandi Puet, Pharm.D. Describe the difference between immunoassay and confirmatory testing. List explanations for unexpected negative or positive

More information

INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE CITY

INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE CITY 2009 FINAL REPORT INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE CITY This report was prepared by: Dr. Jose Arbelaez, M.D. of Baltimore Substance Abuse Systems, and Ryan J. Petteway,

More information

Urine Drug Testing (UDT) to Monitor Opioid Use. Feb 2018

Urine Drug Testing (UDT) to Monitor Opioid Use. Feb 2018 Urine Drug Testing (UDT) to Monitor Opioid Use Feb 2018 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or

More information

Maternal-fetal Opiate Medical Home (MOMH) Jocelyn Davis DNP,CNM, RN, CEFMM Karen Frantz BSN, RNC

Maternal-fetal Opiate Medical Home (MOMH) Jocelyn Davis DNP,CNM, RN, CEFMM Karen Frantz BSN, RNC Maternal-fetal Opiate Medical Home (MOMH) Jocelyn Davis DNP,CNM, RN, CEFMM Karen Frantz BSN, RNC Objectives 1. Discuss the effects of opiate addiction on mothers and infants. 2. Discuss a Medical Home

More information

Neonatal Abstinence Syndrome Questions & Answers Webinar #1 (February 9, 2012) Webinar #2 (March 30, 3012)

Neonatal Abstinence Syndrome Questions & Answers Webinar #1 (February 9, 2012) Webinar #2 (March 30, 3012) Neonatal bstinence Syndrome Questions & nswers Webinar #1 (February 9, 2012) Webinar #2 (March 30, 3012) For more information and to download a copy of the NS Clinical Practice Guidelines, please visit

More information

Overview. Opioids and HIV Infection: From Pain Management to Addiction Treatment

Overview. Opioids and HIV Infection: From Pain Management to Addiction Treatment FORMATTED: 01/23/2017 New York, New York: February 24, 2017 Opioids and HIV Infection: From Pain Management to Addiction Treatment Chinazo Cunningham, MD, MS Professor of Medicine Albert Einstein College

More information

INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE, MARYLAND QUARTERLY REPORT: FOURTH QUARTER, 2008 AND 2008 SUMMARY

INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE, MARYLAND QUARTERLY REPORT: FOURTH QUARTER, 2008 AND 2008 SUMMARY INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE, MARYLAND QUARTERLY REPORT: FOURTH QUARTER, 2008 AND 2008 SUMMARY A report from the Office of Epidemiology and Planning Baltimore

More information

Urine Drug Testing (UDT) in Pain Management. Nov 27, 2017

Urine Drug Testing (UDT) in Pain Management. Nov 27, 2017 Urine Drug Testing (UDT) in Pain Management Nov 27, 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or

More information

A Review of the Methods, Interpretation, and Limitations of the Urine Drug Screen

A Review of the Methods, Interpretation, and Limitations of the Urine Drug Screen Section Editor: Kelly M. Smith, PharmD, BCPS, FASHP, FCCP A Review of the Methods, Interpretation, and Limitations of the Urine Drug Screen E. Claire Markway, PharmD; Stephanie N. Baker, PharmD, BCPS Abstract:

More information

The Opioid-Exposed Woman

The Opioid-Exposed Woman The Opioid-Exposed Woman Management Considerations for Labor and Delivery Jane Sublette, MS, RN, CNM, WHNP-BC Fairview Ridges Hospital Objectives Describe opioid-associated risks to the mother and fetus

More information

The Role of Opioid Overdoses in Confirmed Maternal Deaths,

The Role of Opioid Overdoses in Confirmed Maternal Deaths, The Role of Opioid Overdoses in Confirmed Maternal Deaths, 2012-2015 Introduction The Department of State Health Services (DSHS) conducted an analysis of maternal deaths resulting from drug overdoses from

More information

INTRODUCTION. Baltimore, Maryland 6 School of Medicine West Virginia University, Morgantown, West Virginia

INTRODUCTION. Baltimore, Maryland 6 School of Medicine West Virginia University, Morgantown, West Virginia The American Journal on Addictions, 27: 92 96, 2018 Copyright 2018 American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/ajad.12687 Brief Report: Treating Women

More information

Cutoff levels for hydrocodone in a blood test

Cutoff levels for hydrocodone in a blood test Cutoff levels for hydrocodone in a blood test The premier DNA and drug testing company in the North Texas area. Specializing in legal cases but also provide testing for employers and private individuals.

