AOAAM is pleased to announce that on Saturday, July 27, 2019, the AOA House of Delegates passed House Resolution 232. This resolution allows osteopathic physicians who completed an AOA approved fellowship in addiction medicine to take a primary certifying exam in addiction medicine, and also creates a practice pathway for qualified DOs to take a primary certifying exam in addiction medicine. It is the intent of the AOA that any DO with an active primary AOA board certification in any specialty will be able to seek certification through this pathway.

Thanks to our AOAAM Delegate Margi Kotz, DO, alternate Delegate Steve Wyatt, DO, past presidents, and Executive Director Nina Vidmer, who have been working tirelessly for years on getting the CAQ reinstated.

Julie Kmiec, DO
AOAAM President

By Michael Nedelman and Arman Azad, CNN Updated 12:35 PM ET, Wed July 24, 2019
Study: E-cigarette maker Juul triggers nicotine 'arms race'

(CNN)Tobacco opponents and Juul executives are testifying on Capitol Hill this week during a two-day hearing on the company's role in "the youth nicotine epidemic," according to the House Oversight Subcommittee on Economic and Consumer Policy.

The hearing will scrutinize the leading vape company's marketing, health claims and relationship with Big Tobacco -- namely, tobacco giant Altria, which invested nearly $13 billion in Juul Labs late last year.

The list of attendees sets the stage for a heated clash over whether e-cigarettes should be subject to stronger regulation, weighing their potential benefit to adults who want to quit smoking against the risk that a generation of young people will become addicted to nicotine.

Democratic Rep. Raja Krishnamoorthi of Illinois, the chairman of the subcommittee, announced last month that his panel was investigating Juul, and asked the company to "provide memoranda and communicationsregarding its social media practices, advertising, and the product's long-term impact on consumer health."

"The safety and well-being of America's youth is not for sale," Krishnamoorthi said in a letter to Juul CEO Kevin Burns dated June 7. "I am extremely concerned about reports that JUUL's high nicotine content is fueling addiction and that frequent JUUL use is sending kids across the country into rehab, some as young as 15."

Social media about Juul continues to soar, new study says

During the first day of the hearing, on Wednesday, committee members will hear from representatives of groups such as the American Academy of Pediatrics and Parents Against Vaping E-cigarettes. Other witnesses include experts such as Dr. Robert Jackler, founder of Stanford Research Into the Impact of Tobacco Advertising.

In research shared exclusively with CNN and now posted online, Jackler's team found that the amount of Juul-related content posted by Instagram users has exploded in the months since the company shut down its own social media accounts in November.

In the eight months since Juul phased out its social media, more than half a million Instagram posts have featured hashtags related to Juul, the paper says. That's double the number that had been posted in the three and a half years before Juul discontinued its accounts.

"Among #juul posts, 15.4% showed JUUL products, 28.1% JUUL competitors, and 3.7% products from both JUUL and its competitors," says the paper, which has not yet undergone peer review. "Reflecting the popularity of #juul as a gathering place for its largely youthful audience, non-vaping related posts made up the remaining 52.8%." 

Read more....

This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.

Read more online.

V. Yu. Skryabin MD & M. A. Vinnikova PhD, MD
Journal of Addictive Diseases
Published on 7/4/2019

Senators Markey and Murkowski Introduce Legislation to Support Access to Opioid Use Disorder Treatment in Correctional Facilities

Providing MAT in correctional facilities can help reduce opioid overdose deaths upon re-entry by 60 percent

Data indicates recently released individuals are 129 times more likely to die from opioid overdose in first two weeks of release

Washington (June 28, 2019) – Senators Edward J. Markey (D-Mass.) and Lisa Murkowski (R-Alaska) today introduced the Community Re-Entry through Addiction Treatment to Enhance (CREATE) Opportunities Act, legislation to help expand access to medication-assisted treatment (MAT) like Suboxone for justice-involved individuals. This legislation would create a new grant program within the Department of Justice for state and local governments to provide MAT in their correctional facilities. The program would require grantees to provide more than one MAT option and to develop a plan for connecting individuals to continued treatment upon release into the community. Data indicates recently released individuals are 129 times more likely to die from opioid overdose in first two weeks of release.

