Reminder: Virtual Meet and Greet with the Opioid Response Network Sexuality and Gender Diversity Workgroup

ORN's Sexuality and Gender Diversity Workgroup (formally called the LGBTQ+ Workgroup) virtual meet and greet will be held on October 22, 2021 at 12:00 PM EST.This Friday! Members will be sharing how the workgroup supports ORN’s mission to help you help others reach LGBTQ+ communities facing opioid and stimulant use struggles and how to access ORN as a free resource. Learn more and register for the meet and greet. 

One Way to Overcome Substance Use Disorder as a Barrier to Financial Aid for Working Families

Awareness

Dear Opioid Response Network Community: The Child Tax Credit in the American Rescue Plan provides the largest Child Tax Credit ever and historic relief to the most working families ever. This program is reaching most American families with automatic monthly payments without them having to take any action and it is a key strategy to lift many out of poverty. Reaching even more families continues to be a national priority and awareness is critical, especially in reaching families who have not filed taxes recently and therefore need to sign up themselves to receive payments. Today, we ask for this community’s support in sharing this message with your members, within your practices and at all junctures where our work directly reaches individuals and families impacted by substance use disorders. Let's reach and help more families. 

Research shows us that poverty can lead to substance use disorders, including opioid and stimulant use issues. Research also shows that drug-related death rates have been seen to be significantly higher in poorer areas and in areas with high levels of family distress. To this end, programs like the Child Tax Credit offer an important strategy to address a key social determinate of health for individuals who are at risk for opioid or stimulant use and their families. Assisting families in obtaining resources such as early childhood education, welfare benefits and adult education has been a frequent call to action during many Opioid Response Network training events. But addressing barriers for non-filers (individuals who have not filed taxes recently) in particular presents clear challenges. We ask that you share these outreach materials as broadly as possible. Together – we can make a difference!

Upcoming Trainings and New ORN Educational Resources

Harm Reduction Through a Prevention Lens

Learning Collaborative in Session: Integrated Treatment for Individuals with Co-Occurring Substance Use Disorders and Serious Mental Illness

The American Psychiatry Association, an ORN partner organization, is hosting an ORN-funded online learning collaborative called Integrated Treatment for Individuals with Co-Occurring Substance Use Disorders and Serious Mental Illness, which is being led by Ken Minkoff, MD, Senior System Consultant, ZiaPartners, Inc., Part-time Assistant Professor of Psychiatry, Harvard Medical School. Open now through November 21, 2021, this collaborative serves as a virtual community for participants working in settings serving people with serious mental illness (SMI) to understand how to implement the routine delivery of integrated mental health/substance use disorder services to individuals with SMI, co-occurring substance use conditions (with a particular focus on co-occurring opioid use disorder), and other complex needs, within their own practice, their own program, and their own agency.

Harm Reduction Through a Prevention Lens

New resource within the ORN's repository: Harm Reduction Through a Prevention Lens. This one-page information sheet, developed by the Prevention Technology Transfer Center, provides a brief overview of harm reduction and its connection with prevention. It also includes basic harm reduction strategies for commonly used substances and viral infections that are a heightened risk for people who use substances. Submit a request today for access at OpioidResponseNetwork.org. Your local Technology Transfer Specialist can not only provide access, but, as your local champion, provide you with a range of related education and training support. 

Substance Use Disorders in the LGBTQ Population

New presentation within the ORN's repository: Substance Use Disorders in the LGBTQ Population. This presentation tool examines understanding of why sexual minorities are at increased risk for substance use disorders; epidemiology of substance use disorders with a focus on methamphetamine use; recommendations for substance use disorder treatment in the LGBTQ population; and more. If you would like a similar, but tailored training, for your community, staff, etc., submit a request today at OpioidResponseNetwork.org and your local Technology Transfer Specialist will be in touch within one business day.

orn@aaap.org 401-270-5900
OpioidResponseNetwork.org

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Providing Affirming Care for LGBTQ+ People in Substance Use Treatment Settings

In the last addition of the Bulletin we shared that Columbia University Department of Psychiatry Division on Substance Use Disorders has created a one-of-a-kind, web-based training funded by ORN that will help substance use disorder treatment providers deliver more affirming care to their LGBTQ+ clients. This course has since launched and is available to access, and benefit from, at no cost. Authors: Margaret Paschen-Wolff, DrPH, MSW; Jeremy D. Kidd MD, MPH; Avery DeSousa, BA; Theresa V. Navalta, BA; and the Community Advisory Board. Duration: 1 - 1.5 hours. Access here.

