Emergency Room Physicians Overcoming Barriers to Opioid Use Disorder Treatment

The American College of Emergency Physicians (ACEP) is working to address barriers to treating opioid use disorder in emergency departments across the country. ACEP, an ORN partner, has developed new trainings, podcasts and a mobile app, all aimed at its 38,000 members.

Emergency room physicians, Eric Ketcham, MD, FACEP, and Kathryn Hawk, MD, MHS, discussed these educational products in an episode of ACEP Frontline, a podcast that reaches over 5,000 listeners. Opening, Dr. Ketcham said: “We’re the ones engaging with patients with opioid use disorder when they’re really at their worst. We have this opportunity to engage with a very captive audience, treat them more effectively and compassionately when they’re in withdrawal and make a bridge into treatment." He describes the emergency room as “a catchment area for a lot of folks in crisis” and that emergency department physicians can make a significant mortality and morbidity impact. Read further.

The Collection of Opioid Response Network Brochures is Growing. At OpioidResponseNetwork.org you will find new prevention, recovery and American Indian/ Alaskan Native brochures.

Are You Interested in Exhibiting On Behalf of ORN? If so, please first check the exhibit tracking sheet to see if another party has already registered. If not, notify jane@aaap.org and nic@aaap.org. We are striving to avoid duplication and to also have TTSs exhibit as much as possible as it supports their role as the point person for each community. If you can not access the exhibit tracking sheet, please let Jane or Nic know.

Have You or a Requester Been Approached by the Media? If yes, that's great! If a news outlet wants to report on your work for ORN, we ask that you first inform jane@aaap.org and nic@aaap.org

and coordinate all efforts with the press through them. SAMHSA wants to make sure we are consistent in our message and it gives Jane and Nic an opportunity to help track and highlight for the website and newsletter. They are also available to help to prepare.

Read more.

On Tuesday September 24^th, the University of New England Student Chapter of AOAAM held an opioid overdose response training put on by the Portland, Maine Public Health Department for students from all the health profession schools as well as undergraduates. It was extremely helpful to hear from those who are in the midst of the crisis how we can all be prepared for such an event. They provided an inside perspective into how Maine is approaching this overwhelming issue.

 

Catherine Frye on behalf of University of New England Student Chapter of AOAAM

By Kathleen T. Brady

In response to the opioid epidemic in the U.S., cities, counties, states, insurers, and medical groups have filed more than 2,000 lawsuits seeking to hold pharmaceutical companies accountable for it. Those lawsuits are now consolidated in front of a single judge in Ohio who must decide how the billions of dollars in settlements should be used. Opinions abound on how this money should be spent.

In the midst of this discussion, we shouldn't miss the tragic reality that we are still losing 130 lives every day as a result of opioid overdoses.

That's why I, on behalf of five organizations representing physicians and experts on the front line of this crisis, urge that money garnered from the opioid settlement be used to directly combat the opioid crisis through three main approaches:

Treatment and prevention efforts desperately need financial support. Between 2009 and 2012, state budget cuts to mental health and addictions services amounted to $5 billion and have never recovered since. An abundance of evidence shows that these services actually make a difference. Numerous studies, for example, indicate that medications for addiction treatment significantly reduce the risk of overdose, relapse, and other health and social outcomes of opioid addiction.

But partly due to lack of funding, only about 10% of the 2 million Americans with substance use disorders receive treatment for them. And while the federal government recently announced some funding for access to evidence-based treatment for individuals with opioid use disorders, it's a short-term investment with an unclear future.

In spite of what we now know about treatment and its effectiveness, we can learn much more. Exciting advances in neuroscience have identified neural pathways underlying addictions and pain that can be used to develop new therapeutic interventions, but the pathway from basic discovery to everyday usage is costly. At a systems level, health services research can help transform and reshape the treatment system, making it more accessible and effective. And there is much more we can discover about preventing substance use disorder in the first place.

Most physicians and other health care providers receive only basic training in the prevention, recognition, and treatment of addiction and the care of pain. Lack of provider preparedness in these areas has been partially blamed for the limited response to the opioid crisis. Meanwhile, there is a dearth of qualified addiction treatment specialists. Funding from the opioid settlement should be dedicated toward extending the workforce capacity through additional addiction psychiatry and addiction medicine fellowships, as well as better training for health care providers in general on addiction and pain care.