Companion legislation has been reintroduced in the House of Representatives by Rep. Ann McLane Kuster (NH-2).

“Our local jails are on the front lines of the response to the nation’s opioid overdose crisis,” said Senator Markey. “Too often, our local jails witness some of the most devastating impacts of the opioid crisis, but don’t have the resources to mount a robust and appropriate response. My bill would help change that. We know we cannot incarcerate our way out of this crisis. Instead, we must rehabilitate in order to reduce recidivism and save lives. Providing reliable access to evidence-based treatment within correctional facilities will help counties and states respond to this crisis like the public health issue that it is. I thank Senator Murkowski and Representative Kuster for their partnership in this endeavor.”

“Opioid use has skyrocketed in Alaska. And for those struggling with opioid abuse or a mental health disorder who are in the criminal justice system, the transition from incarceration into their community can be incredibly difficult.  To truly break the vicious cycle of substance abuse, we must ensure those incarcerated have a path to treatment,” said Senator Murkowski. “By combining access to approved medications in combination with behavioral health therapy, we’re not just decreasing the rate of relapses, re-incarcerations, and overdoses, we’re giving those in the criminal justice system hope for a future that isn’t dictated by substance abuse.”

“Too many incarcerated individuals in our jails suffer from untreated mental health and substance use disorder, and most lack access to the treatment they need,” said Rep. Kuster. “Medication assisted treatment (MAT) has an important role to play in helping incarcerated individuals suffering from substance use disorder recover and reclaim their lives to become productive, contributing members of our society. Reducing recidivism is a win for our communities: it’s good for public safety, public health, and budgets. The CREATE Opportunities Act is commonsense legislation to provide a commonsense solution to put an end to the cycle between addiction and the criminal justice system.”

A copy of the CREATE Opportunities Act can be found HERE.

“Drugs do not know age, race, gender, religion or economic status and the cost of addiction is astronomical – it tears families apart, ransacks communities and undermines public safety,” said Major County Sheriffs of America (MCSA) President Sheriff Grady Judd. “On behalf of the largest Sheriff’s Offices in the U.S. we endorse Senator Markey’s effort to address the lack of access to medication-assisted treatment (MAT) in local correctional facilities. Through the creation of a new grant program within the Department of Justice, Sheriffs will have access to funds that provide a much-needed tool for corrections and can help reduce the likelihood of overdose deaths after release. We look forward to working with Senator Markey’s office to move this bill across the finish line.”

“People exiting the criminal justice system are at high risk of overdose deaths,” said Michael Collins, Director of the Office of National Affairs at Drug Policy Alliance. “Rhode Island’s jail system has shown that offering all three MATs is a successful way of reducing fatalities. We applaud Senators Markey and Murkowski for their work on this important bill.”

“In jails across America, sheriffs see first-hand the devastating impacts that the mental health crisis and the opioid epidemic have on their communities,” said NSA’s Executive Director, Jonathan Thompson. “This common-sense legislation introduced by Senator Markey provides a solution to inmates lack of mental health care/medically assisted treatment, when they need it most. We commend Senator Markey’s efforts to create a grant program that can be widely accessed by both urban and rural sheriffs.”

“Counties experience the human toll of addiction every day in our communities. We are the nation’s first responders and deliver services to residents in our emergency rooms, public health departments and justice systems. As we pursue proven solutions in our fight against addiction, greater access to medication-assisted treatment is important,” said National Association of Counties Executive Director Matthew Chase.“NACo applauds Senators Markey and Murkowski’s efforts to strengthen resources available to local officials, and we look forward to working with our congressional partners to reduce overdoses and addiction-related fatalities.”

