http://ifi-wikis.com/IFI-OpioidCrisis/api.php?action=feedcontributions&user=Josiebeets&feedformat=atomMedia Wiki - User contributions [en]2024-03-28T09:12:30ZUser contributionsMediaWiki 1.30.1http://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs&diff=19433Expand Law Enforcement Assisted Diversion and Deflection Programs2019-12-27T16:14:32Z<p>Josiebeets: </p>
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''Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]]&nbsp;''<br />
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The most common phrase you will hear from law enforcement leadership across the country is, “We recognize we cannot arrest our way out of this problem.” We must provide our first responders and criminal justice system with the tools, resources, and support to ensure those fighting substance use disorder receive treatment and those profiting from their addiction and tragic deaths face harsh justice.&nbsp;Whether in the aftermath of an opioid overdose reversal or while transitioning in and out of incarceration, those battling addiction must be presented with the opportunity for treatment so they can begin their road to recovery.<br />
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= Background =<br />
<div class="_">LEAD is a pre-booking diversion program that allows officers to redirect low-level offenders engaged in drugs or prostitution activity to community-based services instead of jail and prosecution. LEAD participants begin working immediately with case managers to access services.<sup class="reference">[1]</sup></div> <div class="_">&nbsp;</div> <div class="_">According to a 2015 report by the International Centre for the Prevention of Crime (ICPC), "One of the [ONDCP] strategy's objectives for 2015 is to break the cycle of drug use, crime, delinquency, and incarceration by increasing by 5% the number of residential juvenile justice facilities offering substance abuse treatment, and increasing by 2.6% the number of treatment plans completed by individuals referred by the Criminal Justice System (ONDCP, 2012, p.18)."<ref>https://www.unodc.org/documents/ungass2016/Contributions/Civil/ICPC/Rapport_FINAL_ENG_2015.pdf</ref></div> <div class="_">&nbsp;</div> <br />
= Other Programs =<br />
<br />
== The S.M.A.R.T. Approach ==<br />
SMART supports chronic misdemeanor offenders, particularly those who are otherwise resistant to intervention, with a case manager and offers individualized treatment and tailored housing placements. SMART prioritizes chronic misdemeanor offenders with acute drug addictions and complex social service needs.<sup class="reference">[2]</sup><br/> See fact sheet here: <div class="objectEmbed">[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|[File:http://www.wikispaces.com/i/mime/32/application/pdf.png SMART Fact Sheet.pdf]]] <div>[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|SMART Fact Sheet.pdf]]</div> </div> <br />
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== DTAP - Drug Treatment Alternative To Prison ==<br />
<br />
This program had a high rate of success.&nbsp; See this [https://www.centeronaddiction.org/addiction-research/reports/crossing-bridge-evaluation-drug-treatment-alternative-prison-dtap-program evaluation report] from 2003 for impressive statistics.&nbsp;<br />
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= Tools & Resources =<br />
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[[TR_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|TR - Expand Law Enforcement Assisted Diversion Programs]]<br />
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= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
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= Actions to Take =<br />
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[[PA_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|Potential Actions and Partners]]<br />
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= Resources to Investigate =<br />
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[[RTI_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|More RTI on Expand Law Enforcement Assisted Diversion Programs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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= Sources =<br />
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#[http://leadkingcounty.org/about/ [1]] <br />
#[https://www.sandiego.gov/cityattorney/divisions/criminal/smart [2]] <br />
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[[Category:SAFE-Law Enforcement and Criminal Justice]] [[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Access_to_Medication-Assisted_Treatment_(MAT)&diff=19420Expand Access to Medication-Assisted Treatment (MAT)2019-12-05T23:56:38Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output">Return to [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|Zoom Map - Expand Access to Optimized MAT]]&nbsp;or&nbsp;&nbsp;[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]]&nbsp;or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
<br/> __TOC__<br />
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= Medication-Assisted Treatment =<br />
<div class="_">Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.<sup class="reference"><ref>[1]chanell.baylor. (2015, July 21). Medication-Assisted Treatment (MAT) [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/medication-assisted-treatment<br />
</ref></sup> Information on medications used in MAT can be found further down on this page.</div> <div class="_">&nbsp; The President's [https://www.whitehouse.gov/ondcp/presidents-commission Commission on Combating Drug Addiction and the Opioid Crisis] has recommended that federal government "immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)."<sup class="reference"><ref>[2]Commission to the President (2016), Retrieved from: https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf</ref></sup></div> <div class="_">&nbsp; The above reports documents that MAT has been proven to:</div> <div class="_">&nbsp;</div> <br />
*Reduce overdose deaths <br />
*retain persons in treatment <br />
*decrease use of heroin <br />
*Prevent spread of infectious disease <br />
<br />
&nbsp;<br />
<br />
= Opportunity to Enhance Common MAT Research and Practices =<br />
<div class="_">An article in the August 2017 issue of the American Journal of Psychiatry, by Roger D. Weiss, MD, the Chief of the Division of Alcohol and Drug Abuse at McLean Hospital (Belmont, MA) and Professor of Psychiatry at Harvard Medical School and Kathleen Carroll, Ph.D. concluded:<br/> &nbsp; "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment."</div> <div class="_">&nbsp; This report reveals the need for significantly more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning and well-being including employment, stable housing and other measures of well-being. Also, research would ideally have information on many other factors such as information on co-occurring disorders and different types of behavioral treatments that would be appropriate for different individuals, While not mentioned specifically in that article, a person's history of trauma or ACEs, length of time with an SUD, current level of supports and genetic factors such as the rates at which they metabolize different drugs would all impact what type of treatment would be most appropriate. All of these unique factors and the wide range of potential interventions are reasons that more research is needed, and conclusions from studies that look at a limited number of inputs and outcomes and lack visibility into all the unique factors that influence what might impact successful outcomes should be seen as early insights in a journey of finding the optimal forms of treatment for each person's situation.</div> <div class="_">&nbsp; Weiss and Carroll highlight some key findings from their report in a Webinar done through the American Journal of Psychiatry learning center.<sup class="reference">[3]</sup> Key points include:</div> <div class="_">&nbsp;</div> <br />
*<br />
**Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done. <br />
*Research designs, such as the intensity of Medication Management, the dose of buprenorphine, and the characteristics of the group participants, influence outcomes. <br />
*Different sub-groups respond differently to different elements of treatment plans. <br />
*Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making. <br />
**Paients who abstain from opioids in the first two weeks of treatment have a good chance of a good 12-week outcome. <br />
**Patients who use opioids during the first two weeks of treatment have very little chances of abstaining by week 12. <br />
*There is evidence that the use of [https://drugabuse.com/library/contingency-management/ Contingency Management ](CM), including the use of computer-based therapies, seems to increase success rates <br />
*Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users. <br />
*Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates. <br />
*More data is needed to better understand what treatment options are best for different individuals, <br />
<br />
&nbsp;<br />
<br />
= Ways to Improve and Optimize&nbsp;MAT =<br />
<br />
The effectiveness of MAT is enhanced when there is an emphasis on a broad range of treatment and recovery supports, not just providing the medication part of the MAT.&nbsp; &nbsp;MAT is optimized when those providing and funding the treatment keep striving to improve all aspects of the treatment plan, optimized for each individual as much as practical.&nbsp;<br />
<br />
Some of the ways that MAT can be optimized are listed below::<br />
<br />
*Precision medication ([[Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|Expand DNA Testing to Improve Precision MAT]]) <br />
*A coordinated, proactive, whole-person care plan ([[Integrate_MAT_into_a_Whole_Person_Care_Model|Integrate MAT into whole-person care model]]) <br />
*Community engagement ([[Expand_community_engagement_to_improve_MAT|Expand community engagement to improve MAT]]) <br />
*Use of innovative technologies ([[Use_innovative_technologies_to_enhance_MAT|Use innovative technologies to enhance MAT]]) <br />
<br />
<br/> &nbsp;<br />
<br />
= Current Status of MAT Practices =<br />
<br />
*Only 10% of conventional drug treatment facilities in the United States provide MAT for opioid use disorders (need source and date) <br />
*According to SAMHSA data collected in early 2017, 40 percent of the physicians who have a waiver do not prescribe buprenorphine at all. This may be due to physicians' reluctance to have patients with addictive disorders frequenting their offices or due to concerns about DEA audits, among other reasons.<sup class="reference">[4]</sup> <br />
*Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths<sup class="reference">[5]</sup> <br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><br />
= The Value of MAT (or Opioid-Agonist Treatment) =<br />
<br />
*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20, 2018&nbsp;in Annals of Internal Medicine.<ref>Association, A. P. (n.d.). APA Learning Center The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment (Webinar). Retrieved December 5, 2019, from APA Learning Center website: http://education.psychiatry.org/Users/ProductDetails.aspx?ActivityID=6092<br />
</ref> <br />
*But in California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the false belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long term costs for criminal justice and healthcare systems. <br />
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal-justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<ref>Krebs, E., Enns, B., Evans, E., Urada, D., Anglin, M. D., Rawson, R. A., … Nosyk, B. (2018). Cost-Effectiveness of Publicly Funded Treatment of Opioid Use Disorder in California. Annals of Internal Medicine, 168(1), 10. https://doi.org/10.7326/M17-0611<br />
</ref> <br />
**“If we want to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills." <br />
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles." <br />
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness. <br />
<br />
Access the study here:<ref>What’s this agonist / antagonist stuff? (n.d.). Retrieved December 5, 2019, from https://www.naabt.org/faq_answers.cfm?ID=5<br />
</ref><br/> &nbsp;<br />
This article talks of how the use of Buprenorphine reduces the cost of opioid addiction<br/> <ref>[1]Behavioral Healthcare Executive | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/node/721<br />
</ref></div> <div class="_">&nbsp;</div> </div> <br />
= New 2018 SAMHSA Guide for Medications for Opioid Use Disorder =<br />
<br />
This latest, detailed [https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM 330-page report] can be downloaded for free.&nbsp;<br />
<br />
= Co-occurring Disorders =<br />
<br />
Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<ref> [6]Weiss, R. D., Potter, J. S., Fiellin, D. A., Byrne, M., Connery, H. S., Dickinson, W., … Ling, W. (2011). Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial. Archives of General Psychiatry, 68(12), 1238–1246. https://doi.org/10.1001/archgenpsychiatry.2011.121<br />
</ref><br />
<br />
= Different Medications Used in MAT: =<br />
<br />
== Agonists & Antagonists ==<br />
<div class="_">An opioid agonist activates opioid receptors in the brain. An antagonist blocks opioids by attaching to the opioid receptors without activating them.<sup class="reference"><ref>[7]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from https://www.nga.org/wp-content/uploads/</ref></sup><br/> &nbsp; [Detoxification vs. Stabilization]</div> <div class="_">&nbsp;</div> <div class="_">Buprenorphine</div> <br />
*Buprenorphine is used in MAT to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. One study showed that 50% of the people in treatment who were also on Buprenorphine stayed on treatment compared with 7% who only had treatment.<sup class="reference"><ref>[8]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Buprenorphine is a partial agonist that suppresses opioid withdrawal symptoms. It can produce opioid agonist effects, such as euphoria, it is milder than full agonists such as methadone.<sup class="reference"><ref>[9]Page Not Found</ref></sup> <br />
*Buprenorphine can be prescribed by physicians in an outpatient setting who have completed a training course and received a DEA DATA 2000 waiver. It is taken as a pill or sublingual film. Buprenorphine was also approved in a 6-month implant form in May 2016<sup class="reference"><ref>[10]Page Not Found</ref></sup> <br />
*Training for Buprenorphine providers is an 8 hour course (24 for Nurse Pracitioners and Physician Assistants) and allow for the following patient loads and responsibilities:<sup class="reference"><ref>[11]Medication-Assisted Treatment: Buprenorphine in the HCH Community (2016), National Health Care for the Homeless Council, Retrieved From: https://nhchc.org/wp-content/uploads/2019/08/policy-brief-buprenorphine-in-the-hch-community-final.pdf</ref></sup> <br />
<br />
#30 Addiction Treamtent Patients per provider for the first year <br />
#100 patients each year thereafter <br />
#An additional 175 (totalling 275) patients can be alloted is the Physician is board certified in addiction, or a facility: <br />
<br />
*Has 24 Call Coverage for patients <br />
*Uses an EMR/EHS to monitor and update patient records (for those looking for an entry level EHS, PracticeFusion is a free system) <br />
*Provision of Care Management Services <br />
*Subscribing to a State led Drug Management System <br />
*Acceptance of Third Party Insurance <br />
<br />
<br/> It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it<sup class="reference"><ref>[12]Page Not Found</ref></sup> . As a result, there are cases where medication diversion do occur, and there is a black market for the drug for self-treatment purposes.<sup class="reference"><ref>[13]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup><br/> <br/> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<sup class="reference"><ref>[14]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup><br />
<br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine] <br />
*[[More_info_on_Buprenorphine|More info on Buprenorphine]] <br />
<br />
For more information, one can visit the information page on [[File/view/BupForOUD.pdf/614583113/BupForOUD.pdf|Buprenorphine for Patients and Families]], which includes information on side effects, information to share with providers and other useful information. This document was compiled by Intermountain Health Care.<br />
<br />
== Suboxone ==<br />
<br />
*Suboxone is a brand name for a hybrid that is three parts Buprenorphine and one part Naloxone. <br />
*Suboxone is more difficult to misuse because it will cause the patient to enter opioid withdrawal if it is misused in any way such as injection.<sup class="reference"><ref>[15]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*[[More_info_on_Suboxone|More info on Suboxone]] (including generic options) <br />
<br />
== Probuphine ==<br />
<br />
*Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy. <br />
*Because Probuphine contains buprenorphine, it may cause physical dependence. <br />
*Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP). <br />
*The implants remain in your arm for six months. <br />
*After the six-month period, your doctor must remove the implants. <br />
*If you wish to continue Probuphine, your doctor may insert new implants to continue treatment. <br />
*The implants can be removed sooner if you want to stop treatment. <br />
*Patients must continue to see their doctor at least every month while on Probuphine therapy. <br />
*[https://probuphine.com/ For more information visit their website.] <br />
<br />
== Methadone ==<br />
<br />
*Methadone, sold under the brand name [https://www.drugs.com/cdi/dolophine.html Dolophine] among others, is used in MAT to help with detoxification or as part of [https://en.wikipedia.org/wiki/Maintenance_therapy maintenance therapy] or [https://en.wikipedia.org/wiki/Opioid_replacement_therapy Opioid Replacement Therapy]. <br />
*Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<sup class="reference"><ref>[16]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs. <br />
*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <sup class="reference">[<ref>17]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<sup class="reference"><ref>[18]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone] <br />
*[[More_Information_on_Methadone|More info on Methadone]] <br />
<br />
== Naltrexone ==<br />
<br />
*Naltrexone is a nonaddictive medicine that serves as an opioid receptor antagonist and not an opioid replacement unlike methadone and buprenophine. It is a primary ingredient in the treatment of alcohol and opioid dependence. Naltrexone blocks certain receptors in the part of the brain that triggers dopamine release so they cannot be activated. Dopamine release reinforces the vicious and compulsive addiction feedback loop. When we block these areas of the brain, the craving for alcohol and opiates is eliminated or significantly reduced. The pleasure is very limited and the uncontrollable cascade of relapse is much less likely, if alcohol is consumed after the implant procedure, in addition if opiates are consumed after the procedure, there are no effects.<sup class="reference"><ref>[19]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Naltrexone is administered in a long-active, injectable formulation administered once a month.<sup class="reference"><ref>[20]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Naltrexone does not prevent withdrawal symptoms so it is recommended for patients who do not have opioid in their system.<sup class="reference"><ref>[21]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone SAMSHA page on Naltrexone] (The 30-day injectable version is commercially known as Vivitrol) <br />
*[[More_info_on_Naltrexone_and_Vivitrol|More info on Naltrexone and Vivitrol]] <br />
<br />
== Naloxone ==<br />
<br />
*Naloxone is an opioid antagonist used to reverse opioid overdose <br />
*Naloxone (commercially known as Narcan) is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery as safe for administration by any person.<sup class="reference"><ref>[22]Murphy, K, Becker, M, Locke, J, Kelleher, C, (2016), Finding Solution to the Prescription Opioid and Heroin Crisis: A Road Map for States, National Governors Association Center, Retrieved from: https://www.nga.org/wp-content/uploads/</ref></sup> <br />
*Naloxone works within minutes and effects last for up to an hour. Multiple doses may be required depending on the severity of respiratory depression.<sup class="reference"><ref>[23]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031<br />
</ref></sup> <br />
*Naloxone does not produce tolerance or dependence. <sup class="reference"><ref>[24]Moving from Stigma to Science in Treating Addiction. (2016, December 17). Retrieved December 5, 2019, from California Health Care Foundation website: https://www.chcf.org/blog/moving-from-stigma-to-science-in-treating-addiction/<br />
</ref></sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone SAMSHA page on Naloxone] <br />
*[[More_info_on_Naloxone|More info on Naloxone]] (including discounted public pricing and free Narcan for schools) <br />
*(for [http://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose opioid overdose]) <br />
*&nbsp; <br />
<br />
<br/> Find information on physical ailments often diagnosed in MAT patients. Also known as [http://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities common comorbidities], these include viral hepatitis, HIV, and AIDS.<br/> <br/> <br/> <br/> Medications Used in Addiction Treatment**<sup class="reference"><ref>[25]The Case for Medication-Assisted Treatment. (n.d.). Retrieved December 5, 2019, from http://pew.org/2kdLIf2<br />
</ref></sup><br />
<br />
{| border="1" class="wiki_table"<br />
|-<br />
| Sept 2017<br />
| Where it can be provided<br />
| FDA indications<br />
| Effectiveness<br />
| Administration<br />
|-<br />
| Methadone<br />
| OUD. Licensed opioid treatment programs<br/> Pain. Any Drug Enforcement Agency (DEA)-licensed prescriber<br />
| OUD and pain management<br />
| 74% to 80%<sup class="reference"><ref>[26]Summary: Major components of the HHS final rule. Effective August 8, 2016. (n.d.). Retrieved December 5, 2019, from https://www.asam.org/resources/publications/magazine/read/article/2016/07/06/summary-of-the-major-components-of-the-hhs-final-rule-which-will-be-effective-on-august-5-2016<br />
</ref></sup><br />
| OUD. Daily pill, liquid, and wafer forms; injectable form in hospitalized patients unable to take oral medications<br/> Pain. Injectable, transdermal, and buccal film<br />
|-<br />
| Buprenorphine and buprenorphine/naloxone<br />
| <br />
*Prescribed by community physicians and dispensed by pharmacies; available in some opioid treatment programs. <br />
*Physicians receive federal waivers after eight hours of training; nurse practitioners and physician assistants require 24 hours. Patient panels are capped at 30, 100, and 275 per provider (depending on experience and setting).<sup class="reference"><ref>[27]Why Health Plan Should Go to the “MAT” in the Fight against Opioid Addiction(2017), California Health Care Foundation, Retrieved form: https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf</ref></sup><sup class="reference"><ref>[28]Garcia-Portilla, M. P., Bobes-Bascaran, M. T., Bascaran, M. T., Saiz, P. A., & Bobes, J. (2014). Long term outcomes of pharmacological treatments for opioid dependence: Does methadone still lead the pack? British Journal of Clinical Pharmacology, 77(2), 272–284. https://doi.org/10.1111/bcp.12031<br />
</ref></sup><sup class="reference"><ref>[29]Kakko, J., Svanborg, K. D., Kreek, M. J., & Heilig, M. (2003). 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomised, placebo-controlled trial. The Lancet, 361(9358), 662–668. https://doi.org/10.1016/S0140-6736(03)12600-1<br />
</ref></sup> <br />
*Any DEA-licensed provider can prescribe buprenorphine for pain. <br />
<br />
| OUD and pain management (depending on formulation and dose)<br />
| 60% to 90%<sup class="reference"><ref>[30]McNicholas, L.(n.d).Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, U.S Department of Health and Human Rights, Retrieved from : https://www.naabt.org/documents/TIP40.pdf</ref></sup><br />
| OUD. Daily sublingual, buccal, film, and tablet, or six-month intradermal device<br/> Pain. Injectable, transdermal, and buccal film<br />
|-<br />
| Naltrexone<br />
| No restrictions<br />
| Opioid and alcohol use disorders<br />
| OUD. 10% to 21%<sup class="reference"><ref>[31]Miranda, A., & Taca, A. (2018). Neuromodulation with percutaneous electrical nerve field stimulation is associated with reduction in signs and symptoms of opioid withdrawal: A multisite, retrospective assessment. The American Journal of Drug and Alcohol Abuse, 44(1), 56–63. https://doi.org/10.1080/00952990.2017.1295459<br />
</ref></sup><br />
| Daily pill or monthly injectable<br />
|-<br />
| Naloxone<br/> (used only for overdose reversal, not addiction treatment)<br />
| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.<br />
| To reverse respiratory suppression in suspected opioid overdose<br />
| May require high doses for extremely high-potency illicit drug use (fentanyl and carfentanyl)<br />
| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable<br />
|}<br />
<div class="_">Extensive research has demonstrated the effectiveness of opioid agonist treatment (methadone and buprenorphine) in opioid use disorder. A meta-analysis of 50 studies showed methadone's retention rate ranging from 70% to 84% at one year, buprenorphine ranging from 60% to 90% at one year, with both treatments resulting in significant reductions in overdose death, illicit drug use, criminal activity, arrests, risk behaviors, HIV and hepatitis C incidence, as well as improvements in health status, functioning, and quality of life.<sup class="reference"><ref>[32]Page Not Found</ref></sup><br/> <br/> <br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Stages of MAT with Buprenorphine =<br />
<br />
== Induction ==<br />
<div class="_">"Induction is the first stage of buprenorphine treatment and involves helping patients begin the process of switching from the opioid of abuse to buprenorphine. The goal of the induction phase is to find the minimum dose of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids and experiences no withdrawal symptoms, minimal or no side effects, and no craving for the drug of abuse."<sup class="reference"><ref>[33]Addiction experts look to new and expanded opioid treatment options in 2017. (2017, January 13). Retrieved December 5, 2019, from FOX 61 website: https://fox61.com/2017/01/13/addiction-experts-look-to-new-and-expanded-opioid-treatment-options-in-2017/<br />
</ref></sup></div> <div class="_">&nbsp; New non-pharmacological approaches to treat opioid withdrawal could provide alternative pathways to help a patient manage withdrawal symptoms as they transition into MAT.. The [https://i-h-s.com/ BRIDGE]® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. An article published in 2018 in The American Journal of Drug and Alcohol Abuse shared significant promising results in using the BRIDGE to help people transition to MAT. The neurostimulation rapidly and dramatically reduced the [https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf COWS scores] of the participants and 64 of the 73 people successfully transitioned to MAT.<sup class="reference"><ref>[34]Page Not Found</ref></sup><br/> &nbsp; Some training program suggest that [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99a59495-2a48-4276-bbe3-cdd55a45aba4 Clonidine] or [https://www.webmd.com/drugs/2/drug-16910-8296/ondansetron-oral/ondansetron-disintegrating-tablet-oral/details Ondansetron] may be used to ease the withdrawal symptoms during induction.<ref> [35]Vermont Global Commitment to Health Section 1115 Demonstration Fact Sheet (2018). Retrieved from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/vt/vt-global-commitment-to-health-fs.pdf</ref></div> <div class="_">&nbsp;[[More_information_on_buprenorphine_induction|More information on buprenorphine induction]].</div> <div class="_">&nbsp;</div> <br />
== Stabilization ==<br />
<div class="_">"The stabilization phase has begun when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance."</div> <div class="_">&nbsp;[[More_information_on_buprenorphine_stabilization|More information on buprenorphine stabilization]].<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Maintenance ==<br />
<div class="_">"The longest period that a patient is on buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction."</div> <div class="_">&nbsp;[[More_information_on_buprenorphine_maintenance|More information on buprenorphine maintenance]]<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Medically Supervised Withdrawal (Detoxification) ==<br />
<div class="_">As an alternative to the three stages above, The goal of using buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of buprenorphine). Medically supervised withdrawal with buprenorphine consists of an induction phase and a dose-reduction phase. The consensus panel recommends that patients dependent on shortacting opioids (e.g., hydromorphone, oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto buprenorphine/naloxone tablets. The use of buprenorphine (either as buprenorphine monotherapy or buprenorphine/naloxone combination treatment) to taper off longacting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability,</div> <div class="_">&nbsp;</div> <br />
== Canadian Guidelines ==<br />
<div class="_">This [https://www.cpso.on.ca/uploadedFiles/policies/guidelines/office/buprenorphine_naloxone_gdlns2011.pdf document ]has details on the MAT Buprenorphine guidelines from Canada</div> <div class="_">&nbsp;</div> <br />
= New & Expanded Treatment Options =<br />
<br />
== Connecticut ==<br />
<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medical assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network.<ref> [36]Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/2279713<br />
</ref><br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Vermont ==<br />
<div class="_">Vermont's Health Home for Opioid Addiction have employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts<ref> [37] Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals<br />
</ref>:</div> <div class="_">&nbsp;</div> <br />
*The Hub, a designated provider of specialty addiction treatment, designed as an Opioid Treatment Program which are operated by Community Behavioral Health Agencies. <br />
*The Spokes, which are health care teams led by Physicians who can prescribe Buprenorphine and are regulated as Office Based Opioid Treatment providers. <br />
<br />
Payment infrastructure for providers are structured after already existing Medicare and Medicaid Structures, which are documented in the<br/> Vermont Global Commitment To Health Section 1115 Demonstration Fact Sheet<sup class="reference"><ref>[38]Kashef, Z. (2015, April 28). Emergency department treatment for opioid addiction better than referrals. Retrieved December 5, 2019, from YaleNews website: https://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals<br />
</ref></sup><br />
<br />
*<br />
**An evaluation of the Care Alliance for Opioid Addiction, has shown that people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences, according to a [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 new report] from the Vermont Department of Health released 1/22/18. <br />
**Additional findings include: <br />
***92% drop in injection drug use. <br />
***89% decrease in emergency department visits. <br />
***90% reduction in both illegal activities and police stops/arrests. <br />
***Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment. <br />
***Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives. <br />
<br />
More information can be found at: <ref>[3]Hub and Spoke Evaluation Shows Significant Impact (January 22, 2018). (2018, January 22). Retrieved December 5, 2019, from Vermont Department of Health website: https://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018<br />
<br />
</ref><br/> &nbsp;<br />
<br />
== Emergency Department Treatment Protocols ==<br />
<div class="_">In a Yale Randomized trial, it was found that individuals who receive Buprenorphine while getting medical care within an Emergency Room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<ref>[39] Weiss, R. D., Potter, J. S., Griffin, M. L., Provost, S. E., Fitzmaurice, G. M., McDermott, K. A., … Carroll, K. M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence, 150, 112–119. https://doi.org/10.1016/j.drugalcdep.2015.02.030<br />
</ref>This can be an initiation point for treatment of Opioid dependence and can be followed up by primary care facilities. This has shown to decrease the need of in patient facilities. This can be attributed to engaging patients at the optimal point of access. <sup class="reference"><ref>[40]Health plan offers financial incentives for MAT training | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved December 5, 2019, from https://www.psychcongress.com/article/policy/health-plan-offers-financial-incentives-mat-training<br />
</ref></sup><br/> <br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== National Healthcare For Homeless Council ==<br />
<div class="_">Aa one may assume, there is cross-over between the homeless and addicted communities. The National Healthcare for the Homeless Council have as a result released a policy brief that may be of some use for both policy makers and health care providers alike. Within the brief, a basic strategy is considered as follows when treating addicted and homeless/addicted patients:</div> <div class="_">&nbsp; • Establish stability. Stable housing is central to attaining treatment goals as it provides patients with stability, a sense of safety, an increased ability to meet basic needs and an opportunity to have increased control over their lives and environment. Securing stable housing as early as possible is key to the treatment and recovery process.<br/> &nbsp; • Address comorbidities using integrated care. Untreated medical and/or other behavioral health conditions may complicate MAT. The most successful interventions are provided through integrated care models of interdisciplinary teams made up of medical, mental health, substance use, and social service providers. Each discipline should not only be co-located, but should work collaboratively as a team with multiple services offered in the same visit.<br/> &nbsp; • Treat the whole person. Substance use disorders cannot be treated apart from addressing the needs of the whole person in the context of his or her environment. In addition to addressing comorbidities, assistance in accessing food, clothing, shelter/housing, financial assistance, counseling, job training, employment services, and other needs as identified must be included alongside MAT.<br/> &nbsp; • Take a harm reduction approach. Harm reduction therapy is an evidence-based practice that supports and respects a person’s experience and treats them with dignity, which is especially important for persons experiencing homelessness who regularly interact with systems and situations that limit self-determination and lack respect. Harm reduction therapy relies on collaboration, respect, and stage-based interventions that acknowledge self-defined positive change. Harm reduction therapy focuses on client-defined priorities and acknowledges that any improvement that reduces harm is beneficial. The key to harm reduction therapy is low barrier, integrated care that is trauma informed and respectful of the collaborative therapeutic relationship.<br/> &nbsp; • Utilize evidence based best practices. In addition to harm reduction, using other evidence-based best practices such as the use of peer specialists, motivational interviewing, and individual and group therapy can help patients maintain recovery and have successful treatment outcomes.<br/> &nbsp; • Be patient centered. Building trust and developing relationships is essential to providing high-quality care and achieving good health outcomes. Engaging in patient centered care based on a patient’s individual needs, strengths, goals, and timeframe rather than on a pre-determined benchmark for outcomes is one way to build relationships and empower patients in the process. Patients should be actively involved in setting goals and planning their treatment.<br/> &nbsp; • Be flexible. There is no one-size-fits-all treatment that will work for all patients. While MAT recommends a combination of medication and behavioral health therapy, treatment should be flexible and individualized to the patient’s needs, especially the frequency/schedule for therapy. For some, medication alone and regular consultation with a primary care provider is enough to maintain and recover from addiction, while others may need the additional supports provided by behavioral health therapy.</div> <div class="_">&nbsp; More information can be found on the [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Document]] itself.</div> <div class="_">&nbsp;</div> <br />
= Opioid Treatment Program Directory =<br />
<div class="_">Select [http://dpt2.samhsa.gov/treatment/directory.aspx this directory] to view the opioid treatment programs in each state</div> <div class="_">&nbsp;</div> <br />
= Moving from Stigma to Science =<br />
<div class="_">Pennsylvania and New Jersey</div> <div class="_">&nbsp; The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <ref>[41] Page Not Found</ref>Underlying problems still exist in restrictive medication regiment practices, insurance coverage and Public-Private partnerships which require support to overturn previous hard lined policies. An evidence based approach has shown that introduction of MAT, especially with Buprenorphine has had an increased mitigation effect on relapse and a higher chance of long term recovery.<ref> [42]Page Not Found</ref></div> <div class="_">&nbsp; National Healthcare For Homeless Council<br/> &nbsp; The National Healthcare for the Homeless Council also have recommendations of policy that not only controls the prescription of opiates, but also the treatment of opioid addiction. They are as follows:</div> <div class="_">&nbsp; Remove the cap on the number of patients a physician can treat with buprenorphine. Existing limits are arbitrary and create barriers to accessing treatment. While put in place to mitigate diversion, cap limits may inadvertently aid diversion by limiting the supply of MAT, leading to individuals pursuing selftreatment by purchasing diverted drugs. Ironically, there are no limits to the number of patients a physician can prescribe other opioid drugs that present a much greater risk of causing addiction, overdose, and death (e.g., Methadone, Oxycodone, Hydrocodone, and Fentanyl). Removing the caps will allow providers to determine the number of patients they are able to treat based on the capacity of their practice and other factors, thereby increasing access to treatment.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
*Expand prescribing rights to all clinicians who are eligible to prescribe Class III, IV, and V CDS drugs. Limiting prescribing rights to physicians creates an additional barrier to accessing treatment and is incongruent with the existing scope of many clinical practices. Expanding prescribing rights to Nurse Practitioners, Physicians Assistants, and other clinicians who are authorized to prescribe Class III, IV, and V CDS drugs will expand treatment opportunities and decrease barriers to care. Clinicians who can prescribe opioids for pain should also be able to prescribe buprenorphine to treat the addictions that sometimes result. <br />
*Require training to prescribe all opioids, not just buprenorphine. Specialized training is required to prescribe buprenorphine, but no other drug (opioid or otherwise) requires this as a condition of practice. Given the lower risks associated with diversion of buprenorphine, and the elevated risk associated with many opiates that can be prescribed with few restrictions, training should be extended to the prescribing of any opioid and focus on administering and monitoring prescriptions and understanding the nature of addiction. In addition prescribers should have greater access to technical assistance and resources to develop plans to identify and avoid diversion. <br />
*Enforce parity laws. Substance abuse treatment and other behavioral health services should be just as easy to access as primary care services. Parity laws are in place to ensure insurance plans treat these services equally, and should be enforced. Health insurance practices that require prior authorizations for opioid treatment should be scrutinized, especially when they create barriers to behavioral health care that do not exist for primary care. Just as there are no prior authorizations required for opioid drugs prescribed for pain management, there should be no prior authorizations required for MAT. Addiction is a time-sensitive condition to treat, and presenting for treatment is a big step for patients; even a delay of one day can be the difference in someone getting treatment or not. <br />
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment. <br />
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention and referral to treatment need to be identified and implemented. <br />
<br />
More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].<br/> &nbsp;<br />
<br />
= Financial Incentives for MAT training =<br />
<br />
'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<sup class="reference"><span style="background-color:#f1c40f;">[43]</span></sup> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture and physical therapy.<br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <sup class="reference"><span style="background-color:#f1c40f;">[44]</span></sup><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> is a DATA 2000 accredited resource for providing either an 8 hour training for Physicians or 24 training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. Offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine trainings are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA),American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<sup class="reference"><span style="background-color:#f1c40f;">[45]</span></sup><br/> &nbsp;<br />
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= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources (Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
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= Resources to Investigate =<br />
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[[RTI_-_Expand_Access_to_Optimized_Medication-Assisted_Treatment|More RTI on MAT]]<br/> <br/> PAGE MANAGER: [insert name here]<br/> SUBJECT MATTER EXPERT: [fill out table below]<br />
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[[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Access_to_Quality_Treatment_Programs&diff=19419Improve Access to Quality Treatment Programs2019-12-05T23:12:51Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]]<br/> &nbsp; __TOC__<br />
<br />
= Current Status =<br />
<br />
With so many people needing treatment, it is important to find ways for more of them to get access to quality and affordable treatment. This could involve a variety of innovations, such as expanded use of on-line tools, Virtual Reality, and more.<br />
<br />
&nbsp; Most recovery support services fall under the Recover-Oriented Systems of Care (ROSC) umbrella which follow the recovery-related values and beliefs. These include concepts such as people who suffer from addiction have essential worth and dignity; the stigma related to addiction is something that prevents many people who are addicted from seeking help and this must be combated; there are many paths to recovery; access to treatment is a human right, even though recovery might mean something more; people who are in recovery as well as their families have valuable experiences and support to offer to those who are still struggling with substance abuse. Recovery-Oriented Systems of Care are based on the idea that severe substance use disorders are treated most effectively through a chronic care management model which involves outpatient care, recovery housing, recovery coaching, and management checkups.They are meant to be culturally sensitive and easy to navigate.<sup class="reference"><ref>[1]The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016), Drug-Free Communities, Retrieved from: https://obamawhitehouse.archives.gov/sites/default/files/ondcp/dfc/AdministratorEnomotoMeetDFCTeamPresentation.pdf</ref></sup><br />
<br />
&nbsp; Current treatment programs are largely based on the 12-Steps of Alcoholics Anonymous (AA), but there is little to no scientific evidence showing that this process is effective. Dr. Lance Dodes stated in the documentary ''The Business of Recovery'' that 12-Step programs are typically only helpful for 5-10% of people who partake in them, meaning that they are largely ineffective for the vast majority of people. Treatment programs that are based off of AA's 12-Step program therefore are not necessarily providing effective treatment, but are still charging exorbitant prices, especially considering that AA is a fellowship that is free to participants outside of treatment programs.<ref> [2]Inside The $35 Billion Addiction Treatment Industry. (n.d.). Retrieved December 5, 2019, from https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#c20c67817dc9<br />
</ref><br />
<br />
&nbsp; Studies conducted on patients with Alcohol Use Disorders (AUD) have found that pharmaceutical interventions, when used with psychosocial co-interventions, resulted in better alcohol consumption outcomes. This demonstrates that looking into adding in medication to treatment programs could be advantageous for opioid users.<sup class="reference"><ref>[3]Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings: A Systematic Review and Meta-analysis | Research, Methods, Statistics | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/1869208<br />
</ref></sup><br />
<br />
&nbsp; Other treatment programs include recovery coaching, recovery housing, recovery management, peer-led recovery community centers, and recovery-based eduaction.<br />
<br />