More information

Opioids in Pregnancy. Beyond to Baby GENERAL INFO

Opioids in Pregnancy. Beyond to Baby GENERAL INFO Opioids in Pregnancy and Beyond to Baby by Marcia W. VanVleet, MD, MPH Medical Director, Newborn Service Team, Women and Infants Hospital, and Assistant Professor of Pediatrics, Brown Alpert Medical School,

More information

Urine Drug Testing (UDT) in Pain Management. Nov 5, 2017

Urine Drug Testing (UDT) in Pain Management. Nov 5, 2017 Urine Drug Testing (UDT) in Pain Management Nov 5, 2017 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or

More information

2/24/2017. Pregnant Women Who Use Drugs: Stigma, Science and Society

2/24/2017. Pregnant Women Who Use Drugs: Stigma, Science and Society Pregnant Women Who Use Drugs: Stigma, Science and Society Mishka Terplan MD MPH FACOG FASAM Professor Departments Obstetrics and Gynecology and Psychiatry Associate Director Addiction Medicine Virginia

More information

Beyond Birth: A Comprehensive Recovery Center serving parenting women

Beyond Birth: A Comprehensive Recovery Center serving parenting women Beyond Birth: A Comprehensive Recovery Center serving parenting women Session Objectives Highlight Plan of Safe Care Introduce the Beyond Birth Comprehensive Recovery Center Describe Levels of Care The

More information

Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up

Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up Dr. Bhushan M. Kapur Associate Professor Department of Laboratory Medicine and Pathobiology, Faculty

More information

ADDRESSING THE OPIOID EPIDEMIC. Joint principles of the following organizations representing front-line physicians

ADDRESSING THE OPIOID EPIDEMIC. Joint principles of the following organizations representing front-line physicians ADDRESSING THE OPIOID EPIDEMIC Joint principles of the following organizations representing front-line physicians American Academy of Family Physicians American Academy of Pediatrics American College of

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

EDUCATIONAL COMMENTARY rd TEST EVENT Chemistry Urine Drug Testing

EDUCATIONAL COMMENTARY rd TEST EVENT Chemistry Urine Drug Testing EDUCATIONAL COMMENTARY 2003 3 rd TEST EVENT Chemistry Urine Drug Testing Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE

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

September HCMC Toxicology Transition: Additional information and Frequently Asked Questions

September HCMC Toxicology Transition: Additional information and Frequently Asked Questions September 2016 HCMC Toxicology Transition: Additional information and Frequently Asked Questions Many clinicians have asked for more information about the Urine Drug Compliance Analysis (LAB8742) switch

More information

Effects of Prenatal Illicit Drug. Use on Infant and Child

Effects of Prenatal Illicit Drug. Use on Infant and Child Effects of Prenatal Illicit Drug Use on Infant and Child Development Andrew Hsi, MD, MPH Larry Leeman, MD, MPH Family Medicine MCH Grand Rounds 6 July 2011 Objectives for Presentation At the end of this

More information

Does ultram show up as an opiate

Does ultram show up as an opiate Search Does ultram show up as an opiate Tramadol ( Ultram ) is prescribed for treating moderate to severe pain in adults. 19-2-2018 I took Tramadol Hydrochloride for 6 months due to joint pain from my

More information

MAT IN PREGNANCY KAYLA LIFE STAGE 1: ADOLESCENCE LIFE STAGE 2: EARLY ADULTHOOD. family History of addiction. addiction to oral opioids

MAT IN PREGNANCY KAYLA LIFE STAGE 1: ADOLESCENCE LIFE STAGE 2: EARLY ADULTHOOD. family History of addiction. addiction to oral opioids MAT IN PREGNANCY R. COREY WALLER MD, MS PRINCIPAL, HEALTH MANAGEMENT ASSOCIATES FACULTY, INSTITUTE FOR HEALTHCARE INNOVATION (IHI) CHAIR, LEGISLATIVE ADVOCACY COMMITTEE, ASAM KAYLA LIFE STAGE 1: ADOLESCENCE

