Click here to view the October 2016 Addiction Education News - COPE

Click to view SAMHSA’s presentation on “Understanding the Buprenorphine Final Rule for a Patient Limit of 275”.

Physicians who have prescribed buprenorphine to 100 patients for at least one year can now increase their patient limits to 275 under new federal regulations. Read CSAT's Dear Colleague Letter (PDF | 234 KB) on the new rule.

The Understanding the Final Rule for a Patient Limit of 275 (PDF | 163 KB) guidance document will help you determine whether you are eligible to request the new, higher limit on the patients that you may treat based on your credentials or features of your practice setting. You may also review the final rule in the Federal Register for further information.

If you wish to be considered for the higher limit please complete the online Waiver Notification Form SMA-167. SAMHSA reviews applications within 45 days of receipt. For more information, send an email to info@buprenorphine.samhsa.gov  or call 866-BUP-CSAT (866-287-2728).

The Senate earlier this week passed the Comprehensive Addiction and Recovery Act (CARA). 

The bill, which focuses on treating substance use disorder as a chronic illness rather than a criminal offense, expands education and prevention efforts, strengthens prescription drug monitoring programs, and increases first responder access to naloxone. The bill also allows nurse practitioners and physician assistants to prescribe buprenorphine with some restrictions.

The Department of Health and Human Services (HHS) issued a final rule on July 6, 2016 to increase access to Medication Assisted Treatment (MAT) with buprenorphine. This Rule will become effective on August 5, 2016.  Below are key points that outlines which practitioners are eligible for an expanded patient limit of 275.  (To read the entire rule click here)

Who is Eligible for a Patient Limit of 275 Under the Final Rule?

Under routine conditions, a practitioner would qualify for the higher limit in one of two ways:

1. by possessing subspecialty certification in addiction medicine or addiction psychiatry, or
2. by practicing in a Qualified Practice Setting (QPS) as defined in the rule. In either case, practitioners with the higher limit would have to possess a waiver to treat 100 patients for at least 1 year in order to gain experience treating at a higher limit.

The purpose of offering the 275 patient limit to practitioners in these two categories is to recognize the benefit offered to patients through: the advanced training and maintenance of knowledge and skill associated with the acquisition of subspecialty certification; and; the higher level of direct service provision and care coordination envisioned in the qualified practice setting. 

In addition to ensuring higher quality of care, the criteria for the higher limit is intended to minimize the risk of diversion of controlled substances to illicit use and accidental exposure that could result from increased prescribing of buprenorphine.

Route 1 - Subspecialty Certification:
A practitioner with board certification in addiction would have the training and experience necessary to recognize and address behaviors associated with increased risk of diversion.

Route 2 – A Qualified Practice Setting (QPS)
The QPS is an alternative to advanced certification to acquire the new 275 patient limit. If you terminate your relationship with a QPS you return to the 100 patient limit.

What is a QPS?

1. the ability to offer patients professional coverage for medical emergencies during hours when the practitioner’s practice is closed; this does not need to involve another waivered practitioner, only that coverage be available for patients experiencing an emergency even when the office is closed;
2. the ability to ensure access to patient case-management services including behavioral health services;
3. health information technology (health IT) systems such as electronic health records, when practitioners are required to use it in the practice setting in which he or she practices;
4. participation in a prescription drug monitoring program (PDMP), where operational, and in accordance with State law.  PDMP means a statewide electronic database that collects designated data on substances dispensed in the State.  For practitioners providing care in their capacity as employees or contractors of a Federal government agency, participation in a PDMP would be required only when such participation is not restricted based on State law or regulation based on their State of licensure and is in accordance with Federal statutes and regulations; and
5. employment, or a contractual obligation to treat patients in a setting that has the ability to accept third-party payment for costs in providing health services, including written billing, credit and collection policies and procedures, or Federal health benefits. (100% cash only clinics are out by design because “pill mills" were cash only).

NOTE:
The Higher 275 patient limit must be applied for every 3 years.
Final documentation construction is pending and a form will be available at www.samhsa.gov.