How else can ORN support your efforts in delivering affirming care for LGBTQ+ people? ORN's Sexuality and Gender Diversity Workgroup (formally known as the LGBTQ+ Workgroup) is coordinating a virtual “Meet and Greet” aiming to introduce you and your organization to the workgroup's members and share how the workgroup supports ORN’s mission to help you help others reach LGBTQ+ communities facing opioid and stimulant use struggles. Learn how to access ORN as a free resource to receive support in providing affirming, culturally intelligent and evidence-based education and trainings around substance use. Register here for the Meet and Greet. 

Deadly Adulterants: Another Threat from the Opioid Epidemic

The American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) is identifying and reporting on novel and emerging opioid and stimulant exposures for ORN every quarter. ACMT is an ORN partner organization. The latest in the series of reports is titled "Deadly Adulterants: Another Threat from the Opioid Epidemic."

Adulteration and contamination of illicit drugs has long been a potential hazard for people who use both sporadically and chronically. Over the centuries, clusters of illness tied to specific adulterants can be found in historical descriptions. For example, in 1982 four young adults living around San Jose, CA developed Parkinson’s like movements after intravenous illicit opioid drug use. The substance was tested and found were byproducts of the production of a synthetic “street heroin” that was newly emerging in northern California at the time. Read the full report here. Past reports here.

Adverse Childhood Experiences (ACEs) Data Spotlight

 The increased accessibility to prescription pain medications over the last 20 years has made it easier for adolescents to engage in opioid misuse and, subsequently, be at heightened risk for opioid use disorder and related adverse outcomes. As a result, it is important to identify risk factors for opioid misuse to inform prevention and treatment efforts among children and adolescents. Recent research has highlighted a significant relationship between adverse childhood experiences (ACEs) and subsequent opioid misuse among adolescents. Specifically, findings show that adolescents who are exposed to five or more ACEs are 15 times more likely to report recent opioid misuse. In total, over 70% of recent opioid misuse is attributed to previous childhood adversity.

Past Month Opioid Misuse Among Adolescents, by Number of ACEs

[Source: Swedo, E. A., Sumner, S. A., de Fijter, S., Werhan, L., Norris, K., Beauregard, J. L., ... & Massetti, G. M. (2020). Adolescent opioid misuse attributable to adverse childhood experiences. The Journal of Pediatrics, 224, 102-109.]

How is ORN Responding? ORN responds to technical assistance requests from individuals, organizations (and anyone!) specific to ACEs both in-person and virtually. These requests and subsequent action result in training, educational materials, and strategic planning which spans prevention, treatment and recovery. For example, ORN conducted a webinar on the association between ACEs and criminal justice involvement. This presentation highlighted the extent to which ACE trauma has been linked to challenges with brain development in adults and subsequent behavioral health issues. For example, a study of California’s prison population reported that over half of inmates had experienced ACEs. For access to this resource (all at no cost) or to coordinate your own training submit a request at OpioidResponseNetwork.org.

This data spotlight is part of a series brought to the Bulletin by ORN partner organization, RTI International.

Upcoming Education and Training Opportunities

Medication for Opioid Use Disorder (MOUD) Implementation Guides for Probation and Parole

Justice System Partners, in a partnership with the Brown University School of Public Health, and with ORN funding, is developing a suite of resources and practical tools for implementing MOUD in criminal justice settings. A series of guides for community corrections work are now available. The series is for individuals trying to ignite (or re-ignite) an interest in using or expanding the use of MOUD within communities, and specifically within probation and parole. Contact your local ORN representative by submitting a request at OpioidResponseNetwork.org for access to the guides - provided at no cost.

AUGUST 27, 2021• PRESIDENTIAL ACTIONS

The overdose epidemic has taken a toll on far too many Americans and their loved ones.  Addiction is a disease that touches families in every community, including my own.  The epidemic is national, but the impact is personal.  It is personal to the millions who confront substance use disorder every day, and to the families who have lost loved ones to an overdose. 

