The most current updates will be here: Removal of DATA Waiver (X-Waiver) Requirement | SAMHSA

Update on 1/25/2023:

·         Section 1262 of the Consolidated Appropriations Act, 2023 (also known as Omnibus bill), removes the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe medications, like buprenorphine, for the treatment of opioid use disorder (OUD). With this provision, and effective immediately, SAMHSA will no longer be accepting NOIs (waiver applications).

All practitioners who have a current DEA registration that includes Schedule III authority, may now prescribe buprenorphine for Opioid Use Disorder in their practice if permitted by applicable state law and SAMHSA encourages them to do so. SAMHSA and DEA are actively working on implementation of a separate provision of the Omnibus related to training requirements for DEA registration that becomes effective in June 2023. Please continue to check this webpage for further updates and guidance.

275 Annual Report

275 Annual Reports are no longer required or being accepted.

Current Updates, use this link:

Removal of DATA Waiver (X-Waiver) Requirement | SAMHSA

Overdose Prevention Task Force – National Toolkit for Advocacy

Authors: Erin L. Winstanley, Emily P. Thacker, Lyn Yuen Choo, Laura R. Lander, James H. Berry, Babak Tofighi

Abstract:

Background: While barriers to accessing buprenorphine (BUP) therapy have been well described, little is known about pharmacy-related barriers. The objective of this study was to estimate the prevalence of patient-reported problems filling BUP prescriptions and determine whether these problems were associated with illicit use of BUP. The secondary objectives included identifying motivations for illicit BUP use and the prevalence of naloxone acquisition among patients prescribed BUP.

Methods: Between July 2019 and March 2020, 139 participants receiving treatment for an opioid use disorder (OUD) at two sites within a rurally-located health system, completed an anonymous 33-item survey. A multivari- able model was used to assess the association between pharmacy-related problems filling BUP prescriptions and illicit substance use.

Results: More than a third of participants reported having problems filling their BUP prescription (34.1%, n = 47) with the most commonly reported problems being insufficient pharmacy stock of BUP (37.8%, n = 17), pharmacist refusal to dispense BUP (37.8%, n = 17), and insurance problems (34.0%, n = 16). Of those who reported illicit BUP use (41.5%, n = 56), the most common motivations were to avoid/ease withdrawal symptoms ( n = 39), prevent/reduce cravings ( n = 39), maintain abstinence ( n = 30), and treat pain ( n = 19). In the multivariable model, participants who reported a pharmacy-related problems were significantly more likely to use illicitly obtained BUP (OR = 8.93, 95% CI: 3.12, 25.52, p < 0.0001).

Conclusion: Efforts to improve BUP access have primarily focused on increasing the number of clinicians waivered to prescribe; however, challenges persist with BUP dispensing and coordinated efforts may be needed to system- atically reduce pharmacy-related barriers.

Read the Article

Earlier this year, the Centers for Disease Control and Prevention (CDC) reported that deaths from unintentional drug poisonings in the United States exceeded 100,000 in 2021. This is the largest number of overdose deaths ever recorded in a one-year period in this country. Further analysis of the data reveals that more than 75% of these overdose deaths were due to opioids.

Lancaster County has not been shielded from this national epidemic of opioid-related overdose deaths. During the 2020 calendar year, our county saw 143 deaths from unintentional drug poisonings, and opioids were implicated in 89% of those deaths. The broad consensus is that untreated, or inadequately treated, opioid use disorder (OUD) is a major factor underlying this crisis.

Our colleague Tara Tawil, MD, described the evolution of this epidemic over the past 30 years in the pages of this journal in 2019. In that article, which serves as useful background for this manuscript, Tawil also described treatment options for OUD, the emergence of buprenorphine in 2002, and efforts to increase prescribing of buprenorphine within the Penn Medicine Lancaster General Health network of primary care practices. Buprenorphine is a medication approved by the Food and Drug Administration (FDA) to treat OUD; the provision of the medication is associated with substantial reductions in all-cause mortality and opioid overdose deaths.