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

Urine drug testing it s not always crystal clear

Urine drug testing it s not always crystal clear Urine drug testing it s not always crystal clear Kirk Moberg, MD, PhD, FASAM Executive Medical Director, UnityPoint Health Illinois Institute for Addiction Recovery Clinical Professor of Internal Medicine

More information

Anesthetics, Local a / or Anesthesia, Epidural a / or Anesthesia, Obstetrical a / or Pain, Postoperative a / or Postpartum Period a

Anesthetics, Local a / or Anesthesia, Epidural a / or Anesthesia, Obstetrical a / or Pain, Postoperative a / or Postpartum Period a Appendix 1. Literature Search Databases Years Search Terms Pubmed 01/1966 1. Analgesics, Opioid a / or Opioid-related Disorders a / PsycINFO EMBASE Cochrane 09/2016 or Heroin a / or Heroin Dependence a

More information

Testing for Controlled Substances

Testing for Controlled Substances Testing for illicit drugs Testing for Controlled Substances 1 Purposes: Employment Sports Screening medical eval. Legal Monitoring Treatment Probation Prescribing controlled substances Forensics 2 Drug

More information

1/27/ New Release, Quest Diagnostics Nichols Institute, Valencia

1/27/ New Release, Quest Diagnostics Nichols Institute, Valencia NEW TESTS Please Note: Not all test codes assigned to each assay are listed in the table of contents. Please refer to the complete listing on the page numbers indicated. Test Code Test Name Effective Date

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

The Scoop on Biological Testing for Detecting or Confirming Drug-Exposed Newborns What, When and How?

The Scoop on Biological Testing for Detecting or Confirming Drug-Exposed Newborns What, When and How? The Scoop on Biological Testing for Detecting or Confirming Drug-Exposed Newborns What, When and How? Gwen McMillin, PhD, DABCC University of Utah, ARUP Laboratories Objectives Compare and contrast approaches

More information

4/19/2018. Opioid Use Disorder in Pregnancy OBJECTIVES ANTENATAL TESTING

4/19/2018. Opioid Use Disorder in Pregnancy OBJECTIVES ANTENATAL TESTING Opioid Use Disorder in Pregnancy 2017 Recommendations from ACOG and The Pew Charitable Trust KATHY D. HARTKE, MD, LEGISLATIVE CO-CHAIR AND IMMEDIATE PAST CHAIR, WISCONSIN SECTION OF THE AMERICAN COLLEGE

More information

Pregnancy, Opioid Addiction, and Care Issues in Virginia

Pregnancy, Opioid Addiction, and Care Issues in Virginia Pregnancy, Opioid Addiction, and Care Issues in Virginia Mishka Terplan MD MPH FACOG FASAM Professor Departments Obstetrics and Gynecology and Psychiatry Associate Director Addiction Medicine Virginia

More information

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J.

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J. Drug Adherence Assessment Report Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - REPORTED MEDICATION DETECTED (PARENT DRUG AND/OR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED

More information

ORAL FLUID AS A CHEMICAL TEST FOR THE DRE PROGRAM : HISTORY, THE FUTURE, AND PRACTICAL CONSIDERATIONS

ORAL FLUID AS A CHEMICAL TEST FOR THE DRE PROGRAM : HISTORY, THE FUTURE, AND PRACTICAL CONSIDERATIONS ORAL FLUID AS A CHEMICAL TEST FOR THE DRE PROGRAM : HISTORY, THE FUTURE, AND PRACTICAL CONSIDERATIONS Barry K Logan PhD, DABFT National Director of Forensic Services, NMS Labs Willow Grove PA Disclaimer

More information

Brief History of Methadone Maintenance Treatment

Brief History of Methadone Maintenance Treatment METHADONE Brief History of Methadone Maintenance Treatment Methadone maintenance treatment was on the cusp of the social revolution in the sixties. Doctors and public health workers had concluded what