The Higher 275 patient limit may be revoked if there are violation of good practices.
Under the new increase, if you are outside of the standard of care, action can be taken and you will lose the waiver for the new limit.

Besides numbers what is the difference between the lower limit and the higher limit?

• Practitioners approved to treat up to 275 patients will also be required to accept greater responsibility for providing behavioral health services and care coordination, and ensuring quality assurance and improvement practices, diversion control, and continuity of care in emergencies.
• The higher limit will also carry with it the duty to regularly reaffirm the practitioner’s ongoing eligibility and to participate in data reporting and monitoring as required by SAMHSA.

AOAAM applauds SAMHSA for taking a conservative approach 
in raising the limit to prescribe buprenorphine for SUD 

July 6, 2016:  Today the Obama Administration took further action to address prescription opioid and the heroin epidemic. The Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration, is issuing a final rule to increase from 100 to 275 the number of patients that qualified physicians who prescribe buprenorphine for opioid use disorders can treat. Providers, policymakers, advocates, and experts have pointed to the current 100 patient limit for buprenorphine prescribing as a barrier to opioid use disorder treatment. AOAAM is pleased that SAMHSA raised the number far below the 500 limit that some had proposed, and also set up safeguards to prevent diversion. The rule aims to increase access to medication-assisted treatment and associated behavioral health supports for tens of thousands of people with opioid use disorders, while preventing diversion.  

“Clinics throughout the country, particularly in urban areas, have had long lists of people waiting to receive buprenorphine, an opioid partial agonist. The number goes up from 100 to 275 patients in August. The line gets shorter; that is the beginning.  I want to thank President Barak Obama, HHS Secretary Sylvia Burwell and all the staff burning midnight oil at SAMHSA, “says AOAAM President William Morrone, DO.

In addition to raising the proposed patient limit from 200 to 275, the final rule revised the qualifications for the higher limit to include board certification in addiction medicine or addiction psychiatry from the American Board of Addiction Medicine (ABAM) or the American Board of Medical Specialties (ABMS) or certifications by the American Osteopathic Academy of Addiction Medicine, ABAM or ASAM. 

Dr. Morrone says that this is one of the fastest responses he has witnessed. “This is bigger than flu shots, bigger than pneumonia. More people die from drug overdose than from motor vehicle accidents or guns. This is stealing young people in their prime. We are losing mothers and fathers of small children. Additional prescribers and access to behavior health treatment is key in helping those individuals who struggle with opioid use disorder.”

The final rule will become effective on August 5, 2016.

At 5:13 ET April 12, 2016, the American Osteopathic Association (AOA) passed a resolution that will provide DOs who are ABAM diplomats with a process to attain an AOA subspecialty certification in Addiction Medicine.

Since 2002, when the AOA closed the clinical pathway to the addiction medicine subspecialty/CAQ, 390 osteopathic physicians sought and obtained an ABAM certification outside of the AOA. ABAM recently entered into an agreement under which its certification program will be administered by the American Board of Preventive Medicine (an American Board of Medical Specialties, ABMS board) and the new subspecialty of Addiction Medicine will be open to any physician certified by any of the 24 Member Boards of the ABMS. As a result, osteopathic physicians who have primary certification from AOA Certifying Boards are effectively shut out of the ABMS process.

The resolution calls for the AOA to create a mechanism to allow those osteopathic physicians who have an active AOA primary certification and an active ABAM certification to be granted subspecialty/CAQ certification in Addiction Medicine, with a requirement that they maintain such certification through the AOA’s Addiction Medicine Osteopathic Continuous Certification (OCC) process.

"For 30 years, securing a process for an Addiction Medicine CAQ has been promoted by the American Osteopathic Academy of Addiction Medicine(AOAAM). It has been a key part of our mission and couldn’t come at more critical time," said AOAAM President Dr. William Morrone. "With the exponential increase of substance misuse and addiction, expanding the expert workforce needed to wrestle the challenge is paramount. Every past president should be recognized for their dedication, perseverance and commitment in making this possible," said Dr. Morrone.