In 2020, the American Society of Addiction Medicine (ASAM) released a focused update to their National Practice Guideline (NPG) for the treatment of OUD.6 The release of this document was overshadowed by the COVID-19 pandemic and likely escaped the attention of many providers of buprenorphine treatment. These guidelines contain new recommendations and.... Read the full article.

Article: Pittsburgh Post-Gazette

James R. Latronica: Drug users have human rights, and they include harm reduction the state can supply

The news was grim. Overdose deaths in 2020 increased across the board, and rose a staggering 44% among Black individuals and 39% among American Indian and Alaskan Native individuals. Perhaps most surprisingly, overdose deaths were higher in areas where opioid treatment programs were available — Having “access” to health care does not mean being able to get it.

The root causes of this continued epidemic are manifold. As the medical community slowly comes to terms with the role that social determinants of health play in people’s lives, the role of marginalization and dispossession in driving this epidemic has become obvious and inescapable. In its latest report, for example, the Centers for Disease Control and Prevention notes that counties with higher income inequality suffered a disproportionate number of overdose deaths.

Increasing access to treatment for Substance Use Disorders is a critical part of this struggle, but people arrive to my clinic in various ways and not always in a predictable pattern. Not everyone is ready, able or willing to begin treatment at a given point in their life.

This is one reason we need increased harm reduction efforts. Medical and public health professionals engage in harm reduction efforts in many arenas. Seatbelts in cars are harm reduction. Medication for high cholesterol is harm reduction. Fatal motor vehicle accidents and heart attacks are devastating outcomes that relatively low-cost, high-impact primary interventions can prevent or mitigate.

Physicians call this type of intervention “preventive medicine.” As I’ll explain later it is an extension of human rights.

Two bills supporting effective harm reduction for people who use drugs are currently being considered in the Pennsylvania Legislature. The first, SB926, would permit the establishment of Syringe Service Programs in the commonwealth (They are already legal in 31 states and Washington, D.C.) Explicit legalization is important as these critical public health institutions operate in a legal grey area.

Syringe Service Programs have been shown to decrease overdose deaths, decrease the rate of blood-borne illnesses like hepatitis C and HIV, decrease the rate of discarded needles in the community and harm to first responders, and increases the rate at which people enter into formal treatment. They are a relatively inexpensive, overwhelmingly positive public health benefit.

The second, HB1393, which recently passed the full House unanimously, would permit the use of fentanyl test strips across the commonwealth. (They are now only legal within Philadelphia and Pittsburgh city limits). The strips allow people using substances to determine if fentanyl is present or not with a simple color-changing strip, similar to a pregnancy test.

This is critical as fentanyl is now present in nearly every substance available in the banned drug supply, and users of non-opioid substances are at enormous risk of overdose given the potency of fentanyl. Perhaps most importantly, with amended language, the bill would allow for the testing of a wide range of contaminants and poisons that are now pervasive in the banned drug supply. For example, a significant proportion of seized drugs contain xylazine,  an anesthetic used by veterinarians. Naloxone cannot reverse its effects.

Available evidence strongly supports interventions like providing syringes and ways to test the drug supply, but there is a deeper, more fundamental reason to legalize these measures. People do not deserve to suffer and die for using a given substance, especially when saving their lives is so easy to do. That is why I consider harm reduction efforts as a matter of basic human rights.

Human rights constitute an agreement and a promise: the agreement that humans have an immutable dignity that must be protected, and a promise that we strive together to construct and maintain institutions that ensure it. This is true whatever needs they have, even if many people look down on their needs. When we stigmatize harm reduction for people who use drugs, we’re telling them that their lives are not valuable, that they are worth less than other people.

Harm reduction efforts for people who use drugs are a moral and clinical good and should be argued for on their merits, without prevarication. Lives depend on the passage of the current bills and sufficient funding for harm reduction across the commonwealth.