More information

THE OPIOID CRISIS 9/19/2018 DEFINING THE CRISIS DEFINING THE CRISIS NUMBER OF OPIOID-RELATED OVERDOSE DEATHS IN ALABAMA

THE OPIOID CRISIS 9/19/2018 DEFINING THE CRISIS DEFINING THE CRISIS NUMBER OF OPIOID-RELATED OVERDOSE DEATHS IN ALABAMA THE OPIOID CRISIS DEFINING THE CRISIS KATHLEEN DUPPER, MD MEDICAL DIRECTOR, HUNTSVILLE RECOVERY 19 th Annual Perinatal Conference: The Opioid Crisis September 21, 2018 DEFINING THE CRISIS NUMBER OF OPIOID-RELATED

More information

MOMS Project Panel Overview

MOMS Project Panel Overview MOMS Project Panel Overview Rick Massatti, PhD, Ohio Department of Mental Health and Addiction Services Jennifer Bailit, MD, MetroHealth Medical Center Mike Marcotte, MD, Tri-Health Mona Prasad, DO,MPH,

More information

Physician s Reference for Urine and Blood Drug Testing and Interpretation

Physician s Reference for Urine and Blood Drug Testing and Interpretation Physician s Reference for Urine and Blood Drug Testing and Interpretation DETECTIMED PANEL Urine (test code 70195) Screen Confirmation Screen Confirmation Alcohol Ethanol Amphetamines Amphetamine Methamphetamine

More information

Forensic Toxicology Scope of Testing and Detection Limits

Forensic Toxicology Scope of Testing and Detection Limits Forensic Toxicology Scope of Testing and Detection Limits Table of Contents QUALITATIVE ANALYSES... 2 Volatile Screen by GC/FID... 2 Carbon Monoxide by Microdiffusion... 2 Ethylene Glycol by GC/MS... 2

More information

3/8/2018. Reasons for Doing UDT. UDT: A Tool in Risk Assessment. Faculty/Presenter Disclosure. Urine Drug Testing in Chronic Pain Management

3/8/2018. Reasons for Doing UDT. UDT: A Tool in Risk Assessment. Faculty/Presenter Disclosure. Urine Drug Testing in Chronic Pain Management Urine Drug Testing in Chronic Pain Management March 8, 2018 Faculty/Presenter Disclosure Faculty: Andrew J Smith, MDCM Relationships with commercial interests: None to report Andrew J Smith, MDCM Staff

More information

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years Drug Adherence Assessment Report CleanAssure TM (DRIED BLOOD SPOT): Detection Range see NOTES. Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - MEDICATION DETECTED (PARENT DRUG

More information

Many companies conduct drug screenings. But you better avoid the following nine items and save yourself a world of frustration, if you need

Many companies conduct drug screenings. But you better avoid the following nine items and save yourself a world of frustration, if you need 18-8-2017 Many companies conduct drug screenings. But you better avoid the following nine items and save yourself a world of frustration, if you need to pass the test 2-2-2018 25 Answers (question resolved)

More information

Managing drug misuse in pregnancy and beyond

Managing drug misuse in pregnancy and beyond Managing drug misuse in pregnancy and beyond Dr Emily Finch Clinical Director Addictions CAG, South London and Maudsley Foundation NHS Trust Rachel Evans, Adfam 1 / Aims of the session Update on management

More information

(Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines)

(Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines) Buprenorphine Initiation and Maintenance in Pregnancy (Adapted with permission from the D-H Knowledge Map Primary Care Buprenorphine Guidelines) Assessment The diagnosis of OUD should be confirmed by DSM-5

More information

Learning Objectives. Drug Testing 10/17/2012. Utilization of the urine drug screen: The good, the bad, and the ugly

Learning Objectives. Drug Testing 10/17/2012. Utilization of the urine drug screen: The good, the bad, and the ugly Utilization of the urine drug screen: The good, the bad, and the ugly Jennifer A. Lowry, MD Chief, Section of Medical Toxicology Children s Mercy Hospital Kansas City, MO Learning Objectives Describe the

More information

Public Policy Statement on Substance Use, Misuse, and Use Disorders During and Following Pregnancy, with an Emphasis on Opioids

Public Policy Statement on Substance Use, Misuse, and Use Disorders During and Following Pregnancy, with an Emphasis on Opioids Public Policy Statement on Substance Use, Misuse, and Use Disorders During and Following Pregnancy, with an Emphasis on Opioids Background The American Society of Addiction Medicine (ASAM) is deeply committed