During Overdose Awareness Week, we recommit to taking bold actions to prevent overdoses and related deaths, and enhance our support for individuals with substance use disorders.

In recent years, we have seen synthetic opioids, such as illicitly manufactured fentanyl, drive many overdose deaths with cocaine- and methamphetamine-related deaths also increasing at alarming rates.  The COVID-19 pandemic has exacerbated the overdose epidemic, as necessary pandemic restrictions made it harder for individuals with addiction to receive the treatment and support services they need.  These factors contributed to the more than 93,000 drug overdose deaths in 2020.  As a Nation, we need a strong response to America’s overdose epidemic and an investment in prevention, harm reduction, treatment and recovery services, as well as strategies to reduce the supply of illicit drugs.  

While drug overdose and addiction affect many different communities across the United States, we also recognize the longstanding inequities experienced by people of color, people who identify as LGBTQ+, formerly incarcerated individuals, people experiencing homelessness, and others.  For too many years, these communities have faced disparate access to health care, differential treatment in the criminal justice system, and poorer health outcomes. 

My Administration is committed to addressing addiction and the overdose epidemic with evidence-based strategies.  In April, to ensure that the Federal Government is promoting evidence-based public health and safety interventions, the Office of National Drug Control Policy released my Administration’s first year drug policy priorities.  These include expanding access to prevention, treatment and harm reduction efforts, reducing youth substance use, reducing the supply of illicit substances, advancing recovery-ready workplaces, and expanding the addiction workforce and access to recovery support services for all Americans.  My Administration is also committed to eliminating racial disparities in responding to the overdose epidemic as well as reviewing the overall approach to drug policy.

This effort requires significant investments in our health care infrastructure.  In my American Rescue Plan, we provided crucial funding for substance use disorder treatment and harm reduction, including a nearly $4 billion investment in our Nation’s behavioral health infrastructure.  This includes $30 million for a new Substance Abuse and Mental Health Services Administration grant program to support community-based efforts aimed at preventing overdoses and reducing harm associated with substance use. 

We also recognize that many of our brave veterans recovering from service injuries may be vulnerable to opioid addiction.  I signed the Dispose Unused Medications and Prescription Opioids Act to ensure that Veterans Affairs facilities provide locations to dispose controlled substances in a safe, secure and supportive environment. 

Agencies across the Federal Government are also making significant strides in supporting individuals with substance use disorders.  The Department of Health and Human Services continues to work on expanding access to evidence-based treatment, including a new policy to expand access to buprenorphine, a medication for the treatment of opioid use disorder.  The Drug Enforcement Administration also issued a new rule that allows more opioid use disorder treatment programs to operate mobile components to better serve rural and underserved communities.  These actions are only the beginning.  My Administration will be taking additional actions to reduce barriers to life-saving treatment and expand access to prevention, harm reduction, and recovery support services.

Overdose Awareness Week provides us an opportunity to recommit ourselves to addressing this epidemic.  By enhancing our support for individuals facing substance use disorder we can save lives. 

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim August 29 through September 4, 2021, as Overdose Awareness Week.  I call upon citizens, government agencies, organizations, healthcare providers, and research institutions to raise awareness of substance use disorders to combat stigma, to promote treatment and celebrate recovery, and to strengthen our collective efforts to prevent overdose deaths.  August 31st also marks Overdose Awareness Day, on which our Nation mourns the lives lost to the drug overdose epidemic.  

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-seventh day of August, in the year of our Lord two thousand twenty-one, and of the Independence of the United States of America the two hundred and forty-sixth.