Members will receive more detailed information as it becomes available. AOAAM is hosting a small town hall session at the ASAM 2016 Annual Conference in Baltimore where AOAAM officials can provide more details about the ramifications of this milestone and answer questions.

Today, President Obama announced several public and private sector actions to escalate the fight against the prescription opioid abuse and heroin epidemic, which is claiming the lives of tens of thousands of Americans each year.  Included in the President’s announcement, as well as remarks to be delivered at the National Rx Drug Abuse and Heroin Summit in Atlanta, GA, by SAMHSA Principal Deputy Administrator Kana Enomoto, are several initiatives being led by the Substance Abuse and Mental Health Services Administration (SAMHSA), including the new buprenorphine rule on increased access:

Buprenorphine Rule

One of the important steps that the Department of Health and Human Services (HHS) is taking to address the opioid crisis is looking at ways to increase access to Medication-Assisted Treatment (MAT). As part of this effort to expand the use of MAT, SAMHSA, in collaboration with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the HHS Office of General Counsel, and other HHS components has been exploring efforts to increase access to buprenorphine.  We are happy to announce that we have taken a major step forward in this process and that at 8:45 AM, a Notice of Proposed Rulemaking (NPRM) to expand access to buprenorphine went on display in the Federal Register.   

Under current regulations, physicians that are certified to prescribe buprenorphine for MAT are allowed to prescribe up to 30 patients initially and then after one year can request authorization to prescribe up to a maximum of 100 patients. This cap on prescribing limits the ability of some physicians to prescribe to patients with opioid use disorder.  If adopted, the proposed rulemaking would allow for a qualified and currently waivered physician to prescribe buprenorphine for up to 200 patients.  Existing evidence shows that this lifesaving, evidence-based treatment is under-utilized. This proposed expansion is especially important to people who are seeking help for an untreated opioid use disorder.  In many cases there are long waiting lists of patients for prescribers who have reached the 100 patient limit.  Easing additional barriers to treatment, such as this cap, is a major step HHS is taking to help reduce prescription opioid and heroin related overdose, death, and dependence.  The proposed rule is designed to strike an appropriate balance between expanding access to this important treatment, encouraging use of evidence-based MAT, and minimizing the risk of drug diversion.   

HHS welcomes public comment on this proposed rule, which will be open for comment for 60 days starting Wednesday, March 30, 2016. 

Additionally, we thought you might be interested in watching President Obama speak today at 2:15 pm ET at the 2016 National Rx Drug Abuse and Heroin Summit. Below is a letter from White House Office of National Drug Control Policy Director Michael Botticelli with details.

Watch President Obama Speak at the 2016 National Rx Drug Abuse and Heroin Summit

Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic

Dear Stakeholders,

I'm here in Atlanta at the 2016 National Rx Drug Abuse & Heroin Summit gearing up to hear the President speak on how we turn the corner on this national epidemic. Join me at 2:15pm (EST) today at WH.Gov/Live to watch President Obama's conversation with community leaders and advocates at the Summit, including people in recovery. 

During his conversation, the President will talk about the challenges we face with prescription drug misuse and heroin use.  He will also talk about the actions we are taking - and need to take - to prevent more people from developing opioid use disorders and to make sure those who want treatment can access it.  

The President has made clear that addressing this epidemic is a priority for his Administration - and should be a bipartisan priority for all Americans.  And that's why - building on his $1.1 billion budget proposal to help every American seeking treatment get the care they need - the President announced additional public and private sector actions to help more families.

Today, the Administration is:

• Expanding access to treatment through doctors, community health centers, and state programs.  
• Investing in partnerships between law enforcement and communities.  
• Working to save more lives by making the overdose reversal drug naloxone more readily available to first responders.                                                       
• Ensuring those on Medicaid and CHIP can access mental health and substance use services as readily as medical services.  
• Pulling together medical schools to train students on the newest CDC guidelines on prescribing opioid painkillers.  

The President has made clear that addressing this epidemic is a priority for his Administration, and today's actions represent further steps to expand access to treatment, prevent overdose deaths and increase community prevention strategies.  