More information

Opioid Use in Pregnant Women and Prenatal Care. Murray F Dweck MD, FACOG Medical Director/OBGYN Florida Department of Health -Brevard

Opioid Use in Pregnant Women and Prenatal Care. Murray F Dweck MD, FACOG Medical Director/OBGYN Florida Department of Health -Brevard Opioid Use in Pregnant Women and Prenatal Care Murray F Dweck MD, FACOG Medical Director/OBGYN Florida Department of Health -Brevard Objectives Summarize contextual and co-morbid factors observed among

More information

Effective Date: Approved by: Laboratory Executive Director, Ed Hughes (electronic signature)

Effective Date: Approved by: Laboratory Executive Director, Ed Hughes (electronic signature) 1 Policy #: 803 (PLH-803-02) Effective Date: NA Reviewed Date: 4/11/2008 Subject: URINE DRUG SCREENS Approved by: Laboratory Executive Director, Ed Hughes (electronic signature) Approved by: Laboratory

More information

NOWS The Time Caring for the Infant with Neonatal Opiate Withdrawal Syndrome

NOWS The Time Caring for the Infant with Neonatal Opiate Withdrawal Syndrome NOWS The Time Caring for the Infant with Neonatal Opiate Withdrawal Syndrome Meghan Howell, MD FAAP Assistant Professor of Pediatrics Clinical Director, Tulane NICU Graduate Clinic Tulane University School

More information

Prescribing Opioid for. Opioid Naïve Patients AN OPIOD RX

Prescribing Opioid for. Opioid Naïve Patients AN OPIOD RX Prescribing Opioid for Opioid Naïve Patients AN OPIOD RX Optimal Approach to Initiating Opioids for Chronic Non-Cancer Pain AN OPIOID RX Assessment biopsychosocial Non-opioid treatments Opioid risks vs.

More information

HIV/AIDS Definition: CDC Classification of HIV Infection Stage 1: Stage 2: Stage 3: Risk Factors

HIV/AIDS Definition: CDC Classification of HIV Infection Stage 1: Stage 2: Stage 3: Risk Factors HIV/AIDS Definition: Acquired immune deficiency syndrome (AIDS) is a progressive, incurable disease caused by the human immunodeficiency virus (HIV). Aids destroys the CD4+ T cells, impairing the immune

More information

Drug Testing Basics. by Erowid

Drug Testing Basics. by Erowid Drug Testing Basics by Erowid INDEX 1. What do they Test for? 2. Test Types 3. Test Sensitivity 4. Detection Periods WHAT DO THEY TEST FOR? The first thing to know about drug testing is what the standard

More information

The Drug Testing Process. Employer or Practice

The Drug Testing Process. Employer or Practice Disclosures Clinical Professor, Jefferson Medical College BOD MROCC [Medical Review Officer Certification Council] BOD National Sleep Foundation BOD POEMS [Pennsylvania Occupational & Environmental Medicine

More information

Michael M. Miller, MD, FASAM, FAPA

Michael M. Miller, MD, FASAM, FAPA Michael M. Miller, MD, FASAM, FAPA mmiller@rogershospital.org Medical Director, Herrington Recovery Center (HRC) Rogers Memorial Hospital Oconomowoc, Wisconsin Vice Speaker Wisconsin Medical Society Clinical

More information

Child Welfare and Substance Abuse. Erica Tarasovitch, MSW Central Florida Behavioral Health Network

Child Welfare and Substance Abuse. Erica Tarasovitch, MSW Central Florida Behavioral Health Network Child Welfare and Substance Abuse Erica Tarasovitch, MSW Central Florida Behavioral Health Network Parental Substance Use Marijuana was the most commonly used illicit drug in 2006, accounting for 72.8

More information

The Emerging Science of E-Cigarette Use and Nicotine Addiction

The Emerging Science of E-Cigarette Use and Nicotine Addiction The Emerging Science of E-Cigarette Use and Nicotine Addiction 2016-2017 TCN Podcast Series Dr. Jay C. Butler, Alaska Department of Health and Social Services and ASTHO President Dr. Brian King, CDC Office

More information

Drug Screening. Separating Facts from Myths

Drug Screening. Separating Facts from Myths Drug Screening Separating Facts from Myths Today s Presenter: Todd Shoulberg, EVP ClearStar Medical Information Services Todd Shoulberg, Executive Vice President of Medical Information Services for ClearStar,