JOSEPH R. BIDEN JR

How ORN is Responding to the Co-Occurrence of Serious Mental Illness and Opioid Use Disorder

Past Year Serious Mental Illness and Opioid Use Disorder Among Adults Aged 18 or Older: 2019 [Source: 2019 National Survey on Drug Use and Health (NSDUH) Detailed Tables. Data extracted on 7/8/21.] In 2019, over 14 million adults in the United States reported experiencing past year serious mental illness (SMI) or opioid use disorder (OUD). Of those with OUD, nearly half (40.2%) also reported having SMI. The relatively high co-occurrence of SMI among those with OUD is an important consideration for providers, as treatment utilization is poor among those with co-occurring disorders. Prior research has shown that fewer than one in three individuals with co-occurring OUD and SMI receive substance use and mental health treatment (Novak, Feder, Ali, & Chen, 2019). How Has ORN Responded? From March 2018 to June 2021, the Opioid Response Network (ORN) responded to 84 specific requests for education and training related to SMI. This resulted in over 140 activities, delivered face-to-face and virtually, for a range of mental and behavioral health providers. Activity objectives encompassed awareness, education and training strategies related to a number of relevant topics, including medications for OUD, harm reduction, and recovery in this population. This data spotlight is part of a series brought to the Impact Bulletin by ORN partner organization, RTI International. Novak, P., Feder, K. A., Ali, M. M., & Chen, J. (2019). Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey. Journal of substance abuse treatment, 98, 47-52.

Mark Your Calendars: Upcoming ORN Trainings

Social Work Chat Live: Kratom - Benefits, Risks and Harm Reduction Considerations (July 26, 2021) Funded by ORN, the Boston Medical Center's Office Based Addiction Treatment Program is running a series of Live Social Work Chats for social workers. This month, Dan Hogan will be leading a discussion of Kratom - Benefits, Risks and Harm Reduction Considerations. To register for this month's session and future Zoom sessions, visit: https://bit.ly/2V5lVvK.

To read the full news letter, forward to colleagues or add to your newsfeed use this link: View as Webpage

How can ORN help you? Visit www.OpioidResponseNetwork.org to submit a request for opioid use disorder and stimulant use disorder training and/or education.

orn@aaap.org 401-270-5900 www.OpioidResponseNetwork.org

The American Academy of Addiction Psychiatry (AAAP) is working in partnership with leadership from the National Judicial Opioid Task Force, a working committee of key judicial leaders, as well as addiction psychiatrists, the Conference of Chief Justices and the Conference of State Court Administrators, to create a variety of resources. The most recent is an educational guide for judges and other justice-system stakeholders on the basics of the medical perspective of substance use disorders. Available at no cost, the guide provides a foundational level understanding of the medical aspects of substance use disorders and the evidence-based practices needed in prevention, identification and treatment. This resource, supported by ORN, is available to all electronically and limited in print in the near future: https://www.aaap.org/education/law-and-medicine-guide/ Share with your colleagues.

COPE Announces Winners of the Medical Student Curriculum Challenge: Innovative Learning and Teaching About Substance Use/ Opioid Use Disorders

The Board of Directors of the Coalition on Physician Education in Substance Use Disorders (COPE), an ORN partner organization, is delighted to announce the winners of the Medical Student Curriculum Challenge: Innovative Learning and Teaching About Substance Use/ Opioid Use Disorders. This ORN-funded initiative challenged medical students to utilize their knowledge and creativity to design learning resources related to the development of the knowledge, skills and attitudes critical to providing care to persons with substance use/ opioid use disorders. Congratulations to the winners! See here for more information: https://adobe.ly/3z8b57Q

Opioid Regulations: State by State Guide

The American College of Emergency Physicians (ACEP) has developed a state-by-state guide on opioid regulations. This resource was created for the purpose of providing practical, state specific information for emergency physicians that prescribe opioid medications in an emergency department setting. This guide includes: PDMP mandates; accessibility by delegates of the physician in order to comply with those requirements; CME mandates; community availability of Naloxone and Suboxone; limitations on days’ supply of a prescription originating in the emergency department; and availability of community treatment resources. Anyone can access this free, ORN-funded resource. Submit a request at OpioidResponseNetwork.org.

Much more! View the complete newsletter.

Overdose Deaths Involving Psychostimulants Have Increased Drug overdose deaths involving psychostimulants, such as cocaine and methamphetamine, have increased drastically in the United States over the past decade, particularly after the rise of the opioid epidemic in 2014. From 2010 to 2019, overdose deaths involving psychostimulants were nearly 16 times higher than in the decade prior. Additionally, since 2016, overdose deaths in polysubstance use, such as psychostimulants in combination with synthetic opioids, have increased sharply.