James R. Latronica, DO, is an addiction specialist physician and public policy chair of the Pennsylvania Society of Addiction Medicine based in Pittsburgh. He can be found on Twitter @JamesRLatronica.

First Published July 28, 2022, 12:00am

Link to details.

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death."

Dr. Martin Luther King, Jr.

ORN acknowledges February as Black History Month. This, and every month, we recognize the contributions and sacrifices of Black people in the American story.

Preventing and treating substance use disorders in Black Communities is critical as rates of overdose deaths in these communities are outpacing other populations. Read more about ORN's Black Communities Workgroup's efforts here.

Medical School Addiction Medicine Curriculum: Designed for Medical Students by Medical Students

New medical school curriculum developed by winners of the Coalition for Physician Education in Substance Use Disorders (COPE) Medical Student Curriculum Challenge is now available to download at no cost.

The ORN-funded challenge had medical students use their knowledge and creativity to design learning resources related to the development of the skills and attitudes critical to providing care to persons with substance use disorders. From 36 submissions, there were 8 winners and 4 honorable mentions. Twelve curriculum designs are now available and free of charge on COPE’s website for use by medical schools across the country. See the list and instructions on how to download here.

For additional evidence-based resources on the prevention, treatment and recovery of opioid use, stimulant use and all substance use disorders, submit a request at OpioidResponseNetwork.org.

If an opportunity listed below sparks your interest but you are not sure how to begin or would like more information, email orn@aaap.org. We are here to help you!
All ORN trainings are provided at no cost. 
To coordinate a training designed specifically to meet your needs, submit a request today at OpioidResponseNetwork.org. 

Social Work Chat Live: Spiro Spero - February 28, 2022

This ORN-funded activity coordinated by the Boston Medical Center is a viewing of a play titled "Spiro Spero." Participants will watch the streamed play from 11:30am - 12:30pm ET on YouTube and then attend a talk-back following. Spiro Spero is a one woman play written and performed by a psychiatric nurse practitioner who specializes in addiction. It explores the lives of five people impacted by substance use disorder and their experiences in treatment, in the community, and in the healthcare setting. A talk back will occur immediately following the stream. Learn more. 

Virtual Training: Stimulants 101 - March 10, 2022

This ORN-funded training from the Boston Medical Center is designed to provide an overview of stimulant use disorders for all healthcare staff including providers, nurses, counselors and other non-clinical staff. The training reviews stigma, identifying stimulant overdose, managing acute stimulant intoxication, de-escalation techniques, and evidence-based treatment for people who use stimulants. Learn more. 

Virtual Training: Recovery Ambassador Training - March 22-24, 2022

This ORN-funded, Faces & Voices of Recovery, Recovery Ambassador Program is a free training that prepares individuals to advance public understanding and appropriate responses to addiction. The training program consists of Our Stories Have Power, Recovery Messaging, the Science of Addiction & Recovery and the Recovery Ambassador curriculum. Course material includes instruction in language and stigma, recruiting volunteers, building messages, organizing community action, engaging policymakers, raising money and effective advocacy. Learn more.

Reminder: On Demand Webinars Presented by Psychiatric-Mental Health Nurses 

New ORN-funded webinars from the American Psychiatric Nurses Association have been posted and are available to all at no cost. These include:

·     What’s in Grandma’s Medicine Cabinet? – Understanding Substance Use Disorders in Older Adults Explore how age-related physiological and social changes present unique challenges for the identification and treatment of this disorder.

·     Substance-Exposed Pregnancies: What to Know As They Grow Discover how substance use during pregnancy impacts maternal/fetal development and increases the neurological vulnerabilities of the neonate.

A Primer on Stimulant Use Disorder: A Growing Concern 

Examine neuroscience changes as a result of a substance use disorder, along with the signs and symptoms that often present with the diagnosis as well as potential treatment options.