&nbsp;'''Medication-assisted treatment''' (MAT) is available in accredited and certified private and public clinics across the United States. The [https://www.samhsa.gov/medication-assisted-treatment/about Division of Pharmacologic Therapies (DPT)] of the [https://www.samhsa.gov/ Substance Abuse and Mental Health Administration ]is responsible for overseeing the certification of opioid treatment programs (OTPs). Medication-assisted OTPs include using buprenorphine, methadone, and naltrexone.<sup class="reference"><ref>[4]Medication-Assisted Treatment (MAT) | SAMHSA - Substance Abuse and Mental Health Services Administration. (n.d.). Retrieved December 5, 2019, from https://www.samhsa.gov/medication-assisted-treatment<br />
</ref></sup> A combination of medication, counseling and behavioral therapy is regarded as the most effective in treating opioid dependency. According to an article in the New England Journal of Medicine MATs are both cost-effective and safe, and result in the reduction of the risk to overdose.<sup class="reference"><ref>[5]Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine, 370(22), 2063–2066. https://doi.org/10.1056/NEJMp1402780<br />
</ref></sup><br />
<br />
&nbsp; [How to get people in rural communities to actually get the treatment that they need, info on this many people who cant get treatment, transportation (what the barriers to access?) payment, how are they supported in current standard of care? talk more about online programs]<br />
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&nbsp;<span style="color: #e81f1f">'''[Insert NEJMl table]'''</span><br />
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= Cost of Rehab =<br />
<br />
== Overview ==<br />
<br />
See [https://www.drugrehab.com/treatment/how-much-does-rehab-cost/ drugrehab.com] for overview of cost and it's contributing factors.<br />
<br />
&nbsp;<br />
<br />
== Insurance ==<br />
<br />
[http://Drugrehab.com Drugrehab.com] has site that [https://www.drugrehab.com/insurance-check/ checks if your insurance provider covers addiction care].<br />
<br />
= Promising Programs =<br />
<br />
== Mobile App reSET-O ==<br />
<br />
[https://peartherapeutics.com/ Pear Therapeutics] has developed an eFORMULATIONS treatment tool for opiate dependence called reSET-O. reSET-O is a mobile medical application that is used in conjunction with pharmaceutical therapies to treat opioid dependence. Clinical trials have shown reSET-O to be a promising solution to opiate dependence, showing that reSET-O plus pharmacotherapy achieved enhanced abstinence from opioids, reduced drop-outs in treatment, and reduced required clinical intervention when compared to traditional face-to-face therapy.<sup class="reference"><ref>[6]Page Not Found </ref></sup><br/> &nbsp;<br />
<br />
== My Life Recovery Program ==<br />
<br />
'''[http://myliferecoverycenters.com/ My Life Recovery Program]''' - This online program that has some good recognition. This might be an option for rural areas and/or during incarceration. The program is designed to last 3 to 6 months and consists of bi-weekly online video/audio workshops and practical tools, along with homework exercising, grounding techniques, and supportive emails. <sup class="reference"><ref>[7]LRP - Home. (n.d.). Retrieved December 5, 2019, from https://www.liferecoveryprogram.org/<br />
</ref></sup><br/> &nbsp;<br />
<br />
== myStrength ==<br />
<br />
[http://www.mystrength.com myStrength] is an on-line and smartphone platform that can enhance the capacity of mental health service providers by enabling them to serve more people more effectively. It can also provide valuable tools to support the people during the times between professional consultations. There is solid and growing research on the value and effectiveness of this innovative platform.<sup class="reference"><ref>[8]Inc, myStrength. (n.d.). MyStrength | Outcomes. Retrieved December 5, 2019, from http://mystrength.com/outcomes<br />
</ref></sup> Learn more about [[MyStrength|myStrength]].<br/> &nbsp;<br />
<br />
== Baltimore, MD ==<br />
<br />
*The County Health Department has created a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance abuse issues move toward recovery for themselves or loved ones.<sup class="reference"><ref>[9]Baltimore County News. (n.d.). Retrieved December 5, 2019, from https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_<br />
</ref></sup> <br />
*This resource, education and advocacy help line will operate during normal County business hours, from 8:30 a.m. to 4:30 p.m.<sup class="reference"><ref>[10]Baltimore County News. (n.d.). Retrieved December 5, 2019, from https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_<br />
</ref></sup> <br />
*The County will advertise and extensively promote the new help line in order to connect families and substance users with the resources they need for recovery.<sup class="reference"><ref>[11]Baltimore County News. (n.d.). Retrieved December 5, 2019, from https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_<br />
</ref></sup> <br />
*In addition to connecting with County support by phone, individuals may go directly to the [http://baltimorecountymd.gov/41088REACH County website] for information. <br />
<br />
&nbsp;<br />
<br />
== Boston Medical Center ==<br />
<br />
Boston Medical Center opened its [https://www.bmc.org/programs/faster-paths-to-treatment Faster Paths to Treatment Opioid Urgent Care Center] in August 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits and transportation to detox.<br/> &nbsp;:<br />
<br />
&nbsp;<br />
<br />
== Telepsychiatry ==<br />
<br />
Innovative use of technology and new business models can bring access to quality mental health care to people for whom it has been frequently out of reach or not affordable.<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Using County Jails as Treatment Centers ==<br />
<br />
In Kenton County in northern Kentucky, the prison has become an important treatment facility. Instead of focusing on punishing or just locking up people with substance abuse issues, the Kenton County Detention Center focuses on turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail be the best place to initiate addict recovery. They often end up in jail for minor crimes, long before they commit more serious crimes that warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time “therapeutic communities” that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside.<sup class="reference"><ref>[12]Opinion | Addicts Need Help. Jails Could Have the Answer. - The New York Times. (n.d.). Retrieved December 5, 2019, from https://www.nytimes.com/2017/06/16/opinion/sunday/opioid-epidemic-kentucky-jails.html<br />
</ref></sup><br/> <br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Access_to_Quality_Treatment_Programs|TR - Improve Access to Quality Treatment Programs]]<br />
<br />
= Scorecard Building =<br />
<br />
Potential Objective Details (Under Construction)<br/> Potential Measures and Data Sources (Under Construction)<br/> Potential Actions and Partners (Under Construction)<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Access_to_Quality_Treatment_Programs|More RTI on Treatment Programs]]<br/> <br/> <span class="reference" style="background-color: #ffffff; font-size: 9.75px; vertical-align: baseline"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span><br/> <span class="reference" style="background-color: #ffffff; font-size: 9.75px; vertical-align: baseline"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span><br />
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{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
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| &nbsp;<br />
| &nbsp;<br />
|}<br />
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= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Reduce_Stigma&diff=19417Reduce Stigma2019-12-05T22:35:18Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|ZOOM MAP - Improve Treatment & Enable Recovery of People with SUDs]]&nbsp;or&nbsp;&nbsp;[[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|the Zoom Map (Expand Access to Optimized MAT)]]&nbsp;or&nbsp;[[ZOOM_MAP_-_Strengthen_Peer_Recovery_Support_Services_&_Programs|ZOOM MAP - Strengthen Peer Recovery Support Services & Programs]] <br />
__TOC__<br />
<div class="mw-parser-output"><div class="mw-parser-output"><br />
= Background =<br />
<div class="_">Recent research showed that substance use is more stigmatized than obesity and smoking tobacco.<sup class="reference"><ref>[1]Substance use more stigmatized than smoking and obesity: Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved December 5, 2019, from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516<br />
</ref></sup><br/> <br/> '''Self-stigma''': Shame, evaluative thoughts, and fear of enacted stigma -- prevents users from seeking prevention services, testing and treatment. Stigma also limits employment, school enrollment, housing and access to social and safety net services for users.<sup class="reference"><ref>[2]LUOMA, J. B., KOHLENBERG, B. S., HAYES, S. C., BUNTING, K., & RYE, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165. https://doi.org/10.1080/16066350701850295<br />
</ref></sup><sup class="reference"><ref>[3]Opioid-Associated Outbreaks: Preparation & Prevention Lessons from the Indiana HIV/HCV Outbreak among People Who Inject Drugs | NACCHO Preparedness Brief. (n.d.). Retrieved December 5, 2019, from http://nacchopreparedness.org/opioid-associated-outbreaks-preparation-prevention-lessons-from-the-indiana-hivhcv-outbreak-among-people-who-inject-drugs/<br />
</ref></sup></div> <div class="_">&nbsp;<span style="background-color: #ffffff">Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people in recovery --and early recovery especially -- need. Outside stigma can become internalized, leading people in recovery to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces.<sup class="reference"><ref>[4]Home | Addiction Technology Transfer Center (ATTC) Network. (n.d.). Retrieved December 5, 2019, from https://attcnetwork.org/regcenters/productDocs/2/Anti-Stigma%20Toolkit.pdf<br />
</ref></sup></span></div> <div class="_">&nbsp;</div> <br />
&nbsp;<br />
</div> </div> <br />
= <span style="background-color: #ffffff">Current Status</span> =<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff">A 2014 literature review of programs for reducing stigma found that online education programs and face-to-face education programs were equally effective in reducing personal stigma (an individual's own attitude towards people with mental illness), but neither was effective in reducing self-stigma.<sup class="reference"><ref>[5]Griffiths, K. M., Carron-Arthur, B., Parsons, A., & Reid, R. (2014). Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry, 13(2), 161–175. https://doi.org/10.1002/wps.20129<br />
</ref></sup> Other research has shown that therapeutic interventions such as group-based Acceptance and Commitment Therapy (ACT) and vocational counseling produce positive outcomes for substance users suffering from self-stigma.<sup class="reference"><ref>[6]Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x<br />
</ref></sup><br/> <br/> <span style="background-color: #ffffff">Some suggestions for stigma-reducing language:<sup class="reference"><ref>[7]Social stigma and substance use: Why language matters | Smart Approaches. (n.d.). Retrieved December 5, 2019, from http://smartapproaches.bangordailynews.com/2015/12/04/recovery/social-stigma-and-substance-use-why-language-matters/<br />
</ref></sup></span></span></span><br />
<br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Call it what it is: substance use disorder (or alcohol use disorder, cocaine use disorder, etc.) or substance dependence (or alcohol dependence, drug dependence, etc.). In a non-clinical environment, addiction is also acceptable.</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Use "people first" language and refer to people with substance use disorder, people with drug dependence, people with addiction.</span></span></span> <br />
**<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The new edition of the Associated Press style book recommends people first phrasing with the goal of separating the person from the disease.</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Avoid negative terms like addict, junkie, wino, boozer, drug fiend, and bum.</span></span></span> <br />
<br />
&nbsp;<br />
<br />
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Social Factors & Participation in Treatment Programs</span></span></span> =<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Individual and Social Factors Associated With Participation in Treatment Programs for Drug Users</span><br/> <span style="background-color: #ffffff">Research conducted by: V. Anna Gyarmathy and Carl A. Latkin</span><br/> <br/> <span style="background-color: #ffffff">The purpose of the research project was to establish a clear connection between the effect of positive social influence and the number of recovering addicts seeking treatment. The research team worked </span><br/> <span style="background-color: #ffffff">to identify factors that impede or facilitate treatment participation. <span style="background-color: #ffffff">Based on this analysis, they concluded that social influence may not only promote entry into treatment but also the success of treatment results.</span></span><br/> <br/> <span style="background-color: #ffffff">[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626660/ Click here to read academic article.]</span></span></span></span><br />
<br />
== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Stigma Around Addiction Treatment</span></span></span> ==<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Due to a high volume of treatment centers more focused on profit than patients, a certain stigma has developed around seeking treatment. Certain practices, however, can be seen as red flags for these unscrupulous treatment centers. Educate users seeking treatment as well as people who do patient referrals about these signs to avoid sending patients to these types of treatment centers. </span><br/> <span style="background-color: #ffffff">'''Causes of Addiction Treatment Stigma'''</span></span></span></span><br />
<br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The High Number of Arrests for Drug Possession in the United States</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Patient Brokering</span></span></span> <br />
**<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">This illegal practice occurs when "body brokers" make money by recruiting addicts for unethical and unscrupulous treatment facilities</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Rampant Urinalysis Testing and Lab Abuse</span></span></span> <br />
**<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Some sober homes around the country have found a way to make money by recruiting people for the intensive outpatient programs (IOPs) that take place at drug rehab centers. These centers charge millions of dollars in fees to insurance companies for drug urinalysis performed on patients in IOPs.</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Unbranded Drug Rehab Websites</span></span></span> <br />
**<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Some facilities have created unbranded websites to attract additional web traffic. These websites often try to appear like an independent source verifying that one rehab center may be better than another, when in reality that website was created by a rehab center.</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Lack of Outcomes Data</span></span></span> <br />
**<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The measure of substance use disorder treatment effectiveness may be more nuanced than presented by the treatment center's website. For example, if a center says it has a 90% success rate, that most likely refers to the following conditions</span></span></span> <br />
***<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">A reduction in the frequency of substance use ''during'' drug rehab treatment</span></span></span> <br />
***<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">A reduction in the amount of the substance being used ''during'' drug rehab treatment</span></span></span> <br />
***<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Successful sobriety for a relative period of time (i.e. self-reported sobriety among patients between 3 and 6 months after treatment)</span></span></span> <br />
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Drug Rehab Centers: Some Claim to Be Experts at Everything</span></span></span> <br />
<br />
&nbsp;<br />
<br />
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Use Person-Centric Language</span></span></span> =<br />
<br />
&nbsp;<br />
<div class="_"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Those writing about mental health and addiction should strongly consider the language they use when describing those struggling with those issues. [https://en.wikipedia.org/wiki/People-first_language People-first language] or person-centric language can influence whether the material produced is further stigmatizing to people. See [[TR_-_Reduce_Stigma_of_Seeking_Help_for_Substance_Misuse|Tools & Resources]] for a guide to using person centric language.</span></span></span></div> <div class="_">&nbsp;</div> <br />
&nbsp;<br />
<br />
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Tools & Resources</span></span></span> =<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[[TR_-_Reduce_Stigma_of_Seeking_Help_for_Substance_Misuse|TR - Reduce Stigma of Seeking Help for Substance Misuse]]</span></span></span></span><br />
<br />
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Scorecard Building</span></span></span> =<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Potential Objective Details (Under Construction)</span><br/> <span style="background-color: #ffffff">Potential Measures and Data Sources (Under Construction)&nbsp;</span><br/> <span style="background-color: #ffffff">Potential Actions and Partners&nbsp;(Under Construction)</span></span></span></span><br />
<br />
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Resources to Investigate</span></span></span> =<br />
<br />
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[[RTI_-_Stigma_&_Substance_Misuse|More RTI on Stigma and Substance Misuse]]</span><br/> <br/> <span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span><br/> <span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span></span></span></span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Reviewer'''</span></span></span><br />
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Date'''</span></span></span><br />
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Comments'''</span></span></span><br />
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= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Sources</span></span></span> =<br />
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----<br />
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&nbsp;<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Public Awareness]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_SBIRT_Program&diff=19416Expand SBIRT Program2019-12-05T22:29:37Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">''Return to &nbsp;[[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Intervention for People Misusing Drugs]]'' <br />
''Go to [[ZOOM_MAP_-_Expand_SBIRT_Program|Zoom Map - Expand SBIRT Program]]''<br />
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Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the ''Diagnostic and Statistical Manual of Mental Disorders,'' Fourth Edition.<br />
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The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.<sup class="reference"><ref>[1]Page Not Found </ref></sup><br />
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By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices. &nbsp;<br />
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= Research on the Effectiveness of SBIRT =<br />
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While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.<br/> &nbsp; This [https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675 2017 report summarizes five years of research on SBIRT]<br/> &nbsp; The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.<br />
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*Greater intervention intensity was associated with larger decrease in substance use. <br />
*Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances. <br />
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<br/> Four factors influenced SBIRT sustainability:<br />
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*Presence of a program champion <br />
*Availability of funding <br />
*Systematic change <br />
*Effective management of SBIRT provider challenges <br />
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<br/> Key Findings:<br />
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*SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs <br />
*SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine <br />
*SBIRT improved treatment system equity, efficiency, and economy <br />
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= SBIRT Related Training =<br />
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== General Training ==<br />
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One of the keys to expanding the use of Screening and SBIRT tools is to increase the general awareness of the SBIRT approach and the value of identifying people who are misusing substances (or at risk of misusing substances) as soon as possible.&nbsp;<br />
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This set of Webinars provides valuable background and could be shared with many different community stakeholders:&nbsp;&nbsp;[https://sbirt.webs.com/webinars https://sbirt.webs.com/webinars]<br />
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More SBIRT Training Resources are available at&nbsp; [http://www.sbirteducation.com http://www.sbirteducation.com]&nbsp;<br />
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== Screening and Intervention Training ==<br />
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Efforts to significantly expand SBIRT in a region will require significant training of a large number of people. One option to accomplish this is through the use of technology.<br />
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'''Kognito''' offers and accredited [https://kognito.com/products/sbi-with-adolescents technology-based training on Screening and Brief Intervention] for youth that use innovative simulations to provide training and evaluate the skills of those taking the training.<br />
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The program was developed in collaboration with NORC at the University of Chicago and adopted by more than 40 schools of health professions and state agencies. It helps improve patient-provider communication and supports the integration of substance use SBI in primary care settings. It is a cost-effective way to train large numbers of people.<br />
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The [https://kognito.com/approach Kognito Conversation Platform] has an innovative behavior change model integrates several evidence-based models and techniques, game mechanics, and learning principles. In these simulations, users enter a virtual environment and engage in role-play conversations with emotionally-responsive virtual humans. Through practice and receiving personalized feedback, users learn and assess their competency to lead similar conversations in real life. Kognito is the only company with health simulations listed in the National Registry of Evidence-based Programs and Practices (NREPP).<br />
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= Screening&nbsp; =<br />
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== Effective Screening Tools ==<br />
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One of the most promising ways to enhance SBIRT is to use some of the new screening tools that are based on new science and that use new technology.&nbsp; The use of tools make it easier for screenings to be done, and the results of the screenings shoudl be more detailed and valuable.&nbsp; &nbsp;Also, in many cases, the screening is a billable event, and if it is done using technology, then it will minize the burden on the healthcare professionals.&nbsp;<br />
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'''[http://interasolutions.com OARS]'''<br/> '''Opioid Abuse Risk Screener (OARS)''' was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk.<ref>Development and preliminary validation of the Opioid Abuse Risk Screener. (n.d.). Retrieved December 5, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/<br />
</ref>&nbsp;This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.<br />
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The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.<br />
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InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's [https://www.usnews.com/news/best-states/ohio/articles/2018-09-12/ohio-set-to-award-latest-prizes-in-opioid-science-challenge Opioid Science Challenge] that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs.&nbsp;<br />
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[[More_information_on_the_Opioid_Abuse_Risk_Screener|More information on the Opioid Abuse Risk Screener]] (OARS)<br />
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= Brief Intervention =<br />
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Models for brief treatment recommended by SAMHSA<sup class="reference"><ref>[8]Page Not Found </ref></sup> include:<br />
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#[[Resources_on_Brief_Negotiated_Interview|Brief Negotiated Interview]] <br />
#Brief counseling <br />
#[[Additional_Info_on_FRAMES|Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)]] <br />
#[[Additional_Info_on_Motivational_Interviewing|Motivational Interviewing (MI) techniques]] <br />
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= Referral to Treatment =<br />
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According to SAMHSA<sup class="reference"><ref>[9]Page Not Found </ref></sup> , commonly used models for brief treatment include:<br />
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#[[Resources_on_Cognitive_Behavioral_Therapy|Cognitive-Behavioral Therapy]] (CBT) <br />
#Motivational Enhancement Therapy <br />
#Community Reinforcement Approach <br />
#Solution-focused Therapy <br />
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= Promising Programs =<br />
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There are many promising programs that seek to expand SBIRT into places where professionals come into contact with people who have started to misuse substances.&nbsp; Several programs have focused on populations that have co-occuring mental health issues, which often leads to self-medication and abuse.<br />
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== Healthcare&nbsp;Settings ==<br />
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Healthcare professinals often come into contact with patients who may have substance misuse issues.&nbsp;&nbsp;<br />
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=== Hopsitals and Emergency Rooms ===<br />
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[https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf]<br />
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=== Dentists and Oral Surgeons ===<br />
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The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810&nbsp;&nbsp;[http://attcnetwork.org/userfiles/file/NFA-SBIRT/110727_The_Applicability_of_SBIRT_in_Dental_Settings_CABHP_Lit_Rev https://www.sciencedirect.com/science/article/pii/S0002817714622649]<br />
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The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638&nbsp;[https://www.sciencedirect.com/science/article/pii/S0002817714607674 https://www.sciencedirect.com/science/article/pii/S0002817714607674]<br />
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== Community Health Centers and Clinics ==<br />
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== Agencies and Programs Addressing Mental Health ==<br />
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Add information here<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning https://ireta.org/resources/what-i]<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning s-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/]<br />
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== Schools ==<br />
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Some states, like Massachusetts have been moving to significantly expand SBIRT in schools.<ref> [2]SBIRT in Schools | Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT). (n.d.). Retrieved December 5, 2019, from https://www.masbirt.org/schools<br />
</ref><br/> A research report shared early findings:&nbsp;<sup><ref>[3]Brenda L, Curtis (2014). Translating SBIRT to public school settings: An initial test of feasibility, Journal of Substance Abuse Treatment, Retrieved from https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf<br />
</ref></sup><br/> Training on using SBIRT in schools to address alcohol use:&nbsp;<sup><ref>[4]School SBIRT: Identifying and Addressing Substance Use, (n.d), Retrieved from: https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf.</ref></sup><br/> This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:<sup><ref>[5]Substance Use Prevention in SBHC | School-Based Health Alliance Substance Use Prevention in SBHC | Redefining Health for Kids and Teens. (n.d.). Retrieved December 5, 2019, from http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/<br />
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= Referral Pathways =<br />
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= Integration of SBIRT into Electronic Health Records =<br />
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One way to enhance the impact of SBIRT is to integrate information from the process into the Electronic Health Record (EHR).&nbsp; "Modifying your organization's electronic health record to support SBIRT can accelerate your patient flow, reduce the burden of data collection, and allow you to monitor and measure the success of your SBIRT implementation."<ref>https://www.indianasbirt.org/ehr-modification</ref><br />
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An overview on this topic, and links to recorded webinars can be found in the SBIRT and Electronic Health Records Toolkit:&nbsp;[https://ireta.org/resources/electronic-health-record-toolkit/ https://ireta.org/resources/electronic-health-record-toolkit/]<br />
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This [https://www.youtube.com/watch?v=faO_bJdNyBQ recorded webinar], provided by [https://ireta.org/ IRETA] and&nbsp;the [https://attcnetwork.org/ Addiction Technology Transfer Center Network], provides a good overview on implementing the integration of SBIRT data into EHRs.&nbsp;<br />
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= Funding =<br />
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The following organizations are currently funding research and initiatives to expand SBIRT:<br />
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#Conrad N. Hilton Foundation<sup class="reference"><ref>[6]Foundation 818.851.3700, C. N. H. (n.d.). Grants. Retrieved December 5, 2019, from Conrad N. Hilton Foundation website: https://www.hiltonfoundation.org/grants<br />
</ref></sup> <br />
#Substance Abuse and Mental Health Service Administration<sup class="reference"><ref>[7]michelle.harrington. (2014, April 3). SBIRT Grantees [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/sbirt/grantees<br />
</ref></sup> <br />
#A report by Catalyst shares several innovative ways to fund SBIRT in schools&nbsp;&nbsp;<br/> [https://www.communitycatalyst.org/resources/publications/document/Funding-and-Sustaining-SBIRT-in-Schools-December-2015.pdf?1451325931 Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools] <br />
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= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
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= Tools & Resources =<br />
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[[TR_-_Expand_SBIRT_Program|TR - Expand SBIRT Program]]<br />
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= Resources to Investigate =<br />
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[[RTI_-_Expand_SBIRT_Program|More RTI on SBIRT]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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= Sources =<br />
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[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_ER_%26_Healthcare_Handoffs_to_Treatment&diff=19415Expand ER & Healthcare Handoffs to Treatment2019-12-05T22:28:32Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output">Return to&nbsp;[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|ZOOM MAP -&nbsp;Improve Treatment & Enable Recovery for People with SUDs]] <br />
&nbsp; By systematically expanding processes for "warm handoffs" by Emergency Departments to treatment, recovery coaches and the other support needed by people who are misusing opioids, developing dependence or who have an SUD, many people will be more likely to get on the path for avoiding addiction or moving forward to long-term recovery.<br />
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= Background =<br />
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ER visits and hospitalizations due to opioid overdose is high and rising.&nbsp;"Overall, ED visits (reported by 52 jurisdictions in 45 states) for suspected opioid overdoses increased 30 percent in the U.S., from July 2016 through September 2017."<ref>Emergency Department Data Show Rapid Increases in Opioid Overdoses | CDC Online Newsroom | CDC. (2019, April 11). Retrieved December 5, 2019, from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html<br />
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More than 140,000 people&nbsp;[https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html visited an ER for overdoses]&nbsp;nationwide between July 2016 and Sept. 2017, according to the Centers for Disease Control and Prevention.<ref>How ER Docs Could Play A Key Role In Fighting The Opioid Epidemic | Center for Health Journalism. (n.d.). Retrieved December 5, 2019, from https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic<br />
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According to a May 2018 article, "Most ER doctors stabilize patients and release them with little or no attempt to offer long-term treatment."<ref>How ER Docs Could Play A Key Role In Fighting The Opioid Epidemic | Center for Health Journalism. (n.d.). Retrieved December 5, 2019, from https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic<br />
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“Research shows that people who have had an overdose are more likely to have another. Emergency department education and post-overdose protocols, including providing naloxone and linking people to treatment, are critical needs,” said Alana Vivolo-Kantor, Ph.D., behavioral scientist in CDC’s National Center for Injury Prevention and Control. “Data on opioid overdoses treated in emergency departments can inform timely, strategic, and coordinated response efforts in the community as well.”<ref>Emergency Department Data Show Rapid Increases in Opioid Overdoses | CDC Online Newsroom | CDC. (2019, April 11). Retrieved December 5, 2019, from https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html</ref><br />
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= Success Stories =<br />
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== Pioneering work in Rhode Island ==<br />
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The "warm handoff" model was pioneered in Rhode Island where&nbsp;all of the state’s emergency departments and hospitals were required to be state-certified to treat OUDs. The&nbsp;EDs must offer&nbsp;peer recovery support; prescribing the overdose reversal drug naloxone to at-risk patients; and offering MAT, including buprenorphine, in the ER or at a doctor’s office or treatment facility.&nbsp; A study by Yale researchers found that opioid-addicted patients were more likely to get treatment and reduce opioid use long-term when started on medication-assisted treatment in the ER.[https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic]&nbsp;<br />
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= Tools & Resources =<br />
<div class="_">TR - ___</div> <div class="_">&nbsp;</div> <div class="_">This white paper from HealthLeaders magazine, [https://interactive.healthleadersmedia.com/Recovery_Begins_in_the_ED Recovery Begins in the ED], has good information.&nbsp;</div> <div class="_">&nbsp;</div> <div class="_">This 2018 report in the Annals of Emergency Medicine provides valuable details: [https://www.annemergmed.com/article/S0196-0644(18)30079-9/fulltext Opportunities for Prevention and Intervention of Opioid Overdoses in the Emergency Department]&nbsp;&nbsp;</div> <div class="_">&nbsp;</div> <div class="_">This [https://emergency.cdc.gov/coca/calls/2018/callinfo_031318.asp webinar from March of 2018] goes into a lot of details on coordinating ER, Public Health and&nbsp;</div> <div class="_">&nbsp;</div> </div> <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
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= Actions to Take =<br />
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[[PA_-_Expand_ER_&_Healthcare_Handoffs_to_Treatment|Potential Actions and Partners]]<br />
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= Resources to Investigate =<br />
<div class="_">More RTI on __</div> <div class="_">&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></div> <div class="_">&nbsp;</div> <br />
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= Sources =<br />
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[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Re-Entry_After_Incarceration_for_People_with_MH_and_SUDs&diff=19389Improve Re-Entry After Incarceration for People with MH and SUDs2019-12-05T17:23:32Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output">Return to<span style="font-size: 13px;">&nbsp;</span>[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]]&nbsp;or [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|<font face="arial, helvetica, sans-serif">Zoom Map - Prioritize SUD Treatment over Incarceration</font>]] <br />
This objective focuses specifically on improving the transition back into society for people with an SUD who have spent time incarcerated.&nbsp; People who are returning to society are at a high risk to overdose and die because their tolerance to opioids is lower and taking the amount of opioids they have previously taken can lead to overdose and death.&nbsp; There are many steps that should be taken to help people move foreward with successful recovery rather than returning to using opioids and the higher chance of overdose.&nbsp;&nbsp;<br />
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= Background =<br />
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*More than 50 percent of graduates of many prison treatment programs relapse within 12 months.<sup class="reference"><ref>[1]Inciardi, J. A., MartIn, S. S., & ButzIn, C. A. (2004). Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders after Release from Prison. Crime & Delinquency, 50(1), 88–107. https://doi.org/10.1177/0011128703258874</ref></sup> <br />
*Upon release from jail or prison, many people with mental or substance use disorders continue to lack access to services and, too often, become enmeshed in a cycle of costly justice system involvement<ref> [2]The Revolving Door of American’s Prisons.(2011). State of Recidivism, Retrieved December 5, 2019, from http://pew.org/1SIW19g</ref> <br />
*An estimated 10-15 percent of the total state and federal prison population, approximately 200,000 people, are estimated to currently or historically have struggled with opioid dependence or abuse.<sup class="reference"><ref>[3]Mumola, C. J., & Karberg, J. C. (2006). Drug Use and Dependence, State and Federal Prisoners, 2004: (560272006-001) [Data set]. https://doi.org/10.1037/e560272006-001</ref></sup> <br />
*A study in Massachusetts showed that people with an OUD who were released from prison were up to 120 times more likely to die than&nbsp;??? (Get details. Healthcare for the Homeless presentation) <br />
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= Potential Benefits =<br />
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== Economic Benefits of People Remaining Substance-Free and Crime-Free after Re-entry ==<br />
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A CASAColumbia report focused on 1996 to 2006 and "found that only 11% of all inmates with addiction received any treatment during their incarceration. The report found that if all inmates who needed treatment and aftercare received such services, the nation would break even in a year if just over 10% remained substance-free, crime-free and employed. Thereafter, for each former inmate who remained substance-free, crime-free and employed, the nation would reap an economic benefit of $90,953 per year."<ref>Substance Abuse & America’s Prison Population 2010 | Center on Addiction. (n.d.). Retrieved December 5, 2019, from https://www.centeronaddiction.org/addiction-research/reports/behind-bars-ii-substance-abuse-and-america%E2%80%99s-prison-population<br />
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= Tools & Resources =<br />
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[[TR_-_Improve_Re-Entry_After_Incarceration_for_People_with_SUDs|TR - Improve Re-Entry After Incarceration for People with SUDs]]<br />
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= Scorecard Building =<br />
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Potential Objective Details (Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
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= Actions to Take =<br />
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[[PA_-_Improve_Re-Entry_After_Incarceration_for_People_with_SUDs|Potential Actions and Partners]]<br />
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= Resources to Investigate =<br />
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[[RTI_-_Improve_Re-Entry_After_Incarceration_for_People_with_SUDs|More RTI on Re-Entry After Incarceration for People with SUDs]]<br/> <br/> '''PAGE MANAGER:''' [insert name here]</span></span><br/> >SUBJECT MATTER EXPERT</span>''': [fill out table below]'''<br />
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[[Category:SAFE-Law Enforcement and Criminal Justice]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Links_to_Treatment_for_People_who_Experience_a_Non-Lethal_Overdoses_or_Naloxone_Revivals&diff=19387Improve Links to Treatment for People who Experience a Non-Lethal Overdoses or Naloxone Revivals2019-12-05T17:14:51Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (<span style="font-family: Helvetica; font-size: 10pt;">Improve Treatment & Enable Recovery for People with SUDs</span>)]]&nbsp;<span style="font-size: 13px;">or </span>[[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]<br />
<br />
As first responders and others in communities are increasingly using naloxone (often Narcan) to reverse overdoses and prevent deaths, there is often a missed opportunity to connect the people who were revived from the overdose with the appropriate Medication-Assisted Treatment (MAT).&nbsp; Typically, after receiving a lifesaving dose of naloxone, patients are released with only information and numbers to call if they’re ready to start their recovery.&nbsp; Regardless of whether a person survived due to administration of naloxone, or whether they were taken to an ER or hospital or if they survived the overdose without either of those, a comprehensive strategy should have multiple ways that help that person get into treatment.&nbsp;<br />
<br />
= Background =<br />
<br />
*One of the best opportunities to prescribe maintenance medication occurs during the hours or days after the overdose reversal or hospitalization for an overdose <br />
*Maintenance medication is the only approach known to cut the overdose mortality rate by 50-70%<sup class="reference"><ref>[1]Pierce, M., Bird, S. M., Hickman, M., Marsden, J., Dunn, G., Jones, A., & Millar, T. (2016). Impact of treatment for opioid dependence on fatal drug-related poisoning: A national cohort study in England. Addiction, 111(2), 298–308. https://doi.org/10.1111/add.13193<br />
</ref></sup> <br />
*In one clinical trial, those offered immediate medication treatment were: <br />
**Twice as likely as those who were simply offered treatment referrals to still be in treatment a month later<sup class="reference"><ref>[2]Szalavitz, M. (2016). Opioid Overdose: Emergency Treatment Is Crucial, but It’s Not Enough. Retrieved December 5, 2019, from Scientific American Blog Network website: https://blogs.scientificamerican.com/guest-blog/opioid-overdose-emergency-treatment-is-crucial-but-it-s-not-enough/<br />
</ref></sup> <br />
**Reduced their illegal opioid use from an average of five days a week to an average of just one<sup class="reference"><ref>[3]Szalavitz, M. (2016). Opioid Overdose: Emergency Treatment Is Crucial, but It’s Not Enough. Retrieved December 5, 2019, from Scientific American Blog Network website: https://blogs.scientificamerican.com/guest-blog/opioid-overdose-emergency-treatment-is-crucial-but-it-s-not-enough/<br />
</ref></sup> <br />
<br />
&nbsp;<br />
<br />
= Programs =<br />
<div class="mw-parser-output"><br />
== Emergency Medicine Initiative ==<br />
<div class="_">The Addiction Policy Forum will work with hospitals to develop tools to support effective post-overdose interventions. This project will ensure that health systems have the necessary protocols, assessment tools, and linkages between care and follow-up to turn an overdose into an opportunity for intervention and connection with treatment and recovery. Pilots underway with Mercy Health Systems and Berger Hospital in Ohio will produce open-source tools and protocols necessary to support emergency departments across the country in implementing interventions to help patients who overdose.<sup class="reference"><ref>[4]Page Not Found </ref></sup></div> </div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Links_to_Treatment_for_People_who_Experience_a_Non-Lethal_Overdoses_or_Naloxone_Revivals|TR - Improve Links to Treatment for People who Experience a Non-Lethal Overdoses or Naloxone Revivals]]<br />