Source: CDC WONDER How Is ORN Responding? In October 2020, ORN broadened its scope to include education and training to address misuse of psychostimulants. To build capacity to respond to requests in this area, ORN built a diverse team with experience in prevention, treatment and recovery of stimulant use disorder (StUD) from across the continuum of care. Co-chaired by Frances R. Levin, MD, and Bryan Hartzler, PhD, this workgroup leads the network’s efforts in identifying educational resources, vetting consultants, and creating training materials as needed. Nearly two dozen new consultants with StUD expertise have been added to ORN's national network of nearly 800 consultants -- with hundreds more available to support on request. Additionally, ORN's bank of evidence-based resources has been updated with new StUD specific material to support education and training in that area. How can ORN help you? Visit www.OpioidResponseNetwork.org to submit a request for StUD training and/or education. Within one business day a technology transfer specialist will respond to learn more about your request and determine how ORN can help. This data spotlight is part of a monthly series brought to the Impact Bulletin by ORN partner organization, RTI International. Stay tuned for more.

orn@aaap.org 401-270-5900 www.OpioidResponseNetwork.org

Funding for this initiative was made possible (in part) by grant no. 1H79TI083343 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

New and upcoming resources and trainings (all free!) from the Opioid Response Network (ORN). Do you have needs for education and training in the prevention, treatment and recovery of opioid use disorders and stimulant use? Learn more and submit a request at www.OpioidResponseNetwork.org.

Hot Topic Webinars from the American Osteopathic Academy of Addiction Medicine

In partnership with the ORN, the American Osteopathic Academy of Addiction Medicine is holding a series of webinars this spring on Hot Topics in Addiction Medicine. The first in the series, titled “Access to Buprenorphine Treatment for Opioid Use Disorder” is March 24 with a follow-up Q&A session March 31. Separate registrations are required for each webinar and Q&A session. 

More here.

Northwest Portland Area Indian Health Board Launches Behavioral Health ECHO Program

Clinicians serving American Indian and Alaska Native people are invited to participate in the Behavioral Health ECHO Program operated by the Northwest Portland Area Indian Health Board in partnership with the ORN. The program provides comprehensive information for clinicians to integrate evidence-based treatment with holistic, trauma informed and culturally appropriate care. CE will be offered. More here.

Adoption of Virtual Services in Judicially Led Diversion Programs Preliminary Findings: National Center for State Courts Report

The National Center for State Courts, Rulo Strategies and the Wayne State University Center for Behavioral Health and Justice, in partnership with the ORN, conducted one of the first nationwide explorations of virtual services in judicially led diversion programs since March 2020. The focus of the subsequent report is judicially led diversion programs, an umbrella term that encompasses drug courts, opioid courts, and recovery-oriented compliance dockets. Access here.

New Boston Medical Center App Provides Information, Guidance for Treating Patients with Opioid Use Disorder

Boston Medical Center, with the ORN, created an app that provides guidelines and resources for treating opioid use disorder with buprenorphine and naltrexone. Information on opioid use disorder treatment with methadone and pain management strategies are also included. Access via The Apple App Store and Google Play Store.

American Psychiatric Association Launches Medications for Opioid Use Disorder Virtual Learning Collaboratives

In partnership with the ORN, the American Psychiatric Association has launched a series of four 8-week virtual learning collaboratives on topics focused on using medications for opioid use disorder to treat patients. Each collaborative is led by a faculty expert and participants will earn up to 8.0 CMEs by completing various activities such as watching pre-recorded webinars, calling into office hours, participating in group discussions, analyzing case vignettes, and completing an individual project. More here.

PCSS-X is a free, six-session course that was created to give practitioners guidance on implementing medications for the treatment of opioid use disorder (OUD) into your practice. The first live Zoom session is Thursday April 8 at 3:00 pm ET.

PCSS-X is intended for an interprofessional audience, and participants are welcome to attend whichever sessions are most relevant to their current situation. Please go here for a summary of each session. Prescribers with frontline experience prescribing medications for OUD and developing clinic workflows will be available during each session to answer participants’ questions and discuss real-world cases.