Share our mission in your community!

Opioids, stimulants and other substances have created an unprecedented health crisis so the Opioid Response Network created an unprecedented response. As communities mobilize to address local need, we are here to enhance their efforts. Help us spread the word! Post the video below to your network's social channels. Encourage your network to tell us what they need via the simple request form at OpioidResponseNetwork.org.

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

The Commission on Combating Synthetic Opioid Trafficking, established under Section 7221 of the National Defense Authorization Act for Fiscal Year 2020, was charged with examining aspects of the synthetic opioid threat to the United States—specifically, with developing a consensus on a strategic approach to combating the illegal flow of synthetic opioids into the United States. This final report describes items involving the illegal manufacturing and trafficking of synthetic opioids, as well as the deficiencies in countering their production and distribution, and includes action items directed to appropriate executive branch agencies and congressional committees and leadership.

Read the report.

The CDC draft Clinical Practice Guideline for Prescribing Opioids (update to the 2016 Guideline for Prescribing Opioids for Chronic Pain) has posted in the Federal Register and the 60-day public comment period begins today. Public comment provides valuable insight from the populations that we serve. Please note that the 60-day public comment period will end on April 11, 2022.  CDC is committed to supporting safe and effective pain care options for patients. CDC’s National Center for Injury Prevention and Control (NCIPC) is in the process of updating the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Both healthcare professionals and members of the public who experience acute or chronic pain have expressed interest in understanding the recommendations outlined in the draft updated Guideline, and CDC highly values public and partner engagement and feedback in this process. <Visit the Federal Register to provide your comments on the draft Guideline update>  Please see our webpage detailing the process of updating the Guideline. Encourage people you know who have direct experience with the role of opioids in pain care and the importance of the patient-clinician relationship to visit the Federal Register, review the draft update to the Guideline, and add their perspectives to the Federal Register Notice.

Submitting a Comment See below for instructions to submit a comment during the public comment period. More detailed instructions can also be found on the Federal Register Notice (FRN) webpage and in the FRN for this document.   To locate the FRN and view the draft of the updated Guideline, you can either:    Click on the direct link to the FRN in this email or Go to Federal Register.gov and search for "CDC's Guideline for Prescribing Opioids" or Document Number 2022-02802 To inspect the draft Clinical Practice Guideline and supporting documents, please go to this link and click "View More Documents:” https://www.regulations.gov/document/CDC-2022-0024-0002 To submit a comment to CDC, please view the methods outlined in the FRN under the "Addresses" heading and select which option you prefer: Electronic comments via the website Regulations.gov

Go to https://www.regulations.gov and search for "CDC Guideline for Prescribing Opioids" A comment button on the top left of the page will allow you to submit your comments via a webpage with step-by-step instructions

Mail

Directions for how to submit a comment through the mail are provided in the "Addresses" section of the FRN on FederalRegister.gov

To ask a question, click on the “For Further Information Contact” heading in the FRN for the agency official contact information.  General information about the process to provide a public comment can be found at the following links:   Federal Register: Reader Aids: Using FederalRegister.Gov Federal Register: Reader Aids: Videos & Tutorials

New RI Program will Divert Individuals with Substance Use Disorders from Incarceration and into Treatment

Training, education and implementation efforts provided by the Opioid Response Network (ORN) has helped to establish a new program in Woonsocket, RI. This program, championed by RI Superior Court Judge Kristin Rodgers, will divert individuals with an opioid or other substance use disorders who have been arrested away from jail and into treatment and recovery support services. An estimated 70 to 100 people arrested every year could qualify to participate in this program, which was recently awarded the funding needed to get it off the ground.