<br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)<br/> Potential Measures and Data Sources(Under Construction)<br/> Potential Actions and Partners(Under Construction)<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Links_to_Treatment_for_People_who_Experience_a_Non-Lethal_Overdoses_or_Naloxone_Revivals|More RTI on Links to Treatment for Those that Experience a Non-lethal Overdose]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]] [[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Become_a_Trauma-Informed_Community&diff=19383Become a Trauma-Informed Community2019-12-05T17:12:01Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|the Zoom Map (Minimize Desire to Misuse Opioids)]]&nbsp;or [[ZOOM_Map-Become_a_Trauma_Informed_Community|ZOOM MAP - Become a Trauma-Informed Community]]<br />
<br />
&nbsp;<br />
<br />
= What is a Trauma-Informed Community =<br />
<br />
This article provides information on Trauma-Informed Community<br/> [https://blog.oup.com/2018/05/underlying-drivers-opioid-crisis/ https://blog.oup.com/2018/05/underlying-drivers-opioid-crisis/]<br />
<br />
= Root Causes of Trauma =<br />
<br />
*Childhood abuse or neglect <br />
*Physical, emotional, or sexual abuse <br />
*Accidental and natural disasters <br />
*Witnessing acts of violence <br />
*Cultural, intergenerational and historical trauma <br />
*Medical interventions <br />
*War and other forms of violence <br />
<br />
= Trauma-Informed Systems =<br />
<br />
Trauma Informed Systems provide the following protective factors for children:<br />
<br />
&nbsp;<br />
<br />
#Strong supportive relationship with a caring, committed adult <br />
#Connection with a positive role model or mentor <br />
#Recognition and nurturance of their strengths and abilities <br />
#Some sense of control over their own lives <br />
#A sense of membership in a community larger than themselves, such as their neighborhood or cultural group or peer group<sup class="reference"><ref>[1]Brown, D.(2013), Trauma & Community Violence in a Socio-Ecological Model, SDSU Child, Family Development, Retrieved from https://www.sandiego.gov/sites/default/files/legacy/gangcommission/pdf/traumancommunityviolence.pdf</ref></sup> <br />
<br />
&nbsp;<br />
<br />
= Successful City Initiatives =<br />
<br />
Self-Healing Communities program in Washington<br />
<br />
&nbsp; Community Trauma and Addressing Community Trauma<br/> &nbsp; The Prevention Institute is working on understanding and addressing Community Trauma in Ohio<br/> &nbsp; &nbsp;&nbsp;[https://blog.oup.com/2018/05/underlying-drivers-opioid-crisis/ https://blog.oup.com/2018/05/underlying-drivers-opioid-crisis/]<br />
<br />
&nbsp;<br />
<br />
= Training Opportunities and Materials =<br />
<br />
There is a growing amount of material on how trauma-informed practices can improve prevention, treatment and recovery.<br />
<br />
&nbsp;<br />
<br />
== Training on Trauma-Informed Practices as a Prevention Strategy ==<br />
<br />
Webinar on [https://www.youtube.com/watch?v=vdqX3febYN8 How to Implement Trauma-Informed Practices in Schools] by Jim Sporleder<br/> &nbsp; Webinar on [https://www.youtube.com/watch?v=-O6yjHl3Jt4 Implementing Trauma-Informed Approaches in Minnesota Schools] hosted by Minnesota Communities Caring for Children<br />
<br />
&nbsp;<br />
<br />
== Training in Trauma-Informed Practices for Addiction Treatment ==<br />
<br />
New Beginnings, a Minnesota-based treatment center, will be conducting a workshop on [https://nbminnesota.com/project/trauma-informed-care-workshop-8-10-18/ Trauma-Informed Care in Addiction Treatment] on August 10, 2018<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Training on Trauma-Informed Practices to Support Recovery ==<br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Become_a_Trauma_Informed_Community|TR - Become a Trauma-Informed Community]]<br/> [http://rxtip.org/ RXTip.org- submit anonymous tips about drug abuse]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
<span style="background-color: #ffffff">Potential Objective Details</span>(Under construction)&nbsp;<br/> <span style="background-color: #ffffff">Potential Measures and Data Sources</span>(Under construction)&nbsp;<br/> <span style="background-color: #ffffff">Potential Actions and Partners</span>(Under construction)&nbsp;<br />
<div class="mw-parser-output">&nbsp;</div> </div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Become_a_Trauma_Informed_Community|More RTI on Trauma Informed Communities]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
</div> <br />
= Sources =<br />
</div> </div> </div> </div> </div></div> <br />
[[Category:SAFE-Public Awareness]] [[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_SBIRT_Program&diff=19380Expand SBIRT Program2019-12-05T17:08:56Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">''Return to &nbsp;[[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Intervention for People Misusing Drugs]]'' <br />
''Go to [[ZOOM_MAP_-_Expand_SBIRT_Program|Zoom Map - Expand SBIRT Program]]''<br />
<br />
----<br />
<br />
Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the ''Diagnostic and Statistical Manual of Mental Disorders,'' Fourth Edition.<br />
<br />
The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.<sup class="reference"><ref>[1]Page Not Found </ref></sup><br />
<br />
By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices. &nbsp;<br />
<br />
__TOC__<br />
<br />
&nbsp;<br />
<br />
= Research on the Effectiveness of SBIRT =<br />
<br />
While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.<br/> &nbsp; This [https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675 2017 report summarizes five years of research on SBIRT]<br/> &nbsp; The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.<br />
<br />
&nbsp;<br />
<br />
*Greater intervention intensity was associated with larger decrease in substance use. <br />
*Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances. <br />
<br />
<br/> Four factors influenced SBIRT sustainability:<br />
<br />
*Presence of a program champion <br />
*Availability of funding <br />
*Systematic change <br />
*Effective management of SBIRT provider challenges <br />
<br />
<br/> Key Findings:<br />
<br />
*SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs <br />
*SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine <br />
*SBIRT improved treatment system equity, efficiency, and economy <br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
SBIRT in Schools<br />
<br />
Some states, like Massachusetts have been moving to significantly expand SBIRT in schools.<ref> [2]SBIRT in Schools | Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT). (n.d.). Retrieved December 5, 2019, from https://www.masbirt.org/schools<br />
</ref><br/> &nbsp; A research report shared early findings:&nbsp;<sup><ref>[3]Brenda L, Curtis (2014). Translating SBIRT to public school settings: An initial test of feasibility, Journal of Substance Abuse Treatment, Retrieved from https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf<br />
</ref></sup><br/> &nbsp; Training on using SBIRT in schools to address alcohol use:&nbsp;<sup><ref>[4]School SBIRT: Identifying and Addressing Substance Use, (n.d), Retrieved from: https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf.</ref></sup><br/> &nbsp; This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:<sup><ref>[5]Substance Use Prevention in SBHC | School-Based Health Alliance Substance Use Prevention in SBHC | Redefining Health for Kids and Teens. (n.d.). Retrieved December 5, 2019, from http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/<br />
</ref></sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><br />
== SBIRT in Emergency Room Settings ==<br />
<br />
Add information here<br />
<br />
[https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf]<br />
<br />
&nbsp;<br />
</div> <br />
== SBIRT in Community Clinics & FQHCs ==<br />
<br />
Add information here.<br/> &nbsp;<br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><div class="mw-parser-output"><br />
== SBIRT in Mental Health Settings ==<br />
<br />
Add information here<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/]<br />
</div> <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
== SBIRT in Dental Settings ==<br />
<br />
Add information here<br />
<br />
The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810&nbsp;&nbsp;[http://attcnetwork.org/userfiles/file/NFA-SBIRT/110727_The_Applicability_of_SBIRT_in_Dental_Settings_CABHP_Lit_Rev https://www.sciencedirect.com/science/article/pii/S0002817714622649]<br />
<br />
The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638&nbsp;[https://www.sciencedirect.com/science/article/pii/S0002817714607674 https://www.sciencedirect.com/science/article/pii/S0002817714607674]<br />
</div> <br />
= Funding =<br />
<div class="mw-parser-output"><div class="mw-parser-output"><br />
The following organizations are currently funding research and initiatives to expand SBIRT:<br />
<br />
&nbsp;<br />
<br />
#Conrad N. Hilton Foundation<sup class="reference"><ref>[6]Foundation 818.851.3700, C. N. H. (n.d.). Grants. Retrieved December 5, 2019, from Conrad N. Hilton Foundation website: https://www.hiltonfoundation.org/grants<br />
</ref></sup> <br />
#Substance Abuse and Mental Health Service Administration<sup class="reference"><ref>[7]michelle.harrington. (2014, April 3). SBIRT Grantees [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/sbirt/grantees<br />
</ref></sup> <br />
#A report by Catalyst shares several innovative ways to fund SBIRT in schools&nbsp;&nbsp;<br/> [https://www.communitycatalyst.org/resources/publications/document/Funding-and-Sustaining-SBIRT-in-Schools-December-2015.pdf?1451325931 Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools] <br />
</div> </div> <div class="mw-parser-output"><br />
= Screening =<br />
<br />
More information about [[Improve_&_Expand_Screening_for_Risk_Factors_&_Testing_for_Misuse|screening and testing for misuse]].<br />
</div> <br />
= Brief Intervention =<br />
<br />
Models for brief treatment recommended by SAMHSA<sup class="reference"><ref>[8]Page Not Found </ref></sup> include:<br />
<br />
&nbsp;<br />
<br />
#[[Resources_on_Brief_Negotiated_Interview|Brief Negotiated Interview]] <br />
#Brief counseling <br />
#[[Additional_Info_on_FRAMES|Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)]] <br />
#[[Additional_Info_on_Motivational_Interviewing|Motivational Interviewing (MI) techniques]] <br />
<div class="mw-parser-output">&nbsp;</div> </div> <br />
= Referral to Treatment =<br />
<br />
According to SAMHSA<sup class="reference"><ref>[9]Page Not Found </ref></sup> , commonly used models for brief treatment include:<br />
<br />
&nbsp;<br />
<br />
#[[Resources_on_Cognitive_Behavioral_Therapy|Cognitive-Behavioral Therapy]] (CBT) <br />
#Motivational Enhancement Therapy <br />
#Community Reinforcement Approach <br />
#Solution-focused Therapy <br />
</div> <div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_SBIRT_Program|TR - Expand SBIRT Program]]<br />
<div class="mw-parser-output"><br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_SBIRT_Program|More RTI on SBIRT]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
&nbsp;<br />
</div> <br />
= Sources =<br />
<br />
----<br />
</div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Detection_and_Treatment_of_Mental_Health_Conditions&diff=19369Improve Detection and Treatment of Mental Health Conditions2019-12-03T19:32:18Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]] <br />
Initial use of opioids by youth is often done as self-medication for dealing with trauma, depression or anxiety. (Research and sources needed).&nbsp; In one national survey of young adults aged 18-24, more than 61 percent of respondents who had used opioids not prescribed to them had done so primarily to relieve anxiety and stress<sup class="reference"><ref>[1]Hazelden Betty Ford Foundation(2015), Youth Opioid Study: Attitudes and Usage, Retrieved from http://marychristiefoundation.org/core/uploads/2015/04/Youth-Opioid-Survey-Report.pdf<br />
</ref></sup>. Therefore, a comprehensive strategy should include efforts to improve the detection and treatment of mental health conditions.<br />
<br />
= Background =<br />
<br />
== Youth are Struggling with Mental Health Issues ==<br />
<br />
A nationwide U.S. survey of over 1300 14- to 22-year-olds done in February and March of 2018 shows evidence of a growing mental health crisis affecting young people. The survey, sponsored by Hopelab and Well Being Trust (WBT), finds that many teens and young adults are experiencing moderate to severe symptoms of depression are turning to the internet for help. Common uses of the Internet include researching mental health issues online (90 percent), accessing other people’s health stories through blogs, podcasts, and videos (75 percent), using mobile apps related to well-being (38 percent), and connecting with health providers through digital tools such as texting and video chat (32 percent).<ref> [2]Page Not Found </ref><br />
<br />
== Depression ==<br />
<br />
*Because depression is under-diagnosed and untreated, depression and opioid abuse are strongly concurrent.<sup class="reference"><ref>[3]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*People with depression show abnormalities in the body’s release of its own opioid chemicals<sup class="reference"><ref>[4]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery<sup class="reference"><ref>Sullivan, M. D. (2016). Why does depression promote long-term opioid use? PAIN, 157(11), 2395. https://doi.org/10.1097/j.pain.0000000000000658</ref></sup> <br />
*Depression nearly doubles the risk that someone already using opioids will continue to use them long-term<sup class="reference"><ref>[6]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
<br />
== Depression & Opioids ==<br />
<br />
*Depressed people are about twice as likely as non-depressed people to misuse their painkillers for non-pain symptoms<sup class="reference"><ref>[7]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depressed individuals were between two and three times more likely to ramp up their own doses of painkillers<ref> [8]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref> <br />
*Adolescents with depression are also more likely to use prescription painkillers for non-medical reasons and to become addicted<sup class="reference"><ref>[9]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depressed people are likely to keep using opioids, even when their pain has subsided and when they are more functional <sup class="reference"><ref>[10]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
<br />
== Stigma & Depression ==<br />
<br />
Stigmatization of depression can reduce the likelihood of people reaching out to get the mental care they need. Instead, depressed people may ask for prescriptions for physical ailments, and use their prescription drugs to treat their emotional pain. <sup class="reference"><ref>[11]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup><br />
<br />
== Rural Areas ==<br />
<br />
In particular, shortages of mental-health providers are prominent in rural areas where the opioid epidemic hit the hardest. Some have suggested that providing mental health care to those suffering from chronic pain may help detangle the relationship between pain and depression.<sup class="reference"><ref>[12]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup><br/> &nbsp;<br />
<br />
== Co-Occurring Disorders ==<br />
<br />
Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
There are a growing number of promising programs for helping to identify and address mental health issues.<br />
<br />
== Virtual Reality Therapy ==<br />
<br />
[http://ict.usc.edu/profile/albert-skip-rizzo/ Dr. Skip Rizzo] has been working since the 1990s to use virtual reality to treat mental illness. <ref>[13] Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/<br />
</ref>In an "early clinical trial of the software found that "after an average of seven sessions, 45 percent of those treated no longer screened positive for PTSD and 62 percent had reliably improved."<sup class="reference"><ref>[14]Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/</ref></sup><br/> <br/> The [http://www.vrphobia.com/index.htm Virtual Reality Medical Center] uses simulation technologies for:<br />
<br />
#Treating patients with anxiety disorders <br />
#Training for both military and civilian populations <br />
#Enhancing various educational programs <br />
<br />
== Benefits of VR Therapy ==<br />
<br />
*Faster than traditional therapy and desensitization<sup class="reference"><ref>[15]About Us. (n.d.). Retrieved December 3, 2019, from Virtual Reality Medical Center website: https://vrphobia.com/about-us-old/<br />
</ref></sup> <br />
*Practice these skills in situations in which you previously experienced anxiety, allowing the skills to generalize more easily to real world settings<sup class="reference"><ref>[16]About Us. (n.d.). Retrieved December 3, 2019, from Virtual Reality Medical Center website: https://vrphobia.com/about-us-old/<br />
</ref></sup> <br />
*Can do some sessions in between office session at home, cuts down on the number of sessions people need<sup class="reference"><ref>[17]Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/</ref></sup> <br />
<br />
&nbsp;<br />
<br />
== M3 Checklist (Screening Tool) ==<br />
<br />
[https://www.m3information.com/about-us/ M3 Information] developed a mental health screen that measures outcomes based on a 27-question diagnostic checklist and a related algorithm targeted for adults aged 18 and older. The M3 Checklist accurately measures outcomes based on question responses for major depression, bipolar disorder, anxiety disorder and posttraumatic stress disorder (PTSD).<br/> &nbsp;<br />
<br />
== Project Aware ==<br />
<br />
[https://www.samhsa.gov/nitt-ta/distance-learning-videos/project-aware Project AWARE] is a SAMHSA program that focuses on student mental health and wellness, While not specifically focused on opioid abuse prevention, much of the work that grantees are doing may also help prevent opioid misuse. Through Project AWARE, schools are implementing evidence-based, culturally appropriate prevention programs that support youth at the universal, selective, and indicated levels.<br/> &nbsp;<br />
<br />
== Communities that Care ==<br />
<br />
Programs such as [https://www.communitiesthatcare.net/ Communities That Care] promote a range of youth mental and behavioral health outcomes, included reduced risk for opioid misuse and addiction. (Find Source)<br />
<br />
&nbsp;<br />
<br />
== myStrength ==<br />
<br />
[http://www.mystrength.com myStrength] is a digital platform that integrates state-of-the-art technologies to support people in addressing mental and behavioral health issues. It can be integrated with a professional practice to allow them to see more patients more efficiently and better meet the needs of their patients between in-person visits. Learn more at this [https://www.mystrength.com/news/events/webinar-drive-utilization-revenue-and-outcomes-via-an-integrated-in-person-and-digital-therapeutic-model recorded Webinar].<br/> &nbsp;<br />
<br />
= Free Mental Health Apps =<br />
<br />
<span style="color: #ff0000">[need evidence]</span><br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|TR - Improve Detection & Treatment of Mental Health Conditions]]<br/> <br/> Resources for Suicide and Substance Use Prevention in Youth<br/> 2017 SAMHSA Webinar on [https://www.youtube.com/watch?v=AIQWbywRzWY Suicide and Substance Abuse among Young People] and includes best practices for prevention and intervention.<br/> <br/> <br/> SAMHSA has a [https://www.samhsa.gov/sites/default/files/programs_campaigns/nation_prevention_week/npw-2018-organizations-places-assistance.pdf new list of organizations and resources] updated May 2018 with many different types of resources and organizations. (This should be investigated and specific links added throughout the OCRH.<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details (Under Construction)<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
</div><br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|Potential Actions for Coalitions and Partners]]<br />
<br />
Actions for Individuals<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|RTI - Improve Detection & Treatment of Mental Health Conditions]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| &nbsp;<br />
| '''Date'''<br />
| &nbsp;<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> <br />
</div> </div> </div> </div> </div><br />
</div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Detection_and_Treatment_of_Mental_Health_Conditions&diff=19368Improve Detection and Treatment of Mental Health Conditions2019-12-03T19:31:42Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]] <br />
Initial use of opioids by youth is often done as self-medication for dealing with trauma, depression or anxiety. (Research and sources needed).&nbsp; In one national survey of young adults aged 18-24, more than 61 percent of respondents who had used opioids not prescribed to them had done so primarily to relieve anxiety and stress<sup class="reference"><ref>[1]Hazelden Betty Ford Foundation(2015), Youth Opioid Study: Attitudes and Usage, Retrieved from http://marychristiefoundation.org/core/uploads/2015/04/Youth-Opioid-Survey-Report.pdf<br />
</ref></sup>. Therefore, a comprehensive strategy should include efforts to improve the detection and treatment of mental health conditions.<br />
<br />
= Background =<br />
<br />
== Youth are Struggling with Mental Health Issues ==<br />
<br />
A nationwide U.S. survey of over 1300 14- to 22-year-olds done in February and March of 2018 shows evidence of a growing mental health crisis affecting young people. The survey, sponsored by Hopelab and Well Being Trust (WBT), finds that many teens and young adults are experiencing moderate to severe symptoms of depression are turning to the internet for help. Common uses of the Internet include researching mental health issues online (90 percent), accessing other people’s health stories through blogs, podcasts, and videos (75 percent), using mobile apps related to well-being (38 percent), and connecting with health providers through digital tools such as texting and video chat (32 percent).<ref> [2]Page Not Found </ref><br />
<br />
== Depression ==<br />
<br />
*Because depression is under-diagnosed and untreated, depression and opioid abuse are strongly concurrent.<sup class="reference"><ref>[3]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*People with depression show abnormalities in the body’s release of its own opioid chemicals<sup class="reference"><ref>[4]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery<sup class="reference"><ref>Sullivan, M. D. (2016). Why does depression promote long-term opioid use? PAIN, 157(11), 2395. https://doi.org/10.1097/j.pain.0000000000000658</ref></sup> <br />
*Depression nearly doubles the risk that someone already using opioids will continue to use them long-term<sup class="reference"><ref>[6]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
<br />
== Depression & Opioids ==<br />
<br />
*Depressed people are about twice as likely as non-depressed people to misuse their painkillers for non-pain symptoms<sup class="reference"><ref>[7]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depressed individuals were between two and three times more likely to ramp up their own doses of painkillers<ref> [8]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref> <br />
*Adolescents with depression are also more likely to use prescription painkillers for non-medical reasons and to become addicted<sup class="reference"><ref>[9]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
*Depressed people are likely to keep using opioids, even when their pain has subsided and when they are more functional <sup class="reference"><ref>[10]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup> <br />
<br />
== Stigma & Depression ==<br />
<br />
Stigmatization of depression can reduce the likelihood of people reaching out to get the mental care they need. Instead, depressed people may ask for prescriptions for physical ailments, and use their prescription drugs to treat their emotional pain. <sup class="reference"><ref>[11]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup><br />
<br />
== Rural Areas ==<br />
<br />
In particular, shortages of mental-health providers are prominent in rural areas where the opioid epidemic hit the hardest. Some have suggested that providing mental health care to those suffering from chronic pain may help detangle the relationship between pain and depression.<sup class="reference"><ref>[12]Does Depression Contribute to Opioid Abuse? - The Atlantic. (n.d.). Retrieved December 3, 2019, from https://www.theatlantic.com/health/archive/2017/05/is-depression-contributing-to-the-opioid-epidemic/526560/<br />
</ref></sup><br/> &nbsp;<br />
<br />
== Co-Occurring Disorders ==<br />
<br />
Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.<br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
There are a growing number of promising programs for helping to identify and address mental health issues.<br />
<br />
== Virtual Reality Therapy ==<br />
<br />
[http://ict.usc.edu/profile/albert-skip-rizzo/ Dr. Skip Rizzo] has been working since the 1990s to use virtual reality to treat mental illness. <ref>[13] Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/<br />
</ref>In an "early clinical trial of the software found that "after an average of seven sessions, 45 percent of those treated no longer screened positive for PTSD and 62 percent had reliably improved."<sup class="reference"><ref>[14]Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/</ref></sup><br/> <br/> The [http://www.vrphobia.com/index.htm Virtual Reality Medical Center] uses simulation technologies for:<br />
<br />
#Treating patients with anxiety disorders <br />
#Training for both military and civilian populations <br />
#Enhancing various educational programs <br />
<br />
== Benefits of VR Therapy ==<br />
<br />
*Faster than traditional therapy and desensitization<sup class="reference"><ref>[15]About Us. (n.d.). Retrieved December 3, 2019, from Virtual Reality Medical Center website: https://vrphobia.com/about-us-old/<br />
</ref></sup> <br />
*Practice these skills in situations in which you previously experienced anxiety, allowing the skills to generalize more easily to real world settings<sup class="reference"><ref>[16]About Us. (n.d.). Retrieved December 3, 2019, from Virtual Reality Medical Center website: https://vrphobia.com/about-us-old/<br />
</ref></sup> <br />
*Can do some sessions in between office session at home, cuts down on the number of sessions people need<sup class="reference"><ref>[17]Crain.com. (n.d.). Retrieved December 3, 2019, from Crain website: https://www.crain.com/</ref></sup> <br />
<br />
&nbsp;<br />
<br />
== M3 Checklist (Screening Tool) ==<br />
<br />
[https://www.m3information.com/about-us/ M3 Information] developed a mental health screen that measures outcomes based on a 27-question diagnostic checklist and a related algorithm targeted for adults aged 18 and older. The M3 Checklist accurately measures outcomes based on question responses for major depression, bipolar disorder, anxiety disorder and posttraumatic stress disorder (PTSD).<br/> &nbsp;<br />
<br />
== Project Aware ==<br />
<br />
[https://www.samhsa.gov/nitt-ta/distance-learning-videos/project-aware Project AWARE] is a SAMHSA program that focuses on student mental health and wellness, While not specifically focused on opioid abuse prevention, much of the work that grantees are doing may also help prevent opioid misuse. Through Project AWARE, schools are implementing evidence-based, culturally appropriate prevention programs that support youth at the universal, selective, and indicated levels.<br/> &nbsp;<br />
<br />
== Communities that Care ==<br />
<br />
Programs such as [https://www.communitiesthatcare.net/ Communities That Care] promote a range of youth mental and behavioral health outcomes, included reduced risk for opioid misuse and addiction. (Find Source)<br />
<br />
&nbsp;<br />
<br />
== myStrength ==<br />
<br />
[http://www.mystrength.com myStrength] is a digital platform that integrates state-of-the-art technologies to support people in addressing mental and behavioral health issues. It can be integrated with a professional practice to allow them to see more patients more efficiently and better meet the needs of their patients between in-person visits. Learn more at this [https://www.mystrength.com/news/events/webinar-drive-utilization-revenue-and-outcomes-via-an-integrated-in-person-and-digital-therapeutic-model recorded Webinar].<br/> &nbsp;<br />
<br />
= Free Mental Health Apps =<br />
<br />
<span style="color: #ff0000">[need evidence]</span><br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|TR - Improve Detection & Treatment of Mental Health Conditions]]<br/> <br/> Resources for Suicide and Substance Use Prevention in Youth<br/> 2017 SAMHSA Webinar on [https://www.youtube.com/watch?v=AIQWbywRzWY Suicide and Substance Abuse among Young People] and includes best practices for prevention and intervention.<br/> <br/> <br/> SAMHSA has a [https://www.samhsa.gov/sites/default/files/programs_campaigns/nation_prevention_week/npw-2018-organizations-places-assistance.pdf new list of organizations and resources] updated May 2018 with many different types of resources and organizations. (This should be investigated and specific links added throughout the OCRH.<br />
<br />
= Scorecard Building =<br />
<br />
[[PO_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|Potential Objective Details]]<br/> [[PM_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|Potential Measures and Data Sources]]<br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|Potential Actions for Coalitions and Partners]]<br />
<br />
Actions for Individuals<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Detection_&_Treatment_of_Mental_Health_Conditions|RTI - Improve Detection & Treatment of Mental Health Conditions]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| &nbsp;<br />
| '''Date'''<br />
| &nbsp;<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> <br />
</div> </div> </div> </div> </div><br />
</div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Job_Opportunities_for_At-Risk_Individuals&diff=19367Improve Job Opportunities for At-Risk Individuals2019-12-03T19:22:20Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]]<br />
<br />
----<br />
<br />
__TOC__When peoeple don't have job opportunites, the likelihood of drug misuse increases.&nbsp; Therefore, part of a comprehensive strategy should include specific efforts to create job opportunities for people who may choose to not misuse drugs if they have a job.&nbsp; By targeting employment opportunities (and connections to those jobs) to people who might otherwise begin to misuse drugs, the community health benefits can increase.&nbsp;<br />
<br />
= Background =<br />
<br />
*Opioid misuse and use disorders were more common among people with lower family incomes, without health insurance or without jobs.<sup class="reference"><ref>More Than A Third Of US Adults Prescribed Opioids In 2015 | HuffPost Life. (n.d.). Retrieved December 3, 2019, from https://www.huffpost.com/entry/2015-opioids-survey_n_597fbf42e4b08e1430051bd1?utm_medium=email&utm_campaign=TheMorningEmail080117&utm_content=TheMorningEmail080117+CID_aab2173fd55d83c6c55bbc305653daee&utm_source=Email+marketing+software&utm_term=Reuters&ncid=newsltushpmgnewsTheMorningEmail080117<br />
</ref></sup> <br />
*In the United States, 18.1% of unemployed adults use illicit drugs – that’s more than double the percentage of users who are employed full-time.<sup class="reference"><ref>Page Not Found </ref></sup> <br />
*States with higher unemployment rates tend to have higher rates of drug use.<sup class="reference"><ref>Page Not Found </ref></sup> <br />
*After the economic downturn in 2008, marijuana and other drug use increased as unemployment increased. This pattern is reflected in every age group except for the elderly.<sup class="reference"><ref>Page Not Found </ref></sup> <br />
*When teens (14-18) and young adults (18-25) are unemployed, the likelihood to abuse drug increases.<sup class="reference"><ref>Page Not Found </ref></sup> <br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Job_Opportunities|TR - Improve Job Opportunities]]<br />
<br />
= Scorecard Building =<br />
<br />
Potential Objective Details (Under Construction)&nbsp;<br/> Potential Measures and Data Sources (Under Construction)&nbsp;<br/> Potential Actions and Partners (Under Construction)&nbsp;<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Job_Opportunities|RTI - Improve Job Opportunities]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| border="1" class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
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[[Category:Community Resources]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_%26_Improve_Support_for_Youth_Outreach,_Leadership,_Prevention,_and_Education&diff=19366Expand & Improve Support for Youth Outreach, Leadership, Prevention, and Education2019-12-03T19:20:22Z<p>Josiebeets: </p>
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Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or&nbsp;[[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Improve Protective Factors to Minimize Desire to Misuse Opioids)]]<br />
<br />
= Background =<br />
<br />
A positive relationship between peer drug use and drug use among adolescents is well-established in scientific literature.<sup class="reference"><ref>[1]Santor, D. A., Messervey, D., & Kusumakar, V. (2000). Measuring Peer Pressure, Popularity, and Conformity in Adolescent Boys and Girls: Predicting School Performance, Sexual Attitudes, and Substance Abuse. Journal of Youth and Adolescence, 29(2), 163–182. https://doi.org/10.1023/A:1005152515264<br />
</ref></sup><sup class="reference"><ref>[2]Dielman, T. E., et al. </ref></sup><sup class="reference"><ref>[3]Brooks-Russell, A., Conway, K. P., Liu, D., Xie, Y., Vullo, G. C., Li, K., … Simons-Morton, B. (2015). Dynamic Patterns of Adolescent Substance Use: Results From a Nationally Representative Sample of High School Students. Journal of Studies on Alcohol and Drugs, 76(6), 962–970. https://doi.org/10.15288/jsad.2015.76.962<br />
</ref></sup><sup class="reference"><ref>[4]Tucker, J. S., Ewing, B. A., Miles, J. N. V., Shih, R. A., Pedersen, E. R., & D’Amico, E. J. (2015). Predictors and consequences of prescription drug misuse during middle school. Drug and Alcohol Dependence, 156, 254–260. https://doi.org/10.1016/j.drugalcdep.2015.09.018<br />
</ref></sup><sup class="reference"><ref>[5]McDonough, M. H., Jose, P. E., & Stuart, J. (2016). Bi-directional Effects of Peer Relationships and Adolescent Substance Use: A Longitudinal Study. Journal of Youth and Adolescence, 45(8), 1652–1663. https://doi.org/10.1007/s10964-015-0355-4<br />
</ref></sup> Recently, a study of teen and adult drivers showed that the reward-processing areas of the brains of teens are more active when their behavior is observed, suggesting that the "presence of peers is sufficient in itself to make risks feel more worthwhile to teens," including using drugs.<ref>[6]Chein, J., Albert, D., O’Brien, L., Uckert, K., & Steinberg, L. (2011). Peers increase adolescent risk taking by enhancing activity in the brain’s reward circuitry. Developmental Science, 14(2), F1-10. https://doi.org/10.1111/j.1467-7687.2010.01035.x<br />
</ref><br />
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= School Based Prevention =<br />
<br />
'''Social Resistance Skills'''<br/> In this type of training, students are taught how to recognize situations in which they are likely to face peer pressure and are given strategies to deal with these situations including formulating counter arguments.<sup class="reference"><ref>[7]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005<br />
</ref></sup> This approach alone does not counteract peer pressure, but can be effective when used in conjunction with normative education.<sup class="reference"><ref>[8]Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20(3), 414–430. https://doi.org/10.1016/0091-7435(91)90039-7<br />
</ref></sup><sup class="reference"><ref>[9]Clayton, R. R., Cattarello, A. M., & Johnstone, B. M. (1996). The Effectiveness of Drug Abuse Resistance Education (Project DARE): 5-Year Follow-Up Results. Preventive Medicine, 25(3), 307–318. https://doi.org/10.1006/pmed.1996.0061<br />
</ref></sup><br/> <br/> '''Normative Education'''<br/> This approach attempts to counteract inaccurate perceptions of drug and alcohol abuse. According to Griffen and Botvin (2010) "Many adolescents overestimate the prevalence of smoking, drinking, and the use of certain drugs, which can make substance use seem to be normative behavior. Educating youth about actual rates of use, which are almost always lower than the perceived rates of use, can reduce perceptions regarding the social acceptability of drug use."<sup class="reference"><ref>[10]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005<br />
</ref></sup> Studies have shown that normative education alone and in conjunction with social resistance training can be effective in reducing alcohol, cigarette, and marijuana use among adolescents.<sup class="reference"><ref>[11]Hansen, W. B., & Graham, J. W. (1991). Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine, 20(3), 414–430. https://doi.org/10.1016/0091-7435(91)90039-7<br />
</ref></sup><br/> <br/> '''Competence Enhancement/Life Skills Training (LST)'''<br/> This approach focuses on the social learning processes that play a role in the development of drug use in adolescents. Students are taught some combination of the following life skills:<br />
<br />
*<br />
**<br />
***general problem solving and decision-making <br />
***general cognitive skills for resisting interpersonal media influences <br />
***skills for increasing self-control and self-esteem <br />
***adapting coping strategies for relieving stress and anxiety through use of cognitive coping skills or behavioral relaxation techniques <br />
***general social skills and general assertive skills<sup class="reference"><ref>[12]Griffin, K. W., & Botvin, G. J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child and Adolescent Psychiatric Clinics of North America, 19(3), 505–526. https://doi.org/10.1016/j.chc.2010.03.005</ref></sup> <br />
<br />
LST is effective in reducing use of alcohol, tobacco, marijuana, and other psychoactive drugs and is estimated to save $38 for every dollar invested.<sup class="reference"><ref>[13]Botvin, G. J., & Griffin, K. W. (2014). Life skills training: Preventing substance misuse by enhancing individual and social competence. New Directions for Youth Development, 2014(141), 57–65. https://doi.org/10.1002/yd.20086<br />
</ref></sup><br />
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= Campaigns for Helping Teens to Not Misuse Drugs =<br />
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[http://abovetheinfluence.com/ Above the Influence ]national awareness campaign<br />
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= Parental Involvement =<br />
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High levels of parental disapproval of drug use may mitigate the negative influence of drug-using peers.<sup class="reference"><ref>[14]Chan, G. C. K., Kelly, A. B., Carroll, A., & Williams, J. W. (2017). Peer drug use and adolescent polysubstance use: Do parenting and school factors moderate this association? Addictive Behaviors, 64, 78–81. https://doi.org/10.1016/j.addbeh.2016.08.004<br />
</ref></sup><br />
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&nbsp; See Also: [[Empower_&_Strengthen_Parents|Empower & Strengthen Parents]]<br />
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&nbsp;<br />
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= Mentorship and Support =<br />
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Previous research has shown a relationship between peer mentorship and reduction in the size of peer substance-user networks and substance use risk among youth with at least one HIV-positive parent.<sup class="reference"><ref>[15]PhD, A. R., Stephen Magura PhD, C., MS, C. F., BA, P. C., BA, C. N., & MEd, D. C. (2006). Effects of Peer Mentoring on HIV-Affected Youths’ Substance Use Risk and Association with Substance Using Friends. Journal of Social Service Research, 32(2), 45–60. https://doi.org/10.1300/J079v32n02_03<br />
<br />
</ref></sup> More recently, a study showed that greater levels of perceived teacher support was negatively correlated with marijuana and drug use and positively correlated with academic performance. <sup class="reference"><ref>[16]Dudovitz, R. N., Chung, P. J., & Wong, M. D. (2017). Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use. The Journal of School Health, 87(1), 12–20. https://doi.org/10.1111/josh.12462<br />
</ref></sup><br />
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&nbsp;<br />
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= Tools & Resources =<br />
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[[TR_-_Train_Youth_in_How_to_Resist_Peer_Pressure_to_Try_Drugs|TR - Train Youth in How to Resist Peer Pressure to Try Drugs]]<br />
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= Scorecard Building =<br />
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Potential Objective Details ( Under Construction)&nbsp;<br/> Potential Measures and Data Sources( Under Construction)&nbsp;<br/> Potential Actions and Partners( Under Construction)&nbsp;<br />
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= Resources to Investigate =<br />
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[[RTI_-_Train_Youth_to_Resist_Peer_Pressure|More RTI on Training Youth to Resist Peer Pressure]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_School-Based_Prevention_Programs&diff=19360Expand School-Based Prevention Programs2019-12-03T16:51:35Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Improve_Protective_Factors_to_Reduce_SUDs|Zoom Map (Improve Protective Factors to Minimize Desire to Misuse Opioids)]]&nbsp; &nbsp; (Change when page is available) <br />
Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.<br />
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= Background =<br />
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== The Need for Prevention Programs Targeting Youth ==<br />
<br />
This [http://www.wbur.org/commonhealth/2017/08/29/the-opioid-epidemic-needs-a-strategy-for-teens article by two doctors provides a strong case] for specific strategies to address teen opioid abuse. It links to good sources of information and resources.<br/> <br/> The National Survey on Drug Use and Health (NSDUH), conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016). Learn more in [https://www.sciencedirect.com/science/article/pii/S0306460317301351 this article].<br/> <br/> This [https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/opioids/index.html HHS page] also has good information on opioid and adolescents. (Add key points to this wiki page).<br/> <br/> Using "[[Reduce_the_Use_of_Gateway_Drugs|Gateway Drugs]]" and smoking increases risk factors.<br />
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== Opioid Education Programs ==<br />
<br />
Recommendations for selecting a school program<sup class="reference"><ref>[1]The Opioid Epidemic and Youth: Prevention Considerations. (n.d.). Retrieved December 3, 2019, from Prevention Plus Wellness, LLC website: https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations<br />
</ref></sup><br />
<br />
*Start by looking at programs that have evidence that they work. The list on [https://www.blueprintsprograms.org/about Blueprints for Healthy Youth Development] is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. <br />
*Look for programs that have a good Return on Investment (effective, but not too expensive). See below on this page. <br />
*Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. <br />
*Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. <br />
*Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis. <br />
<br />
<br/> '''School Prevention Programs have a Positive Impact'''<br/> In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.<br/> &nbsp;<br />
</div> <br />
= Classroom Resources =<br />
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=== Operation Prevention ===<br />
<br />
[https://www.operationprevention.com/ Operation Prevention], a joint partnership between Discovery Education and the DEA, developed '''free''' resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See [[Empower_&_Strengthen_Parents|Empower & Strengthen Parents]] for more strategies to include parents. See [[TR_-_Expand_School_Prevention_Programs|Tools & Resources for]] copies of toolkits.<br/> &nbsp;<br />
<br />
=== Not Prescribed ===<br />
<br />
[https://notprescribed.org/ Not Prescribed] is a&nbsp;classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.&nbsp; &nbsp;<br />
<br />
&nbsp;<br />
<br />
=== Everfi's Prescription Drug Safety Course ===<br />
<br />
[https://everfi.com/about/mission/ EVERFI] provides schools with a free, state-of-the-art on-line learning course on prescription drug safety&nbsp;&nbsp;[https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/ https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/]<br />
<br />
Due to support from a wide range of public and private supporters in the [https://everfi.com/networks/prescription-drug-safety-network/ Presecription Drug Safety Network], EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.&nbsp; EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.&nbsp; &nbsp;This [https://everfi.com/wp-content/uploads/2018/08/Prescription-Drug-Safety_-17-18-Impact-Report.pdf report] shares some of the impact that this course is having.&nbsp;<br />
<br />
= Analysis of Research-Based Programs and Return on Investment =<br />
<br />
This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs.<br />
<br />
Wsipp_Preventing Youth Substance Use: A Review of Thirteen Programs Benefit-Cost-Results &nbsp; [http://www.wsipp.wa.gov/ReportFile/1563/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Benefit-Cost-Results.pdf Preventing Youth Substance Use]<br/> Positive Prevention Plus: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum ([http://www.positivepreventionplus.com/ Positive Prevention Plus]<br />