The historic $246 billion Tobacco Master Settlement Agreement in 1998 was supposed to support treatment and prevention of smoking. But it mostly wound up covering state budget shortfalls, subsidizing tax cuts, and supporting general services. In fact, according to a report from the Campaign for Tobacco-Free Kids, 20 years after the settlement states had spent only 2.6% of the settlement revenue on smoking prevention and cessation programs.

It would be a shame not to use the opioid settlement to help the people who are living with this public health emergency across our country. The money from any forthcoming opioid settlement must be applied to the problem — to help victims of opioid and other substance use disorders through access to evidence-based care, research, and training.

Kathleen T. Brady, M.D., Ph.D., is professor of medicine and vice president for research at the Medical University of South Carolina, and president and chair of the International Society of Addiction Medicine's executive committee. The views expressed here are shared by the American College of Academic Addiction Medicine, the American Academy of Addiction Psychiatry, the American Psychiatric Association, the American Osteopathic Academy of Addiction Medicine and the Association for Multidisciplinary Education and Research in Substance Use and Addiction. The American Academy of Addiction Psychiatry does not accept funds from pharmaceutical companies to support its educational programming, scientific program, seminars, or print materials. In 2016, Biodelivery Sciences was among the exhibitors at the academy's annual meeting in 2016, and Orexo was an exhibitor in 2018; both companies manufacture addiction treatments as well as opioid pain medications. The American Psychiatric Association receives funding from some pharmaceutical companies, including those that manufacture opioid analgesics, via advertising in its publications and at its meetings in the form of exhibits, sponsorships; or product theaters; those areas are segregated from the association's educational activities.

SAMHSA’s 2019 National Recovery Month Webinar – Strong Community, Strong Recovery.  

Friday, September 20, 2019 - 12:00 PM EDT

Join SAMHSA’s Recovery Month webinar, Strong Community, Strong Recovery. This webinar will focus on how health practitioners, families, and individuals can implement community resources to maintain recovery for persons with mental and substance use disorders, as well as why fellowship sustains recovery.

For call-in information, visit SAMHSA’s 2019 National Recovery Month Webinar Series page.

Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018 and synthetic opioids are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. The goal is to provide decision-makers, researchers, media outlets, and the public with information to better understand the synthetic opioid problem and how to respond to it.

RAND Corporation

Recovery Month is a national observance held every September to educate Americans that substance use treatment and mental health services can enable those with mental and substance use disorders to live healthy and rewarding lives. Now in its 30th year, Recovery Month celebrates the gains made by those in recovery.

Click here for SAMHSA’s Recovery Month webinar series  https://recoverymonth.gov/events/webinar-series-2019

This is an official
CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network
August 30, 2019, 9:35 AM ET
CDCHAN-00421

Severe Pulmonary Disease Associated with Using E-Cigarette Products

Summary
The Centers for Disease Control and Prevention (CDC) is providing: 1) background information on the forms of e-cigarette products, 2) information on the multistate outbreak of severe pulmonary disease associated with using e-cigarette products (devices, liquids, refill pods, and cartridges), and 3) clinical features of patients with severe pulmonary disease. This health advisory also provides recommendations for clinicians, public health officials, and the public based on currently available information.

General Background
E-cigarettes typically contain nicotine, most also contain flavorings and other chemicals, and some may contain marijuana or other substances. They are known by many different names and come in many shapes, sizes and device types. Devices may be referred to as “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” “mods,” tanks, or electronic nicotine delivery systems (ENDS). Some e-cigarette devices resemble other tobacco products such as cigarettes; some resemble ordinary household items such as USB flash drives, pens, and flashlights; and others have unique shapes. Use of e-cigarettes is sometimes referred to as “vaping” or “juuling.” E-cigarettes used for dabbing are sometimes called “dab” pens.

E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g., lead), volatile organic compounds, and cancer-causing chemicals. Additionally, some e-cigarette products are used to deliver illicit substances; may be acquired from unknown or unauthorized (i.e., “street”) sources; and may be modified for uses that could increase their potential for harm to the user. For example, some e-cigarette pods or cartridges marketed for single use can be refilled with illicit or unknown substances. In addition, some e-cigarette products are used for “dripping” or “dabbing.” Dripping involves dropping e-cigarette liquid directly onto the hot coils of an e-cigarette which can result in high concentrations of compounds (e.g., tetrahydrocannabinol [THC] and cannabinoid compounds). Dabbing involves superheating substances such as “budder”, butane hash oil (BHO), and “710” that contain high concentrations of THC and other plant compounds (e.g., cannabidiol [CBD]).