U.S. Senators Jack Reed and Sheldon Whitehouse and Congressman David Cicilline have announced a three-year $819,109 U.S. Department of Justice’s Bureau of Justice Assistance grant for the Woonsocket Police Department (WPD). Working with the non-profit Community Care Alliance, this will fund the Law Enforcement Assisted Deflection, Engagement, and Retention (LEADER) in Treatment program. ORN, a Substance Abuse and Mental Health Services Administration-funded initiative, will continue providing WPD with education and training support as needed. Read more.

If an opportunity listed below sparks interest but you have questions or are not quite sure how it could fit into your own plans, email orn@aaap.org. We can help! All ORN trainings are provided at no cost. To coordinate a tailored training with an ORN consultant to meet your specific needs, submit a request at OpioidResponseNetwork.org. 

New Course: Improving Clinical Practice with Patients who have Stimulant Use Disorder 
Performance in Practice and Self-Assessment Activity

This new course is designed to improve the competence, performance, and patient outcomes of physicians, physician assistants, nurses, nurse practitioners and other healthcare professionals. Learners will determine individual practice gaps and address them through a performance improvement plan. Learners will assess and evaluate performance techniques used in their practices. This ORN course was developed by ORN lead organization the American Academy of Addiction Psychiatry. Read more.

Live Training: Certified Addiction Registered Nurse Exam Review for RNs/NPs - PART ONE: February 7, 2022

This ORN-funded training from the Boston Medical Center is an exam review course for RNs and NPs working in the addiction field who have an interest in becoming a Certified Addictions Registered Nurse (CARN) or a Certified Addictions Registered Nurse - Advanced Practice (CARN-AP). This course is intended to support nurses studying for the CARN and CARN-AP exam by reviewing material the exam will cover. Read more.

PLEASE NOTE: This is a two-part training. You must attend both parts to receive continuing education credits. See here for information on PART TWO.

Live Training: Treating Stimulant Use Disorder
February 9, 2022

This ORN-funded training from the Boston Medical Center is designed to be a guide for addiction providers interested in providing and caring for people who use stimulants including cocaine and methamphetamines. The training will review the basic science of addiction related to stimulants as well as evidence-based treatment for people who use stimulants. The session will also talk about the practical implementation of evidence-based treatment for patients who use stimulants in the office-based addiction treatment setting. Read more.

Live Training: Recovery Community Organization Bootcamp
February 22 - 24, 2022

This ORN-funded, Faces & Voices of Recovery activity is a 13-hour free training for new and emerging Recovery Community Organization (RCO) directors, program managers and board members. The training covers all the basics to help build the capacity of small non-profit organizations. Breakout sessions focus on RCO start-up, governance, sustainability, policies and procedures, strategic planning, staff development and more. Read more.

On Demand Trainings: New Webinars Presented by Psychiatric-Mental Health Nurses 

New ORN-funded webinars from the American Psychiatric Nurses Association have been posted and are available to all at no cost. These include:

·     What’s in Grandma’s Medicine Cabinet? – Understanding Substance Use Disorders in Older AdultsExplore how age-related physiological and social changes present unique challenges for the identification and treatment of this disorder.

·     Substance-Exposed Pregnancies: What to Know As They Grow Discover how substance use during pregnancy impacts maternal/fetal development and increases the neurological vulnerabilities of the neonate.  

·     A Primer on Stimulant Use Disorder: A Growing Concern Examine neuroscience changes as a result of a substance use disorder, along with the signs and symptoms that often present with the diagnosis as well as potential treatment options.

Read more.

Tailored Trainings: Providing Peer Based Recovery Support Services for Pregnant and Parenting Families

This ORN-funded training opportunity developed by the Addiction Technology Transfer Center prepares participants to meet the diverse needs of pregnant and parenting families in early recovery. Recovery and parenting both occur in the context of relationships. Trainings are designed to help participants build skills to support/ strengthen families as they grow and develop in their roles as nurturing parents. Submit a request for this training topic at OpioidResponseNetwork.org. Your local ORN Technology Transfer Specialist will connect with you to learn more about your specific needs and help facilitate a tailored, localized training on this topic. 

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