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&nbsp;<br />
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= Examples of Promising, Evidence-based Programs =<br />
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These are programs the you can consider...<br/> [https://preventionpluswellness.com SPORT Prevention Plus Wellness]: A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<br />
<br />
&nbsp;[http://www.positivepreventionplus.com/ Positive Prevention Plus]: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<br />
<br />
&nbsp;[https://olweus.sites.clemson.edu/ Olweus Bullying Prevention Program]: Includes schoolwide, classroom, individual, and community strategies.<br/> &nbsp;<br />
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&nbsp;<br />
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= Media Literacy =<br />
<br />
Media literacy is a promising approach to school-based substance abuse intervention."<ref>[2] Media Literacy as an Approach to Substance Abuse Prevention. (n.d.). Retrieved December 3, 2019, from http://irtinc.us/Products/MediaDetective/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx<br />
</ref>Beneficial outcomes include:<br />
<br />
&nbsp;<br />
<br />
*Increased media skepticism<sup class="reference"><ref>[3]Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx</ref></sup> <br />
*Increased perceived efficiency in resisting pro-drug media messages<sup class="reference"><ref>[4]Austin, E. W., Pinkleton, B. E., Hust, S. J. T., & Cohen, M. (2005). Evaluation of an American Legacy Foundation/Washington State Department of Health media literacy pilot study. Health Communication, 18(1), 75 Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx</ref></sup> <br />
*Greater ability to make counter-arguments to beer advertisements<sup class="reference"><ref>[5]Slater, M.D., Rouner, D., Murphy, K., Beauvais, F., Van Leuven, J., & Domenech-Rodriguez, M.M. (1996). Adolescent counterarguing of tv beer advertisements: Evidence for the effectiveness of alcohol education and critical viewing discussions. Journal of Drug Education, 26(2), 143-158. Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx</ref></sup> <br />
*Increased belief that smoking and drinking are "wrong"<sup class="reference"><ref>[6]Kupersmidt, J., Feagans, L., Eisen, M., & Hicks, R. (May 2005). The North Carolina Media Literacy Education Program: An evaluation. Poster presented at the annual meeting of the Society for Intervention Research, Washington, D.C. Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx</ref></sup> <br />
*Reduced middle school boys' intentions to use alcohol or tobacco in the future<sup class="reference"><ref>[7]Kupersmidt, J., Feagans, L., Eisen, M., & Hicks, R. (May 2005). The North Carolina Media Literacy Education Program: An evaluation. Poster presented at the annual meeting of the Society for Intervention Research, Washington, D.C. Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx </ref></sup> <br />
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= Healthy Youth Development Programs in Schools reduce Opioid Misuse =<br />
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Article on Evidence-based practices: <ref>[3]]Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. Retrieved from http://irtinc.us/Products/MediaReady/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx</ref><br/> <br/> &nbsp;<br />
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&nbsp;<br />
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= Successful Examples =<br />
<br />
== Putnam Middle School Social Norms Campaign ==<br />
<br />
In partnership with [http://putnampride.org/ Putnam Pride], this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."<br />
<br />
&nbsp; Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.<br />
<br />
&nbsp;<br />
<br />
== SAFIR -- Substance Abuse Free Indian River ==<br />
<br />
This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.<br/> &nbsp; “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”<ref>[8] Coalitions in Action: Partnering for Prevention with Local Law Enforcement | CADCA. (n.d.). Retrieved December 3, 2019, from https://www.cadca.org/resources/coalitions-action-partnering-prevention-local-law-enforcement<br />
</ref>At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.<br />
<br />
&nbsp; SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.<br />
<br />
&nbsp; A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Boy Scouts & Girl Scouts ==<br />
<br />
Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See [[TR_-_Expand_School_Prevention_Programs|Tools & Resources details on participation]].<br />
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= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
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= Actions to Take<br/> <br/> &nbsp; =<br />
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[[PA_-_Expand_School_Prevention_Programs|Potential Actions and Partners]] Actions for Individuals<br />
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= Tools & Resources =<br />
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[[TR_-_Expand_School_Prevention_Programs|TR - Expand School Prevention Programs]]<br />
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= Resources to Investigate =<br />
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<span style="font-family: arial,helvetica,sans-serif; font-size: 13px">[[RTI_-_Expand_School_Prevention_Programs|RTI - Expand School Prevention Programs]]</span><br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Empower_Parents&diff=19359Empower Parents2019-12-03T16:43:51Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to &nbsp;[[ZOOM_MAP_-_Improve_Protective_Factors_to_Reduce_SUDs|Zoom Map - Improve Protective Factors to Reduce SUDs]] <br />
Parents are one of the main influencers on whether or not their kids misuse drugs.&nbsp; But, parenting is not easy.&nbsp; Communities can take advantage of a wide variety of tools and programs to help parents be more effective in buiding the developmental assets that reduce the likelihood that kids use drugs.&nbsp; While good&nbsp;parenting (however that is defined) is certainly no guarantee that kids won't use drugs, and the use of drugs by kids does not mean that the parenting was bad, it still makes sense to try to help parents be more effective in helping their kids to grow in a good, supportive environment and for the parents to have as good of influence as they can on their kids' choices regarding use of drugs or alcohol.&nbsp;<br />
<br />
= Background =<br />
<br />
== Parents have a big influence on youth behavior ==<br />
<br />
Youth who perceive that their parents would strongly disapprove of their use of marijuana are far less likely to have used it in the last month than youth who don’t receive such messages from their parents (4.3 percent versus 31 percent). <sup class="reference"><ref>[1]Results from the 2012 National Survey on Drug Use .pdf. (n.d.). Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf<br />
</ref></sup><br />
<br />
&nbsp; When school prevention programs are supported by families, peers, and the community all sending the consistent message that drug use is not tolerated, it can have a powerful effect on young people.<ref> [2]Hazelden Publishing Releases Opioid Toolkit. (n.d.). Retrieved December 3, 2019, from https://www.hazeldenbettyford.org/about-us/news-media/press-release/2014-hazelden-publishing-release-heroin-prescription-toolkit<br />
</ref><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Parents Influence Use of Opioid Pain Medication ==<br />
<br />
In many cases, doctors, dentists and oral surgeons are still prescribing opioids to teens more often than would be ideal. Many parents may not realize the risks. Helping educate parents may result in some parents working with medical care providers to reduces the prescription of opioid pain medication and pursue other options. This resource is targeting [http://masstapp.edc.org/rx-student-athlete parents of student athletes].<br />
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<br />
= Promising Programs =<br />
<br />
== Safe Homes Network and App ==<br />
<br />
Originated near Scottsdale, Arizona, Safe Homes Network is an application that allows parents to know where their kids are when they go to a party. When the child goes to a party the parent can check on the app. to see whether or not the house is registered in the directory. If so, parents can contact that head of house and make sure they know whether or not a party is occurring. The system is set up to act like a barrier for alcohol and drug consumption to happen under people's roofs. <sup class="reference"><ref>[3]Page not found </ref></sup><br />
<br />
&nbsp; To become a Safe Homes member, you must:<br/> &nbsp; 1. Parents sign a pledge not to allow underage drinking or drug use in their home.<br/> &nbsp; 2. Parents' contact information is entered into the Safe Homes Network database.<br/> &nbsp; 3. Parents download the Safe Homes Network App to their phone or tablet and check it when their child is invited to a party or gathering where they don't know the parents.<br />
<br />
&nbsp; Since the Fountain Hills, AZ coalition started the Safe Homes Network, there has been a 44 percent decrease in the past 30-day use of alcohol, a 37 percent decrease in marijuana use and a 51 percent decrease in prescription drug abuse.<sup class="reference"><ref>[4]Page not found </ref></sup><br />
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&nbsp;[[More_information_on_Safe_Homes_Network|More information on Safe Homes Network]]<br/> &nbsp;<br />
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== Gobi ==<br />
<br />
Parent involvement is critical in preventing teen substance use. As a parent, it can be extremely difficult to talk about drug use with your kids in an engaging and effective way. Whether you suspect there's already a problem or you want to help make sure there is never a problem, Gobi can help.<br />
<br />
[https://www.gobi.support/ Gobi] is the only online prevention program designed by professionals and young adults for teens and their families. Gobi is based on the proven principles of professional drug and alcohol prevention. It’s designed specifically for teens, and it speaks their language—using a tool they already have in hand. Every day for 21&nbsp;days teens get an email assignment on their smartphone and it takes only 5 minutes per day. Several times a week they get a supportive text message that is meant to be irreverent, humorous, cynical, and just offensive enough to keep them laughing (and engaged).<br />
<br />
Parents are involved and get their own series of emails on adolescent development and communication skills. Teens will be asked three&nbsp;times to schedule a time to talk with their parents. Topics and guidelines will be included to make the conversation as successful as possible, and parents will also receive program support.<br />
<br />
&nbsp; Teens Using Gobi Report: (Get source)<br />
<br />
*Improved relationship with their parents <br />
*A decrease in their use of drugs and alcohol <br />
*Better ability to manage stress <br />
*Increased awareness of their choices <br />
<br />
[https://www.gobi.support/get-started Signing up for Gobi] is free to use by both parents and youth.<br/> [[More_information_on_adopting_the_Gobi_program|More information on adopting the Gobi program]]<br />
</div> <br />
== &nbsp; ==<br />
<br />
== Drug Prevention Resources ==<br />
<br />
[https://drugfreegeneration.org/ Drug Prevention Resources] has an abundance of tools and resources to help parents to reduce the likelihood of their kids using drugs.<br/> &nbsp;<br />
<br />
== Fathers' Uplift ==<br />
<br />
[http://fathersuplift.org/fathers/ Fathers' Uplift] empowers fathers to overcome barriers and become positively engaged in their children's lives.<sup class="reference"><ref>[5]Front Page | Fathers Uplift. (n.d.). Retrieved December 3, 2019, from http://fathersuplift.org/fathers/<br />
</ref></sup><br />
<br />
= Parent Education =<br />
<div class="mw-parser-output"><br />
== DEA Books ==<br />
<br />
The DEA produced two books, "Growing Up Drug Free: A Parent's Guide to Prevention" and "Prescription for Disaster: How Teens Abuse Medicine." Copies of each resource can be found in [[TR_-_Empower_&_Strengthen_Parents|Tools & Resources]].<br />
</div> <div class="mw-parser-output"><br />
== Family Life's Art of Parenting ==<br />
<br />
FamilyLife’s [https://www.familylife.com/parenting Art of Parenting] FREE online course gives parents a simple vision and creative ways to make faith the core of their parenting.<br />
</div> <br />
= Tools & Resources =<br />
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[[TR_-_Empower_&_Strengthen_Parents|TR - Empower & Strengthen Parents]]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
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= Actions to Take =<br />
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[[PA_-_Empower_&_Strengthen_Parents|Potential Actions and Partners]]<br />
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Actions for Individuals<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Empower_&_Strengthen_Parents|RTI - Empower & Strengthen Parents]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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{| class="wiki_table"<br />
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= Sources =<br />
<br />
----<br />
<br />
#Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013), www.samhsa.gov/data/ NSDUH/2012SummNatFindDetTables/NationalFindings/ NSDUHresults2012.htm#ch6.7. <br />
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016. <br />
#[http://dev.cadca.org/resources/coalitions-action-connecting-prevention-parents-safe-homes-network [1]] <br />
#[http://dev.cadca.org/resources/coalitions-action-connecting-prevention-parents-safe-homes-network [2]] <br />
#[http://fathersuplift.org/fathers/ [3]] <br />
</div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Professional_Training_on_Opioids_%26_Alternative_Pain_Management_Approaches&diff=19348Improve Professional Training on Opioids & Alternative Pain Management Approaches2019-11-25T01:03:34Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Mapor]] [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|ZOOM MAP-Reduce Prescription of Opioids]] <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">__TOC__&nbsp; <br />
= Partnering With Prescribers to Prevent Prescription Opioid Misuse =<br />
<br />
{| class="wiki_table"<br />
|-<br />
| <br />
==Engaging Prescribers== The importance of engaging prescribers in efforts to prevent prescription drug misuse—to provide credibility, reach target audiences, and provide their critical perspective.<br/> &nbsp;<br />
<br />
|}<br />
<br />
&nbsp;<br />
<br />
{| class="wiki_table"<br />
|-<br />
| <br />
==Supply, Demand, and the Role of Prescribers== The unique role prescribers play in modulating both the amount and dosage of prescription drugs being prescribed, as well as the demand for these prescriptions.<br/> &nbsp;<br />
<br />
|}<br />
<br />
&nbsp;<br />
<br />
= &nbsp; =<br />
<br />
= Current Status =<br />
<br />
*72% of doctors in one study indicated their knowledge of opioid dependence was low.<sup class="reference"><ref>[1]Davis, C. S., & Carr, D. (2016). Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug and Alcohol Dependence, 163, 100–107. https://doi.org/10.1016/j.drugalcdep.2016.04.002</ref></sup> <br />
*Many doctors in one study rated their training "unsatisfactory."<sup class="reference"><ref>[2]Davis, C. S., & Carr, D. (2016). Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug and Alcohol Dependence, 163, 100–107. https://doi.org/10.1016/j.drugalcdep.2016.04.002</ref></sup> <br />
*Only 5 states require all physicians to receive opioid-related CME.<sup class="reference"><ref>[3]Davis, C. S., & Carr, D. (2016). Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug and Alcohol Dependence, 163, 100–107. https://doi.org/10.1016/j.drugalcdep.2016.04.002</ref></sup> <br />
*Physicians who studied at lower-ranked medical schools prescribe nearly three times as many opioids per year as those who attended top-tier institutions <sup class="reference"><ref>[4]Doctors who attend lower-tier medical schools prescribe far more opioids. (2017, August 7). Retrieved November 24, 2019, from STAT website: https://www.statnews.com/2017/08/07/doctors-opioid-prescriptions/</ref></sup> <br />
**On average, the researchers found, physicians who attended Harvard wrote fewer than 100 opioid prescriptions per year, while physicians trained at the lowest-ranked schools wrote about 300 per year.<sup class="reference"><ref>[5]Doctors who attend lower-tier medical schools prescribe far more opioids. (2017, August 7). Retrieved November 24, 2019, from STAT website: https://www.statnews.com/2017/08/07/doctors-opioid-prescriptions/</ref></sup> <br />
<br />
&nbsp;<br />
<br />
== Medical Education ==<br />
<div class="_">The Forum, in collaboration with the Chris Cornell Foundation, will enhance the education of healthcare providers about the identification and treatment of substance use disorder (SUD). Only 8 percent of all U.S. medical schools have a distinct course on addiction built into the required coursework and only a handful of schools teach a robust, evidence-based curriculum on the diagnosis and treatment of SUDs.<sup class="reference"><ref>[6]Forum, A. P. (n.d.). Https://www.addictionpolicy.org/404. Retrieved November 24, 2019, from https://www.addictionpolicy.org/404</ref></sup></div> <div class="_">&nbsp;</div> <br />
= Prescribing Guidelines =<br />
<div class="_">The Department of Drug and Alcohol Programs (DDAP) and Department of Health (DOH) in Pennsylvania are co-chairing the Prescribing Practices initiative with the purpose of reducing prescription drug abuse and overdoses, while maintaining effective pain management. The group includes representation from all medical professionals, as well as their professional associations and regulatory agencies. The focus of this group is to identify and find consensus on best and safest prescribing and pain management practices, and to identify ways that the stakeholders at the table (representing various state departments and private organizations) can most effectively promote those practices.<ref> [7]Can't find source </ref></div> <div class="_">&nbsp; The[https://www.va.gov/painmanagement/ Veterans Health Administration] recognizes the clinical challenges to successfully managing pain and prescribing safely for Veterans. The National Pain Management Program office convened a national task force comprised of multidisciplinary pain exerts to create an[https://www.va.gov/PAINMANAGEMENT/Opioid_Safety_Initiative_OSI.asp Opioid Safety Toolkit] that contains documents and presentations that can aid in your clinical decisions about starting, continuing, or tapering opioid therapy, and other challenges related to safe opioid prescribing.<sup class="reference"><ref>[8]HealthITSecurity. (2016, November 2). Addressing Opioid Abuse with Analytics, Population Health Strategies. Retrieved November 24, 2019, from HealthITAnalytics website: https://healthitanalytics.com/features/addressing-opioid-abuse-with-analytics-population-health-strategies</ref></sup></div> <div class="_">&nbsp; Although the act of going to multiple doctors with the goal of getting multiple prescriptions for painkillers, known as doctor shopping, is a pretty rare phenomenon (studies indicate that only 0.7 percent of patients actively attempted to scam providers into issuing duplicate prescriptions), doctors should still educate themselves on the signs that someone's just looking for a prescription.<sup class="reference"><ref>[9]Can't find source</ref></sup> This one group is particularly good at getting multiple prescriptions, purchasing a total of 11.1 million grams of opioids from their average of 32 prescriptions from ten different prescribers in less than a</div> <div class="_">&nbsp; This [https://insight.athenahealth.com/infographic-opioid-regulations-state-by-state infographic] describes how state-by-state laws such as supply limits, PDMP, and assessment requirements vary in relation to prescription pain management and opioid use.</div> <div class="_">&nbsp;'''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] to download the CDC Opioid Prescribing Guidelines'''</div> <div class="_">&nbsp;</div> <br />
= Best Practices =<br />
<br />
*CDC Prescribing Guidelines <br />
*Non-pharmacologic therapies <br />
*Non-opioid pharmacologic therapies <br />
*“Start low and go slow” <br />
*Regularly monitor patients <br />
<br />
&nbsp;<br />
<br />
= Screening Before Prescribing =<br />
<div class="_">Dr. John Zweifler recommends that clinicians "find objective evidence of severe disease through physical examination or diagnostic studies before prescribing long-term opioids.<sup class="reference"><ref>[10]page not found </ref></sup></div> <div class="_">&nbsp;</div> <br />
== DIRE Scoring System ==<br />
<div class="_">(Diagnosis, intractability, reliability with 4 measures, and efficacy)</div> <div class="_">&nbsp;</div> <br />
*A validated measure used to predict patient suitability for long-term opioid analgesic treatment for non-cancer pain.<sup class="reference"><ref>[11]Page not found</ref>12</sup> <br />
*&nbsp; <br />
*[http://www.emergingsolutionsinpain.com/content/tools/esp_9_instruments/pdf/DIRE_Score.pdf DIRE Rubric] via University of Colorado, Denver <br />
<br />
= Alternative Pain Management Approaches =<br />
<div class="_">See page on [[Increase_Access_to_Alternative_Therapies_to_Treat_Pain|increasing access to alternate pain management]]</div> <div class="_">&nbsp;</div> <br />
= Training Curriculum & Programs =<br />
<br />
== <span style="font-size: 110%">Project ECHO</span> ==<br />
<div class="_">Project ECHO ([https://echo.unm.edu/wp-content/uploads/2016/11/Project-ECHO-Extension-for-Community-Healthcare-Outcomes-A-new-model-for-educating-primary-care-providers-about-treatment-of-substance-use-disorders.pdf Extension for Community Healthcare Outcomes]) is a program offered through the University of New Mexico. The program is a remote training that focuses on treatment of substance use disorders (SUDs) and behavioral health disorders. It features an [https://echo.unm.edu/nm-teleecho-clinics/opioid/faculty/ a team of multidisciplinary addiction specialists] and is offered for '''free''' to care providers in the U.S.<br/> &nbsp; This ECHO provides training in opioid addiction treatment at no cost, delivered right to your clinic, with a variety of bi-weekly schedules to choose from. They serve federally-qualified health centers, with a special focus on those that received the Substance Abuse Service Expansion awards using simple videoconferencing technology, healthcare teams connect to a community of learners. This [https://echo.unm.edu/nm-teleecho-clinics/opioid/ free program] ends in August of 2018.</div> <div class="_">&nbsp;</div> <br />
== <span style="font-size: 110%">Applying CDC's Guidelines for Prescribing Opioids</span> ==<br />
<div class="_">This[https://www.cdc.gov/drugoverdose/training/online-training.html free online training series] aims to help healthcare providers apply CDC’s recommendations in a clinical setting through interactive patient scenarios, videos, knowledge checks, tips, and resources. You will gain a better understanding of the recommendations, the risks and benefits of prescription opioids, non-opioid treatment options, patient communication, and risk mitigation.</div> <div class="_">&nbsp;'''Two training courses are already provided on their website:'''</div> <div class="_">&nbsp;</div> <br />
*<span style="font-family: Lato,">[https://www.cdc.gov/drugoverdose/training/overview/index.html Addressing the Opioid Epidemic: Recommendations from CDC]</span> <br />
*<span style="font-family: Lato,">[https://www.cdc.gov/drugoverdose/training/nonopioid/index.html Treating Chronic Pain Without Opioids]</span> <br />
<br />
''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more''<br/> <br/> '''Training Courses Coming Soon:'''<br />
<br />
*''Communicating With Patients'': Providers will learn communication strategies they can use when treating chronic pain, including motivational interviewing. <br />
*''Deciding Whether to Prescribe'': In this section of the training, providers learn mechanisms for deciding if opioids should be prescribed, and next steps for treatment – whether opioid or non-opioid treatments are selected. <br />
*''Dosing and Titration of Opioids: How Much, How Long, and How and When to Stop?'' When providers choose to prescribe opioids, they need to know how to properly dose and titrate opioids to reduce risk of opioid use disorder and overdose. This module explains methods of dosing and titration. <br />
*''Reducing the Risks of Opioids'': Providers will learn best risk mitigation strategies and when to employ them after prescribing an opioid. <br />
*''Assessing and Addressing Opioid Use Disorder'': This module describes methods available to a provider for assessing and addressing an opioid use disorder when it is suspected. <br />
*''Implementing the CDC Guideline'': This module provides strategies and tools for implementing the CDC Guideline for Prescribing Opioids for Chronic Pain in a provider’s own practice, while outlining steps to overcome common barriers to implementation. <br />
<br />
&nbsp;<br />
<br />
== <span style="font-size: 110%">COCA Call Webinar Series</span> ==<br />
<div class="_">CDC’s National Center for Injury Prevention and Control (NCIPC) partnered with CDC’s Clinician Outreach and Communication Activity ([https://emergency.cdc.gov/coca/calls/index.asp COCA]) and the University of Washington to present a [https://www.cdc.gov/drugoverdose/training/webinars.html webinar series] about the CDC Guideline for Prescribing Opioids for Chronic Pain.</div> <div class="_">&nbsp; This seven-part series is intended to use a data-driven approach to help providers choose the most effective pain treatment options and improve the safety of opioid prescribing for chronic pain. The primary objective is to provide informative, case-based content that will demonstrate and instruct participants on how the 12 recommendations of the CDC Guideline for Prescribing Opioids for Chronic Pain can be incorporated and applied in a primary care practice setting.</div> <div class="_">&nbsp;</div> <br />
== <span style="font-size: 110%">Providers' Clinical Support System For Opioid Therapies</span> ==<br />
<br />
[http://pcss-o.org/ PCSS-O] is a national training and mentoring project developed in response to the prescription opioid overdose epidemic. The consortium of major stakeholders and constituency groups with interests in safe and effective use of opioid medications offers extensive experience in the treatment of substance use disorders and specifically, opioid use disorder treatment, as well as the interface of pain and opioid use disorder. PCSS-O makes available at no cost CME programs on the safe and effective use of opioids for treatment of chronic pain and safe and effective treatment of opioid use disorder.<br/> <br/> '''Core Curriculum'''<br/> PCSS-O clinical experts have created a [http://pcss-o.org/education-training/core-curriculum/ comprehensive course] on opioid prescribing for primary care providers in the essential evidence-based clinical practices in treating chronic pain—with or without medications.<br/> This course will provide clinicians with a solid base when treating chronic pain. The curriculum was created in an effort to consolidate the vast amount of information available to clinicians into a course that provides clinicians with the information, resources, and knowledge they need to treat their patients who suffer from chronic pain, including non-pharmacological treatments. The result is the most comprehensive and up to date curriculum developed thus far for the treatment of chronic pain.<br/> <br/> '''Clinical Online Modules'''<br/> PCSS-O offers a large library of [http://pcss-o.org/modules/ online modules] that allow you to take trainings when you want and at your own pace. The modules enhance prescribers’ and other health professionals’ knowledge, skills, and attitudes regarding safe and effective use of medication assisted treatment of opioid use disorder. Most modules include CME credit. Details about obtaining credit are provided with each module description and are noted on the page.<br/> <br/> These [http://pcss-o.org/modules/ online modules] are designed to increase your:<br />
<br />
*understanding of the current state of opioid use disorder <br />
*understanding of treatment issues for special populations <br />
*ability to assess and treat patients <br />
<br />
<br/> ''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more''<br/> <br/> '''Archived Webinars'''<br/> These [http://pcss-o.org/calendar-of-events/list/?tribe_event_display=past&tribe_eventcategory=87 archived webinars] present a wide variety of topics, involving opioids, targeted towards physicians.<br/> &nbsp;<br />
<br />
== CO*RE/ASAM Opioid Prescribing ==<br />
<br />
[https://www.asam.org/education/resources/Opioid-Prescribing The CO*RE/ASAM Opioid Prescribing: Safe Practice, Changing Lives course] addresses this public health crisis. This comprehensive course was developed by renowned experts from [http://core-rems.org/ Collaborative for REMS Education (CO*RE)] and incorporates all six units outlined in FDA blueprint for safe opioid prescribing. The updated course also provides necessary context for safe opioid prescribing by discussing biopsychosocial aspects of pain, the newest clinical guidelines on the treatment of chronic pain, and state policies about prescribing opioids.<sup class="reference"><ref>[12]HealthI Security. (2016, November 2). Addressing Opioid Abuse with Analytics, Population Health Strategies. Retrieved November 24, 2019, from HealthITAnalytics website: https://healthitanalytics.com/features/addressing-opioid-abuse-with-analytics-population-health-strategies</ref></sup><br/> &nbsp;<br />
<br />
== <span style="font-size: 110%">SAFE Opioid Course</span> ==<br />
<div class="_">The [https://www.acponline.org/meetings-courses/focused-topics/safe-opioid-prescribing-strategies-assessment-fundamentals-education SAFE Opioid Course by the American College of Physicians] provides guidance that is essential for safe and effective pain management when prescribing extended-release (ER) and long-acting (LA) opioids. It is critical to recognize best practices for how to start to therapy with ER/LA, how to provide therapy, how to end therapy, and what to do in between. Evidence-based tools are required for screening at-risk patients and for monitoring adherence to prescribed ER/LA opioids. Proven methods to counsel patients on ER/LA opioids and to achieve positive outcomes need to be employed. Comprehensive information is also essential on ER/LA-opioids as a drug class. This recorded course will provide clinical insights from the SAFE Opioid Prescribing Blueprint.</div> <div class="_">&nbsp;</div> <br />
== Board Approved CME Regarding Opioid Prescribing ==<br />
<div class="_">Beginning with the 2016-2017 CME reporting cycle, physicians who possess a DEA license will need to include 3 hours of Board approved opioid CME as part of the regular every-other year CME reporting cycle that coincides with license renewal. The New Hampshire Medical Society put together a [http://www.nhms.org/opioidcme Board approved list] as of July 31, 2017.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Best Prescribing Practices - Dentists ==<br />
<br />
[http://maperc.mycrowdwisdom.com/diweb/catalog/item/id/722523/q/q=dentistry&c=61 Best Prescribing Practices in Dentistry Course] - Cost is only $25. This 1-hour online, self-paced course will provide information to understand the significance of the opioid epidemic, understand the role of dentists, learn best practices and strategies for preventing prescription drug diversion and abuse, and identify tools and resources.<br/> '''''<span style="font-size: 130%">See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more E-Learning opportunities and information</span>'''''<br/> <br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|TR - Improve Professional Training on Opioids & Alternative Pain Management Approaches]]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|More RTI on Professional Training on Opioids and Alternative Pain Management]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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{| class="wiki_table"<br />
|-<br />
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[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Professional_Training_on_Opioids_%26_Alternative_Pain_Management_Approaches&diff=19347Improve Professional Training on Opioids & Alternative Pain Management Approaches2019-11-25T00:55:14Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Mapor]] [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|ZOOM MAP-Reduce Prescription of Opioids]] <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">__TOC__&nbsp; <br />
= Partnering With Prescribers to Prevent Prescription Opioid Misuse =<br />
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{| class="wiki_table"<br />
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==Engaging Prescribers== The importance of engaging prescribers in efforts to prevent prescription drug misuse—to provide credibility, reach target audiences, and provide their critical perspective.<br/> &nbsp;<br />
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|}<br />
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{| class="wiki_table"<br />
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==Supply, Demand, and the Role of Prescribers== The unique role prescribers play in modulating both the amount and dosage of prescription drugs being prescribed, as well as the demand for these prescriptions.<br/> &nbsp;<br />
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|}<br />
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&nbsp;<br />
<br />
= &nbsp; =<br />
<br />
= Current Status =<br />
<br />
*72% of doctors in one study indicated their knowledge of opioid dependence was low.<sup class="reference">[1]</sup> <br />
*Many doctors in one study rated their training "unsatisfactory."<sup class="reference">[2]</sup> <br />
*Only 5 states require all physicians to receive opioid-related CME.<sup class="reference">[3]</sup> <br />
*Physicians who studied at lower-ranked medical schools prescribe nearly three times as many opioids per year as those who attended top-tier institutions <sup class="reference">[4]</sup> <br />
**On average, the researchers found, physicians who attended Harvard wrote fewer than 100 opioid prescriptions per year, while physicians trained at the lowest-ranked schools wrote about 300 per year.<sup class="reference">[5]</sup> <br />
<br />
&nbsp;<br />
<br />
== Medical Education ==<br />
<div class="_">The Forum, in collaboration with the Chris Cornell Foundation, will enhance the education of healthcare providers about the identification and treatment of substance use disorder (SUD). Only 8 percent of all U.S. medical schools have a distinct course on addiction built into the required coursework and only a handful of schools teach a robust, evidence-based curriculum on the diagnosis and treatment of SUDs.<sup class="reference">[6]</sup></div> <div class="_">&nbsp;</div> <br />
= Prescribing Guidelines =<br />
<div class="_">The Department of Drug and Alcohol Programs (DDAP) and Department of Health (DOH) in Pennsylvania are co-chairing the Prescribing Practices initiative with the purpose of reducing prescription drug abuse and overdoses, while maintaining effective pain management. The group includes representation from all medical professionals, as well as their professional associations and regulatory agencies. The focus of this group is to identify and find consensus on best and safest prescribing and pain management practices, and to identify ways that the stakeholders at the table (representing various state departments and private organizations) can most effectively promote those practices. <sup class="reference">[7]</sup></div> <div class="_">&nbsp; The[https://www.va.gov/painmanagement/ Veterans Health Administration] recognizes the clinical challenges to successfully managing pain and prescribing safely for Veterans. The National Pain Management Program office convened a national task force comprised of multidisciplinary pain exerts to create an[https://www.va.gov/PAINMANAGEMENT/Opioid_Safety_Initiative_OSI.asp Opioid Safety Toolkit] that contains documents and presentations that can aid in your clinical decisions about starting, continuing, or tapering opioid therapy, and other challenges related to safe opioid prescribing.<sup class="reference">[8]</sup></div> <div class="_">&nbsp; Although the act of going to multiple doctors with the goal of getting multiple prescriptions for painkillers, known as doctor shopping, is a pretty rare phenomenon (studies indicate that only 0.7 percent of patients actively attempted to scam providers into issuing duplicate prescriptions), doctors should still educate themselves on the signs that someone's just looking for a prescription.<sup class="reference">[9]</sup> This one group is particularly good at getting multiple prescriptions, purchasing a total of 11.1 million grams of opioids from their average of 32 prescriptions from ten different prescribers in less than a</div> <div class="_">&nbsp; This [https://insight.athenahealth.com/infographic-opioid-regulations-state-by-state infographic] describes how state-by-state laws such as supply limits, PDMP, and assessment requirements vary in relation to prescription pain management and opioid use.</div> <div class="_">&nbsp;'''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] to download the CDC Opioid Prescribing Guidelines'''</div> <div class="_">&nbsp;</div> <br />
= Best Practices =<br />
<br />
*CDC Prescribing Guidelines <br />
*Non-pharmacologic therapies <br />
*Non-opioid pharmacologic therapies <br />
*“Start low and go slow” <br />
*Regularly monitor patients <br />
<br />
&nbsp;<br />
<br />
= Screening Before Prescribing =<br />
<div class="_">Dr. John Zweifler recommends that clinicians "find objective evidence of severe disease through physical examination or diagnostic studies before prescribing long-term opioids.<sup class="reference">[10]</sup></div> <div class="_">&nbsp;</div> <br />
== DIRE Scoring System ==<br />
<div class="_">(Diagnosis, intractability, reliability with 4 measures, and efficacy)</div> <div class="_">&nbsp;</div> <br />
*A validated measure used to predict patient suitability for long-term opioid analgesic treatment for non-cancer pain.<sup class="reference">[11]</sup> <br />
*[http://www.emergingsolutionsinpain.com/content/tools/esp_9_instruments/pdf/DIRE_Score.pdf DIRE Rubric] via University of Colorado, Denver <br />
<br />
= Alternative Pain Management Approaches =<br />
<div class="_">See page on [[Increase_Access_to_Alternative_Therapies_to_Treat_Pain|increasing access to alternate pain management]]</div> <div class="_">&nbsp;</div> <br />
= Training Curriculum & Programs =<br />
<br />
== <span style="font-size: 110%">Project ECHO</span> ==<br />
<div class="_">Project ECHO ([https://echo.unm.edu/wp-content/uploads/2016/11/Project-ECHO-Extension-for-Community-Healthcare-Outcomes-A-new-model-for-educating-primary-care-providers-about-treatment-of-substance-use-disorders.pdf Extension for Community Healthcare Outcomes]) is a program offered through the University of New Mexico. The program is a remote training that focuses on treatment of substance use disorders (SUDs) and behavioral health disorders. It features an [https://echo.unm.edu/nm-teleecho-clinics/opioid/faculty/ a team of multidisciplinary addiction specialists] and is offered for '''free''' to care providers in the U.S.<br/> &nbsp; This ECHO provides training in opioid addiction treatment at no cost, delivered right to your clinic, with a variety of bi-weekly schedules to choose from. They serve federally-qualified health centers, with a special focus on those that received the Substance Abuse Service Expansion awards using simple videoconferencing technology, healthcare teams connect to a community of learners. This [https://echo.unm.edu/nm-teleecho-clinics/opioid/ free program] ends in August of 2018.</div> <div class="_">&nbsp;</div> <br />
== <span style="font-size: 110%">Applying CDC's Guidelines for Prescribing Opioids</span> ==<br />
<div class="_">This[https://www.cdc.gov/drugoverdose/training/online-training.html free online training series] aims to help healthcare providers apply CDC’s recommendations in a clinical setting through interactive patient scenarios, videos, knowledge checks, tips, and resources. You will gain a better understanding of the recommendations, the risks and benefits of prescription opioids, non-opioid treatment options, patient communication, and risk mitigation.</div> <div class="_">&nbsp;'''Two training courses are already provided on their website:'''</div> <div class="_">&nbsp;</div> <br />
*<span style="font-family: Lato,">[https://www.cdc.gov/drugoverdose/training/overview/index.html Addressing the Opioid Epidemic: Recommendations from CDC]</span> <br />
*<span style="font-family: Lato,">[https://www.cdc.gov/drugoverdose/training/nonopioid/index.html Treating Chronic Pain Without Opioids]</span> <br />
<br />
''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more''<br/> <br/> '''Training Courses Coming Soon:'''<br />
<br />
*''Communicating With Patients'': Providers will learn communication strategies they can use when treating chronic pain, including motivational interviewing. <br />
*''Deciding Whether to Prescribe'': In this section of the training, providers learn mechanisms for deciding if opioids should be prescribed, and next steps for treatment – whether opioid or non-opioid treatments are selected. <br />
*''Dosing and Titration of Opioids: How Much, How Long, and How and When to Stop?'' When providers choose to prescribe opioids, they need to know how to properly dose and titrate opioids to reduce risk of opioid use disorder and overdose. This module explains methods of dosing and titration. <br />
*''Reducing the Risks of Opioids'': Providers will learn best risk mitigation strategies and when to employ them after prescribing an opioid. <br />
*''Assessing and Addressing Opioid Use Disorder'': This module describes methods available to a provider for assessing and addressing an opioid use disorder when it is suspected. <br />
*''Implementing the CDC Guideline'': This module provides strategies and tools for implementing the CDC Guideline for Prescribing Opioids for Chronic Pain in a provider’s own practice, while outlining steps to overcome common barriers to implementation. <br />
<br />
&nbsp;<br />
<br />
== <span style="font-size: 110%">COCA Call Webinar Series</span> ==<br />
<div class="_">CDC’s National Center for Injury Prevention and Control (NCIPC) partnered with CDC’s Clinician Outreach and Communication Activity ([https://emergency.cdc.gov/coca/calls/index.asp COCA]) and the University of Washington to present a [https://www.cdc.gov/drugoverdose/training/webinars.html webinar series] about the CDC Guideline for Prescribing Opioids for Chronic Pain.</div> <div class="_">&nbsp; This seven-part series is intended to use a data-driven approach to help providers choose the most effective pain treatment options and improve the safety of opioid prescribing for chronic pain. The primary objective is to provide informative, case-based content that will demonstrate and instruct participants on how the 12 recommendations of the CDC Guideline for Prescribing Opioids for Chronic Pain can be incorporated and applied in a primary care practice setting.</div> <div class="_">&nbsp;</div> <br />
== <span style="font-size: 110%">Providers' Clinical Support System For Opioid Therapies</span> ==<br />
<br />
[http://pcss-o.org/ PCSS-O] is a national training and mentoring project developed in response to the prescription opioid overdose epidemic. The consortium of major stakeholders and constituency groups with interests in safe and effective use of opioid medications offers extensive experience in the treatment of substance use disorders and specifically, opioid use disorder treatment, as well as the interface of pain and opioid use disorder. PCSS-O makes available at no cost CME programs on the safe and effective use of opioids for treatment of chronic pain and safe and effective treatment of opioid use disorder.<br/> <br/> '''Core Curriculum'''<br/> PCSS-O clinical experts have created a [http://pcss-o.org/education-training/core-curriculum/ comprehensive course] on opioid prescribing for primary care providers in the essential evidence-based clinical practices in treating chronic pain—with or without medications.<br/> This course will provide clinicians with a solid base when treating chronic pain. The curriculum was created in an effort to consolidate the vast amount of information available to clinicians into a course that provides clinicians with the information, resources, and knowledge they need to treat their patients who suffer from chronic pain, including non-pharmacological treatments. The result is the most comprehensive and up to date curriculum developed thus far for the treatment of chronic pain.<br/> <br/> '''Clinical Online Modules'''<br/> PCSS-O offers a large library of [http://pcss-o.org/modules/ online modules] that allow you to take trainings when you want and at your own pace. The modules enhance prescribers’ and other health professionals’ knowledge, skills, and attitudes regarding safe and effective use of medication assisted treatment of opioid use disorder. Most modules include CME credit. Details about obtaining credit are provided with each module description and are noted on the page.<br/> <br/> These [http://pcss-o.org/modules/ online modules] are designed to increase your:<br />
<br />
*understanding of the current state of opioid use disorder <br />
*understanding of treatment issues for special populations <br />
*ability to assess and treat patients <br />
<br />
<br/> ''See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more''<br/> <br/> '''Archived Webinars'''<br/> These [http://pcss-o.org/calendar-of-events/list/?tribe_event_display=past&tribe_eventcategory=87 archived webinars] present a wide variety of topics, involving opioids, targeted towards physicians.<br/> &nbsp;<br />
<br />
== CO*RE/ASAM Opioid Prescribing ==<br />
<br />