Youth, young adults, pregnant women, as well as adults who do not currently use tobacco products should not use e-cigarettes. E-cigarettes containing nicotine have the potential to help some individual adult smokers reduce their use of and transition away from cigarettes. However, e-cigarettes are not currently approved by the Food and Drug Administration (FDA) as a quit smoking aid, and the available science is inconclusive on whether e-cigarettes are effective for quitting smoking.

Outbreak Background
As of August 27, 2019, 215 possible cases have been reported from 25 states and additional reports of pulmonary illness are under investigation. One patient (in Illinois) with a history of recent e-cigarette use was hospitalized on July 29, 2019 with severe pulmonary disease and died on August 20, 2019. Although the etiology of e-cigarette-associated pulmonary disease is undetermined, epidemiologic investigations in affected states are ongoing to better characterize the exposures, demographic, clinical, and laboratory features and behaviors of patients. All patients have reported using e-cigarette products. The exact...... Read More

In a video presentation released with the NSDUH report, Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use, highlighted the State Targeted Response Technical Assistance grant. Dr. McCance-Katz says the Opioid Response Network "puts teams in every state to address the needs of that state as it relates to opioid issues." She underscored that the "program has had over 1,000 requests already and those requests have all been met to meet the needs of Americans living with opioid issues." 

Highlights include:

• 19.3 million Americans report a substance use disorder. Among those with substance use disorders, 7.4 million struggle with illicit drugs.  
• Positive findings when looking specifically at opioids. In 2018 there were 10.3 million opioid misusers. This is down from 11.4 million in 2017. Declines reported for both prescription pain reliever misuse and heroin use.
• Where misuse of prescription opioid subtypes is concerned, buprenorphine and methadone see the highest rate of misuse. Dr. McCance-Katz says this "speaks to the need to continue to educate on safe and effective use of these medications." 

The NSDUH report helps to guide policy directions and decision-making about what types of resources are needed and where resources should be directed. For example, NSDUH's 2016-17 report found that SAMHSA efforts only provided technical assistance to grantees, and the number of grantees was low compared to the number of practitioners, community members and others who need access to information. So, SAMHSA expanded training and technical assistance nationally.

How is SAMHSA responding to the 2018 report? Dr. McCance-Katz says SAMHSA will continue to support states' prevention, treatment and recovery efforts through STR grants, SOR grants, TOR grants and others.

Read other news in the ORN Bulletin.

Recharge and reconnect with thousands of your fellow physicians and medical students at the largest gathering of DOs in the world, Oct. 25-28 in Baltimore.

AOAAM's 2019 program consists of 29 hours of CME including collaborative sessions with American College of Osteopathic Family Physicians (ACOFP), the American College of Osteopathic Pediatricians (ACOP) the American College of Osteopathic Neurologists and Psychiatrists (ACONP), American Academy of Osteopathy (AAO), the Association of Military Osteopathic Physicians & Surgeons (AMOPS) and the American Osteopathic Association Division of Public Health & the Bureau of Scientific Affairs. This year we will offer the Essentials of Addiction Medicine Course and Advanced Studies of Addiction Medicine Course. Our Distinguished Speaker is Albert Wu, MD, Executive Vice President, American Board of Addiction Medicine. Click here to view our complete agenda.

Reserve Your Spot

Community Group Finds Common Ground with Nation's First 24/7 Opioid Treatment on Demand Clinic In response to a request for technical assistance, the Arizona Opioid Response Network team helped the nation’s first 24/7 Opioid Treatment Program in Phoenix, Arizona form a collaborative working relationship with a local community task force to have the program located in their community. Read more.

Update: ORN Partners with CA to Address Post Incarceration Drug Overdose Deaths Previously we announced that ORN is working with California Correctional Health Care Services on developing a road map to increase access to evidence-based treatment for its 35 correctional settings and an estimated 100,000 inmates with substance use disorders. Through July and August, a series of Motivational Interviewing training's have been scheduled. We are happy to report that, to date, the training's have 682 registrants. Stay tuned for updates. See April's story.

Read more news.