More information

Opioid Use Disorders and Pregnancy. Marcela Smid, MD Maternal-Fetal Medicine

Opioid Use Disorders and Pregnancy. Marcela Smid, MD Maternal-Fetal Medicine Opioid Use Disorders and Pregnancy Marcela Smid, MD Maternal-Fetal Medicine UNIVERSITY OF UTAH HEALTH, 2017 OBJECTIVES Definitions Epidemiology Pharmacology Effects on pregnancy Screening Treatment CARE

More information

Pain Medication Management Program Monitors Patient Compliance

Pain Medication Management Program Monitors Patient Compliance PeaceHealth Laboratories UPDATE 2014/15 Edition Pain Medication Management Program Monitors Patient Compliance BENEFITS Monitors analgesic medication adherence to ensure patient safety and protect your

More information

Learning Objectives. Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons

Learning Objectives. Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons Serving Pregnant Women Affected by Substance Use Disorders in Healing to Wellness Court: Sharing Lessons Marianna Corona Jennifer Foley September 12, 2017 Learning Objectives 2017 Improving Family Outcomes

More information

HELPING OUR MOST VULNERABLE POPULATIONS IMPACTED BY THE OPIOID CRISIS: PREGNANT WOMEN, THEIR INFANTS, AND THOSE RECEIVING CHILD WELFARE SERVICES

HELPING OUR MOST VULNERABLE POPULATIONS IMPACTED BY THE OPIOID CRISIS: PREGNANT WOMEN, THEIR INFANTS, AND THOSE RECEIVING CHILD WELFARE SERVICES HELPING OUR MOST VULNERABLE POPULATIONS IMPACTED BY THE OPIOID CRISIS: PREGNANT WOMEN, THEIR INFANTS, AND THOSE RECEIVING CHILD WELFARE SERVICES Learning Objectives Identify approaches for transforming

More information

Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance

Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance Advancing the Care of Pregnant and Parenting Women with Opioid Use Disorder and their Infants: A Foundation for Clinical Guidance Karol Kaltenbach, PhD Emeritus Professor of Pediatrics Sidney Kimmel Medical

More information

Medication for the Treatment of Addiction (MAT)

Medication for the Treatment of Addiction (MAT) Medication for the Treatment of Addiction (MAT) Karol Kaltenbach, PhD Emeritus Professor of Pediatrics Sidney Kimmel Medical College at Thomas Jefferson University Terminology: Words Matter Medication

More information

Texas Strategies to Address the Opioid Crisis and Neonatal Abstinence Syndrome

Texas Strategies to Address the Opioid Crisis and Neonatal Abstinence Syndrome Texas Strategies to Address the Opioid Crisis and Neonatal Abstinence Syndrome 1 Learning Objectives Become familiar with how the opioid epidemic is impacting Texas women Become familiar with Neonatal

More information

Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study

Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study open access Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study Rishi J Desai, 1 Krista F Huybrechts, 1 Sonia Hernandez-Diaz, 2 Helen

More information

NEONATAL ABSTINENCE SYNDROME (NAS) AKA NEWBORN DRUG WITHDRAWAL:THE NEWARK EXPERIENCE

NEONATAL ABSTINENCE SYNDROME (NAS) AKA NEWBORN DRUG WITHDRAWAL:THE NEWARK EXPERIENCE NEONATAL ABSTINENCE SYNDROME (NAS) AKA NEWBORN DRUG WITHDRAWAL:THE NEWARK EXPERIENCE Salma Ali MD, Debra Brendel RN, BSN, MSN and Ona Fofah MD Division of Neonatology and Newborn Medicine Department of

More information

COUNTY OF SAN DIEGO. Opioid Update

COUNTY OF SAN DIEGO. Opioid Update COUNTY OF SAN DIEGO Opioid Update Linda Bridgeman Smith, DUI & Prevention Services Manager Health & Human Services Agency, Behavioral Health Services Co-chair, Prescription Drug Abuse Task Force 1 HEADLINES

More information

Opioid use in pregnancy and Neonatal Abstinence Syndrome

Opioid use in pregnancy and Neonatal Abstinence Syndrome Opioid use in pregnancy and Neonatal Abstinence Syndrome Morissa Ladinsky, MD Assoc. Professor of Pediatrics Division of General Pediatrics and Adolescent Medicine UAB Objectives 1. Understand the magnitude,

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

Pain Medication Management Program Supports Patient Outcomes and Adherence

Pain Medication Management Program Supports Patient Outcomes and Adherence PeaceHealth Laboratories UPDATE 2015 Revised Edition Pain Medication Management Program Supports Patient Outcomes and Adherence BENEFITS Monitors analgesic medication adherence to ensure patient safety

More information

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.

DISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics. DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this

More information

HOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain

HOPE. Considerations. Considerations ISING. Safe Opioid Prescribing Guidelines for ACUTE Non-Malignant Pain Due to the high level of prescription drug use and abuse in Lake County, these guidelines have been developed to standardize prescribing habits and limit risk of unintended harm when prescribing opioid

More information

Alcohol. Ethanol Highlands Parkway, Suite 100 Smyrna, GA 30082

Alcohol. Ethanol Highlands Parkway, Suite 100 Smyrna, GA 30082 Alcohol The alcohol of interest is ethanol. Ethanol has a sedative effect in the brain. Ethanol intoxication symptoms include blurred vision, slurred speech, poor coordination and difficulty thinking depending

More information

nextgen precision Test Report

nextgen precision Test Report nextgen precision TM Test Report SUMMARY OF PRECISION S NEXTGEN TEST REPORT In an effort to provide as much clinical insight as possible to our providers, we created our comprehensive NextGen Precision

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

2/24/2014. Bridging the Gap Between Behavioral Health and Pregnancy. My Background and Interest in the Topic... Plan for Today

2/24/2014. Bridging the Gap Between Behavioral Health and Pregnancy. My Background and Interest in the Topic... Plan for Today Bridging the Gap Between Behavioral Health and Pregnancy Amelia Mahan MSW, LCSW Behavioral Health Program Manager amahan@n3cn.org; (919) 926-3918 My Background and Interest in the Topic... Stumbled into

More information

Dr. Smith. Roneet Lev, MD FACEP Chief, Emergency Department Scripps Mercy Hospital Chair, San Diego Prescription Drug Abuse Medical Task Force

Dr. Smith. Roneet Lev, MD FACEP Chief, Emergency Department Scripps Mercy Hospital Chair, San Diego Prescription Drug Abuse Medical Task Force Dr. Smith Roneet Lev, MD FACEP Chief, Emergency Department Scripps Mercy Hospital Chair, San Diego Prescription Drug Abuse Medical Task Force 1 1 How We Got Here 2 The Epidemic 3 4 San Diego Death Diaries

More information

Just Out of Reach: Women Who Use Drugs, Stigma and Barriers to Care Erin Bortel and Lyla Hunt AIDS Institute Office of Drug User Health

Just Out of Reach: Women Who Use Drugs, Stigma and Barriers to Care Erin Bortel and Lyla Hunt AIDS Institute Office of Drug User Health Just Out of Reach: Women Who Use Drugs, Stigma and Barriers to Care Erin Bortel and Lyla Hunt AIDS Institute Office of Drug User Health March 12, 2018 Envisioning a socially just system where all New Yorkers

More information

C O P E. Milwaukee County Opioid-Related Overdose Report MILWAUKEE COMMUNITY OPIOID PREVENTION EFFORT

C O P E. Milwaukee County Opioid-Related Overdose Report MILWAUKEE COMMUNITY OPIOID PREVENTION EFFORT Milwaukee County Opioid-Related Overdose Report 2012 2016 MILWAUKEE C O P E COMMUNITY OPIOID PREVENTION EFFORT For additional information or if you have questions about the data presented in this report,

More information

An Adaptive Reinforcement-Based Treatment (RBT) Intervention for Pregnant Substance Dependent Women

An Adaptive Reinforcement-Based Treatment (RBT) Intervention for Pregnant Substance Dependent Women An Adaptive Reinforcement-Based Treatment (RBT) Intervention for Pregnant Substance Dependent Women Michelle Tuten, Ph.D. Assistant Professor Department of Psychiatry and Behavioral Sciences and Johns