[https://www.asam.org/education/resources/Opioid-Prescribing The CO*RE/ASAM Opioid Prescribing: Safe Practice, Changing Lives course] addresses this public health crisis. This comprehensive course was developed by renowned experts from [http://core-rems.org/ Collaborative for REMS Education (CO*RE)] and incorporates all six units outlined in FDA blueprint for safe opioid prescribing. The updated course also provides necessary context for safe opioid prescribing by discussing biopsychosocial aspects of pain, the newest clinical guidelines on the treatment of chronic pain, and state policies about prescribing opioids.<sup class="reference">[12]</sup><br/> &nbsp;<br />
<br />
== <span style="font-size: 110%">SAFE Opioid Course</span> ==<br />
<div class="_">The [https://www.acponline.org/meetings-courses/focused-topics/safe-opioid-prescribing-strategies-assessment-fundamentals-education SAFE Opioid Course by the American College of Physicians] provides guidance that is essential for safe and effective pain management when prescribing extended-release (ER) and long-acting (LA) opioids. It is critical to recognize best practices for how to start to therapy with ER/LA, how to provide therapy, how to end therapy, and what to do in between. Evidence-based tools are required for screening at-risk patients and for monitoring adherence to prescribed ER/LA opioids. Proven methods to counsel patients on ER/LA opioids and to achieve positive outcomes need to be employed. Comprehensive information is also essential on ER/LA-opioids as a drug class. This recorded course will provide clinical insights from the SAFE Opioid Prescribing Blueprint.</div> <div class="_">&nbsp;</div> <br />
== Board Approved CME Regarding Opioid Prescribing ==<br />
<div class="_">Beginning with the 2016-2017 CME reporting cycle, physicians who possess a DEA license will need to include 3 hours of Board approved opioid CME as part of the regular every-other year CME reporting cycle that coincides with license renewal. The New Hampshire Medical Society put together a [http://www.nhms.org/opioidcme Board approved list] as of July 31, 2017.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Best Prescribing Practices - Dentists ==<br />
<br />
[http://maperc.mycrowdwisdom.com/diweb/catalog/item/id/722523/q/q=dentistry&c=61 Best Prescribing Practices in Dentistry Course] - Cost is only $25. This 1-hour online, self-paced course will provide information to understand the significance of the opioid epidemic, understand the role of dentists, learn best practices and strategies for preventing prescription drug diversion and abuse, and identify tools and resources.<br/> '''''<span style="font-size: 130%">See [[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|Tools & Resources]] for more E-Learning opportunities and information</span>'''''<br/> <br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
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[[TR_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|TR - Improve Professional Training on Opioids & Alternative Pain Management Approaches]]<br />
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<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
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= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Professional_Training_on_Opioids_&_Alternative_Pain_Management_Approaches|More RTI on Professional Training on Opioids and Alternative Pain Management]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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{| class="wiki_table"<br />
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| '''Date'''<br />
| '''Comments'''<br />
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= Sources =<br />
<br />
----<br />
<br />
#[http://www.sciencedirect.com/science/article/pii/S0376871616300278 [1]] <br />
#[http://www.sciencedirect.com/science/article/pii/S0376871616300278 [2]] <br />
#[http://www.sciencedirect.com/science/article/pii/S0376871616300278 [3]] <br />
#[https://www.statnews.com/2017/08/07/doctors-opioid-prescriptions/ [4]] <br />
#[https://www.statnews.com/2017/08/07/doctors-opioid-prescriptions/ [5]] <br />
#[http://www.addictionpolicy.org/single-post/2017/12/12/Addiction-Policy-Forum-Announces-New-Initiatives-and-Partnerships-to-Address-the-Opioid-Crisis [6]] <br />
#100 Million Healthier Lives State-Wide Efforts.<br/> [http://www.ddap.pa.gov/overdose/Pages/Department%20Focus%20on%20Addressing%20Overdose.aspx [7]] <br />
#100 Million Healthier Lives Country-Wide Efforts <br />
#[https://healthitanalytics.com/features/addressing-opioid-abuse-with-analytics-population-health-strategies [8]] <br />
#[http://www.annfammed.org/content/10/4/366.full [9]] <br />
#[http://www.annfammed.org/content/10/4/366.full [10]] <br />
#[https://www.asam.org/education/resources/Opioid-Prescribing [11]] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Prescribing_Practices&diff=19337Improve Prescribing Practices2019-11-25T00:40:53Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Mapor]] [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">&nbsp; <br />
= Insurance Company Practices Contribute to Over-Prescription of Opioids =<br />
<div class="_">The over-prescription of opioids is largely a result of the US health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people (Medicaid), won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine. “Say you have a patient that's 45 years old. They have lower back pain, you examine them, they have a muscle spasm. Really the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. Even if the insurance covers physical therapy, you probably need prior authorization which is a lot of time and paperwork.” <sup class="reference"><ref>[1]Am, closeAm, a E., & EricksonEmailEmailBioBio, a. (n.d.). Analysis | Opioid abuse in the U.S. is so bad it’s lowering life expectancy. Why hasn’t the epidemic hit other countries? Retrieved November 24, 2019, from Washington Post website: https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/</ref></sup></div> <div class="_">&nbsp; The US health-care system is different from other countries' in other ways, too. There is pressure to address pain, and a pervasive attitude that everything is fixable. As a result, doctors in the United States are much more likely to provide painkillers than are doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time. <sup class="reference"><ref>[2]Am, closeAm, a E., & EricksonEmailEmailBioBio, a. (n.d.). Analysis | Opioid abuse in the U.S. is so bad it’s lowering life expectancy. Why hasn’t the epidemic hit other countries? Retrieved November 24, 2019, from Washington Post website: https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/</ref></sup></div> <div class="_">&nbsp; Prescribing practices must be improved by providing better education in US medical schools about pain management, opioid abuse, and addiction. Other practices that could help reduce the prescription of opioids would be modifying regulations surrounding direct to consumer advertisements by pharmaceutical companies and limiting the ways in which they can influence doctors, such as restricting gifts, vacations, and other forms of compensation.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Prescribing should take Risk Factors into Consideration =<br />
<br />
== Opioid Naive Patients ==<br />
<div class="_">Patients who are considered "[http://drugs.emedtv.com/medicine/what-does-opioid-naive-mean.html Opioid Naive]" should receive education and screening for risk factors.<br/> &nbsp; Multiple studies (five of which are referenced in this UpToDate article) have reported an increased risk of new persistent opioid use after prescription of opioids for acute pain in opioid naïve patients<sup class="reference"><ref>[3]Carlos A Pino, Melissa Covington,MD, Precription of opioids for acute pain in opioid naive patients, UpToDate, May 14,2019, Retrieved from https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients</ref></sup><br/> &nbsp; That article also states: "Importantly, post-surgical opioid prescription in opioid naïve patients is also associated with an increase in overdose and misuse."<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Other Risk Factors ==<br />
<div class="_">This UpToDate article cites 2 studies and concludes: "Risk factors for persistent opioid use after surgery include preoperative pain; medical comorbidities; depression; a history of drug, alcohol, or tobacco abuse; lower socioeconomic status; and use of benzodiazepines or antidepressants."<sup class="reference"><ref>[4]Carlos A Pino, Melissa Covington,MD, Precription of opioids for acute pain in opioid naive patients, UpToDate, May 14,2019, Retrieved from https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients</ref></sup><br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= CDC Guidelines for Prescribing Opioids for Chronic Pain =<br />
<div class="_">The Center for Disease Control and Prevention issued 12 recommendations for primary care providers, who account for nearly half of opioid prescriptions. The agency highlighted three of them:</div> <div class="_">&nbsp;</div> <br />
*Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care. <br />
*When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose. <br />
*Providers should always exercise caution when prescribing opioids and monitor all patients closely. <br />
<br />
The idea is to encourage doctors to be more cautious about prescribing opioids, making them less likely to distribute the drugs to patients who are prone to addiction or don't really need the medication. (The evidence on whether opioid painkillers can even treat chronic pain is [https://www.ncbi.nlm.nih.gov/pubmed/24480962 weak] at best.) And if doctors take up the recommendations, they could help stop one of the deadliest drug epidemics in US history.<sup class="reference"><ref>[5]The CDC is trying to get doctors to help stop the opioid epidemic—Vox. (n.d.). Retrieved November 24, 2019, from https://www.vox.com/2016/3/15/11236600/cdc-guidelines-opioid-epidemic</ref></sup><br/> <br/> Source:[https://www.cdc.gov/drugoverdose/prescribing/guideline.html https://www.cdc.gov/drugoverdose/prescribing/guideline.html]<br/> &nbsp;<br />
<br />
= Ways to Improve Prescribing Practices =<br />
<br />
== Improve Patient Education on the Risks of Using Opioids and the Alternatives ==<br />
<div class="_">Many patients just want relief from pain, and they may not be aware of the risks or alternatives. Doctors who prescribe opioids should take steps to ensure that patients are not "opioid naive"</div> <div class="_">&nbsp;</div> <br />
== Use Tools Built into EHRs ==<br />
<br />
== EHRs are adding tools to support better prescribing practices for opioids. ==<br />
<br />
MEDITECH is one example with ther new (2019) module, the [https://ehr.meditech.com/news/reduce-opioid-related-harm-with-meditechs-opioid-stewardship-toolkit Opioid Stewardship Toolkit]<br />
<br />
== Adopt Policies That Compel Physicians To Utilize PDMPs ==<br />
<div class="_">Long before the current opioid epidemic, most states developed drug-tracking systems to allow physicians and pharmacists to check patients’ prescription drug use, including opioid painkillers, to determine whether they may be receiving too many pills, at too high a dose or in dangerous combination with other medications such as sedatives and muscle relaxants. But few prescribers took advantage of the systems.</div> <div class="_">&nbsp;</div> <br />
*Until states began requiring physicians to use prescription drug-monitoring programs, fewer than 35 percent of medical professionals used the tracking systems to identify patients who may be at risk for addiction and overdose. Now, in states that require doctors to consult PDMPs, physician usage rates exceed 90 percent.<sup class="reference"><ref>[6]5. In Opioid Epidemic, States Intensify Prescription Drug Monitoring. (n.d.). Retrieved November 24, 2019, from https://www.govtech.com/policy/In-Opioid-Epidemic-States-Intensify-Prescription-Drug-Monitoring.html</ref></sup> <br />
*Overall opioid prescribing has declined in those states as well, as have drug-related hospitalizations and overdose deaths. States also are seeing a rise in addiction treatment as more doctors refer patients to treatment after discovering they are taking painkillers from multiple sources and are likely addicted. <br />
*In 2010, Colorado, Delaware, Louisiana, Nevada and Oklahoma were the first states to require doctors and other prescribers to search patients’ drug histories before prescribing opioid painkillers, sedatives or other potentially harmful and addictive drugs. By December 2016, at least 31 states were requiring prescriber use of PDMPs. <br />
*This year (2017), eight more states — Alabama, Alaska, California, Florida, Michigan, South Carolina, Texas and Wisconsin — implemented policies requiring doctors to not only log in to the state’s prescription drug-tracking system before prescribing a controlled substance, but also to analyze each patient’s history of drug use, and if necessary, limit prescription renewals for opioids and other potentially addictive or dangerous medications.<sup class="reference"><ref>[7]5. In Opioid Epidemic, States Intensify Prescription Drug Monitoring. (n.d.). Retrieved November 24, 2019, from https://www.govtech.com/policy/In-Opioid-Epidemic-States-Intensify-Prescription-Drug-Monitoring.html</ref></sup> <br />
<br />
&nbsp;<br />
<br />
== Improve Patient Education on the Risks of Opioids ==<br />
<div class="_">Patient understanding of risks should be assessed, and information should be provided to address gaps in understanding of the risks.<br/> &nbsp; An new technology-enhanced approach to patient understanding and education is available through [https://drproveit.com/ DrProveIt.com]</div> <div class="_">&nbsp;</div> <br />
= Approaches to Reduce Inappropriate Prescriptions =<br />
<br />
== Ohio's Safety Checkpoints ==<br />
<div class="_">Ohio has developed an approach to "safety checkpoints" to minimize inappropriate prescriptions but still allow people who need them to be able to get them--with some added precautions.<br/> <ref>[1]Loudlow, R. (n.d.). State to enforce “safety checkpoints” on prescription opioid use—News—The Columbus Dispatch—Columbus, OH. Retrieved November 24, 2019, from https://www.dispatch.com/news/20180502/state-to-enforce-safety-checkpoints-on-prescription-opioid-use</ref></div> <div class="_">&nbsp;</div> <br />
== GuideMed ==<br />
<div class="_">One option to essentially outsource some of the added requirements for opioid prescribing is to work with a third party that integrates with the prescribing process to follow the recommended best practices without adding to the burden of the prescribing physician. You can learn more about [https://guidemed.com/about-guidemed/how-it-works/ GuideMed at their Website] This added service allows insurance to be billed for a more complex [http://www.medicarepaymentandreimbursement.com/2010/10/time-guideline-for-99211-99212-99213.html Evaluation and Management code] (99213) instead of the typical code (99212), and this adds about $30 to the revenue for each visit.&nbsp;</div> <div class="_">&nbsp;<span style="color: #272647; font-family: Verdana,sans-serif; font-size: 1.5em; letter-spacing: 1px">'''Tools & Resources'''</span><br/> [[TR_-_Improve_Prescribing_Practices|TR - Improve Prescribing Practices]]</div> <div class="_">&nbsp;</div> <div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction )<br/> Potential Measures and Data Sources (Under Construction )<br/> Potential Actions and Partners(Under Construction )<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Prescribing_Practices|More RTI on Improve Prescribing Practices]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Prescribing_Practices&diff=19336Improve Prescribing Practices2019-11-25T00:29:43Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Mapor]] [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">&nbsp; <br />
= Insurance Company Practices Contribute to Over-Prescription of Opioids =<br />
<div class="_">The over-prescription of opioids is largely a result of the US health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people (Medicaid), won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine. “Say you have a patient that's 45 years old. They have lower back pain, you examine them, they have a muscle spasm. Really the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. Even if the insurance covers physical therapy, you probably need prior authorization which is a lot of time and paperwork.” <sup class="reference">[1]</sup></div> <div class="_">&nbsp; The US health-care system is different from other countries' in other ways, too. There is pressure to address pain, and a pervasive attitude that everything is fixable. As a result, doctors in the United States are much more likely to provide painkillers than are doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time. <sup class="reference">[2]</sup></div> <div class="_">&nbsp; Prescribing practices must be improved by providing better education in US medical schools about pain management, opioid abuse, and addiction. Other practices that could help reduce the prescription of opioids would be modifying regulations surrounding direct to consumer advertisements by pharmaceutical companies and limiting the ways in which they can influence doctors, such as restricting gifts, vacations, and other forms of compensation.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Prescribing should take Risk Factors into Consideration =<br />
<br />
== Opioid Naive Patients ==<br />
<div class="_">Patients who are considered "[http://drugs.emedtv.com/medicine/what-does-opioid-naive-mean.html Opioid Naive]" should receive education and screening for risk factors.<br/> &nbsp; Multiple studies (five of which are referenced in this UpToDate article) have reported an increased risk of new persistent opioid use after prescription of opioids for acute pain in opioid naïve patients<sup class="reference">[3]</sup><br/> &nbsp; That article also states: "Importantly, post-surgical opioid prescription in opioid naïve patients is also associated with an increase in overdose and misuse."<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Other Risk Factors ==<br />
<div class="_">This UpToDate article cites 2 studies and concludes: "Risk factors for persistent opioid use after surgery include preoperative pain; medical comorbidities; depression; a history of drug, alcohol, or tobacco abuse; lower socioeconomic status; and use of benzodiazepines or antidepressants."<sup class="reference">[4]</sup><br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= CDC Guidelines for Prescribing Opioids for Chronic Pain =<br />
<div class="_">The Center for Disease Control and Prevention issued 12 recommendations for primary care providers, who account for nearly half of opioid prescriptions. The agency highlighted three of them:</div> <div class="_">&nbsp;</div> <br />
*Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care. <br />
*When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose. <br />
*Providers should always exercise caution when prescribing opioids and monitor all patients closely. <br />
<br />
The idea is to encourage doctors to be more cautious about prescribing opioids, making them less likely to distribute the drugs to patients who are prone to addiction or don't really need the medication. (The evidence on whether opioid painkillers can even treat chronic pain is [https://www.ncbi.nlm.nih.gov/pubmed/24480962 weak] at best.) And if doctors take up the recommendations, they could help stop one of the deadliest drug epidemics in US history.<sup class="reference">[5]</sup><br/> <br/> Source:[https://www.cdc.gov/drugoverdose/prescribing/guideline.html https://www.cdc.gov/drugoverdose/prescribing/guideline.html]<br/> &nbsp;<br />
<br />
= Ways to Improve Prescribing Practices =<br />
<br />
== Improve Patient Education on the Risks of Using Opioids and the Alternatives ==<br />
<div class="_">Many patients just want relief from pain, and they may not be aware of the risks or alternatives. Doctors who prescribe opioids should take steps to ensure that patients are not "opioid naive"</div> <div class="_">&nbsp;</div> <br />
== Use Tools Built into EHRs ==<br />
<br />
== EHRs are adding tools to support better prescribing practices for opioids. ==<br />
<br />
MEDITECH is one example with ther new (2019) module, the [https://ehr.meditech.com/news/reduce-opioid-related-harm-with-meditechs-opioid-stewardship-toolkit Opioid Stewardship Toolkit]<br />
<br />
== Adopt Policies That Compel Physicians To Utilize PDMPs ==<br />
<div class="_">Long before the current opioid epidemic, most states developed drug-tracking systems to allow physicians and pharmacists to check patients’ prescription drug use, including opioid painkillers, to determine whether they may be receiving too many pills, at too high a dose or in dangerous combination with other medications such as sedatives and muscle relaxants. But few prescribers took advantage of the systems.</div> <div class="_">&nbsp;</div> <br />
*Until states began requiring physicians to use prescription drug-monitoring programs, fewer than 35 percent of medical professionals used the tracking systems to identify patients who may be at risk for addiction and overdose. Now, in states that require doctors to consult PDMPs, physician usage rates exceed 90 percent.<sup class="reference">[6]</sup> <br />
*Overall opioid prescribing has declined in those states as well, as have drug-related hospitalizations and overdose deaths. States also are seeing a rise in addiction treatment as more doctors refer patients to treatment after discovering they are taking painkillers from multiple sources and are likely addicted. <br />
*In 2010, Colorado, Delaware, Louisiana, Nevada and Oklahoma were the first states to require doctors and other prescribers to search patients’ drug histories before prescribing opioid painkillers, sedatives or other potentially harmful and addictive drugs. By December 2016, at least 31 states were requiring prescriber use of PDMPs. <br />
*This year (2017), eight more states — Alabama, Alaska, California, Florida, Michigan, South Carolina, Texas and Wisconsin — implemented policies requiring doctors to not only log in to the state’s prescription drug-tracking system before prescribing a controlled substance, but also to analyze each patient’s history of drug use, and if necessary, limit prescription renewals for opioids and other potentially addictive or dangerous medications.<sup class="reference">[7]</sup> <br />
<br />
&nbsp;<br />
<br />
== Improve Patient Education on the Risks of Opioids ==<br />
<div class="_">Patient understanding of risks should be assessed, and information should be provided to address gaps in understanding of the risks.<br/> &nbsp; An new technology-enhanced approach to patient understanding and education is available through [https://drproveit.com/ DrProveIt.com]</div> <div class="_">&nbsp;</div> <br />
= Approaches to Reduce Inappropriate Prescriptions =<br />
<br />
== Ohio's Safety Checkpoints ==<br />
<div class="_">Ohio has developed an approach to "safety checkpoints" to minimize inappropriate prescriptions but still allow people who need them to be able to get them--with some added precautions.<br/> [http://www.dispatch.com/news/20180502/state-to-enforce-safety-checkpoints-on-prescription-opioid-use [1]]</div> <div class="_">&nbsp;</div> <br />
== GuideMed ==<br />
<div class="_">One option to essentially outsource some of the added requirements for opioid prescribing is to work with a third party that integrates with the prescribing process to follow the recommended best practices without adding to the burden of the prescribing physician. You can learn more about [https://guidemed.com/about-guidemed/how-it-works/ GuideMed at their Website] This added service allows insurance to be billed for a more complex [http://www.medicarepaymentandreimbursement.com/2010/10/time-guideline-for-99211-99212-99213.html Evaluation and Management code] (99213) instead of the typical code (99212), and this adds about $30 to the revenue for each visit.&nbsp;</div> <div class="_">&nbsp;<span style="color: #272647; font-family: Verdana,sans-serif; font-size: 1.5em; letter-spacing: 1px">'''Tools & Resources'''</span><br/> [[TR_-_Improve_Prescribing_Practices|TR - Improve Prescribing Practices]]</div> <div class="_">&nbsp;</div> <br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction )<br/> Potential Measures and Data Sources (Under Construction )<br/> Potential Actions and Partners(Under Construction )<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Improve_Prescribing_Practices|More RTI on Improve Prescribing Practices]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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= Sources =<br />
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<br />
#[https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/?utm_term=.2980421eefd1 [2]] <br />
#[https://www.washingtonpost.com/news/worldviews/wp/2017/12/28/opioid-abuse-in-america-is-so-bad-its-lowering-our-life-expectancy-why-hasnt-the-epidemic-hit-other-countries/?utm_term=.2980421eefd1 [3]] <br />
#[https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients [4]] <br />
#[https://www.uptodate.com/contents/prescription-of-opioids-for-acute-pain-in-opioid-naive-patients [5]] <br />
#[https://www.vox.com/2016/3/15/11236600/cdc-guidelines-opioid-epidemic [6]] <br />
##<br />
##*<br />
##**<br />
##***<br />
##****<br />
##*****<br />
##******<br />
##*******[http://www.govtech.com/policy/In-Opioid-Epidemic-States-Intensify-Prescription-Drug-Monitoring.html [7]] <br />
##*****[http://www.govtech.com/policy/In-Opioid-Epidemic-States-Intensify-Prescription-Drug-Monitoring.html [8]] <br />
</div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Improve_Use_of_PDMP_to_Identify_Patients_Misusing_Opioids&diff=19332Improve Use of PDMP to Identify Patients Misusing Opioids2019-11-25T00:22:10Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map&nbsp;or]] [[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP)]]__TOC__<br/> (Replace this text with the information you will place here.)<br/> <br/> <br/> &nbsp;<br />
<div class="mw-parser-output"><br />
= Tools & Resources =<br />
<div class="_">[[TR_-_Improve_Use_of_PDMP_to_Identify_Patients_Misusing_Opioids|TR - Improve Use of PDMP to Identify Patients Misusing Opioids]]</div> <div class="_">&nbsp;</div> </div> <br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<div class="_">Potential Objective Details(Under Construction )&nbsp;<br/> Potential Measures and Data Sources(Under Construction )&nbsp;<br/> Potential Actions and Partners(Under Construction )&nbsp;</div> <div class="_">&nbsp;</div> </div><br />
<br />
= Resources to Investigate =<br />
<div class="_">[[RTI_-_Improve_Use_of_PDMP_to_Identify_Patients_Misusing_Opioids|More RTI on Improve Use of PDMP to Identify Patients Misusing Opioids]]</div> <div class="_">&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></div> <div class="_">&nbsp;</div> <div class="_">&nbsp;</div> <br />
{| class="wiki_table"<br />
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= Sources =<br />
</div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_%26_Enhance_Prescription_Drug_Monitoring_Program_(PDMP)&diff=19330Expand & Enhance Prescription Drug Monitoring Program (PDMP)2019-11-25T00:20:37Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP)&nbsp;]]&nbsp;or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]&nbsp;or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]]&nbsp;or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''<br />
<br />
----<br />
<br />
(PDMP) allows pre-registered users including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards to access timely patient controlled substance history information.<sup class="reference"><ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref></sup><br/> <br/> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<sup class="reference"><ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup><br />
<br />
= Background =<br />
<br />
== The Purpose of PDMPs ==<br />
<br />
The main objectives of PDMP programs are to:<br />
<br />
*Improve patient safety. <br />
*Build a data collection and analysis system at a state level. <br />
*Enhance existing programs' ability to analyze and use collected data. <br />
*Facilitate the exchange of collected prescription data among states. <br />
*Assess the efficiency and effectiveness of the programs funded under this initiative.<sup class="reference"><ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup> <br />
<br />
<br/> PDMPs can alert Healthcare Providers to provide potentially lifesaving information and interventions.<br />
<br />
*They DO for those using prescription opioids <br />
**Help collaborate with the patient to taper to a safer dosage <br />
**Consider offering naloxone <br />
**Communicate with other providers managing the patient <br />
**Weigh patient goals, needs, risks <br />
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<sup class="reference"><ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref></sup> <br />
*They DO NOT dismiss patients from care <br />
<br />
<br/> With this in mind, states are trying to find ways to increase use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<sup class="reference"><ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref></sup><br/> &nbsp; [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]<br />
<br />
__TOC__<br />
<br />
== Examples of Positive Impact ==<br />
<br />
*Between the years of 2010-2012 Florida implemented a PDMP and other "pill mill" policies that had an positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<sup class="reference"><ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref></sup> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<sup class="reference"><ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref></sup> <br />
*New York Experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<sup class="reference"><ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup> <br />
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<sup class="reference"><ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup> <br />
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<sup class="reference"><ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup> <br />
<br />
&nbsp;<br />
<br />
== Examples of Negative Impact ==<br />
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<sup class="reference"><ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></sup></div> <div class="_">&nbsp;</div> <br />
== Legislation ==<br />
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <sup class="reference"><ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1<br />
</ref></sup><br/> <br/> Opportunities to Enhance PDMPs</div> <br />
== TTAC ==<br />
<br />
[http://www.pdmpassist.org/ Training Technical Assistance Center ]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.<br />
<br />
== Third Party Patient Monitoring ==<br />
<br />
'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<sup class="reference"><ref>[17] Can't find the source ( Error 525)</ref></sup> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.<sup class="reference"><ref>[18]Can't find source ( error 525) https://guidemed.com/about-guidemed/</ref></sup><br />
<br />
== Provider Challenges to Effective Use of PDMPs ==<br />
<br />
*<u>Insufficient Resources:</u> Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "it's too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.") <br />
*<u>Patient Provider Relationship:</u> The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.") <br />
*<u>Data Management:</u> There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated. <br />
*<u>Consistency:</u> Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<sup class="reference"><ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref></sup> <br />
<br />
<br/> '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<sup class="reference"><ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from : chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2Fprograms%2Fpmixarchitecture.pdf</ref></sup><br />
<br />
== Use PDMPs to Improve Patient Safety ==<br />
<br />
== National Alliance for Model State Drug Laws ==<br />
<div class="_">View [http://www.namsdl.org/prescription-monitoring-programs.cfm model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_">&nbsp;</div> <br />
*Annual summaries or highlights <br />
*Administration of PDMPs <br />
*Data Reporting and Retention <br />
*Types of Authorized Recipients <br />
*Access and Registration <br />
*PDMPs and Privacy <br />
*Miscellaneaous Documents <br />
<br />
= State PDMPs =<br />
<br />
#<span style="background-color: #ffffff">[https://oag.ca.gov/cures CURES ]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]</span> <br />
#<span style="background-color: #ffffff">[http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie EDIE ]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as patient visits ER.</span> <br />
#<span style="background-color: #ffffff">[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE ]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of it's [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources ].</span> <br />
#<span style="background-color: #ffffff">[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via user name and password.</span> <br />
#<span style="color: #fa1048">[http://www.worxpdmp.com/ WORx]</span><span style="background-color: #ffffff">Wyoming's active PDMP system.</span> <br />
<br />
&nbsp;<br />
<br />
== Find Your State's PDMP ==<br />
<div class="_">Use this [http://mytopcare.org/resources/using-the-state-prescription-monitoring-program-pmp-effectively/find-your-states-pmp/ link] to find your state's Prescription Drug Monitoring Program.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Innovative Use of PDMP Data =<br />
<br />
== Notify the Care Team that Prescribed the Opioids of the Overdose Death ==<br />
<div class="_">In Monterey County, CA, Coroners who identify that a person has died after misusing prescription opioids make use of data in the PDMP to identify and notify the care team that prescribed the opioids that their patient died. This seems to have had a big impact on prescribers and seems to have contributed to significant reductions in opioid prescription rates and increased use of non-opioid treatments for pain. (Need details and source.)</div> <div class="_"><br />
= Funding Opportunities =<br />
<br />
=== Current Funding Methods ===<br />
<br />
*Federal grants <br />
*Private/Non-federal grants <br />
*General revenue funds <br />
*Controlled substance registration fees <br />
*Professional licensing fees <br />
*Regulatory board funds <br />
<br />
=== Potential Funding Methods ===<br />
<br />
*Legal settlements <br />
*PDMP licensing fees <br />
*Health insurance licensing fees <br />
*Private donations <br />
*Medicaid fraud settlements <br />
*Assessed fines <br />
*Asset Forfeiture <br />
*Drug manufacturers' assessment <br />
*Prescription fees <br />
*Private third party payers or health insurers <br />
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=http%3A%2F%2Fwww.pdmpassist.org%2Fpdf%2FPDMP_Funding_Options_TAG.pdf</ref> <br />
*see the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions.<br/> <br/> <u>The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program</u> is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<sup class="reference"><ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals due April 25, 2017.<sup class="reference"><ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup><br/> <br/> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects<br/> Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders.The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program will be applied by April 25, 2017.<sup class="reference"><ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup> <br />
</div> <div class="_">&nbsp;</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]]<br/> <br/> The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
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Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures & Data Sources(Under Construction)&nbsp;<br />
<br />
= Actions to Take =<br/> Potential Coalition Actions & Partners Potential Actions for Individuals(Under Construction)&nbsp;<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|More Resources to Investigate on PDMP Use and Impact]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
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|}<br />
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= Sources =<br />
<br />
&nbsp;<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Increase_Access_to_Non-Pharma_Therapies&diff=19329Increase Access to Non-Pharma Therapies2019-11-24T23:55:56Z<p>Josiebeets: </p>
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Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to Partner Roles: [[Health_Plans_and_Insurance_Companies|Health Plans]] __TOC__<br />
<br />
= Overview =<br />
<br />
This objective focuses on Non-Pharmacologic Pain Care (NPPC).<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<br />
Currently, most insurance plans do not cover most non-medication therapies. Working with insurance companies to put more alternative and complementary pain therapies in their formularies and services covered can decrease the prescribing of opioids for pain. Using such therapies that are alternatives to opiates can prevent patients from having opiates introduced into their bodies, which is one of the best ways to reduce the number of people who try an opiate. Using alternate therapies can also prevent unpleasant adverse effects of opiates, such as nausea and vomiting. Often times, people using opiates use other illicit and addicting substances to treat their nausea such as marijuana, producing a cycle of dependency on those two drugs that is difficult to break. Also, patients with Substance Use Disorder are more likely to try other addicting drugs, making treatment and quitting harder. There are many benefits of using alternative therapies, and as many fields are being studied, they appear to be a promising way to help deal with the Opioid Crisis. Considering alternative and complementary therapies in today’s society where patients often have complicated medical histories and polymedication can also help them avoid adverse drug reactions and help preserve the health of various organs by putting less stress on liver (which metabolizes the drug and detoxifies the body) and kidney (which excretes the drug). Using therapies that have less toll on the body can help our patients stay healthier and overall improve their quality of life.<br />
<br />
&nbsp;<br />
<br />
= Current Status =<br />
<br />
*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference"><ref>[1]AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment. (n.d.). Retrieved November 24, 2019, from http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/<br />
</ref></sup> <br />
*Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.<sup class="reference"><ref>[2]Searching for solutions to the opioid crisis. (2018, May 5). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180505/BLOG/180509948/searching-for-solutions-to-the-opioid-crisis<br />
</ref></sup> <br />
<br />
= Complementary Health Approaches =<br />
<br />
*[[Acupuncture|Acupuncture]] <br />
*[[Chiropractic_Care|Chiropractic Care]] and Spinal Manipulation <br />
*Massage Therapy <br />
*[[Stretching_and_Fitness_Techniques_to_Minimize_Pain|Stretching and Fitness Techniques to Minimize Pain]] <br />
*[[Mindfulness_and_meditation-based_therapies|Mindfulness and meditation-based therapies]] <br />
*[[Tai_Chi|Tai Chi]] and Qi Gong <br />
*Yoga <br />
*Biofeedback <br />
*Transcutaneous electrical nerve stimulation, or TENS. <br />
<br />
&nbsp;<br />
<br />
= Benefits of Active Self-Care Therapies =<br />
<br />
In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<ref>[3] Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promotion Practice, 6(2), 148–156. https://doi.org/10.1177/1524839904266792<br />
</ref>For example, the military has studied “active self-care therapies” as a category of pain management that may be of value in an integrated, multi-modal approac<span style="background-color:#e74c3c;">h.</span><sup class="reference"><span style="background-color:#e74c3c;"><ref>[4]Citation needed </ref></span></sup><br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
These programs have shown promising results with varying degrees of research.<br />
<br />
&nbsp;<br />
<br />
== MyStrength ==<br />
<br />
[http://www.mystrength.com myStrength] helps fill the gap between generalized pain management and prescription opioid use through education, encouragement and evidence-based pain management tools.<br/> myStrength, Inc. is a recognized leader and one of the fastest-growing digital behavioral health companies in the US. myStrength enhances traditional care models while addressing issues of cost, lack of access and stigma in order to deliver mental health and well-being resources at scale. The platform targets the most prevalent and costly behavioral health conditions, empowering consumers with innovative self-care resources to manage and overcome challenges with depression, anxiety, substance use disorders and chronic pain. myStrength collaborates with over 100 health plans, community behavioral health centers, integrated health systems and ACOs. More information on [[MyStrength|myStrength]]<br/> &nbsp;<br />
<br />
== Little Falls, Minnesota's Program to Reduce Opioid Prescriptions for Pain ==<br />
<br />
In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference"><ref>[5]A Minnesota Critical Access Hospital Uses Medication-assisted Therapy to Tackle the Opioid Crisis | AHA News. (n.d.). Retrieved November 24, 2019, from https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted<br />
</ref></sup><br />
<br />
This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference"><ref>[6]Successful Little Falls effort to curb opioids gets big notice in D.C. - StarTribune.com. (n.d.). Retrieved November 24, 2019, from http://www.startribune.com/little-falls-effort-to-curb-opioids-gets-big-notice/448037143/<br />
</ref></sup> For example, On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs based on the program in Little Falls, MN. H.F. No. 2140 would establish opioid abuse prevention pilot projects throughout the state with appropriate funding. Each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts. The bill is currently going through revisions in Minnesota's house and senate.<sup class="reference"><ref>[7]stgabriels. (2017, August 18). MN House bill on Opioid Abuse Prevention seeks to replicate CHI St. Gabriel’s Health and community partner’s model program. Retrieved November 24, 2019, from CHI St. Gabriel’s Health website: https://www.chistgabriels.com/mn-house-bill-on-opioid-abuse-prevention-seeks-to-replicate-chi-st-gabriels-health-and-community-partners-model-program/<br />
</ref></sup> Minnesota is all currently taking applications for places interested in starting pilot programs based on Little Falls' model [http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2018OpioidPreventionRFPFINAL.pdf Opioid Abuse Prevention Pilot Projects]<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Potential Areas of Intervention/Training =<br />
<br />
&nbsp;<br />
<br />
== Education for Future Doctors ==<br />
<br />
When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.<br />
<br />
One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the source (( file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf)) </ref></span></sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Insurance and Coordinated Care ==<br />
<br />
Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;"><ref>[9] Can't find source/ ((file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf))</ref></span></sup><br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|TR - Increase Access to Alternative Therapies to Treat Pain]]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|More RTI on Increase Access to Alternative Therapies to Treat Pain]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
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= Sources =<br />
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<br/> <span style="display: block; height: 1px; left: 0px; overflow: hidden; position: absolute; top: 758px; width: 1px"><span style="background: 0px 0px #ffffff; border: 0px; box-sizing: border-box; color: #3a3a3a; font-family:">On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs. The bill is modeled after Morrison County’s program. “We’ve heard a lot of discussion about the opioid problem, and this bill offers a viable solution,” says Kresha. “There’s no sense reinventing the wheel when we know we have something that works.”<br/> H.F. No. 2140 would require the Commissioner of Health to establish opioid abuse prevention pilot projects throughout the state and appropriate funding for these projects. Current language in the bill states each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts.</span></span><br />
<br />
----<br />
</div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Increase_Access_to_Non-Pharma_Therapies&diff=19328Increase Access to Non-Pharma Therapies2019-11-24T23:55:12Z<p>Josiebeets: </p>
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Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to Partner Roles: [[Health_Plans_and_Insurance_Companies|Health Plans]] __TOC__<br />
<br />
= Overview =<br />
<br />
This objective focuses on Non-Pharmacologic Pain Care (NPPC).<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<br />
Currently, most insurance plans do not cover most non-medication therapies. Working with insurance companies to put more alternative and complementary pain therapies in their formularies and services covered can decrease the prescribing of opioids for pain. Using such therapies that are alternatives to opiates can prevent patients from having opiates introduced into their bodies, which is one of the best ways to reduce the number of people who try an opiate. Using alternate therapies can also prevent unpleasant adverse effects of opiates, such as nausea and vomiting. Often times, people using opiates use other illicit and addicting substances to treat their nausea such as marijuana, producing a cycle of dependency on those two drugs that is difficult to break. Also, patients with Substance Use Disorder are more likely to try other addicting drugs, making treatment and quitting harder. There are many benefits of using alternative therapies, and as many fields are being studied, they appear to be a promising way to help deal with the Opioid Crisis. Considering alternative and complementary therapies in today’s society where patients often have complicated medical histories and polymedication can also help them avoid adverse drug reactions and help preserve the health of various organs by putting less stress on liver (which metabolizes the drug and detoxifies the body) and kidney (which excretes the drug). Using therapies that have less toll on the body can help our patients stay healthier and overall improve their quality of life.<br />