Again, I hope that you can join me in watching the President talk about this epidemic today at 2:15pm (EST) at WH.Gov/Live.

Thanks, 

Michael P. Botticelli

Director, National Drug Control Policy

 

THE WHITE HOUSE

Office of the Press Secretary

FACT SHEET:  Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic

Today the President joins individuals in recovery, family members, medical professionals, law enforcement officials and other leaders at the National Rx Drug Abuse and Heroin Summit in Atlanta, Georgia.  The annual summit is organized by Operation UNITE, which was launched by Congressman Hal Rogers (R-KY).  As part of today's event, the President is announcing additional public and private sector actions to escalate the fight against the prescription opioid abuse and heroin epidemic, which is claiming the lives of tens of thousands of Americans each year.

The President has made clear that addressing this epidemic is a priority for his Administration, and today's actions represent further steps to expand access to treatment, prevent overdose deaths and increase community prevention strategies.  These actions build on the President's proposal for $1.1 billion in new funding to help every American with an opioid use disorder who wants treatment get the help they need. 

As part of today's event, the President will announce the following Administration actions: 

• Expanding Access to Treatment: 

The Department of Health and Human Services (HHS) is issuing a proposed rule to increase the current patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients with the goal of expanding access to this evidence-based treatment while preventing diversion.  The proposed rule aims to increase access to medication-assisted treatment and behavioral health supports for tens of thousands of people with opioid use disorders.  

HHS released $94 million in new funding to 271 Community Health Centers across the country earlier this month to increase substance use disorder treatment services, with a specific focus on expanding medication-assisted treatment of opioid use disorders in underserved communities.  This funding is expected to help health centers treat nearly 124,000 new patients with substance use disorders.

 The Substance Abuse and Mental Health Services Administration (SAMHSA) is releasing a new $11 million funding opportunity for up to 11 States to expand their medication-assisted treatment services.  SAMHSA also is distributing 10,000 pocket guides for clinicians that include a checklist for prescribing medication for opioid use disorder treatment and integrating non-pharmacologic therapies into treatment.  SAMHSA also will coordinate trainings to increase the number of doctors qualified to prescribe buprenorphine, which will be held in targeted States in greatest need.                       

• Establishing a Mental Health and Substance Use Disorder Parity Task Force:   

The President is signing a Memorandum today directing the creation of an interagency Task Force, to be chaired by the Domestic Policy Council, to advance access to mental health and substance use disorder treatment; promote compliance with best practices for mental health and substance use disorder parity implementation; and develop additional agency guidance as needed.  Federal parity protections are intended to ensure that health plans' coverage of mental health and substance use disorder benefits is comparable to their coverage of medical and surgical benefits.  The Task Force will work quickly, with an October 31 deadline, across Federal Departments and with diverse stakeholders to ensure implementation of these important parity protections.

• Implementing Mental Health and Substance Use Disorder Parity in Medicaid:  

HHS is finalizing a rule to strengthen access to mental health and substance use services for people enrolled in Medicaid and Children's Health Insurance Program (CHIP) plans by requiring that these benefits be offered at parity, meaning  that they be comparable to medical and surgical benefits.  These protections are expected to benefit more than 23 million people in Medicaid and CHIP. 

• Preventing Opioid Overdose Deaths: 

SAMHSA is releasing a new $11 million funding opportunity to States to purchase and distribute the opioid overdose reversal drug, naloxone, and to train first responders and others on its use along with other overdose prevention strategies.

• Expanding Public Health-Public Safety Partnerships to Combat the Spread of Heroin: 

The Office of National Drug Control Policy is expanding its heroin initiative among regional High Intensity Drug Trafficking Areas (HIDTAs) by adding Ohio and Michigan to the effort.  These States will join the Appalachia, New England, Philadelphia/Camden, New York/New Jersey, and Washington/Baltimore HIDTAs in accelerating local partnerships between law enforcement and their counterparts in public health to combat heroin use and overdose.