SESSION 1 – EXPLORE, PART 1 – April 8 AT 3:00 PM ET

Presenter(s): TBA

Facilitator: Sherry Larkins, PhD, Director of International Programs and Research Sociologist, Integrated Substance Abuse Programs at the University of California, Los Angeles – Semel Institute for Neuroscience and Human Behavior

Cost: No fee

Target Audience: Physicians, nurse practitioners or other advanced practice nurses, PAs, psychologists, social workers, clinical administrators and healthcare teams.

Credit Designations Available: AMA PRA Category 1 Credit™, Nursing Contact Hours, AAPA Category 1 CME credit, SW CE credit, and Interprofessional Continuing Education (IPCE) credit.

Webinar Description: Have you considered prescribing Medications for Opioid Use Disorder (MOUD) to treat your patients with opioid use disorder (OUD)? Have you wondered what is required to prescribe buprenorphine or other pharmacotherapies? If you answered yes to either or both of these questions, this PCSS Exchange session could provide you with the critical information and steps in determining the readiness of your site and clinical leadership. Initiating MOUD into your setting requires that you understand how pharmacotherapies work, including buprenorphine and its various formulations. Programs must think through the business case for service expansion and strategize how to best engage key staff.

Educational Objectives: At the conclusion of Session 1, participants should be able to:

Go here for more CME information.

https://conta.cc/3t3escv

The American Osteopathic Academy of Addiction Medicine (AOAAM) is a partner of the Opioid Response Network, a coalition of 40 national organizations. The Physician Assistant Education Association (PAEA) is collaborating with the AOAAM to connect OUD-focused clinical sites with PA education programs. The goal is that collaboration will bolster the behavioral health workforce with qualified, well-trained, early-career practitioners.

PA students joining clinical sites for their rotations will be ready to apply their broad medical and behavioral health training to provide team-based psychiatric care, MAT, and primary care. With expanded OUD-treatment training and experience, these graduates will improve access to care for behavioral health practices and increase the availability of providers, helping to address health disparities related to OUD.

By participating in the program, behavioral health clinical sites will be connected with PA programs seeking to set up full-time, supervised, 4- to 8-week rotations for their students. Any honorariums or other compensation will need to be negotiated with the participating PA programs.

PAEA is specifically seeking training sites in New Hampshire, North Carolina, Kentucky, California, Northern Virginia, and Maryland. They are also immediately seeking a clinical placement specialist at Wichita State University in Kansas. They have lost two clinical sites placing graduation for several students in jeopardy. Placement for the following dates

• March 22-April 22
• May 17-June 17
• June 21-July 28

Use this link for additional information or contact DMurray@PAEAonline.org

Suspected Opioid Overdoses Increased During the Pandemic Suspected opioid overdoses reported from over 2,600 agencies across the United States showed an increase in the months following the onset of the COVID-19 pandemic. From March to May 2020, 62 percent of agencies in counties that provided data reported an increase in suspected overdose submissions.

Source: Overdose Detection Mapping Application Program (ODMAP) ODMAP submissions January 1, 2020 to March 18, 2020 compared to March 19, 2020 to May 19, 2020  How Has ORN Responded? One example: Early in the pandemic, the Opioid Response Network (ORN) identified urgent need for education and training regarding changing regulations and guidance concerning the use of telehealth/telemedicine in the management of substance use disorders to help combat a suspected increase in overdoses. One response came from ORN partner, the American Osteopathic Academy of Addiction Medicine, which created a telehealth webinar series. Over 4,000 individuals registered to learn about: federal telehealth regulations; strategies for conducting group and individual sessions; and management of opioid use disorder in the context of social distancing, stay at home, and shelter in place orders. Access the webinars here and other ORN COVID-19 resources here. This data spotlight is the first in a new monthly series brought to the Impact Bulletin by ORN partner organization, RTI International. Stay tuned for more. About the Opioid Response Network (ORN): ORN provides free, localized training and education for states, communities, organizations and individuals in the prevention, treatment and recovery of opioid use disorders and stimulant use. Learn more and submit a request at www.OpioidResponseNetwork.org. References: Alter, A. 2020. COVID-19 impact on US national overdose crisis. Overdose Detection Mapping Application Program. Retrieved from here. Funding for this initiative was made possible (in part) by grant nos. 1H79TI083343 and 6H79TI080816 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.