More information

DRUG OVERDOSE DEATHS ANALYSIS

DRUG OVERDOSE DEATHS ANALYSIS Overview CUYAHOGA COUNTY MEDICAL EXAMINER DRUG OVERDOSE DEATHS ANALYSIS Analysis of Fentanyl-Related Overdose Deaths in Cleveland/Cuyahoga County, Ohio in 2014 April 2015 The Cuyahoga County Medical Examiner

More information

Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention

Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention The Accountable Community for Health of King County Addressing the Opioid Crisis Workgroup: Treatment and Overdose Prevention May 7, 2018 1 Opiate Treatment & Overdose Prevention Project Goal Immediate:

More information

Bill McCarberg, MD. Founder Chronic Pain Management Program Kaiser Permanente San Diego (retired)

Bill McCarberg, MD. Founder Chronic Pain Management Program Kaiser Permanente San Diego (retired) Pain Management Bill McCarberg, MD Founder Chronic Pain Management Program Kaiser Permanente San Diego (retired) Adjunct Assistant Clinical Professor University of California School of Medicine San Diego

More information

Powering Efficient Behavioral Health Care Services

Powering Efficient Behavioral Health Care Services Powering Efficient Behavioral Health Care Services Streamlining behavioral health care decisions through comprehensive and efficient drug monitoring Quest Diagnostics has you and your patients covered

More information

CAN MY DRUG SCREEN BE WRONG?

CAN MY DRUG SCREEN BE WRONG? CAN MY DRUG SCREEN BE WRONG? Drug screens performed for compliance monitoring or as an initial step before prescribing opioids can have several sources of errors. One of the most frequent sources of error

More information

Referral to the Women s Alcohol and Drug Service (WADS) Procedure

Referral to the Women s Alcohol and Drug Service (WADS) Procedure 1. Purpose The following document describes criteria for the referral to Women s Alcohol and Drug Service (WADS) and how a referral is taken and processed. This includes the referral for clinical care

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

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years

3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years Drug Adherence Assessment Report CleanAssure TM (DRIED BLOOD SPOT): Detection Range see NOTES. Prescribed Medications: HYDROMORPHONE (DILAUDID, EXALGO), CYCLOBENZAPRINE (FLEXERIL), METHADONE (METHADOSE),

More information

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50

Clinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50 Clinical Policy: Reference Number: PA.CP.MP.50 Effective Date: 01/18 Last Review Date: 09/17 Coding Implications Revision Log Description Urine drug testing is a key diagnostic and therapeutic tool that

More information

A System of Care Surrounding the Drug Exposed Neonate. Disclosures. Objectives 11/17/2015. I have no financial disclosures

A System of Care Surrounding the Drug Exposed Neonate. Disclosures. Objectives 11/17/2015. I have no financial disclosures A System of Care Surrounding the Drug Exposed Neonate Sean Loudin MD Disclosures I have no financial disclosures Objectives Discuss the epidemiology of Neonatal Abstinence Syndrome (NAS) both nationally

More information

9/19/13. Postpartum Counseling for Women in MAT. Katie Clark MSPH, CSAC. A little about Katie. Definitions. MAT: Medication-Assisted Treatment

9/19/13. Postpartum Counseling for Women in MAT. Katie Clark MSPH, CSAC. A little about Katie. Definitions. MAT: Medication-Assisted Treatment Postpartum Counseling for Women in MAT Katie Clark MSPH, CSAC A little about Katie SUD and PH crossroads BA Health Arts and Sciences Goddard College MSPH MCH UNC Project Lazarus, Yale, CHER Solutions LLC

More information

OPIOID MICRO TRAINING MODULE 4: UNDERSTANDING OPIOID USE, PREGNANCY, AND NEONATAL ABSTINENCE SYNDROME (NAS)

OPIOID MICRO TRAINING MODULE 4: UNDERSTANDING OPIOID USE, PREGNANCY, AND NEONATAL ABSTINENCE SYNDROME (NAS) OPIOID MICRO TRAINING MODULE 4: UNDERSTANDING OPIOID USE, PREGNANCY, AND NEONATAL ABSTINENCE SYNDROME (NAS) This training is offered by the Florida Alcohol and Drug Abuse Association and JBS International.

More information