• Investing in Community Policing to Address Heroin: 

The Department of Justice's COPS program is announcing a $7 million funding opportunity called the COPS Anti-Heroin Task Force Program to advance public safety and to investigate the distribution of heroin, unlawful distribution of prescription opioids and unlawful heroin and prescription opioid traffickers.  These grants will provide funds directly to law enforcement agencies in States with high rates of primary treatment admissions for heroin and other opioids. 

• Tackling Substance Use Disorders in Rural Communities: 

On Monday, the Department of Agriculture announced that its $1.4 million Rural Health and Safety Education Grant Program to enhance the quality of life in rural areas through health and safety education projects has been expanded to include a focus on addressing the critical challenges related to substance use disorders in rural communities across the country.

• Implementing Syringe Services Programs: 

HHS is issuing guidance for HHS-funded programs regarding the use of Federal funds to implement or expand syringe services programs for people who inject drugs.  Syringe services programs are an effective component of a comprehensive approach to preventing HIV and viral hepatitis among people who inject drugs.  The bipartisan budget agreement signed by the President last year revised a longstanding ban on these programs and allows communities with a demonstrated need to use Federal funds for the operational components of syringe services programs. 

New Private Sector Commitments to Address the Epidemic

In connection with today's Federal announcements, more than 60 medical schools are announcing that, beginning in fall 2016, they will require their students to take some form of prescriber education, in line with the newly released Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain, in order to graduate. Schools include: 

 • A.T. Still University of Health Sciences, Kirksville College of Osteopathic Medicine

• A.T. Still University of Health Sciences, School of Osteopathic Medicine in Arizona

• Baylor College of Medicine

• Boston University School of Medicine

• Burrell College of Osteopathic Medicine at New Mexico State University

• Chicago College of Osteopathic Medicine of Midwestern University

• David Geffen School of Medicine at the University of California - Los Angeles

• Dell Medical School at The University of Texas at Austin

• East Carolina University Brody School of Medicine

• Edward Via College of Osteopathic Medicine - Auburn Campus

• Edward Via College of Osteopathic Medicine - Carolinas Campus

• Edward Via College of Osteopathic Medicine - Virginia Campus

• Georgia Campus - Philadelphia College of Osteopathic Medicine

• Hébert School of Medicine Uniformed Services University of the Health Sciences

• Icahn School of Medicine at Mount Sinai

• Kansas City University of Medicine and Biosciences College of Osteopathic   Medicine

• Lincoln Memorial University DeBusk College of Osteopathic Medicine

• Loyola University Chicago Stritch School of Medicine

• Marian University College of Osteopathic Medicine

• Marshall University Joan C. Edwards School of Medicine

• Mercer University School of Medicine

• NYU School of Medicine

• Ohio State University College of Medicine

• Ohio University Heritage College of Osteopathic Medicine

• Oklahoma State University Center for Health Sciences College of Osteopathic Medicine

• Oregon Health & Science University School of Medicine

• Perelman School of Medicine at the University of Pennsylvania

• Philadelphia College of Osteopathic Medicine

• Rocky Vista University College of Osteopathic Medicine

• Rowan University School of Osteopathic Medicine

• Rutgers Robert Wood Johnson Medical School

• Saint Louis University School of Medicine

• State University of New York Upstate Medical University

• The Commonwealth Medical College

• The Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo

• Touro College of Osteopathic Medicine - New York

• Touro University College of Osteopathic Medicine  - California

• Touro University College of Osteopathic Medicine - Nevada

• Tufts University School of Medicine

• Tulane University School of Medicine

• University of Arizona College of Medicine - Tucson

• University of California - Davis School of Medicine

• University of Central Florida College of Medicine

• University of Colorado School of Medicine

• University of Kansas Medical Center

• University of Louisville School of Medicine

• University of New England College of Osteopathic Medicine

• University of North Carolina School of Medicine

• University of North Texas Health Science Center at Fort Worth, Texas College of Osteopathic Medicine