<br />
&nbsp;<br />
<br />
= Current Status =<br />
<br />
*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference"><ref>[1]AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment. (n.d.). Retrieved November 24, 2019, from http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/<br />
</ref></sup> <br />
*Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.<sup class="reference"><ref>[2]Searching for solutions to the opioid crisis. (2018, May 5). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180505/BLOG/180509948/searching-for-solutions-to-the-opioid-crisis<br />
</ref></sup> <br />
<br />
= Complementary Health Approaches =<br />
<br />
*[[Acupuncture|Acupuncture]] <br />
*[[Chiropractic_Care|Chiropractic Care]] and Spinal Manipulation <br />
*Massage Therapy <br />
*[[Stretching_and_Fitness_Techniques_to_Minimize_Pain|Stretching and Fitness Techniques to Minimize Pain]] <br />
*[[Mindfulness_and_meditation-based_therapies|Mindfulness and meditation-based therapies]] <br />
*[[Tai_Chi|Tai Chi]] and Qi Gong <br />
*Yoga <br />
*Biofeedback <br />
*Transcutaneous electrical nerve stimulation, or TENS. <br />
<br />
&nbsp;<br />
<br />
= Benefits of Active Self-Care Therapies =<br />
<br />
In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<ref>[3] Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promotion Practice, 6(2), 148–156. https://doi.org/10.1177/1524839904266792<br />
</ref>For example, the military has studied “active self-care therapies” as a category of pain management that may be of value in an integrated, multi-modal approac<span style="background-color:#e74c3c;">h.</span><sup class="reference"><span style="background-color:#e74c3c;"><ref>[4]Citation needed </ref></span></sup><br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
These programs have shown promising results with varying degrees of research.<br />
<br />
&nbsp;<br />
<br />
== MyStrength ==<br />
<br />
[http://www.mystrength.com myStrength] helps fill the gap between generalized pain management and prescription opioid use through education, encouragement and evidence-based pain management tools.<br/> myStrength, Inc. is a recognized leader and one of the fastest-growing digital behavioral health companies in the US. myStrength enhances traditional care models while addressing issues of cost, lack of access and stigma in order to deliver mental health and well-being resources at scale. The platform targets the most prevalent and costly behavioral health conditions, empowering consumers with innovative self-care resources to manage and overcome challenges with depression, anxiety, substance use disorders and chronic pain. myStrength collaborates with over 100 health plans, community behavioral health centers, integrated health systems and ACOs. More information on [[MyStrength|myStrength]]<br/> &nbsp;<br />
<br />
== Little Falls, Minnesota's Program to Reduce Opioid Prescriptions for Pain ==<br />
<br />
In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference"><ref>[5]A Minnesota Critical Access Hospital Uses Medication-assisted Therapy to Tackle the Opioid Crisis | AHA News. (n.d.). Retrieved November 24, 2019, from https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted<br />
</ref></sup><br />
<br />
This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference"><ref>[6]Successful Little Falls effort to curb opioids gets big notice in D.C. - StarTribune.com. (n.d.). Retrieved November 24, 2019, from http://www.startribune.com/little-falls-effort-to-curb-opioids-gets-big-notice/448037143/<br />
</ref></sup> For example, On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs based on the program in Little Falls, MN. H.F. No. 2140 would establish opioid abuse prevention pilot projects throughout the state with appropriate funding. Each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts. The bill is currently going through revisions in Minnesota's house and senate.<sup class="reference"><ref>[7]stgabriels. (2017, August 18). MN House bill on Opioid Abuse Prevention seeks to replicate CHI St. Gabriel’s Health and community partner’s model program. Retrieved November 24, 2019, from CHI St. Gabriel’s Health website: https://www.chistgabriels.com/mn-house-bill-on-opioid-abuse-prevention-seeks-to-replicate-chi-st-gabriels-health-and-community-partners-model-program/<br />
</ref></sup> Minnesota is all currently taking applications for places interested in starting pilot programs based on Little Falls' model [http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2018OpioidPreventionRFPFINAL.pdf Opioid Abuse Prevention Pilot Projects]<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Potential Areas of Intervention/Training =<br />
<br />
&nbsp;<br />
<br />
== Education for Future Doctors ==<br />
<br />
When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.<br />
<br />
One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the citation</ref></span></sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Insurance and Coordinated Care ==<br />
<br />
Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;">[9]</span></sup><br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|TR - Increase Access to Alternative Therapies to Treat Pain]]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|More RTI on Increase Access to Alternative Therapies to Treat Pain]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
<div class="mw-parser-output"><br />
= Sources =<br />
<br />
<br/> <span style="display: block; height: 1px; left: 0px; overflow: hidden; position: absolute; top: 758px; width: 1px"><span style="background: 0px 0px #ffffff; border: 0px; box-sizing: border-box; color: #3a3a3a; font-family:">On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs. The bill is modeled after Morrison County’s program. “We’ve heard a lot of discussion about the opioid problem, and this bill offers a viable solution,” says Kresha. “There’s no sense reinventing the wheel when we know we have something that works.”<br/> H.F. No. 2140 would require the Commissioner of Health to establish opioid abuse prevention pilot projects throughout the state and appropriate funding for these projects. Current language in the bill states each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts.</span></span><br />
<br />
----<br />
<br />
</div> </div> </div> </div> </div><br />
</div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Increase_Access_to_Non-Pharma_Therapies&diff=19327Increase Access to Non-Pharma Therapies2019-11-24T23:54:37Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to Partner Roles: [[Health_Plans_and_Insurance_Companies|Health Plans]] __TOC__<br />
<br />
= Overview =<br />
<br />
This objective focuses on Non-Pharmacologic Pain Care (NPPC).<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<br />
Currently, most insurance plans do not cover most non-medication therapies. Working with insurance companies to put more alternative and complementary pain therapies in their formularies and services covered can decrease the prescribing of opioids for pain. Using such therapies that are alternatives to opiates can prevent patients from having opiates introduced into their bodies, which is one of the best ways to reduce the number of people who try an opiate. Using alternate therapies can also prevent unpleasant adverse effects of opiates, such as nausea and vomiting. Often times, people using opiates use other illicit and addicting substances to treat their nausea such as marijuana, producing a cycle of dependency on those two drugs that is difficult to break. Also, patients with Substance Use Disorder are more likely to try other addicting drugs, making treatment and quitting harder. There are many benefits of using alternative therapies, and as many fields are being studied, they appear to be a promising way to help deal with the Opioid Crisis. Considering alternative and complementary therapies in today’s society where patients often have complicated medical histories and polymedication can also help them avoid adverse drug reactions and help preserve the health of various organs by putting less stress on liver (which metabolizes the drug and detoxifies the body) and kidney (which excretes the drug). Using therapies that have less toll on the body can help our patients stay healthier and overall improve their quality of life.<br />
<br />
&nbsp;<br />
<br />
= Current Status =<br />
<br />
*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference"><ref>[1]AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment. (n.d.). Retrieved November 24, 2019, from http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/<br />
</ref></sup> <br />
*Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.<sup class="reference"><ref>[2]Searching for solutions to the opioid crisis. (2018, May 5). Retrieved November 24, 2019, from Modern Healthcare website: https://www.modernhealthcare.com/article/20180505/BLOG/180509948/searching-for-solutions-to-the-opioid-crisis<br />
</ref></sup> <br />
<br />
= Complementary Health Approaches =<br />
<br />
*[[Acupuncture|Acupuncture]] <br />
*[[Chiropractic_Care|Chiropractic Care]] and Spinal Manipulation <br />
*Massage Therapy <br />
*[[Stretching_and_Fitness_Techniques_to_Minimize_Pain|Stretching and Fitness Techniques to Minimize Pain]] <br />
*[[Mindfulness_and_meditation-based_therapies|Mindfulness and meditation-based therapies]] <br />
*[[Tai_Chi|Tai Chi]] and Qi Gong <br />
*Yoga <br />
*Biofeedback <br />
*Transcutaneous electrical nerve stimulation, or TENS. <br />
<br />
&nbsp;<br />
<br />
= Benefits of Active Self-Care Therapies =<br />
<br />
In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<ref>[3] Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promotion Practice, 6(2), 148–156. https://doi.org/10.1177/1524839904266792<br />
</ref>For example, the military has studied “active self-care therapies” as a category of pain management that may be of value in an integrated, multi-modal approac<span style="background-color:#e74c3c;">h.</span><sup class="reference"><span style="background-color:#e74c3c;"><ref>[4]Citation needed </ref></span></sup><br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
These programs have shown promising results with varying degrees of research.<br />
<br />
&nbsp;<br />
<br />
== MyStrength ==<br />
<br />
[http://www.mystrength.com myStrength] helps fill the gap between generalized pain management and prescription opioid use through education, encouragement and evidence-based pain management tools.<br/> myStrength, Inc. is a recognized leader and one of the fastest-growing digital behavioral health companies in the US. myStrength enhances traditional care models while addressing issues of cost, lack of access and stigma in order to deliver mental health and well-being resources at scale. The platform targets the most prevalent and costly behavioral health conditions, empowering consumers with innovative self-care resources to manage and overcome challenges with depression, anxiety, substance use disorders and chronic pain. myStrength collaborates with over 100 health plans, community behavioral health centers, integrated health systems and ACOs. More information on [[MyStrength|myStrength]]<br/> &nbsp;<br />
<br />
== Little Falls, Minnesota's Program to Reduce Opioid Prescriptions for Pain ==<br />
<br />
In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference"><ref>[5]A Minnesota Critical Access Hospital Uses Medication-assisted Therapy to Tackle the Opioid Crisis | AHA News. (n.d.). Retrieved November 24, 2019, from https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted<br />
</ref></sup><br />
<br />
This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference"><ref>[6]Successful Little Falls effort to curb opioids gets big notice in D.C. - StarTribune.com. (n.d.). Retrieved November 24, 2019, from http://www.startribune.com/little-falls-effort-to-curb-opioids-gets-big-notice/448037143/<br />
</ref></sup> For example, On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs based on the program in Little Falls, MN. H.F. No. 2140 would establish opioid abuse prevention pilot projects throughout the state with appropriate funding. Each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts. The bill is currently going through revisions in Minnesota's house and senate.<sup class="reference"><ref>[7]stgabriels. (2017, August 18). MN House bill on Opioid Abuse Prevention seeks to replicate CHI St. Gabriel’s Health and community partner’s model program. Retrieved November 24, 2019, from CHI St. Gabriel’s Health website: https://www.chistgabriels.com/mn-house-bill-on-opioid-abuse-prevention-seeks-to-replicate-chi-st-gabriels-health-and-community-partners-model-program/<br />
</ref></sup> Minnesota is all currently taking applications for places interested in starting pilot programs based on Little Falls' model [http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2018OpioidPreventionRFPFINAL.pdf Opioid Abuse Prevention Pilot Projects]<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Potential Areas of Intervention/Training =<br />
<br />
&nbsp;<br />
<br />
== Education for Future Doctors ==<br />
<br />
When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.<br />
<br />
One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference"><span style="background-color:#e74c3c;"><ref>[8]Can't find the citation</ref></span></sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Insurance and Coordinated Care ==<br />
<br />
Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference"><span style="background-color:#c0392b;">[9]</span></sup><br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|TR - Increase Access to Alternative Therapies to Treat Pain]]<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div> <br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|More RTI on Increase Access to Alternative Therapies to Treat Pain]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
<br/> <span style="display: block; height: 1px; left: 0px; overflow: hidden; position: absolute; top: 758px; width: 1px"><span style="background: 0px 0px #ffffff; border: 0px; box-sizing: border-box; color: #3a3a3a; font-family:">On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs. The bill is modeled after Morrison County’s program. “We’ve heard a lot of discussion about the opioid problem, and this bill offers a viable solution,” says Kresha. “There’s no sense reinventing the wheel when we know we have something that works.”<br/> H.F. No. 2140 would require the Commissioner of Health to establish opioid abuse prevention pilot projects throughout the state and appropriate funding for these projects. Current language in the bill states each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts.</span></span><br />
<br />
----<br />
<br />
&nbsp;<br />
<br />
#<span style="background-color:#c0392b;">file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf</span> <br />
#<span style="background-color:#c0392b;">file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf</span> <br />
</div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Increase_Access_to_Non-Pharma_Therapies&diff=19326Increase Access to Non-Pharma Therapies2019-11-24T23:46:54Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids)]] Return to Partner Roles: [[Health_Plans_and_Insurance_Companies|Health Plans]] __TOC__<br />
<br />
= Overview =<br />
<br />
This objective focuses on Non-Pharmacologic Pain Care (NPPC).<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<br />
Currently, most insurance plans do not cover most non-medication therapies. Working with insurance companies to put more alternative and complementary pain therapies in their formularies and services covered can decrease the prescribing of opioids for pain. Using such therapies that are alternatives to opiates can prevent patients from having opiates introduced into their bodies, which is one of the best ways to reduce the number of people who try an opiate. Using alternate therapies can also prevent unpleasant adverse effects of opiates, such as nausea and vomiting. Often times, people using opiates use other illicit and addicting substances to treat their nausea such as marijuana, producing a cycle of dependency on those two drugs that is difficult to break. Also, patients with Substance Use Disorder are more likely to try other addicting drugs, making treatment and quitting harder. There are many benefits of using alternative therapies, and as many fields are being studied, they appear to be a promising way to help deal with the Opioid Crisis. Considering alternative and complementary therapies in today’s society where patients often have complicated medical histories and polymedication can also help them avoid adverse drug reactions and help preserve the health of various organs by putting less stress on liver (which metabolizes the drug and detoxifies the body) and kidney (which excretes the drug). Using therapies that have less toll on the body can help our patients stay healthier and overall improve their quality of life.<br />
<br />
&nbsp;<br />
<br />
= Current Status =<br />
<br />
*Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain.<sup class="reference">[1]</sup> <br />
*Brandeis University Professor Dr. Andrew Kolodny said efforts to limit opioid prescribing in recent years have been positive steps but warns that there are about 10 million to 12 million patients in the U.S. who have been on painkillers for years and need alternative therapies to offset the potential damage that could be caused by being cut off cold turkey.<sup class="reference">[2]</sup> <br />
<br />
= Complementary Health Approaches =<br />
<br />
*[[Acupuncture|Acupuncture]] <br />
*[[Chiropractic_Care|Chiropractic Care]] and Spinal Manipulation <br />
*Massage Therapy <br />
*[[Stretching_and_Fitness_Techniques_to_Minimize_Pain|Stretching and Fitness Techniques to Minimize Pain]] <br />
*[[Mindfulness_and_meditation-based_therapies|Mindfulness and meditation-based therapies]] <br />
*[[Tai_Chi|Tai Chi]] and Qi Gong <br />
*Yoga <br />
*Biofeedback <br />
*Transcutaneous electrical nerve stimulation, or TENS. <br />
<br />
&nbsp;<br />
<br />
= Benefits of Active Self-Care Therapies =<br />
<br />
In contrast to medication-based therapies, many Non-Pharmaceutical Pain Care (NPPC) strategies involve significant patient participation and a commitment to self-care. NPCC strategies tend to increase self-efficacy in managing pain and correlate with improved mood and outcomes in many chronic conditions, including pain.<sup class="reference">[3]</sup> For example, the military has studied “active self-care therapies” as a category of pain management that may be of value in an integrated, multi-modal approach.<sup class="reference">[4]</sup><br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
These programs have shown promising results with varying degrees of research.<br />
<br />
&nbsp;<br />
<br />
== MyStrength ==<br />
<br />
[http://www.mystrength.com myStrength] helps fill the gap between generalized pain management and prescription opioid use through education, encouragement and evidence-based pain management tools.<br/> myStrength, Inc. is a recognized leader and one of the fastest-growing digital behavioral health companies in the US. myStrength enhances traditional care models while addressing issues of cost, lack of access and stigma in order to deliver mental health and well-being resources at scale. The platform targets the most prevalent and costly behavioral health conditions, empowering consumers with innovative self-care resources to manage and overcome challenges with depression, anxiety, substance use disorders and chronic pain. myStrength collaborates with over 100 health plans, community behavioral health centers, integrated health systems and ACOs. More information on [[MyStrength|myStrength]]<br/> &nbsp;<br />
<br />
== Little Falls, Minnesota's Program to Reduce Opioid Prescriptions for Pain ==<br />
<br />
In 2014, doctors in Little Falls, Minnesota noticed that there were a large number of opioid prescriptions and drug-related arrests. Through heightened addiction treatment and monitoring of prescriptions - as well as working with community partners like schools, local health departments, law enforcement, and health alliances - they were able to wean 324 patients off opioids entirely and lower prescriptions of opioids from 48,000 a month to 37,000. Patients must sign a contract when they are prescribed opioids that allows for electronic monitoring of their medical records to look for patterns of abuse, and law enforcement will alter doctors if opioids the doctors prescribed are found in possession of someone other than the patient to whom they were prescribed. Patients caught selling and abusing opioids are not punished; rather, they are given access to Suboxone and to a support team - including a nurse and mental health specialist. Although the program started off as an abstinence-based program, doctors changed to a medically-assisted program when patients started to die.<sup class="reference">[5]</sup><br />
<br />
This program has gained national attention and is currently being looked at by national policymakers.<sup class="reference">[6]</sup> For example, On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs based on the program in Little Falls, MN. H.F. No. 2140 would establish opioid abuse prevention pilot projects throughout the state with appropriate funding. Each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts. The bill is currently going through revisions in Minnesota's house and senate.<sup class="reference">[7]</sup> Minnesota is all currently taking applications for places interested in starting pilot programs based on Little Falls' model [http://www.health.state.mn.us/divs/healthimprovement/content/documents-opioid/2018OpioidPreventionRFPFINAL.pdf Opioid Abuse Prevention Pilot Projects]<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Potential Areas of Intervention/Training =<br />
<br />
&nbsp;<br />
<br />
== Education for Future Doctors ==<br />
<br />
When future doctors go through school, there seems to be very limited education detailing pain and pain management. Pain curricula in medical school education for both MDs and DOs in the U.S. ranges from 1-31 hours during the 3-4 year curriculum, with a mean of 11.13 hours. Thus, the current training system has left primary care practitioners with inadequate tools to deal with some of the most common problems doctors will come across during their years of practice. Any meaningful effort to improve pain management will require a basic culture shift in the nation’s approach to mandating pain-related education for all health professionals who provide care to people with pain.<br />
<br />
One possible solution is cross-training between fields. Many, if not most, pain clinics are still housed in anesthesiology clinics, but fellowship pain training can now be pursued not only by anesthesiologists but other specialists in neurology/psychiatry, PM&R, and internal and family medicine. Physicians who receive fellowship training in pain care learn interventional pain strategies that originated in regional anesthesia and acute pain care, including non-pharmacological options. The expansion of these strategies, which are the mainstay of anesthesiology and acute pain practices, to chronic pain care have had more modest success and only in carefully selected patient.<sup class="reference">[8]</sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Insurance and Coordinated Care ==<br />
<br />
Coordination of care across disciplines and access to nonpharmacologic care have not been optimized in the current system in most states and territories, and improvement to these systems could help reduce opioid use. There are a few state Medicaid policy initiatives aimed at increasing access to effective nonpharmacologic therapies as a first line treatment for pain conditions. For example, the Oregon Health Plan (OHP – Oregon’s Medicaid program) covers acupuncture therapy, chiropractic and osteopathic manipulation, physical therapy and cognitive behavioral therapy for all back conditions. Vermont’s legislature is piloting a program where they will cover acupuncture therapy for back pain in a Medicaid population and monitor health outcomes and cost-effectiveness. Such programs are promising and there is hope that with more interventions like this, the number of opioids being prescribed will decrease.<sup class="reference">[9]</sup><br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|TR - Increase Access to Alternative Therapies to Treat Pain]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Increase_Access_to_Alternative_Therapies_to_Treat_Pain|More RTI on Increase Access to Alternative Therapies to Treat Pain]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
<br/> <span style="display: block; height: 1px; left: 0px; overflow: hidden; position: absolute; top: 758px; width: 1px"><span style="background: 0px 0px #ffffff; border: 0px; box-sizing: border-box; color: #3a3a3a; font-family:">On March 6, 2017, Minnesota State Representative Ron Kresha authored a bill designed to help more Minnesota communities develop opioid abuse prevention programs. The bill is modeled after Morrison County’s program. “We’ve heard a lot of discussion about the opioid problem, and this bill offers a viable solution,” says Kresha. “There’s no sense reinventing the wheel when we know we have something that works.”<br/> H.F. No. 2140 would require the Commissioner of Health to establish opioid abuse prevention pilot projects throughout the state and appropriate funding for these projects. Current language in the bill states each pilot project would establish a multidisciplinary controlled substance care team, deliver health care services and care coordination to reduce inappropriate use of opioids, address any unmet social service needs that create barriers to managing pain effectively and obtain optimal health outcomes, provide prescriber and dispenser education, promote best practices related to opioid disposal, and engage community partners outside the health care system in such efforts.</span></span><br />
<br />
----<br />
<br />
#[http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/ http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/]&nbsp;[[http://www.apta.org/PTinMotion/News/2017/9/27/AGsToAHIP/ 1]] <br />
#[http://www.modernhealthcare.com/article/20180505/BLOG/180509948 http://www.modernhealthcare.com/article/20180505/BLOG/180509948] [2] <br />
#Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6(2):148-156. <br />
#Type the content of your reference here. <br />
#[https://www.aha.org/news/insights-and-analysis/2018-03-28-minnesota-critical-access-hospital-uses-medication-assisted [3]] <br />
#[http://www.startribune.com/little-falls-effort-to-curb-opioids-gets-big-notice/448037143/ [4]] <br />
#[https://www.chistgabriels.com/mn-house-bill-on-opioid-abuse-prevention-seeks-to-replicate-chi-st-gabriels-health-and-community-partners-model-program/ [5]] <br />
#file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf <br />
#file:///C:/Users/Owner/Downloads/Evidence-BasedNonpharmacologicStrategiesforComprehensivePainCareWhitePaper12.15.17%20(1).pdf <br />
</div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Steps_to_Minimize_Substance_Use_During_Pregnancy_or_Pregnancy_During_Substance_Use&diff=19322Expand Steps to Minimize Substance Use During Pregnancy or Pregnancy During Substance Use2019-11-24T23:45:31Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map&nbsp;or]] [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|Zoom Map (Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use)]]&nbsp;or [[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]]&nbsp;View [[Minimize_Babies_born_with_Opioid_Dependence|Minimize Babies Born with Opioid Addictions]] &nbsp;or&nbsp;[[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|ZOOM MAP - Expand Harm Reduction Practices Associated with Opioid Misuse]]__TOC__<br />
<br />
= <span style="color: #ed3900">PRENATAL STRATEGIES</span> =<br />
<br />
= Draft Driver Diagram =<br />
<div class="_">The Public Health Foundation worked with the Department of Public Health at the University of Tennessee Knoxville to create a Driver Diagram for improving perinatal care and reducing Neonatal Abstinence Syndrome (NAS). This format is different from a strategy map, but has useful ideas that could be integrated into this strategy map template.<br/> [http://www.phf.org/resourcestools/Documents/TN%20NAS%20driver%20diagram%20Revised%2012-15-15.pdf [1]]</div> <div class="_">&nbsp;</div> <br />
= Increase Access to Contraception =<br />
<br />
<br/> <br/> General:<br/> The second, the National Preconception Health and Health Care Initiative,§ provides educational resources to clinicians and their patients, and coordinates outreach and social media campaigns related to improving preconception health, including reducing substance use and treating substance use disorders before pregnancy.<br/> &nbsp;<br />
<br />
= Help Women Overcome Obstacles to Treatment, Family Planning and Prenatal Care =<br />
<div class="_">Women who are misusing opioids or who have OUD may have many obstacles to getting treatment, family planning or prenatal care. A strategy to minimize unintentional pregnancies for these women should include plans to help them overcome obstacles to receiving these services. The obstacles include:</div> <div class="_">&nbsp;</div> <br />
*Transportation <br />
*Childcare <br />
*Employment conflicts <br />
*Unsupportive Living Environments <br />
*Unstable Living Environments <br />
*Homelessness <br />
*Partner with a Substance Use Disorder <br />
*Stigma and/or Guilt <br />
*Fear of losing the child <br />
*Fear of incarceration <br />
*Fear of being discovered about misusing substances (by family, employer, etc.) <br />
<br />
&nbsp;<br />
<br />
= Tools + Resources =<br />
<br />
[[TR_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy|TR - Expand Steps to Minimize Opioid Use During Pregnancy]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Abuse|More RTI on Pregnancy and Opioid Addiction]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Treatment and Recovery]][[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_School-Based_Prevention_Programs&diff=19321Expand School-Based Prevention Programs2019-11-24T23:45:13Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Improve_Protective_Factors_to_Reduce_SUDs|Zoom Map (Improve Protective Factors to Minimize Desire to Misuse Opioids)]]&nbsp; &nbsp; (Change when page is available) <br />
Schools are in a unique position to reach the vast majority of youth in a community, and there are excellent low-cost and free resources that can be used by schools to enhance prevention. Schools bear a significant burden when students misuse drugs and develop addictions, so they should be motivated to be partners in prevention.<br />
<br />
= Background =<br />
<br />
== The Need for Prevention Programs Targeting Youth ==<br />
<br />
This [http://www.wbur.org/commonhealth/2017/08/29/the-opioid-epidemic-needs-a-strategy-for-teens article by two doctors provides a strong case] for specific strategies to address teen opioid abuse. It links to good sources of information and resources.<br/> <br/> The National Survey on Drug Use and Health (NSDUH), conducted in 2015 in the United States on 68,073 people 12 years of age and older, revealed that the prevalence of past year pain reliever NMU was 3.9% among 12–17 year olds (Hughes et al., 2016). The 2015 Monitoring The Future (MTF) survey among high school students revealed that older adolescents (12th graders) had the highest annual prevalence of OxyContin® and Vicodin® use (3.7% and 4.4% respectively), with the lowest annual prevalence seen in 8th graders (0.8% and 0.9%, respectively) (Johnston, O'Malley, Miech, Bachman, & Schulenberg, 2016). Learn more in [https://www.sciencedirect.com/science/article/pii/S0306460317301351 this article].<br/> <br/> This [https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/opioids/index.html HHS page] also has good information on opioid and adolescents. (Add key points to this wiki page).<br/> <br/> Using "[[Reduce_the_Use_of_Gateway_Drugs|Gateway Drugs]]" and smoking increases risk factors.<br />
<div class="mw-parser-output"><br />
== Opioid Education Programs ==<br />
<br />
Recommendations for selecting a school program<sup class="reference">[1]</sup><br />
<br />
*Start by looking at programs that have evidence that they work. The list on [https://www.blueprintsprograms.org/about Blueprints for Healthy Youth Development] is a place to start. Do a keyword search of this registry using the term “opioid prevention” to find programs. <br />
*Look for programs that have a good Return on Investment (effective, but not too expensive). See below on this page. <br />
*Adopt programs that not only prevent substance use but also promote protective fitness and healthy habits among teens. Programs that integrate substance use prevention with positive behavior promotion are more likely to be accepted and used by youth, families and funders than those limited to just communicating substance use risks and harm. This was key to the success of the Youth in Iceland Program and is backed by many studies. <br />
*Promote prevention in multiple settings to reach a broader youth audience, and ensure overlapping prevention messages. Critical settings for providing prevention programs include schools and colleges, healthcare, youth and family organizations, juvenile justice, sports and recreation programs, and homes. <br />
*Innovate to make evidence-based programs more relevant in these fast-changing times. Research takes time and the opioid crisis is moving fast. You should consider how to innovate and enhance programs that may have targeted other drugs to make them more relevant for today's opioid crisis. <br />
<br />
<br/> '''School Prevention Programs have a Positive Impact'''<br/> In 2012, a special report of the National Survey on Drug Use and Health reported that 75% of youth ages twelve to seventeen reported having seen or heard drug or alcohol prevention messages at school. Of those who received such exposure, 8.9% reported using an illicit drug in the past month, versus 12.3% among students who reported no exposure to such messages.<br/> &nbsp;<br />
</div> <br />
= Classroom Resources =<br />
<br />
=== Operation Prevention ===<br />
<br />
[https://www.operationprevention.com/ Operation Prevention], a joint partnership between Discovery Education and the DEA, developed '''free''' resources that "that are aligned to national health and science standards and integrate seamlessly into classroom instruction." Toolkits and lesson plans have been designed for middle school students and another for high school students. A parent toolkit designed alongside the material to provide further discussion of the topic at home is included as well. See [[Empower_&_Strengthen_Parents|Empower & Strengthen Parents]] for more strategies to include parents. See [[TR_-_Expand_School_Prevention_Programs|Tools & Resources for]] copies of toolkits.<br/> &nbsp;<br />
<br />
=== Not Prescribed ===<br />
<br />
[https://notprescribed.org/ Not Prescribed] is a&nbsp;classroom-based lesson empowering teens with the science and the stories to understand the risks of misusing prescription drugs and the skills to rise above. It is provided at not cost to non-profit organizations and schools.&nbsp; &nbsp;<br />
<br />
&nbsp;<br />
<br />
=== Everfi's Prescription Drug Safety Course ===<br />
<br />
[https://everfi.com/about/mission/ EVERFI] provides schools with a free, state-of-the-art on-line learning course on prescription drug safety&nbsp;&nbsp;[https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/ https://everfi.com/offerings/listing/prescription-drug-abuse-prevention/]<br />
<br />
Due to support from a wide range of public and private supporters in the [https://everfi.com/networks/prescription-drug-safety-network/ Presecription Drug Safety Network], EVERFI has the resources and experience to delivier a high-quality E-learning course to schools at no charge.&nbsp; EVERFI has a long history of provideing training on topics like personal financial management, and they have leveraged that experience to create a 30 to 40-minute course that can be offered in schools or in out-of-school programs.&nbsp; &nbsp;This [https://everfi.com/wp-content/uploads/2018/08/Prescription-Drug-Safety_-17-18-Impact-Report.pdf report] shares some of the impact that this course is having.&nbsp;<br />
<br />
= Analysis of Research-Based Programs and Return on Investment =<br />
<br />
This report looks at thirteen Youth Marijuana Prevention programs and shares valuable insights on the Return on Investment of these programs. Use of marijuana is a risk factor for starting misuse of opioids, and there are underlying factors where prevention efforts impacts the use of many different types of drugs.<br />
<br />
Wsipp_Preventing Youth Substance Use: A Review of Thirteen Programs Benefit-Cost-Results &nbsp; [http://www.wsipp.wa.gov/ReportFile/1563/Wsipp_Preventing-Youth-Substance-Use-A-Review-of-Thirteen-Programs_Benefit-Cost-Results.pdf Preventing Youth Substance Use]<br/> Positive Prevention Plus: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum ([http://www.positivepreventionplus.com/ Positive Prevention Plus]<br />
<br />
&nbsp;<br />
<br />
= Examples of Promising, Evidence-based Programs =<br />
<br />
These are programs the you can consider...<br/> [https://preventionpluswellness.com SPORT Prevention Plus Wellness]: A single-session screening and brief intervention that integrates substance use prevention with the promoting of physical activity and healthy behaviors for youth.<br />
<br />
&nbsp;[http://www.positivepreventionplus.com/ Positive Prevention Plus]: A comprehensive school-based sexual health education and teen pregnancy prevention curriculum.<br />
<br />
&nbsp;[https://olweus.sites.clemson.edu/ Olweus Bullying Prevention Program]: Includes schoolwide, classroom, individual, and community strategies.<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Media Literacy =<br />
<br />
Media literacy is a promising approach to school-based substance abuse intervention."<sup class="reference">[2]</sup> Beneficial outcomes include:<br />
<br />
&nbsp;<br />
<br />
*Increased media skepticism<sup class="reference">[3]</sup> <br />
*Increased perceived efficiency in resisting pro-drug media messages<sup class="reference">[4]</sup> <br />
*Greater ability to make counter-arguments to beer advertisements<sup class="reference">[5]</sup> <br />
*Increased belief that smoking and drinking are "wrong"<sup class="reference">[6]</sup> <br />
*Reduced middle school boys' intentions to use alcohol or tobacco in the future<sup class="reference">[7]</sup> <br />
<br />
<br/> &nbsp;<br />
<br />
= Healthy Youth Development Programs in Schools reduce Opioid Misuse =<br />
<br />
Article on Evidence-based practices: [https://preventionpluswellness.com/blogs/news/schools-struggle-to-help-children-of-opioid-epidemic [3]]<br/> <br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Successful Examples =<br />
<br />
== Putnam Middle School Social Norms Campaign ==<br />
<br />
In partnership with [http://putnampride.org/ Putnam Pride], this campaign focused on the common misconceptions that students have about their peers' substance use. Most kids believe that a majority of students use substances when, in reality, only a very small percentage does. Changing social norms of a school by educating students on the reality of substance use would lead to a changed perspective of drug use as deviant rather than something that "everyone is doing."<br />
<br />
&nbsp; Although this program focused on alcohol use, the same idea could be used for prescription opioid drugs as an education tool for students.<br />
<br />
&nbsp;<br />
<br />
== SAFIR -- Substance Abuse Free Indian River ==<br />
<br />
This Drug Free Coalition in Vero Beach, Florida, has been implementing several promising programs in schools and working with community partners.<br/> &nbsp; “We are very proud of our initiatives: SAFIR Rx, Talk, They Hear You, No One’s House and Friday Night Done Right, but we are particularly excited about Know the Law, which is conducted by law enforcement officers (LEOs) in the classroom,” said Robin Dapp, Executive Director. “It helps bring students and officers together.”<sup class="reference">[8]</sup> At the beginning of each school year, school resource officers provide the Know the Law classes to incoming high school freshmen. The program is designed to make our local youth and young adults aware of the laws and the consequences of breaking the law. The training covers the common offenses committed by youth on a regular basis.<br />
<br />
&nbsp; SAFIR has supported the delivery of a very comprehensive prevention strategy for our middle school youth. All middle schools in the community receive Botvin’s LifeSkills Training program, beginning in 6th grade through 8th grade. The curriculum is delivered by the Substance Awareness Center, and consists of a total of 30 lessons.<br />
<br />
&nbsp; A significant environmental strategy that has been embraced by local law enforcement is Civil Citation. See details on<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Boy Scouts & Girl Scouts ==<br />
<br />
Each of these groups can participate in the DEA Red Ribbon Patch Program. This program empowers young people to create, embrace and strengthen their drug free belief. See [[TR_-_Expand_School_Prevention_Programs|Tools & Resources details on participation]].<br />
<br />
&nbsp;<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
</div><br />
<br />
= Actions to Take<br/> <br/> &nbsp; =<br />
<br />
[[PA_-_Expand_School_Prevention_Programs|Potential Actions and Partners]] Actions for Individuals<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_School_Prevention_Programs|TR - Expand School Prevention Programs]]<br />
<br />
= Resources to Investigate =<br />
<br />
<span style="font-family: arial,helvetica,sans-serif; font-size: 13px">[[RTI_-_Expand_School_Prevention_Programs|RTI - Expand School Prevention Programs]]</span><br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[https://preventionpluswellness.com/blogs/news/the-opioid-epidemic-and-youth-prevention-considerations [4]] <br />
#[http://irtinc.us/Products/MediaDetective/SubstanceAbusePrevention/MediaLiteracysRoleinPrevention.aspx [5]] <br />
#Kupersmidt, J.B., Barrett, T.M., Elmore, K.C., & Benson, J.W. (2007). Preliminary Findings from the Evaluation of the Elementary Media Literacy, Substance Abuse Prevention Project. Paper presented at the first Research Summit of the Alliance for a Media Literate America, St. Louis, MO. <br />
#Austin, E. W., Pinkleton, B. E., Hust, S. J. T., & Cohen, M. (2005). Evaluation of an American Legacy Foundation/Washington State Department of Health media literacy pilot study. Health Communication, 18(1), 75. <br />
#Slater, M.D., Rouner, D., Murphy, K., Beauvais, F., Van Leuven, J., & Domenech-Rodriguez, M.M. (1996). Adolescent counterarguing of tv beer advertisements: Evidence for effectiveness of alcohol education and critical viewing discussions. Journal of Drug Education, 26(2), 143-158. <br />
#Kupersmidt, J., Feagans, L., Eisen, M., & Hicks, R. (May, 2005). The North Carolina Media Literacy Education Program: An evaluation. Poster presented at the annual meeting of the Society for Intervention Research, Washington, D.C. <br />
#Kupersmidt, J., Feagans, L., Eisen, M., & Hicks, R. (May, 2005). The North Carolina Media Literacy Education Program: An evaluation. Poster presented at the annual meeting of the Society for Intervention Research, Washington, D.C. <br />
#[https://www.cadca.org/resources/coalitions-action-partnering-prevention-local-law-enforcement [6]] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div> <br />
</div> </div><br />
</div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_SBIRT_in_Maternity_Care_Clinics&diff=19320Expand SBIRT in Maternity Care Clinics2019-11-24T23:44:53Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to&nbsp; [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or&nbsp;[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]<br />
<div id="toc"><br />
= Table of Contents =<br />
<div style="margin-left: 1em">[[#Background|Background]]</div> <div style="margin-left: 1em">[[#Best_Practices|Best Practices]]</div> <div style="margin-left: 1em">[[#Increase_Uptake_of_SBIRT|Increase Uptake of SBIRT]]</div> <div style="margin-left: 1em">[[#Promising_Programs|Promising Programs]]</div> <div style="margin-left: 2em">[[#Promising_Programs-Ultrasound_Feedback|Ultrasound Feedback]]</div> <div style="margin-left: 2em">[[#Promising_Programs-Educating_Medical_Students|Educating Medical Students]]</div> <div style="margin-left: 1em">[[#Tools_.26_Resources|Tools & Resources]]</div> <div style="margin-left: 1em">[[#Scorecard_Building|Scorecard Building]]</div> <div style="margin-left: 1em">[[#Resources_to_Investigate|Resources to Investigate]]</div> <div style="margin-left: 1em">[[#Sources|Sources]]</div> </div> <br />
= Background =<br />
<br />
SBIRT (Screening, Brief Intervention, Referral to Treatment) is "a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders" and has been widely acknowledged as an evidenced-based practice.<sup class="reference">[1]</sup> It helps identify the level of risk associated with alcohol or substance use.<br />
<br />
&nbsp; Early identification of substance use allows for early intervention and treatment which minimizes potential harms to the mother and her pregnancy.<sup class="reference">[2]</sup> Selective screening based on “risk factors” perpetuates stigma and misses most women with problematic use. <sup class="reference">[3]</sup><br />
<br />
&nbsp; The goals of SBIRT include:<sup class="reference">[4]</sup><br />
<br />
&nbsp;<br />
<br />
*Educate people about the risks of alcohol and other drugs <br />
*Make people aware of their use and whether it may be creating health risks for them <br />
*Decrease general use so as to reduce the societal risk and burden of the effects of overuse <br />