“Today ASAM commends Senators Markey and Murkowski for their efforts to provide evidence-based addiction treatment to people with opioid use disorder who have been incarcerated,” said Paul H. Earley, MD, DFASAM, president of the American Society of Addiction Medicine (ASAM). “The CREATE Opportunities Act would establish a much-needed federal grant program that can provide addiction treatment access during incarceration and warm handoffs to community-based care upon release that will significantly reduce the risk of opioid-related overdose.  In short, this legislation will save lives.”

“Harm Reduction Coalition welcomes the bipartisan CREATE Act that recognizes that the provision of evidence-based medication treatment is critical to preventing painful withdrawal symptoms, relapse, overdose and increased risk of death that occurs with incarcerating people with opioid use disorder,” said Kimberly Sue, MD, PhD, Medical Director, Harm Reduction Coalition. “Provision of medication for opioid use disorder is both compassionate and the community standard of care; not providing medication such as buprenorphine or methadone therapy has been found by several judges across multiple states to be a violation of the Americans with Disabilities Act (ADA) as well as a violation of the Eighth Amendment of the Constitution prohibiting cruel and unusual punishment. This legislation is an important first step in addressing structural harms contributing to the American opioid overdose crisis.”

“Research has shown that psychosocial interventions in combination with medications provide the greatest chance for success in treating substance use disorders,” CEO, Dr. Arthur C. Evans, American Psychological Association. “The American Psychological Association applauds this legislation, which will help inmates increase access to this effective form of treatment so that they can initiate and maintain recovery, increasing their chance of successful and safe reentry to their communities.”

“Sheriffs across the country are on the front lines of the opioid epidemic.  Substance use is a major driver of crime and individuals leaving prison in Massachusetts are 120 times more likely to die of a fatal overdose compared to others suffering from substance use disorders,” said Middlesex Sheriff Peter J. Koutoujian.“It is critically important sheriffs have the resources necessary to support initiatives like our Medication Assisted Treatment And Directed Opioid Recovery (MATADOR) program, which has shown proven results in increasing public safety, reducing recidivism and improving health outcomes since its launch nearly four years ago.  I want to thank Senator Markey for recognizing the urgent need to provide direct federal resources to address this public health and public safety crisis.”

Organizations endorsing the legislation include: American Society of Addiction Medicine, National Sheriffs’ Association, Major County Sheriffs of America, Drug Policy Alliance, Harm Reduction Coalition, AIDS United, National Association for Behavioral Healthcare, National Council for Behavioral Health, SMART Recovery, Center on Addiction + Partnership for Drug-Free Kids, Young People in Recovery, National Alliance for Medication Assisted Recovery, American Psychological Association, CADA of Northwest Louisiana, Connecticut Certification Board

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Twelve States Pass “Right to Know” Laws

Utah and Washington are the latest states to pass a Patient Notification Law. The laws require all practitioners to have a conversation with their patients on the addictive nature of opioids before they are prescribed and discuss possible non-opioid alternatives that are available.

According to the advocacy campaign Prevent Opioid Abuse , versions of the legislation have passed in California, Connecticut, Maryland, Michigan, New Jersey, Nevada, Oklahoma, Ohio and Rhode Island and West Virginia. Efforts to adopt it are currently underway in six other states and Puerto Rico. In New Jersey the law takes it a step further and requires physicians, physician assistants, dentists and optometrists to complete one Continuing Medical Education credit on topics that include responsible prescribing practices, as well as risks and signs of opioid abuse, addiction and diversion.

Read more.

Dear Representative Kuster and Senator Markey,

The undersigned organizations in the Coalition to Stop Opioid Overdose (CSOO) are writing today to voice our support for your bill – the Community Re-entry through Addiction Treatment to Enhance (CREATE) Opportunities Act. CSOO is a coalition of diverse organizations united around common policy goals to reduce opioid overdose deaths. CSOO members aim to elevate the national conversation around opioid overdose and work to enact meaningful and comprehensive policy changes that support evidence-based prevention, treatment, harm reduction, and recovery support services.