• University of Oklahoma College of Medicine

• University of Pikeville - Kentucky College of Osteopathic Medicine

• University of Rochester School of Medicine and Dentistry

• University of Tennessee College of Medicine

• University of Texas Southwestern Medical Center

• University of Wisconsin School of Medicine and Public Health

• Virginia Commonwealth University School of Medicine

• West Virginia School of Osteopathic Medicine

• West Virginia University School of Medicine

• Western University of Health Sciences College of Osteopathic Medicine of the Pacific

• Western University of Health Sciences College of Osteopathic Medicine of the Pacific Northwest

• William Carey University College of Osteopathic Medicine  

Rite Aid has trained over 8,400 pharmacists on naloxone and is dispensing naloxone to patients without needing an individual prescription in 10 States with plans to expand to additional States.  Kroger currently dispenses naloxone without an individual prescription at its pharmacies in 7 States with plans to expand to at least 12 more by the end of the year.  AmerisourceBergen/Good Neighbor Pharmacy will provide educational materials to encourage their 4,000 independently owned and operated retail pharmacy locations to provide naloxone without an individual prescription.

Updates on Federal Actions and Private Sector Commitments

In October 2015, as part of his visit to West Virginia to discuss the prescription opioid abuse and heroin epidemic, the President announced a number of new public and private sector actions , including a Presidential Memorandum requiring Federal Departments to provide training on appropriate opioid prescribing to Federal health care professionals and requiring Departments to develop plans to address barriers to opioid use disorder treatment in Federal programs.  Departments are ahead of schedule in fulfilling the President's directive that Federal agencies ensure that all employees who prescribe these drugs are trained in appropriate opioid prescribing practices by 2017.  Approximately 75 percent of federal prescribers have been trained to date.  In addition, since the President's Memorandum was released, Departments have taken numerous steps to expand access to opioid use disorder treatment, including medication-assisted treatment, such as:

•           TRICARE:  The Department of Defense issued a proposed rule to implement parity protections in TRICARE, including expanding mental health and substance use disorder treatment to include coverage of intensive outpatient programs and treatment of opioid use disorders with medication-assisted treatment.  TRICARE currently has an estimated 15,000 to 20,000 beneficiaries with opioid use disorder who, under the current benefit, cannot access medication-assisted treatment.

•           FEHBP:  The Office of Personnel Management released a 2017 Call Letter to health plans participating in the Federal Employees Health Benefits Program (FEHBP) making opioid use disorder treatment a priority and calling on health plans to review and improve access to medication-assisted treatment.

•           Medicare:  The Centers for Medicare and Medicaid Services (CMS) released a 2017 Call Letter to plans participating in the Medicare Prescription Drug Program reiterating that reducing the unsafe use of opioids is a priority and making clear that Part D formulary and plan benefit designs that hinder access to medication-assisted treatment for opioid use disorder will not be approved. 

•           Medicaid:  CMS released a guidance document to States identifying "Best Practices for Addressing Prescription Opioid Overdoses, Misuse and Addiction" including effective Medicaid pharmacy benefit management strategies, steps to increase the use of naloxone to reverse opioid overdose, and options for expanding Medicaid coverage of and access to opioid use disorder treatment.  This builds on Medicaid's work with States over the past year to increase access to Medicaid substance use disorder treatment services. 

•           Health Insurance Marketplace: In the last month, CMS finalized a 2017 Marketplace payment notice that clarified that both essential health benefits requirements and Federal mental health and substance use disorder parity requirements apply to qualified health plan coverage of medications to treat opioid use disorder, and additional guidance is forthcoming.

Earlier this month, the Centers for Disease Control and Prevention issued its Guideline for Prescribing Opioids for Chronic Pain - the Agency's first-ever recommendations for primary care clinicians on prescribing opioids.  The Guideline provides recommendations for clinicians on appropriate prescribing, including determining if and when to start prescription opioids for chronic pain treatment; guidance on medication selection, dose, and duration, including when to discontinue medication, if needed; and guidance to help assess the benefits and risks and address the harms of prescription opioid use.