*Identify individuals who have dependence and provide rapid access to care <br />
<br />
&nbsp;<br />
<br />
= Best Practices =<br />
<br />
#Use non-judgmental and caring tone - Patients are usually not offended by questions about substance use if asked in caring and nonjudgmental manner. <br />
<br />
2. Normalize questions:<br/> – Embed them in other health behavior questions<br/> – Preface questions by stating that all patients are asked about substance use<br/> 3. Ask permission<br/> – “Is it OK if I ask you some questions about smoking, alcohol and other drugs?<br/> 4. Avoid closed-ended questions<br/> – “You don’t smoke or use drugs, do you?”<br/> &nbsp;<br />
<br />
= Increase Uptake of SBIRT =<br />
<br />
*Embed it in standard of care <br />
**Staff-wide trainings <br />
**EMR <br />
**Routine part of QA Evaluation <br />
*Don't rely exclusively on physicians <br />
**Physicians (especially primary care physicians) are overburdened by time and an increasing load of screenings <br />
**Think creatively about staff, screening and brief interventions <br />
*Expand types of screening <br />
**Patient completed <br />
**Nurse/staff administered <br />
**Computer-assisted <br />
*Expand types of intervention <br />
**Computer-based <br />
**Peer-based <br />
**Other staff <br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
== Ultrasound Feedback ==<br />
<br />
One study showed that real-time ultrasound feedback focused on the potential effects of smoking on the fetus may be an effective treatment adjunct to improve smoking outcomes.<sup class="reference">[5]</sup> This could be adapted and used to treat women with other types of SUDs as well.<br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
== Educating Medical Students ==<br />
<br />
A 2012 study of medical students in an obstetrics and gynecology rotation found that when students are placed in a residential treatment center for pregnant women (i.e. specialized training) they showed greater comfort in assessing and educating patients about substance abuse during pregnancy compared to those in a regular rotation.<sup class="reference">[6]</sup><br/> <br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_SBIRT_in_Maternity_Care_Clinics|TR - Expand SBIRT in Maternity Care Clinics]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_SBIRT_in_Maternity_Care_Clinics|More RTI on Expand SBIRT in Maternity Care Clinics]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[https://www.samhsa.gov/sbirt/about [1]] <br />
#[http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf [2]] <br />
#[http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf [3]] <br />
#[https://www.samhsa.gov/sites/default/files/programs_campaigns/women_children_families/womens-health.pdf [4]] <br />
#[https://www.researchgate.net/publication/26317678_Ultrasound_feedback_and_motivational_interviewing_targeting_smoking_cessation_in_the_second_and_third_trimesters_of_pregnancy [5]] <br />
#[https://www.ncbi.nlm.nih.gov/pubmed/23154692 [6]] <br />
</div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_SBIRT_Program&diff=19319Expand SBIRT Program2019-11-24T23:44:35Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">''Return to &nbsp;[[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Intervention for People Misusing Drugs]]'' <br />
''Go to [[ZOOM_MAP_-_Expand_SBIRT_Program|Zoom Map - Expand SBIRT Program]]''<br />
<br />
----<br />
<br />
Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the ''Diagnostic and Statistical Manual of Mental Disorders,'' Fourth Edition.<br />
<br />
The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.<sup class="reference">[1]</sup><br />
<br />
By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices. &nbsp;<br />
<br />
__TOC__<br />
<br />
&nbsp;<br />
<br />
= Research on the Effectiveness of SBIRT =<br />
<br />
While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.<br/> &nbsp; This [https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675 2017 report summarizes five years of research on SBIRT]<br/> &nbsp; The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.<br />
<br />
&nbsp;<br />
<br />
*Greater intervention intensity was associated with larger decrease in substance use. <br />
*Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances. <br />
<br />
<br/> Four factors influenced SBIRT sustainability:<br />
<br />
*Presence of a program champion <br />
*Availability of funding <br />
*Systematic change <br />
*Effective management of SBIRT provider challenges <br />
<br />
<br/> Key Findings:<br />
<br />
*SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs <br />
*SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine <br />
*SBIRT improved treatment system equity, efficiency, and economy <br />
<br />
&nbsp;<br />
<br />
= Promising Programs =<br />
<br />
SBIRT in Schools<br />
<br />
Some states, like Massachusetts have been moving to significantly expand SBIRT in schools. <sup>[2]</sup><br/> &nbsp; A research report shared early findings:&nbsp;<sup>[3]</sup><br/> &nbsp; Training on using SBIRT in schools to address alcohol use:&nbsp;<sup>[4]</sup><br/> &nbsp; This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:<sup>[5]</sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><br />
== SBIRT in Emergency Room Settings ==<br />
<br />
Add information here<br />
<br />
[https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf]<br />
<br />
&nbsp;<br />
</div> <br />
== SBIRT in Community Clinics & FQHCs ==<br />
<br />
Add information here.<br/> &nbsp;<br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><div class="mw-parser-output"><br />
== SBIRT in Mental Health Settings ==<br />
<br />
Add information here<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/]<br />
</div> <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
== SBIRT in Dental Settings ==<br />
<br />
Add information here<br />
<br />
The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810&nbsp;&nbsp;[http://attcnetwork.org/userfiles/file/NFA-SBIRT/110727_The_Applicability_of_SBIRT_in_Dental_Settings_CABHP_Lit_Rev https://www.sciencedirect.com/science/article/pii/S0002817714622649]<br />
<br />
The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638&nbsp;[https://www.sciencedirect.com/science/article/pii/S0002817714607674 https://www.sciencedirect.com/science/article/pii/S0002817714607674]<br />
</div> <br />
= Funding =<br />
<div class="mw-parser-output"><div class="mw-parser-output"><br />
The following organizations are currently funding research and initiatives to expand SBIRT:<br />
<br />
&nbsp;<br />
<br />
#Conrad N. Hilton Foundation<sup class="reference">[6]</sup> <br />
#Substance Abuse and Mental Health Service Administration<sup class="reference">[7]</sup> <br />
#A report by Catalyst shares several innovative ways to fund SBIRT in schools&nbsp;&nbsp;<br/> [https://www.communitycatalyst.org/resources/publications/document/Funding-and-Sustaining-SBIRT-in-Schools-December-2015.pdf?1451325931 Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools] <br />
</div> </div> <div class="mw-parser-output"><br />
= Screening =<br />
<br />
More information about [[Improve_&_Expand_Screening_for_Risk_Factors_&_Testing_for_Misuse|screening and testing for misuse]].<br />
</div> <br />
= Brief Intervention =<br />
<br />
Models for brief treatment recommended by SAMHSA<sup class="reference">[8]</sup> include:<br />
<br />
&nbsp;<br />
<br />
#[[Resources_on_Brief_Negotiated_Interview|Brief Negotiated Interview]] <br />
#Brief counseling <br />
#[[Additional_Info_on_FRAMES|Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)]] <br />
#[[Additional_Info_on_Motivational_Interviewing|Motivational Interviewing (MI) techniques]] <br />
<div class="mw-parser-output">&nbsp;</div> </div> <br />
= Referral to Treatment =<br />
<br />
According to SAMHSA<sup class="reference">[9]</sup> , commonly used models for brief treatment include:<br />
<br />
&nbsp;<br />
<br />
#[[Resources_on_Cognitive_Behavioral_Therapy|Cognitive-Behavioral Therapy]] (CBT) <br />
#Motivational Enhancement Therapy <br />
#Community Reinforcement Approach <br />
#Solution-focused Therapy <br />
</div> <br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_SBIRT_Program|TR - Expand SBIRT Program]]<br />
<div class="mw-parser-output"><br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_SBIRT_Program|More RTI on SBIRT]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
&nbsp;<br />
</div> <br />
= Sources =<br />
<br />
----<br />
<br />
#[http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf] <br />
#[http://www.masbirt.org/schools http://www.masbirt.org/schools] <br />
#[https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf] <br />
#[https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf] <br />
#[http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/ http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/] <br />
#[https://www.hiltonfoundation.org/grants?priority=substance-use-prevention#filters https://www.hiltonfoundation.org/grants?priority=substance-use-prevention#filters] <br />
#[https://www.samhsa.gov/sbirt/grantees https://www.samhsa.gov/sbirt/grantees] <br />
#[http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf] <br />
#[http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div></div></div></div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Recovery_Schools_%26_Collegiate_Recovery_Programs&diff=19318Expand Recovery Schools & Collegiate Recovery Programs2019-11-24T23:43:56Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]] __TOC__<br />
<br />
= Background =<br />
<br />
*[http://rhscaps.rutgers.edu/services/adap-recovery-housing/ Substance-Free/Recovery Housing:] a recovery house available on campus that offers [https://housing.tcnj.edu/apply/substance-free-housing/ substance-free ]activities for students recovering from drug or alcohol abuse. <br />
**Rutgers University, the state university of New Jersey, was the first to design this style of college housing.<sup class="reference">[1]</sup> <br />
**While living in this type of housing, students must attend at least two 12-step meetings a week and meet with recovery center counselors.<sup class="reference">[2]</sup> <br />
**New Jersey signed a law that requires all state colleges and universities in the state to offer sober housing if at least a quarter of the students live on campus.<sup class="reference">[3]</sup> <br />
<br />
&nbsp;<br />
<br />
== A.R.H.E. ==<br />
<div class="_">The [https://collegiaterecovery.org/ Association of Recovery in Higher Education] is the only association exclusively representing collegiate recovery programs and communities, the faculty and staff who support them, and the students who represent them.</div> <div class="_">&nbsp;</div> <br />
== Sober Housing Universities ==<br />
<div class="_">See this [https://www.quitalcohol.com/sobriety/sober-living-in-universities.html page] for a list of some of the universities that have options for sober housing<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Association of Recovery Schools ==<br />
<br />
[https://recoveryschools.org/ [1]]<br />
<br />
= Highlights =<br />
<br />
*College programs have low relapse rates and high GPAs<sup class="reference">[4]</sup> <br />
*Students feel like they have a purpose helping their friends stay on track<sup class="reference">[5]</sup> <br />
*Students in CRPs have high retention and graduation rates <br />
<br />
= Assets to Start =<br />
<br />
[[File:8assetstostartcollegerecovery.png|8assetstostartcollegerecovery.png]]<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Recovery_Schools_&_College_Recovery_Programs|TR - Expand Recovery Schools & College Recovery Programs]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Recovery_Schools_&_College_Recovery_Programs|More RTI on Recovery Schools & College Recovery Programs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
&nbsp;<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[http://www.pbs.org/newshour/rundown/colleges-use-sober-dorms-to-combat-opioid-epidemic/ [2]] <br />
#[http://www.pbs.org/newshour/rundown/colleges-use-sober-dorms-to-combat-opioid-epidemic/ [3]] <br />
#[http://www.pbs.org/newshour/rundown/colleges-use-sober-dorms-to-combat-opioid-epidemic/ [4]] <br />
#[http://www.newsworks.org/index.php/health-science/item/107239-how-rutgers-became-a-national-model-for-helping-student-addicts-in-recovery?l=mf&lipi=urn:li:page:d_flagship3_detail_base;lEqXrhzCTS22F0nks6lezA== [5]] <br />
#[http://www.newsworks.org/index.php/health-science/item/107239-how-rutgers-became-a-national-model-for-helping-student-addicts-in-recovery?l=mf&lipi=urn:li:page:d_flagship3_detail_base;lEqXrhzCTS22F0nks6lezA== [6]] <br />
</div> </div> </div> </div> </div> </div> <br />
&nbsp;<br />
<br />
[[Category:Pages with broken file links]][[Category:SAFE-Treatment and Recovery]][[Category:SAFE Campuses]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Programs_%26_Options_for_Chronic_Pain_Management&diff=19315Expand Programs & Options for Chronic Pain Management2019-11-24T23:43:00Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]&nbsp;<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Minimize_Desire_to_Misuse_Opioids|Zoom Map (Minimize Desire to Misuse Opioids)]] or&nbsp;[[Reduce_Prescription_of_Opioids|(Reduce Prescription of Opioids)]]<br/> Return to Partner Roles: [[Health_Plans_and_Insurance_Companies|Health Plans]]<br/> __TOC__<br/> (<span style="color: #f11643">Note: This Objective from the Minimize the Desire to Misuse Opioids/Protective Factors map should be merged with the one on the Reduce Prescriptions Map.</span>)<br />
</div> <br />
= Acute vs. Chronic Pain =<br />
<br />
'''Acute''' pain results from disease, inflammation, or injury to tissue and comes on suddenly, subsiding once the tissue heals. <sup class="reference">[1]</sup><br/> '''Chronic''' pain is pain that persists for three months or more and is outside of active cancer or end-of-life pain. <sup class="reference">[2]</sup><br />
<br />
*More than 100 million Americans suffer from chronic pain.<sup class="reference">[3]</sup> <br />
<br />
= <br/> Non-opioid treatment<sup class="reference">[4]</sup> =<br />
<br />
In addition to the pain itself, chronic pain involves sleeplessness, an inability to remain active, and anxiety, which can also affect the person's relationships. Non-opioid approaches not only reduce pain but can also address those other aspects of chronic pain like quality of life. Some other recommended options include Cognitive Behavior Therapy (CBT), Quell.<br />
<br />
*Quell is a wearable technology that uses an electrical stimulator to trigger your brain to release enkephalins, a natural pain blocking molecule. It also contains a sleep tracker to help you understand your disease and its impact on rest. <br />
<br />
&nbsp;<br />
<br />
= Costs of Chronic Pain =<br />
<br />
*Chronic pain costs Americans more than $635 billion per year.<sup class="reference">[5]</sup> <br />
<br />
= Promising Practices for Health Plans to Support Alternate Pain Management Options =<br />
<br />
One factor that contributes to prescription of opioids versus other options for pain management is that insurance companies often have more barriers, like, to pay for less addictive and sometimes more expensive options for pain management. When it is easier to get reimbursed for prescribing opioids, it is not surprising that doctors use that option more. Working with insurance companies to pay for less addictive options could help reduce the over-prescription of opioids. The following are examples of practices or policies that insurance companies could adopt.<br />
<br />
&nbsp;<br />
<br />
= Tapering off Opioid Use =<br />
<br />
Tapering is important to help people ease off the use of opioid pain medication so that prescriptions can be reduced and the likelihood of misuse or addiction goes down.<br/> The COAT program developed by Essentia Health is a good example of a Tapering program. Link to [https://www.minnpost.com/mental-health-addiction/2016/05/northern-minnesota-coat-program-aims-reduce-opioid-addiction Article]<br />
<br />
&nbsp;<br />
<br />
= Acupuncture =<br />
<br />
*community acupuncture: low cost? <br />
<br />
= Medical Marijuana =<br />
<br />
A 2016 survey from University of Michigan researchers, published in the The Journal of Pain, found that chronic pain suffers who used cannabis reported a 64 percent drop in opioid use as well as fewer negative side effects and a better quality of life than they experienced under opioids.<sup class="reference">[6]</sup><br />
<br />
&nbsp; Another study found annual opioid overdose deaths to be about 25 percent lower on average in states that allowed medical cannabis compared with those that did not.<sup class="reference">[7]</sup><br />
<br />
&nbsp; University of New Mexico researchers say the legal availability of medical marijuana has the potential to reduce opioid use among chronic pain patients.<br/> &nbsp; The results indicate a strong correlation between enrollment in New Mexico's medical marijuana program and cessation or reduction of opioid use.<br/> &nbsp; The study tracked 37 habitual opioid using, chronic pain patients who enrolled in the state medical marijuana program between 2010 and 2015, compared to 29 patients with similar health conditions who didn't enroll. As of October, more than 44,000 people were enrolled in the state program. <sup class="reference">[8]</sup><br />
<br />
&nbsp; On average, physicians in states with medical cannabis prescribed 1,826 fewer painkiller doses for Medicare patients in a given year—because seniors turned to medical cannabis instead of opioids.<sup class="reference">[9]</sup><br/> &nbsp;<br />
<br />
&nbsp;<br />
<br />
= Nabiximol =<br />
<br />
Nabiximol is an oral cannabinoid spray used for treating chronic pain that is currently legal in 29 countries, but not the United States.<br />
<br />
&nbsp;<br />
<br />
*During a two week trial in European hospice care, researchers found significant success in sustaining the painkilling properties of Nabiximol without having to escalate the dose <br />
<br />
&nbsp;<br />
<br />
= Inspiring Examples =<br />
<br />
== Kaiser Permanente's Integrated Pain Service ==<br />
<br />
*An eight-week course designed to educate high-risk opioid patients about pain management, available to Kaiser Permanente members in Colorado for $100. <br />
*Helps patients use alternatives to drugs like exercise, meditation, acupuncture and mindfulness. Also has a chemical dependency unit to deliver medication-assisted treatment for patients with opioid addiction. <br />
*Patient care teams are comprised of: doctors, clinical pharmacists, mental health therapists, physical therapists, and nurses, all on one floor - patients can meet with this team either all at once or in groups. This avoids needing to obtain referrals and schedule individual appointments scattered across different facilities. <br />
*'''Results''': Kaiser researchers tracked more than 80 patients over the course of a year and found the group's ER visits decreased 25 percent. Inpatient admissions dropped 40 percent and patients' opioid use went way down. <br />
*'''Challenges:''' Universal implementation due to the program's scale. Big systems like Kaiser have ample resources and can afford to run programs like this, but smaller fragmented systems don't. Payment can also be challenging, as some insurers won't pay for alternative treatments, others have separate payment streams for different kinds of care. Often, behavioral health and medical health are paid for by entirely different systems. Policy to overcome these challenges is needed. <br />
<br />
<br/> Source: [https://www.npr.org/sections/health-shots/2017/12/29/567525861/pain-management-clinic-offers-an-alternative-to-opioids [1]]<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Programs_&_Options_for_Chronic_Pain_Management|TR - Expand Programs & Options for Chronic Pain Management]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
<span style="font-family: arial,helvetica,sans-serif; font-size: 13px">Potential Objective Details</span>(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
<span style="font-family: arial,helvetica,sans-serif; font-size: 13px">[[RTI_-_Expand_Programs_&_Options_for_Chronic_Pain_Management|More RTI on Chronic Pain Management]]</span><br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| border="1" class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016. <br />
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016. <br />
#Institute of Medicine Committee on Advancing Pain Research, Care, and Education, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (Washington D.C.: National Academies Press, 2011), 1. <br />
#A. Sass, "Exploring New Technological Developments in Chronic Pain Management," March 2017, Mediaplanet. <br />
#A. Bostic and J. Matney, “Reducing Opioid Risk with SBIRT,” webinar, April 9, 2014, opioidssbirt.htm&nbsp;&nbsp;[http://hospitalsbirt.webs.com/ [2]] <br />
#[https://www.scientificamerican.com/article/science-calls-out-jeff-sessions-on-medical-marijuana-and-the-historic-drug-epidemic/ https://www.scientificamerican.com/article/science-calls-out-jeff-sessions-on-medical-marijuana-and-the-historic-drug-epidemic/]&nbsp;&nbsp;[https://www.scientificamerican.com/article/science-calls-out-jeff-sessions-on-medical-marijuana-and-the-historic-drug-epidemic/ [3]] <br />
#[http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878]&nbsp;&nbsp;[http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1898878 [4]] <br />
#[https://www.usnews.com/news/best-states/new-mexico/articles/2017-11-27/unm-study-medical-marijuana-an-alternative-for-opioids https://www.usnews.com/news/best-states/new-mexico/articles/2017-11-27/unm-study-medical-marijuana-an-alternative-for-opioids]&nbsp;&nbsp;[https://www.usnews.com/news/best-states/new-mexico/articles/2017-11-27/unm-study-medical-marijuana-an-alternative-for-opioids [5]] <br />
#[http://content.healthaffairs.org/content/35/7/1230 http://content.healthaffairs.org/content/35/7/1230 [6]] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Perinatal_Treatment_and_Support_for_Women_with_SUDs&diff=19311Expand Perinatal Treatment and Support for Women with SUDs2019-11-24T23:41:36Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output">Return to&nbsp; [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or&nbsp;[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]] <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">__TOC__ <br />
= Background =<br />
<br />
= Promising Programs =<br />
<br />
&nbsp;<br />
<br />
== Perinatal Addiction Treatment Program ==<br />
<br />
<br/> '''[https://geiselmed.dartmouth.edu/psych/care/dhmc_services/perinatal/ Perinatal Addiction Treatment Program] - Dartmouth Hitchcock Medical Center'''<br/> ''Program Highlights''<br />
<br />
*Integrated Care Model: Includes maternity care, substance use treatment, behavioral health/psychiatry, pediatrics <br />
*Participant Drive Design <br />
*Private setting 10 minutes from hospital campus <br />
*Tablet-based [http://www.integration.samhsa.gov/clinical-practice/SBIRT SBIRT] screening <br />
*18 week parenting class <br />
<br />
''Outcome Successes''<br />
<br />
*Perinatal: Average gestational age is over 38 weeks; Average birthweight in the normal range <br />
*Decreased NAS treatment rate <br />
*Decreased neonatal LOS <br />
*Effective use of technology for screening <br />
*2/3 of participants remain in treatment postpartum <br />
<br />
&nbsp;<br />
<br />
== Centering Pregnancy ==<br />
<div class="_">While not specifically focusing on issues of addiction or substance misuse among pregnant women, the [https://www.centeringhealthcare.org/what-we-do/centering-pregnancy CenteringPregnancy] approach has the potential to cost-effectively improve prenatal and perinatal care among women who may be using or be addicted to opioids or other substances. It is a group approach to prenatal and perinatal care.&nbsp;</div> <div class="_">&nbsp;</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Perinatal_Treatment_for_Women_with_SUDs|TR - Expand Perinatal Treatment for Women with SUDs]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Perinatal_Treatment_for_Women_with_SUDs|More RTI on Expand Perinatal Treatment for Women with SUDs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Motivational_Interviewing_for_Pregnant_Women&diff=19309Expand Motivational Interviewing for Pregnant Women2019-11-24T23:40:59Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to&nbsp; [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or&nbsp;[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<div class="_">Motivational Interviewing is an evidence-based practice that is effective in helping people make decisions to stop negative behaviors and start positive ones. It has a high potential to help women who are pregnant and misusing opioids to make choices to get on a path to recovery.</div> <div class="_">&nbsp;</div> <br />
= Promising Program =<br />
<br />
'''Electronic Motivational Interviewing'''<br/> The patient can either use a tablet or be given a link on their smartphone to access the app. The link has a 3-D animated guide who walks them through an intervention specific to the patient’s responses, using the technique of motivational interviewing. The guide can ask questions like “what you like about the opioid use, and why do you use it, and what it does for you?.” The guide then reflects their answers. At the end of the session, if the patient indicates a need for change, the guide in the app can 1) help them develop a plan to change, 2) send tailed text messages after they leave the doctor’s office, and 3) suggest treatment options in there area. This type of intervention has already shown success in some communities and is currently being tested to address opioids. This intervention could be very successful for the following reasons 1) Using an electronic based system to ask these difficult questions could remove stigma from the situation 2) Most women will have access to a mobile device 3) It automates follow-up 4) Does not require additional motivational interviewing training for doctors as they do not have much time for in-depth screenings.<br/> <br/> '''Contact for app:''' Steven Ondersma, Wayne State University, email?<br/> <br/> &nbsp;<br />
<br />
= Expanding Training for Doing Motivational Interviewing =<br />
<br />
== Motivational Interviewing Network of Trainers ==<br />
<div class="_">The [https://motivationalinterviewing.org/ Motivational Interviewing Network of Trainers] (MINT) is an international organization of trainers in motivational interviewing, incorporated as a 501(c)(3) tax-exempt non-profit charitable organization in the state of Virginia, USA. The trainers come from diverse backgrounds and apply MI in a variety of settings. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. Started in 1997 by a small group of trainers trained by William R. Miller and Stephen Rollnick, the organization has since grown to represent 35 countries and more than 20 different languages.</div> <div class="_">&nbsp;</div> <br />
== Clinical Health Coach online training ==<br />
<div class="_">The Clinical Health Coach® training is provided by the Iowa Chronic Care Consortium (ICCC), a not for profit, population health consulting, training and planning organization. Their mission is to build capacity<br/> &nbsp; with other organizations to deliver effective, personalized health improvement and chronic care strategies. [http://clinicalhealthcoach.com/ Clinical Health Coach Training Online] is a flexible, 26-hour self-paced, six to twelve week experience engaging participants in an online learning platform for topics that include Motivational Interviewing.</div> <div class="_">&nbsp;</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Motivational_Interviewing_for_Pregnant_Women|TR - Expand Motivational Interviewing for Pregnant Women]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Motivational_Interviewing_for_Pregnant_Women|More RTI on Expand Motivational Interviewing for Pregnant Women]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs&diff=19307Expand Law Enforcement Assisted Diversion and Deflection Programs2019-11-24T23:40:05Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
''Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]]&nbsp;''<br />
<br />
----<br />
<br />
By adopting programs where law enforcement professionals can divert peopel from the typical criminal justice system and help them get the help then need in dealing with their drug use or Substance Use Disorder.&nbsp;&nbsp;<br />
<br />
= Background =<br />
<div class="_">LEAD is a pre-booking diversion program that allows officers to redirect low-level offenders engaged in drugs or prostitution activity to community-based services instead of jail and prosecution. LEAD participants begin working immediately with case managers to access services.<sup class="reference">[1]</sup></div> <div class="_">&nbsp;</div> <div class="_">According to a 2015 report by the International Centre for the Prevention of Crime (ICPC), "One of the [ONDCP] strategy's objectives for 2015 is to break the cycle of drug use, crime, delinquency, and incarceration by increasing by 5% the number of residential juvenile justice facilities offering substance abuse treatment, and increasing by 2.6% the number of treatment plans completed by individuals referred by the Criminal Justice System (ONDCP, 2012, p.18)."<ref>https://www.unodc.org/documents/ungass2016/Contributions/Civil/ICPC/Rapport_FINAL_ENG_2015.pdf</ref></div> <div class="_">&nbsp;</div> <br />
= Other Programs =<br />
<br />
== The S.M.A.R.T. Approach ==<br />
SMART supports chronic misdemeanor offenders, particularly those who are otherwise resistant to intervention, with a case manager and offers individualized treatment and tailored housing placements. SMART prioritizes chronic misdemeanor offenders with acute drug addictions and complex social service needs.<sup class="reference">[2]</sup><br/> See fact sheet here: <div class="objectEmbed">[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|[File:http://www.wikispaces.com/i/mime/32/application/pdf.png SMART Fact Sheet.pdf]]] <div>[[File/view/SMART_Fact_Sheet.pdf/623773107/SMART_Fact_Sheet.pdf|SMART Fact Sheet.pdf]]</div> </div> <br />
&nbsp;<br />
<br />
== DTAP - Drug Treatment Alternative To Prison ==<br />
<br />
This program had a high rate of success.&nbsp; See this [https://www.centeronaddiction.org/addiction-research/reports/crossing-bridge-evaluation-drug-treatment-alternative-prison-dtap-program evaluation report] from 2003 for impressive statistics.&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|TR - Expand Law Enforcement Assisted Diversion Programs]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
</div><br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|Potential Actions and Partners]]<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Law_Enforcement_Assisted_Diversion_Programs|More RTI on Expand Law Enforcement Assisted Diversion Programs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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{| class="wiki_table"<br />
|-<br />
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| '''Date'''<br />
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= Sources =<br />
<br />
----<br />
<br />
#[http://leadkingcounty.org/about/ [1]] <br />
#[https://www.sandiego.gov/cityattorney/divisions/criminal/smart [2]] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Law Enforcement and Criminal Justice]] [[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Harm_Reduction_Practices&diff=19305Expand Harm Reduction Practices2019-11-24T23:39:24Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
''Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]''<br />
<br />
----<br />
Brief Description Goes Here</div> <div class="wiki" style="display: block">&nbsp;</div> <br />
= Overview on Harm Reduction =<br />
<br />
Link to a national organization focusing on Harm Reduction: [http://harmreduction.org/ Harm Reduction Coalition]<br />
<br />
= Tools & Resources =<br />
<div class="wiki" style="display: block">[[TR_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|TR - ]]<span style="font-family: Helvetica; font-size: 10pt">[[TR_-_Expand_Harm_Reduction_Practices|Expand Harm Reduction Practices]]</span></div> <div class="wiki" style="display: block">&nbsp;</div> <br />
<div class="mw-parser-output"><br />
= Scorecard Building&nbsp; =<br />
<div class="wiki" style="display: block">Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;</div> <div class="wiki" style="display: block">&nbsp;</div> </div><br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Expand_Harm_Reduction_Practices|Potential Actions and Partners]]<br />
<div class="wiki" style="display: block">&nbsp;</div> <br />
= Resources to Investigate =<br />
<div class="wiki" style="display: block">[[RTI_-_Expand_Harm_Reduction_Practices|More RTI on <span style="font-family: Helvetica; font-size: 10pt">Expand Harm Reduction Practices</span>]]<br/> <br/> &nbsp;</div> <div class="wiki" style="display: block"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></div> <div class="wiki" style="display: block"><br />
{| border="1" cellpadding="1" cellspacing="1" style="width: 500px;"<br />
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</div> <br />
= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Fentanyl_Testing_Options&diff=19304Expand Fentanyl Testing Options2019-11-24T23:39:03Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map&nbsp;]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]__TOC__<br/> (Replace this text with the information you will place here.)<br/> <br/> <br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<div class="_">[[TR_-_Expand_Fentanyl_Testing_Options|TR_-&nbsp;Expand_Fentanyl_Testing_Options]]</div> <div class="_">&nbsp;</div> <br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<div class="_">Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;</div> <div class="_">&nbsp;</div> </div><br />
<br />
= Resources to Investigate =<br />
<div class="_">[[RTI_-_Expand_Fentanyl_Testing_Options|More RTI on&nbsp;Expand Fentanyl Testing Options]]</div> <div class="_">&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></div> <div class="_">&nbsp;</div> <br />
{| class="wiki_table"<br />
|-<br />
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| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
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= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Disrupt_the_Supply_of_Illegal_Drugs&diff=19303Disrupt the Supply of Illegal Drugs2019-11-24T23:38:45Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] <br />
&nbsp;<br />
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Add a intro paragraph here. &nbsp;<br />
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<div class="mw-parser-output"><br />
= Background =<br />
<br />
Key to any strategy to reduce opioid misuse is preventing illicit opioids, including heroin and synthetic opioids, from ever reaching communities. This role is almost exclusively the role and responsiblity of law enforcement at both the federal and state level, and requires cooperation between jurisdictions and federal partners to ensure success.<br />
<br />
<div class="mw-parser-output"><br />
== Perceived Dangers of Accidental Overdoses ==<br />
<br />
With the distribution of [[Additional_Info_on_Fentanyl|fentanyl]], a powerful opioid that can be lethal in small amounts,&nbsp;overdoses have been reported by law enforment personnel as having&nbsp;occured&nbsp;through inhalation&nbsp;or absorption&nbsp;through the skin during routine encounters.<ref>http://www.cnn.com/2017/05/16/health/police-fentanyl-overdose-trnd/?iid=ob_article_footer_expansion]</ref>&nbsp;These instances, however, are more myth than reality,<ref>_</ref> and can lead to misplaced fear when law enforement and emergency responders come upon a suspected overdose. Any delay in responding to an overdose could cause brain damage and even death.<br />
<br />
See page on [[Support_Strategies_to_Address_Fentanyl|Support Strategies to Address Fentanyl]] </div><br />
</div><br />
<br />
= National Programs =<br />
<br />
== DEA 360 Strategy ==<br />
<br />
'''Target Drug Trafficking Organizations'''<br/> In the past, the DEA has targeted low-level, first time non-violent offenders who usually are selling to get high themselves.<sup class="reference">[6]</sup> This new strategy will target all drug deals, but start from the top down.<sup class="reference">[7]</sup><br/> <br/> "''These drug trafficking organizations are predators. There's no other way to describe it. They look for the vulnerable, they exploit them by finding them while they are trying to get treatment; that's how severe, how bad these drug trafficking organizations are to find their customer and peddle their poison. We're going to put together a task force and this task force is going to put together building federal cases based on these overdoses, and there is significant sentencing around and this is a way to impact straight into the organization and take out upper level members of an organization that directly impact the flow of drugs''.”<sup class="reference">[8]</sup><br/> <br/> -Thomas Gorman, Assistant Special Agent in Charge, DEA<br />
<br />
== Organized Crime Drug Enforcement Task Force ==<br />
<br />
'''Organized Crime Drug Enforcement Task Force (OCTDEF) National Heroin/Fentanyl and Opioid Initiative'''<br/> Since its inception in December of 2014, the ultimate goal of this initiative has been to develop multi-agency, multi-jurisdictional cases against criminal organizations. The Initiative leverages the national structure, resources and information sharing capabilities to identify the local street level distributors who are responsible for overdose deaths, as well as their network of suppliers at the local and regional level. In the last several years, OCDETF investigators and prosecutors attacked the opioid epidemic by prosecuting rogue physicians, pharmacists, internet sales, and pill mill operations. Their traditional diversion investigations involved overwriting of oxycodone by doctors, and misuse of fentanyl patches by users who clipped the edges to consume the gel inside. Today, OCTDEF funds 60 Heroin/Fentanyl and Opioid Initiatives across the country. <sup class="reference">[9]</sup><br/> <br/> '''Working With China to Stop Export of Controlled Substances'''<br />
<br />
*A large number of synthetic opioids, specifically fentanyl, come to the US from China. <sup class="reference">[10]</sup> <br />
*China has agreed to crack down on the exports of substances that are controlled in the US, but not in China.<sup class="reference">[11]</sup> <br />
*The US and China will work together to exchange more law enforcement and scientific information to coordinate actions.<sup class="reference">[12]</sup> <br />
*Cooperation between the U.S. Drug Enforcement Agency (DEA) and the China Ministry of Public Security (MPS) and recognized China’s actions toward combating global synthetic drug trafficking.<sup class="reference">[13]</sup> <br />
*On October 1, 2015, China took an important step in international coordination by controlling a list of 116 synthetic drugs that were widely abused in the U.S.<sup class="reference">[14]</sup> <br />
*When evaluating a substance for control, the new provision also allows China to consider harm to the public in countries other than China.<sup class="reference">[15]</sup> <br />
*DEA continues to share information with Chinese officials to secure scheduling of additional fentanyl-class substances in China due to the wave of recent deaths in the United States from these synthetic opioids. <sup class="reference">[16]</sup> <br />
*At a time of massive growth in postal shipments from China due to e-commerce, the investigators found that the postal system received the electronic data on just over a third of all international packages, making more than 300 million packages in 2017 much harder to screen. Data in the Senate report shows no significant improvement during 2017 despite the urgency. <sup class="reference">[17]</sup> <br />
*The U.S. Postal Service said it has made dramatic progress in the last year in total packages with opioids seized by U.S. Customs and Border Protection... implementing the use of electronic data is slowed by the need to negotiate with international partners, but the service is making progress. <sup class="reference">[18]</sup> <br />
<br />
&nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Efforts_to_Disrupt_the_Supply_of_Heroin_&_Synthetic_Opioids_to_the_Community|TR - Expand Efforts to Disrupt the Supply of Heroin & Synthetic Opioids to the Community]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Efforts_to_Disrupt_the_Supply_of_Heroin_&_Synthetic_Opioids_to_the_Community|More RTI on Synthetic Opioids]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
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= Sources =<br />
<br />
----<br />
<br />
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [https://www.dea.gov/press-releases/2016/06/10/dea-warning-police-and-public-fentanyl-exposure-kills]] <br />
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [2]] <br />
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [3]] <br />
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [4]] <br />
#[https://www.dea.gov/divisions/hq/2016/hq061016.shtml [5]] <br />
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [6]] <br />
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [7]] <br />
#[http://www.wdrb.com/story/33150219/dea-announces-new-strategy-to-stop-drug-trafficking-drug-violence-and-drug-abuse [8]] <br />
#[https://www.justice.gov/usao/file/895091/download [9]] <br />
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [10]] <br />
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [11]] <br />
#[https://www.statnews.com/2016/09/03/us-china-fentanyl/ [12]] <br />
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [13]] <br />
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [14]] <br />
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [15]] <br />
#[https://www.dea.gov/divisions/hq/2017/hq011317.shtml [16]] <br />
##<br />
##*<br />
##**<br />
##***<br />
##****<br />
##*****<br />
##******<br />
##*******[http://time.com/5117820/china-opioids-postal-service-drugs/ [17]] <br />
##*******[http://time.com/5117820/china-opioids-postal-service-drugs/ [18]] <br />
</div> </div> </div> </div> <br />
[[Category:SAFE-Law Enforcement and Criminal Justice]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_ER_%26_Healthcare_Handoffs_to_Treatment&diff=19302Expand ER & Healthcare Handoffs to Treatment2019-11-24T23:38:11Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output">Return to&nbsp;[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|ZOOM MAP -&nbsp;Improve Treatment & Enable Recovery for People with SUDs]] <br />
&nbsp; By systematically expanding processes for "warm handoffs" by Emergency Departments to treatment, recovery coaches and the other support needed by people who are misusing opioids, developing dependence or who have an SUD, many people will be more likely to get on the path for avoiding addiction or moving forward to long-term recovery.<br />
<br />
= Background =<br />
<br />
ER visits and hospitalizations due to opioid overdose is high and rising.&nbsp;"Overall, ED visits (reported by 52 jurisdictions in 45 states) for suspected opioid overdoses increased 30 percent in the U.S., from July 2016 through September 2017."<ref>https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html</ref><br />
<br />
More than 140,000 people&nbsp;[https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html visited an ER for overdoses]&nbsp;nationwide between July 2016 and Sept. 2017, according to the Centers for Disease Control and Prevention.<ref>https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic</ref><br />
<br />
According to a May 2018 article, "Most ER doctors stabilize patients and release them with little or no attempt to offer long-term treatment."<ref>https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic</ref><br />
<br />
“Research shows that people who have had an overdose are more likely to have another. Emergency department education and post-overdose protocols, including providing naloxone and linking people to treatment, are critical needs,” said Alana Vivolo-Kantor, Ph.D., behavioral scientist in CDC’s National Center for Injury Prevention and Control. “Data on opioid overdoses treated in emergency departments can inform timely, strategic, and coordinated response efforts in the community as well.”<ref>https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html</ref><br />
<br />
= Success Stories =<br />
<br />
== Pioneering work in Rhode Island ==<br />
<br />
The "warm handoff" model was pioneered in Rhode Island where&nbsp;all of the state’s emergency departments and hospitals were required to be state-certified to treat OUDs. The&nbsp;EDs must offer&nbsp;peer recovery support; prescribing the overdose reversal drug naloxone to at-risk patients; and offering MAT, including buprenorphine, in the ER or at a doctor’s office or treatment facility.&nbsp; A study by Yale researchers found that opioid-addicted patients were more likely to get treatment and reduce opioid use long-term when started on medication-assisted treatment in the ER.[https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic https://www.centerforhealthjournalism.org/fellowships/projects/how-er-docs-could-play-key-role-fighting-opioid-epidemic]&nbsp;<br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><br />
= Tools & Resources =<br />
<div class="_">TR - ___</div> <div class="_">&nbsp;</div> <div class="_">This white paper from HealthLeaders magazine, [https://interactive.healthleadersmedia.com/Recovery_Begins_in_the_ED Recovery Begins in the ED], has good information.&nbsp;</div> <div class="_">&nbsp;</div> <div class="_">This 2018 report in the Annals of Emergency Medicine provides valuable details: [https://www.annemergmed.com/article/S0196-0644(18)30079-9/fulltext Opportunities for Prevention and Intervention of Opioid Overdoses in the Emergency Department]&nbsp;&nbsp;</div> <div class="_">&nbsp;</div> <div class="_">This [https://emergency.cdc.gov/coca/calls/2018/callinfo_031318.asp webinar from March of 2018] goes into a lot of details on coordinating ER, Public Health and&nbsp;</div> <div class="_">&nbsp;</div> </div> <div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
</div><br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Expand_ER_&_Healthcare_Handoffs_to_Treatment|Potential Actions and Partners]]<br />