The morbidity and mortality statistics related to addiction, and in particular addiction involving opioid use, are grim. In 2017, there were a record 70,237 drug overdose deaths in the United States, two-thirds of which have been linked to opioids.  i. Furthermore, those who report opioid use are significantly more likely to interact with the criminal justice system than those who do not report opioid use. ii. It is vital that those who are incarcerated while suffering from opioid use disorder (OUD) receive the treatment they need to improve their health outcomes and decrease recidivism. Fortunately, medication-assisted treatment (MAT) has proven to be successful in treating OUD. Those receiving MAT as part of their treatment are 75% less likely to experience a mortality related to addiction than those not receiving MAT, and are more likely to maintain gainful employment. iii. Additionally, MAT has been shown to reduce recidivism, illegal drug overdose deaths, and infectious disease transmission.iv Given the positive impact of MAT, we appreciate your leadership in the introduction of the CREATE Opportunities Act. Read more.

AOAAM supports the Opioid Workforce Act of 2019 (H.R. 3414).

Dear Chairman Neal and Ranking Member Brady:

On behalf of the organizations below, we write to express our support for the Opioid Workforce Act of 2019 (H.R. 3414). This thoughtful, bipartisan legislation would provide Medicare support for an additional 1,000 graduate medical education (GME) positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine. We greatly appreciate the Committee’s commitment to advancing policies that would strengthen the health care workforce serving on the front lines of the nation’s opioid epidemic.

According to the Substance Abuse and Mental Health Services Administration, in 2016 approximately 21 million people needed treatment for a substance abuse disorder, however only 11% of those received any treatment at all. Part of the reason for this disparity is a shortage of physicians trained in addiction medicine, addiction psychiatry, or pain management. The lack of physicians trained in these specialties reflects the nation’s larger physician shortages. Funding new, targeted residency positions will strengthen the health care workforce and help mitigate the effects of the overall physician shortage.

The Opioid Workforce Act of 2019 is a targeted and important step that Congress must take to help ensure a robust physician workforce that can deliver high-quality care to those suffering from substance abuse disorders.

We encourage all members of the Committee to support this bipartisan bill.

View the full letter.

A new National Health Service Corps Program, the Rural Community Loan Repayment Program, will expand and improve access to quality opioid and substance use disorder (SUD) treatment in our rural, underserved areas nationwide. Health care clinicians qualified to provide SUD treatment may be eligible for this loan repayment in return for service at an NHSC-approved SUD treatment facility. For more information and to apply, visit the Rural Community LRP website.

The application cycle closes Thursday, July 18, 2019 at 7:30 p.m. ET.

A group shot from the ORN Summit in Kansas City (May 15-17). During this summit Technology Transfer Specialists and Partners worked collaboratively on how to streamline and optimize our efforts. Summaries from select presentations are included in this issue of the ORN Impact Bulletin.

• Photos and copies of presentations from the ORN Summit are now available here.
• ORN now has a Spanish brochure! Email jane@aaap.org and nic@aaap.org for copies.

Read more.

With recent data from our evaluator, RTI International, the Opioid Response Network will be releasing our first year summary. See preliminary information below. 

More community trainings are scheduled. ORN community trainings are free two-day meetings  focusing on the opioid crisis. The purpose is to share ORN resources , provide opioid use disorder training and help participants develop technical assistance requests and action plans for their communities. Select upcoming trainings will be hosted in Indianapolis, IN; Montgomery, AL; Reno and Las Vegas, NV; and Juneau, AK.

Are you participating in an ORN event? We need your help! We want to see your smiling faces at ORN events across the country. Please take photos at your events and share with jane@aaap.org and nic@aaap.org so we can post in the Bulletin and on our website.

The 2019 Opioid Response Network Summit was held from May 15-17 in Kansas City. Technology Transfer Specialists and Partners worked collaboratively on how to streamline and optimize our efforts across the country and locally. Stay tuned for a recap.

Read more news including: Lessons Learned, Consulting Spotlight, CORE Team Snapshots, Filed Updates, Upcoming Webinars and In the News.