The Food and Drug Administration recently announced safety labeling changes for all immediate-release opioid pain medications, including requiring a new boxed warning about the serious risks of misuse, abuse, addiction, overdose and death associated with these drugs.  The Agency also issued a draft guidance intended to support the development of generic versions of abuse-deterrent opioids.  Abuse-deterrent drug formulations are designed to make the drug more difficult to abuse, including making it harder to crush a tablet in order to snort the contents or more difficult to dissolve the product in order to inject it.

The Drug Enforcement Administration (DEA) recently announced it will hold its 11th National Prescription Drug Take-Back Day on Saturday, April 30, providing a safe, convenient, and responsible way of disposing of unneeded prescription drugs.  More than 5.5 million pounds of medication have been collected over the last ten Take Back Days.  Local communities are also establishing ongoing drug take-back programs. 

Examples of private sector actions taken to date include the following:

In conjunction with the October event, more than 40 health care provider groups announced a commitment to ensure that more than 540,000 health care providers will complete training on appropriate opioid prescribing in the next two years.  In the first five months of this initiative, the provider coalition reports that more than 75,000 providers have completed prescriber training.  In addition, more than 2,200 additional physicians have committed to completing training to prescribe buprenorphine as part of the coalition's effort to double the number of buprenorphine prescribers in the next three years.

As part of their commitment announced at the October 2015 event, the National Association of Counties, National Governors Association, National League of Cities and United States Conference of Mayors, with the U.S. Communities Purchasing Alliance and Premier, Inc., announced in January they had secured discounts on naloxone and medication-assisted treatment drugs through their purchasing program for State and local agencies.

In February, Walgreens announced it will install safe medication disposal kiosks in more than 500 drugstores across the country, primarily at locations open 24 hours. The program will make the disposal of medications - including opioids and other controlled substances - easier and more convenient while helping to reduce the misuse of medications.  Walgreens also will make naloxone available without needing an individual prescription at its pharmacies in 35 States and Washington, D.C. throughout this year.

CVS Health has worked to increase access to naloxone by establishing standing orders or collaborative practice agreements.  By the end of March 2016, CVS Pharmacy locations in 23 States will be able to dispense naloxone to patients without needing an individual prescription, increasing to 35 States by the end of 2016 as part of its program expansion announced at the October 2015 event.  CVS Health has also launched a drug abuse prevention program called Pharmacists Teach, which brings CVS Pharmacists into schools across the country to educate students about the dangers of drug abuse.  To date, more than 30,000 students have participated in the program. 

###

Marijuana: Risks for the Primary Care Doc                                                                         

       Contraindications:                                 

Hypersensitivity to Cannabinoids

Cardiovascular Diseases including:

◦        Arrhythmia

◦        Heart failure (any kind)

◦        Poorly regulated Hypertension

◦        Ischemic heart disease

History of Psychotic Disorders

◦      (Schizophrenia, Schizoaffective)

Family History of Psychotic Disorders

History of Drug Abuse

Family history of Drug Abuse

Males intending to start a family

Children less than 18 years old

Pregnant or breast feeding females                  

Serious Risks:   

Severe Psychiatric Side effects

◦        Psychosis

◦        Anxiety

◦        Mood Disorder

CNS Depression

◦        Decreased Cognitive Performance

◦        Impairs Short Term Memory

◦        Impairs Attention, Coordination and Balance

◦        Impairs Judgment

                 Impairs motor skills.

                 IMPAIRED DRIVING

Tachycardia

Drug Abuse Potential

Hepatic Dysfunction – Transaminitis

Interactions:

CNS Depressants adverse effects are enchanced

Anticholinergics increase tachycardia with marijuana

Cocaine worsens tachycardia with marijuana

Sympathomimetics can worsen tachycardia with marijuana

 
 

       Adapted from

            NIDA Research Report Series Marijuana Abuse. NIH

            Pub# 10-3859

               and

            Handbook of the Medical Consequences of Alcohol and Drug

            Abuse / John Brick, editor.-2nd ed. p. cm. And referenced articles

               and

            Smith,PF, “GW-1000. GW Pharmaceuticals, “Curr Opin Investig

            Drugs, 2004, 5(7):748-54. {PubMed 15298072]

                        Author: Michael Dekker, D.O.

Click here for the pocket card.