<div class="_">&nbsp;</div> </div> </div> <br />
= Resources to Investigate =<br />
<div class="_">More RTI on __</div> <div class="_">&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></div> <div class="_">&nbsp;</div> <br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
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= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies&diff=19301Expand DNA Testing to Improve Precision MAT Therapies2019-11-24T23:37:48Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or&nbsp;[[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|the Zoom Map (Expand Access to Optimized MAT)]]&nbsp;<br />
<br />
= Background =<br />
<br />
*Individuals all process and metabolize drugs in differing ways.<sup class="reference">[1]</sup> <br />
*Someone's genetic makeup, the amount of enzymes, and specific receptors they have contribute to how a person can metabolize medicine<sup class="reference">[2]</sup> <br />
*A person's genetic makeup also impacts how certain foods will affect how drugs are metabolized. <sup class="reference">[3]</sup> <br />
*Genetic testing reveals information that can help us accurately tailor medications on a patient-to-patient basis.<sup class="reference">[4]</sup><sup class="reference">[5]</sup> This is called Precision or Personalized Medicine<sup class="reference">[6]</sup><sup class="reference">[7]</sup> <br />
*In the past, physicians have had limited tools when it comes to evaluating options or dosages for Medication Assisted Treatment Plans <sup class="reference">[8]</sup> <br />
*The result is that Medication Assisted Treatment plans usually rely on a series of "trial and error" doses that are adjusted based on response of the patient to the doses being tried without using insights from genetic tests to optimize the plan for each patient.<sup class="reference">[9]</sup> <br />
*When the does of medication is not ideal, the patient either receives insufficient benefit from the medication or has side effects or adverse drug reactions. See [https://www.journals.elsevier.com/addictive-behaviors-reports Addictive Behaviors Reports, June 2017] <br />
*The inconsistent impact of medication used in MAT is a contributing factor to the high relapse rates in opioid addicted patients. Even for those receiving MAT, the relapse rate tends to be about 50% <sup class="reference">[10]</sup> <br />
*Patients who abstain from opioids in the first two weeks have a good chance of good 12-week outcome. However, those who use opioids in each of the first 2 weeks (even in week 1 alone) have very little chance of abstaining by week 12<sup class="reference">[11]</sup> <br />
<br />
= The Opportunity with Precision MAT =<br />
<br />
*With today's more refined analysis of the human genome map, their is a growing database of variability of gene alleles and how they account for changes in drug metabolism. <br />
*A clinical genomic test can be performed and a report can be created that displays the expected benefits and risks the patient has if they receive any one of over 200 medications (in this case with a focus on the drugs being used to treat opioid addiction), and how the patient's dietary regimen can affect medications they may be taking or will take in the future to treat their addiction and potential related diseases. (This reporting is similar to what is being used in the [[Cancer_treatment_programs_that_rely_on_genomic_testing|cancer treatment programs that rely on genomic testing]] to help guide post-diagnostic clinical care.) <br />
*This Webinar provides a good overview on Pharmacogenetics and MAT: [https://pcssnow.org/event/clinical-applications-pharmacogenomic-testing-opioid-use-disorder-management/ Clinical Applications of Pharmacogenomic Testing in Opioid Use Disorder Management] <br />
*Such dynamic, interactive reports can then be used by physicians and other medical providers such as nurse practitioners, pharmacists, therapists, dietitians and other social service professionals to develop more precise treatment plans of care for the individual patient. <br />
*An on-going research study is showing that more precise dosing in Medication Assisted Treatment, based on more accurate analysis of [[Gene_allele_variability|gene allele variability]], has decreased relapse rates in opioid addicted patients down to 25% over an 18 month tracking period.<sup class="reference">[12]</sup> <br />
<br />
== Genetic Tests ==<br />
<br />
*A genetic test is performed by obtaining a simple cheek swab that collects DNA from the cells on the inside of a person’s mouth. The specimen collection can be performed by an appropriately trained individual and the report results available in 1-2 weeks. <br />
*Using a cheek swab is one of the two most popular ways to do DNA tests<sup class="reference">[13]</sup> . <br />
*Insurance coverage varies for this test which costs approximates between $500 and $1,200 based on whether annual pharmacy consultative services are included. <br />
*Medicare is the most reliable payer and the commercial carriers range in reliability of payment. Few Medicaid carriers are currently paying for these tests today but with the significant funding being made available to individual states to address the opioid addiction crisis, the anticipation is that the state based Medicaid plans will begin to address this coverage gap. <br />
*Premier DNA is a genetics testing company that has created a integrated care model combining genetic testing, interactive genetic reporting, and pharmacy consultation. They offer this program under the registered trade name Med Op Rx. This service becomes a useful tool to guide the physician in terms of implementing the most precise MAT program given the individual patient's genetic makeup. <br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|TR - Expand DNA Testing to Improve Precision MAT Therapies]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|More RTI on Expand DNA Testing to Improve Precision MAT Therapies]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="font-size: 12.8px">[fill out table below]</span><br />
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= Sources =<br />
<br />
----<br />
<br />
#[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447546/ [1]] <br />
#[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447546/ [2]] <br />
#[https://www.practicalpainmanagement.com/treatments/genetic-testing-pain-medicine-future-coming [3]] <br />
#[https://www.practicalpainmanagement.com/treatments/genetic-testing-pain-medicine-future-coming [4]] <br />
#Levran O, Peles E, Hamon S, Randesi M, Adelson M, Kreek MJ. CYP2B6 SNPs are associated with methadone dose required for effective treatment of opioid addiction. Addict Biol. 2011;18(4):709–716. doi: 10.1111/j.1369-1600.2011.00349.x <br />
#[https://ghr.nlm.nih.gov/primer/precisionmedicine/definition [5]] <br />
#<span class="element-citation">Hamburg MA, Collins FS. The path to personalized medicine. </span><span class="ref-journal">N. Engl. J. Med. </span>2010;<span class="ref-vol">363</span>(4):301–304. <br />
#[https://www.practicalpainmanagement.com/treatments/genetic-testing-pain-medicine-future-coming [6]] <br />
#[https://www.naabt.org/documents/TIP40.pdf [7]] <br />
#[https://www.statnews.com/2017/11/14/vivitrol-suboxone-study-nida/ [8]] <br />
##* [https://education.psychiatry.org/Users/ProductDetails.aspx?ActivityID=6092 [9]] <br />
#This statistic is based on on a study of 175 people. The results are still being written up for publication. <br />
#[https://dnacenter.com/blog/swabs-vs-blood-samples-dna-testing [10]] <br />
</div> </div></div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Community_Service_Alternatives_to_Incarceration&diff=19298Expand Community Service Alternatives to Incarceration2019-11-24T23:36:05Z<p>Josiebeets: </p>
<hr />
<div>Return to [[ZOOM_MAP_-_Prioritize_SUD_Treatment_Over_Incarceration|Zoom Map - Prioritize SUD Treatment Over Incarceration]] <br />
----<br />
<br />
When people are breaking laws, get arrested and convicted of a crime, having their punishment be in the form of community service can be an alternative to incarceration.&nbsp; This can be less damaging to their lives moving forward than incarceration.&nbsp; &nbsp;<br />
<br />
= Background =<br />
<br />
== Research on the community service versus incarceration<br/> <br/> &nbsp; ==<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Community_Service_Alternatives_to_Incarceration|TR - Expand Community Service Alternatives to Incarceration]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br />
</div><br />
<br />
= Actions to Take =<br />
<br />
[[PA_-_Expand_Community_Service_Alternatives_to_Incarceration|Potential Actions and Partners]]<br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Community_Service_Alternatives_to_Incarceration|More RTI on Expand Community Service Alternatives to Incarceration]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
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= Sources =<br />
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[[Category:SAFE-Law Enforcement and Criminal Justice]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Access_to_Medication-Assisted_Treatment_(MAT)&diff=19297Expand Access to Medication-Assisted Treatment (MAT)2019-11-24T23:35:45Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="mw-parser-output">Return to [[ZOOM_MAP_-_Expand_Access_to_Optimized_MAT|Zoom Map - Expand Access to Optimized MAT]]&nbsp;or&nbsp;&nbsp;[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]]&nbsp;or the [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
<br/> __TOC__<br />
<br />
= Medication-Assisted Treatment =<br />
<div class="_">Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.<sup class="reference">[1]</sup> Information on medications used in MAT can be found further down on this page.</div> <div class="_">&nbsp; The President's [https://www.whitehouse.gov/ondcp/presidents-commission Commission on Combating Drug Addiction and the Opioid Crisis] has recommended that federal government "immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)."<sup class="reference">[2]</sup></div> <div class="_">&nbsp; The above reports documents that MAT has been proven to:</div> <div class="_">&nbsp;</div> <br />
*Reduce overdose deaths <br />
*retain persons in treatment <br />
*decrease use of heroin <br />
*Prevent spread of infectious disease <br />
<br />
&nbsp;<br />
<br />
= Opportunity to Enhance Common MAT Research and Practices =<br />
<div class="_">An article in the August 2017 issue of the American Journal of Psychiatry, by Roger D. Weiss, MD, the Chief of the Division of Alcohol and Drug Abuse at McLean Hospital (Belmont, MA) and Professor of Psychiatry at Harvard Medical School and Kathleen Carroll, Ph.D. concluded:<br/> &nbsp; "Finally, with 6-month retention rates seldom exceeding 50% and poor outcomes following dropout, we must explore innovative strategies for enhancing retention in buprenorphine treatment."</div> <div class="_">&nbsp; This report reveals the need for significantly more studies that can yield additional insights to inform MAT practices. Current literature focuses mainly on the outcome of treatment retention and negative urine drug screens. Enhanced research would look at broader outcomes of social functioning and well-being including employment, stable housing and other measures of well-being. Also, research would ideally have information on many other factors such as information on co-occurring disorders and different types of behavioral treatments that would be appropriate for different individuals, While not mentioned specifically in that article, a person's history of trauma or ACEs, length of time with an SUD, current level of supports and genetic factors such as the rates at which they metabolize different drugs would all impact what type of treatment would be most appropriate. All of these unique factors and the wide range of potential interventions are reasons that more research is needed, and conclusions from studies that look at a limited number of inputs and outcomes and lack visibility into all the unique factors that influence what might impact successful outcomes should be seen as early insights in a journey of finding the optimal forms of treatment for each person's situation.</div> <div class="_">&nbsp; Weiss and Carroll highlight some key findings from their report in a Webinar done through the American Journal of Psychiatry learning center.<sup class="reference">[3]</sup> Key points include:</div> <div class="_">&nbsp;</div> <br />
*<br />
**Buprenorphine is an excellent medication, but there is still much room for improvement in how MAT is done. <br />
*Research designs, such as the intensity of Medication Management, the dose of buprenorphine, and the characteristics of the group participants, influence outcomes. <br />
*Different sub-groups respond differently to different elements of treatment plans. <br />
*Early treatment response has a major impact on long-term success, and a better understanding of that insight may help decision-making. <br />
**Paients who abstain from opioids in the first two weeks of treatment have a good chance of a good 12-week outcome. <br />
**Patients who use opioids during the first two weeks of treatment have very little chances of abstaining by week 12. <br />
*There is evidence that the use of [https://drugabuse.com/library/contingency-management/ Contingency Management ](CM), including the use of computer-based therapies, seems to increase success rates <br />
*Patients dependent on prescription opioids seemed to respond more positively to Cognitive Behavioral Therapy (CBT) than those who were primarily heroin users. <br />
*Different treatment approaches appeal to different patients, and using approaches that appeal to the patients helps to increase their retention rates. <br />
*More data is needed to better understand what treatment options are best for different individuals, <br />
<br />
&nbsp;<br />
<br />
= Ways to Improve and Optimize&nbsp;MAT =<br />
<br />
The effectiveness of MAT is enhanced when there is an emphasis on a broad range of treatment and recovery supports, not just providing the medication part of the MAT.&nbsp; &nbsp;MAT is optimized when those providing and funding the treatment keep striving to improve all aspects of the treatment plan, optimized for each individual as much as practical.&nbsp;<br />
<br />
Some of the ways that MAT can be optimized are listed below::<br />
<br />
*Precision medication ([[Expand_DNA_Testing_to_Improve_Precision_MAT_Therapies|Expand DNA Testing to Improve Precision MAT]]) <br />
*A coordinated, proactive, whole-person care plan ([[Integrate_MAT_into_a_Whole_Person_Care_Model|Integrate MAT into whole-person care model]]) <br />
*Community engagement ([[Expand_community_engagement_to_improve_MAT|Expand community engagement to improve MAT]]) <br />
*Use of innovative technologies ([[Use_innovative_technologies_to_enhance_MAT|Use innovative technologies to enhance MAT]]) <br />
<br />
<br/> &nbsp;<br />
<br />
= Current Status of MAT Practices =<br />
<br />
*Only 10% of conventional drug treatment facilities in the United States provide MAT for opioid use disorders (need source and date) <br />
*According to SAMHSA data collected in early 2017, 40 percent of the physicians who have a waiver do not prescribe buprenorphine at all. This may be due to physicians' reluctance to have patients with addictive disorders frequenting their offices or due to concerns about DEA audits, among other reasons.<sup class="reference">[4]</sup> <br />
*Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths<sup class="reference">[5]</sup> <br />
<br />
&nbsp;<br />
<div class="mw-parser-output"><br />
= The Value of MAT (or Opioid-Agonist Treatment) =<br />
<br />
*International addiction experts consider initial opioid-agonist treatment, or OAT, ''with no duration restrictions'', the evidence-based standard of care for opioid-use disorder, the authors write online November 20, 2018&nbsp;in Annals of Internal Medicine.<ref>https://annals.org/aim/article-abstract/2664093/cost-effectiveness-publicly-funded-treatment-opioid-use-disorder-california</ref> <br />
*But in California, where more people have been diagnosed with opioid disorder than in any other U.S. state, ''publicly funded treatment programs require patients to “fail” - twice - at a three-week course of medically supervised withdrawal before they become eligible for OAT''. Policymakers likely maintained this medically managed withdrawal requirement under the false belief it was saving money. The study demonstrates, however, that the policy creates significantly greater long term costs for criminal justice and healthcare systems. <br />
**The study concludes OAT would have saved as much as $850 million over five years, not including savings to the criminal-justice system, and more than $2 billion, including the cost of arrests and prosecutions. Over 10 years, the total savings would rise to $2.87 billion.<ref>https://annals.org/aim/article-abstract/2664093/cost-effectiveness-publicly-funded-treatment-opioid-use-disorder-california</ref> <br />
**“If we want to see overdose deaths come down, we need to make sure people who have opioid addiction are able to access effective treatment more easily than they can access heroin, fentanyl or pain pills." <br />
**"We need a model whereby patients can get immediate access to opioid-agonist treatment, a lifesaving intervention, without obstacles." <br />
**“Among experts in the field of addiction, we already know that detox doesn’t work, that they’re going to relapse and when they relapse, they’re going to be at great risk for an overdose, that they’ll be at great risk for hepatitis,” Kolodny said. “Opioid addiction is a life-threatening illness. <br />
<br />
Access the study here:<ref>https://annals.org/aim/article-abstract/2664093/cost-effectiveness-publicly-funded-treatment-opioid-use-disorder-california</ref><br/> &nbsp;<br />
This article talks of how the use of Buprenorphine reduces the cost of opioid addiction<br/> [https://www.behavioral.net/print/article/finance/buprenorphine-helps-lower-cost-opioid-crisis [1]]</div> <div class="_">&nbsp;</div> </div> <br />
= New 2018 SAMHSA Guide for Medications for Opioid Use Disorder =<br />
<br />
This latest, detailed [https://store.samhsa.gov/product/TIP-63-Medications-for-Opioid-Use-Disorder-Executive-Summary/SMA18-5063EXSUMM 330-page report] can be downloaded for free.&nbsp;<br />
<br />
= Co-occurring Disorders =<br />
<br />
Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time. <sup class="reference">[6]</sup><br />
<br />
= Different Medications Used in MAT: =<br />
<br />
== Agonists & Antagonists ==<br />
<div class="_">An opioid agonist activates opioid receptors in the brain. An antagonist blocks opioids by attaching to the opioid receptors without activating them.<sup class="reference">[7]</sup><br/> &nbsp; [Detoxification vs. Stabilization]</div> <div class="_">&nbsp;</div> <br />
*[https://www.whitehouse.gov/sites/default/files/ondcp/recovery/medication_assisted_treatment_9-21-20121.pdf [2]] (Page 3) <br />
<br />
== Buprenorphine ==<br />
<br />
*Buprenorphine is used in MAT to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. One study showed that 50% of the people in treatment who were also on Buprenorphine stayed on treatment compared with 7% who only had treatment.<sup class="reference">[8]</sup> <br />
*Buprenorphine is a partial agonist that suppresses opioid withdrawal symptoms. It can produce opioid agonist effects, such as euphoria, it is milder than full agonists such as methadone.<sup class="reference">[9]</sup> <br />
*Buprenorphine can be prescribed by physicians in an outpatient setting who have completed a training course and received a DEA DATA 2000 waiver. It is taken as a pill or sublingual film. Buprenorphine was also approved in a 6-month implant form in May 2016<sup class="reference">[10]</sup> <br />
*Training for Buprenorphine providers is an 8 hour course (24 for Nurse Pracitioners and Physician Assistants) and allow for the following patient loads and responsibilities:<sup class="reference">[11]</sup> <br />
<br />
#30 Addiction Treamtent Patients per provider for the first year <br />
#100 patients each year thereafter <br />
#An additional 175 (totalling 275) patients can be alloted is the Physician is board certified in addiction, or a facility: <br />
<br />
*Has 24 Call Coverage for patients <br />
*Uses an EMR/EHS to monitor and update patient records (for those looking for an entry level EHS, PracticeFusion is a free system) <br />
*Provision of Care Management Services <br />
*Subscribing to a State led Drug Management System <br />
*Acceptance of Third Party Insurance <br />
<br />
<br/> It should be noted that only around 10% of those who wish to seek treatment can find qualified providers to allow for it<sup class="reference">[12]</sup> . As a result, there are cases where medication diversion do occur, and there is a black market for the drug for self-treatment purposes.<sup class="reference">[13]</sup><br/> <br/> Treatment with buprenorphine has been proven effective in opioid addiction, decreasing mortality by approximately 50%. Patients treated with buprenorphine show improved social functioning with increased retention in treatment (67% at one year) compared to drug-free treatment (7% to 25% at one year), reduced criminal activity, lower rates of illicit substance abuse, and reduced risk of HIV and hepatitis infection.<sup class="reference">[14]</sup><br />
<br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine SAMSHA page on Buprenorphine] <br />
*[[More_info_on_Buprenorphine|More info on Buprenorphine]] <br />
<br />
For more information, one can visit the information page on [[File/view/BupForOUD.pdf/614583113/BupForOUD.pdf|Buprenorphine for Patients and Families]], which includes information on side effects, information to share with providers and other useful information. This document was compiled by Intermountain Health Care.<br />
<br />
== Suboxone ==<br />
<br />
*Suboxone is a brand name for a hybrid that is three parts Buprenorphine and one part Naloxone. <br />
*Suboxone is more difficult to misuse because it will cause the patient to enter opioid withdrawal if it is misused in any way such as injection.<sup class="reference">[15]</sup> <br />
*[[More_info_on_Suboxone|More info on Suboxone]] (including generic options) <br />
<br />
== Probuphine ==<br />
<br />
*Probuphine is an implant that contains the medicine buprenorphine. Probuphine is used to treat certain adults who are addicted to (dependent on) opioid drugs (either prescription or illegal). Probuphine is part of a complete treatment program that also includes counseling and behavioral therapy. <br />
*Because Probuphine contains buprenorphine, it may cause physical dependence. <br />
*Four implants are inserted under the skin of your upper arm during a procedure done in your physician's office or Opioid Treatment Program (OTP). <br />
*The implants remain in your arm for six months. <br />
*After the six-month period, your doctor must remove the implants. <br />
*If you wish to continue Probuphine, your doctor may insert new implants to continue treatment. <br />
*The implants can be removed sooner if you want to stop treatment. <br />
*Patients must continue to see their doctor at least every month while on Probuphine therapy. <br />
*[https://probuphine.com/ For more information visit their website.] <br />
<br />
== Methadone ==<br />
<br />
*Methadone, sold under the brand name [https://www.drugs.com/cdi/dolophine.html Dolophine] among others, is used in MAT to help with detoxification or as part of [https://en.wikipedia.org/wiki/Maintenance_therapy maintenance therapy] or [https://en.wikipedia.org/wiki/Opioid_replacement_therapy Opioid Replacement Therapy]. <br />
*Methadone is an opioid replacement. It works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.<sup class="reference">[16]</sup> <br />
*Methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs. <br />
*Methadone can only be dispensed at SAMHSA-certified outpatient treatment programs or in hospitals in an emergency. <sup class="reference">[17]</sup> <br />
*Methadone has been used to treat chronic pain, however, this use is limited because of the serious risk of dependence and overdose.<sup class="reference">[18]</sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone SAMSHA page on Methadone] <br />
*[[More_Information_on_Methadone|More info on Methadone]] <br />
<br />
== Naltrexone ==<br />
<br />
*Naltrexone is a nonaddictive medicine that serves as an opioid receptor antagonist and not an opioid replacement unlike methadone and buprenophine. It is a primary ingredient in the treatment of alcohol and opioid dependence. Naltrexone blocks certain receptors in the part of the brain that triggers dopamine release so they cannot be activated. Dopamine release reinforces the vicious and compulsive addiction feedback loop. When we block these areas of the brain, the craving for alcohol and opiates is eliminated or significantly reduced. The pleasure is very limited and the uncontrollable cascade of relapse is much less likely, if alcohol is consumed after the implant procedure, in addition if opiates are consumed after the procedure, there are no effects.<sup class="reference">[19]</sup> <br />
*Naltrexone is administered in a long-active, injectable formulation administered once a month.<sup class="reference">[20]</sup> <br />
*Naltrexone does not prevent withdrawal symptoms so it is recommended for patients who do not have opioid in their system.<sup class="reference">[21]</sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone SAMSHA page on Naltrexone] (The 30-day injectable version is commercially known as Vivitrol) <br />
*[[More_info_on_Naltrexone_and_Vivitrol|More info on Naltrexone and Vivitrol]] <br />
<br />
== Naloxone ==<br />
<br />
*Naloxone is an opioid antagonist used to reverse opioid overdose <br />
*Naloxone (commercially known as Narcan) is available in intravenous or intramuscular injection and nasal delivery options. Intramuscular injection or intranasal delivery as safe for administration by any person.<sup class="reference">[22]</sup> <br />
*Naloxone works within minutes and effects last for up to an hour. Multiple doses may be required depending on the severity of respiratory depression.<sup class="reference">[23]</sup> <br />
*Naloxone does not produce tolerance or dependence. <sup class="reference">[24]</sup> <br />
*Link to [http://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone SAMSHA page on Naloxone] <br />
*[[More_info_on_Naloxone|More info on Naloxone]] (including discounted public pricing and free Narcan for schools) <br />
*(for [http://www.samhsa.gov/medication-assisted-treatment/treatment/opioid-overdose opioid overdose]) <br />
*&nbsp; <br />
<br />
<br/> Find information on physical ailments often diagnosed in MAT patients. Also known as [http://www.samhsa.gov/medication-assisted-treatment/treatment/common-comorbidities common comorbidities], these include viral hepatitis, HIV, and AIDS.<br/> <br/> <br/> <br/> Medications Used in Addiction Treatment**<sup class="reference">[25]</sup><br />
<br />
{| border="1" class="wiki_table"<br />
|-<br />
| Sept 2017<br />
| Where it can be provided<br />
| FDA indications<br />
| Effectiveness<br />
| Administration<br />
|-<br />
| Methadone<br />
| OUD. Licensed opioid treatment programs<br/> Pain. Any Drug Enforcement Agency (DEA)-licensed prescriber<br />
| OUD and pain management<br />
| 74% to 80%<sup class="reference">[26]</sup><br />
| OUD. Daily pill, liquid, and wafer forms; injectable form in hospitalized patients unable to take oral medications<br/> Pain. Injectable, transdermal, and buccal film<br />
|-<br />
| Buprenorphine and buprenorphine/naloxone<br />
| <br />
*Prescribed by community physicians and dispensed by pharmacies; available in some opioid treatment programs. <br />
*Physicians receive federal waivers after eight hours of training; nurse practitioners and physician assistants require 24 hours. Patient panels are capped at 30, 100, and 275 per provider (depending on experience and setting).<sup class="reference">[27]</sup><sup class="reference">[28]</sup><sup class="reference">[29]</sup> <br />
*Any DEA-licensed provider can prescribe buprenorphine for pain. <br />
<br />
| OUD and pain management (depending on formulation and dose)<br />
| 60% to 90%<sup class="reference">[30]</sup><br />
| OUD. Daily sublingual, buccal, film, and tablet, or six-month intradermal device<br/> Pain. Injectable, transdermal, and buccal film<br />
|-<br />
| Naltrexone<br />
| No restrictions<br />
| Opioid and alcohol use disorders<br />
| OUD. 10% to 21%<sup class="reference">[31]</sup><br />
| Daily pill or monthly injectable<br />
|-<br />
| Naloxone<br/> (used only for overdose reversal, not addiction treatment)<br />
| Any setting: prescribed or dispensed by a clinician, furnished by a pharmacy without a prescription (legal in several states), dispensed by lay staff in community settings (by standing order), or carried by law enforcement or other first responders.<br />
| To reverse respiratory suppression in suspected opioid overdose<br />
| May require high doses for extremely high-potency illicit drug use (fentanyl and carfentanyl)<br />
| Intranasal spray, or intravenous, intramuscular, or subcutaneous injectable<br />
|}<br />
<div class="_">Extensive research has demonstrated the effectiveness of opioid agonist treatment (methadone and buprenorphine) in opioid use disorder. A meta-analysis of 50 studies showed methadone's retention rate ranging from 70% to 84% at one year, buprenorphine ranging from 60% to 90% at one year, with both treatments resulting in significant reductions in overdose death, illicit drug use, criminal activity, arrests, risk behaviors, HIV and hepatitis C incidence, as well as improvements in health status, functioning, and quality of life.<sup class="reference">[32]</sup><br/> <br/> <br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Stages of MAT with Buprenorphine =<br />
<br />
== Induction ==<br />
<div class="_">"Induction is the first stage of buprenorphine treatment and involves helping patients begin the process of switching from the opioid of abuse to buprenorphine. The goal of the induction phase is to find the minimum dose of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids and experiences no withdrawal symptoms, minimal or no side effects, and no craving for the drug of abuse."<sup class="reference">[33]</sup></div> <div class="_">&nbsp; New non-pharmacological approaches to treat opioid withdrawal could provide alternative pathways to help a patient manage withdrawal symptoms as they transition into MAT.. The [https://i-h-s.com/ BRIDGE]® is a noninvasive, percutaneous electrical nerve field stimulator developed to target pain. An article published in 2018 in The American Journal of Drug and Alcohol Abuse shared significant promising results in using the BRIDGE to help people transition to MAT. The neurostimulation rapidly and dramatically reduced the [https://www.drugabuse.gov/sites/default/files/files/ClinicalOpiateWithdrawalScale.pdf COWS scores] of the participants and 64 of the 73 people successfully transitioned to MAT.<sup class="reference">[34]</sup><br/> &nbsp; Some training program suggest that [https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99a59495-2a48-4276-bbe3-cdd55a45aba4 Clonidine] or [https://www.webmd.com/drugs/2/drug-16910-8296/ondansetron-oral/ondansetron-disintegrating-tablet-oral/details Ondansetron] may be used to ease the withdrawal symptoms during induction. <sup class="reference">[35]</sup></div> <div class="_">&nbsp;[[More_information_on_buprenorphine_induction|More information on buprenorphine induction]].</div> <div class="_">&nbsp;</div> <br />
== Stabilization ==<br />
<div class="_">"The stabilization phase has begun when a patient is experiencing no withdrawal symptoms, is experiencing minimal or no side effects, and no longer has uncontrollable cravings for opioid agonists. Dosage adjustments may be necessary during early stabilization, and frequent contact with the patient increases the likelihood of compliance."</div> <div class="_">&nbsp;[[More_information_on_buprenorphine_stabilization|More information on buprenorphine stabilization]].<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Maintenance ==<br />
<div class="_">"The longest period that a patient is on buprenorphine is the maintenance phase. This period may be indefinite. During the maintenance phase, attention must be focused on the psychosocial and family issues that have been identified during the course of treatment as contributing to a patient’s addiction."</div> <div class="_">&nbsp;[[More_information_on_buprenorphine_maintenance|More information on buprenorphine maintenance]]<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Medically Supervised Withdrawal (Detoxification) ==<br />
<div class="_">As an alternative to the three stages above, The goal of using buprenorphine for medically supervised withdrawal from opioids is to provide a transition from the state of physical dependence on opioids to an opioid-free state, while minimizing withdrawal symptoms (and avoiding side effects of buprenorphine). Medically supervised withdrawal with buprenorphine consists of an induction phase and a dose-reduction phase. The consensus panel recommends that patients dependent on shortacting opioids (e.g., hydromorphone, oxycodone, heroin) who will be receiving medically supervised withdrawal be inducted directly onto buprenorphine/naloxone tablets. The use of buprenorphine (either as buprenorphine monotherapy or buprenorphine/naloxone combination treatment) to taper off longacting opioids should be considered only for those patients who have evidence of sustained medical and psychosocial stability,</div> <div class="_">&nbsp;</div> <br />
== Canadian Guidelines ==<br />
<div class="_">This [https://www.cpso.on.ca/uploadedFiles/policies/guidelines/office/buprenorphine_naloxone_gdlns2011.pdf document ]has details on the MAT Buprenorphine guidelines from Canada</div> <div class="_">&nbsp;</div> <br />
= New & Expanded Treatment Options =<br />
<br />
== Connecticut ==<br />
<div class="_">Connecticut's Department of Mental Health and Addiction Services (DMHAS) recently received two federal grants, one of which is meant to go to medical assisted treatment, the other toward prevention efforts. DMHAS is also collaborating with the Connecticut Community for Addiction Recovery on a new program that will enable people who were saved from overdose through the use of naloxone to work with a recovery coach who can connect them to services and a support network. <sup class="reference">[36]</sup><br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== Vermont ==<br />
<div class="_">Vermont's Health Home for Opioid Addiction have employed a "Hub & Spoke" system in handling the Opioid Crisis, called the "Care Alliance for Opioid Addiction," which has seen some success in treating addicted individuals while helping lift the burden of care from singular doctors and clinics. The system is composed of the following parts <sup class="reference">[37]</sup>&nbsp;:</div> <div class="_">&nbsp;</div> <br />
*The Hub, a designated provider of specialty addiction treatment, designed as an Opioid Treatment Program which are operated by Community Behavioral Health Agencies. <br />
*The Spokes, which are health care teams led by Physicians who can prescribe Buprenorphine and are regulated as Office Based Opioid Treatment providers. <br />
<br />
Payment infrastructure for providers are structured after already existing Medicare and Medicaid Structures, which are documented in the<br/> Vermont Global Commitment To Health Section 1115 Demonstration Fact Sheet<sup class="reference">[38]</sup><br />
<br />
*<br />
**An evaluation of the Care Alliance for Opioid Addiction, has shown that people in treatment for opioid addiction reported a 96 percent decrease in opioid use, and a 100 percent drop in overdose incidences, according to a [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 new report] from the Vermont Department of Health released 1/22/18. <br />
**Additional findings include: <br />
***92% drop in injection drug use. <br />
***89% decrease in emergency department visits. <br />
***90% reduction in both illegal activities and police stops/arrests. <br />
***Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment. <br />
***Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives. <br />
<br />
More information can be found at: [http://www.healthvermont.gov/media/newsroom/hub-and-spoke-evaluation-shows-significant-impact-january-22-2018 [3]]<br/> &nbsp;<br />
<br />
== Emergency Department Treatment Protocols ==<br />
<div class="_">In a Yale Randomized trial, it was found that individuals who receive Buprenorphine while getting medical care within an Emergency Room are more likely to adhere to treatment protocols and have a better chance at ceasing opioid use when compared to those who have received referrals to receive the treatment, or those who received motivational support.<sup class="reference">[39]</sup> This can be an initiation point for treatment of Opioid dependence and can be followed up by primary care facilities. This has shown to decrease the need of in patient facilities. This can be attributed to engaging patients at the optimal point of access. <sup class="reference">[40]</sup><br/> <br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
== National Healthcare For Homeless Council ==<br />
<div class="_">Aa one may assume, there is cross-over between the homeless and addicted communities. The National Healthcare for the Homeless Council have as a result released a policy brief that may be of some use for both policy makers and health care providers alike. Within the brief, a basic strategy is considered as follows when treating addicted and homeless/addicted patients:</div> <div class="_">&nbsp; • Establish stability. Stable housing is central to attaining treatment goals as it provides patients with stability, a sense of safety, an increased ability to meet basic needs and an opportunity to have increased control over their lives and environment. Securing stable housing as early as possible is key to the treatment and recovery process.<br/> &nbsp; • Address comorbidities using integrated care. Untreated medical and/or other behavioral health conditions may complicate MAT. The most successful interventions are provided through integrated care models of interdisciplinary teams made up of medical, mental health, substance use, and social service providers. Each discipline should not only be co-located, but should work collaboratively as a team with multiple services offered in the same visit.<br/> &nbsp; • Treat the whole person. Substance use disorders cannot be treated apart from addressing the needs of the whole person in the context of his or her environment. In addition to addressing comorbidities, assistance in accessing food, clothing, shelter/housing, financial assistance, counseling, job training, employment services, and other needs as identified must be included alongside MAT.<br/> &nbsp; • Take a harm reduction approach. Harm reduction therapy is an evidence-based practice that supports and respects a person’s experience and treats them with dignity, which is especially important for persons experiencing homelessness who regularly interact with systems and situations that limit self-determination and lack respect. Harm reduction therapy relies on collaboration, respect, and stage-based interventions that acknowledge self-defined positive change. Harm reduction therapy focuses on client-defined priorities and acknowledges that any improvement that reduces harm is beneficial. The key to harm reduction therapy is low barrier, integrated care that is trauma informed and respectful of the collaborative therapeutic relationship.<br/> &nbsp; • Utilize evidence based best practices. In addition to harm reduction, using other evidence-based best practices such as the use of peer specialists, motivational interviewing, and individual and group therapy can help patients maintain recovery and have successful treatment outcomes.<br/> &nbsp; • Be patient centered. Building trust and developing relationships is essential to providing high-quality care and achieving good health outcomes. Engaging in patient centered care based on a patient’s individual needs, strengths, goals, and timeframe rather than on a pre-determined benchmark for outcomes is one way to build relationships and empower patients in the process. Patients should be actively involved in setting goals and planning their treatment.<br/> &nbsp; • Be flexible. There is no one-size-fits-all treatment that will work for all patients. While MAT recommends a combination of medication and behavioral health therapy, treatment should be flexible and individualized to the patient’s needs, especially the frequency/schedule for therapy. For some, medication alone and regular consultation with a primary care provider is enough to maintain and recover from addiction, while others may need the additional supports provided by behavioral health therapy.</div> <div class="_">&nbsp; More information can be found on the [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Document]] itself.</div> <div class="_">&nbsp;</div> <br />
= Opioid Treatment Program Directory =<br />
<div class="_">Select [http://dpt2.samhsa.gov/treatment/directory.aspx this directory] to view the opioid treatment programs in each state</div> <div class="_">&nbsp;</div> <br />
= Moving from Stigma to Science =<br />
<div class="_">Pennsylvania and New Jersey</div> <div class="_">&nbsp; The Department of Behavioral Health and Intellectual Disability Services of Pennsylvania has taken actions to ensure that halfway houses and other rehabilitation facilities cannot turn away individuals using MAT as a means of treating Opioid Abuse. <sup class="reference">[41]</sup> Underlying problems still exist in restrictive medication regiment practices, insurance coverage and Public-Private partnerships which require support to overturn previous hard lined policies. An evidence based approach has shown that introduction of MAT, especially with Buprenorphine has had an increased mitigation effect on relapse and a higher chance of long term recovery. <sup class="reference">[42]</sup></div> <div class="_">&nbsp; National Healthcare For Homeless Council<br/> &nbsp; The National Healthcare for the Homeless Council also have recommendations of policy that not only controls the prescription of opiates, but also the treatment of opioid addiction. They are as follows:</div> <div class="_">&nbsp; Remove the cap on the number of patients a physician can treat with buprenorphine. Existing limits are arbitrary and create barriers to accessing treatment. While put in place to mitigate diversion, cap limits may inadvertently aid diversion by limiting the supply of MAT, leading to individuals pursuing selftreatment by purchasing diverted drugs. Ironically, there are no limits to the number of patients a physician can prescribe other opioid drugs that present a much greater risk of causing addiction, overdose, and death (e.g., Methadone, Oxycodone, Hydrocodone, and Fentanyl). Removing the caps will allow providers to determine the number of patients they are able to treat based on the capacity of their practice and other factors, thereby increasing access to treatment.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
*Expand prescribing rights to all clinicians who are eligible to prescribe Class III, IV, and V CDS drugs. Limiting prescribing rights to physicians creates an additional barrier to accessing treatment and is incongruent with the existing scope of many clinical practices. Expanding prescribing rights to Nurse Practitioners, Physicians Assistants, and other clinicians who are authorized to prescribe Class III, IV, and V CDS drugs will expand treatment opportunities and decrease barriers to care. Clinicians who can prescribe opioids for pain should also be able to prescribe buprenorphine to treat the addictions that sometimes result. <br />
*Require training to prescribe all opioids, not just buprenorphine. Specialized training is required to prescribe buprenorphine, but no other drug (opioid or otherwise) requires this as a condition of practice. Given the lower risks associated with diversion of buprenorphine, and the elevated risk associated with many opiates that can be prescribed with few restrictions, training should be extended to the prescribing of any opioid and focus on administering and monitoring prescriptions and understanding the nature of addiction. In addition prescribers should have greater access to technical assistance and resources to develop plans to identify and avoid diversion. <br />
*Enforce parity laws. Substance abuse treatment and other behavioral health services should be just as easy to access as primary care services. Parity laws are in place to ensure insurance plans treat these services equally, and should be enforced. Health insurance practices that require prior authorizations for opioid treatment should be scrutinized, especially when they create barriers to behavioral health care that do not exist for primary care. Just as there are no prior authorizations required for opioid drugs prescribed for pain management, there should be no prior authorizations required for MAT. Addiction is a time-sensitive condition to treat, and presenting for treatment is a big step for patients; even a delay of one day can be the difference in someone getting treatment or not. <br />
*Reduce stigma and treat addiction as a disease. The main barrier to any type of treatment for persons experiencing homelessness is a lack of stable housing. In addition, drug screens are often required when accessing housing, and employers often require drug screens for employment. Landlords and employers need to accept buprenorphine prescribed as part of a MAT plan as a medical treatment process, and not have it count negatively against a person by including it as a prohibited substance. Addiction needs to be seen as a disease and not a moral failing, and engagement in MATs as a health care intervention should not be a liability to accessing housing or employment. <br />
*Train all health care disciplines on addiction. Expanding awareness of addiction and providing substance abuse education for medical students, residents, practicing physicians, and all other health care providers is essential. Curricula which treat substance use conditions similarly to other chronic disorders and provide more adequate basic preparation need to be implemented. In addition, continuing education opportunities to learn about evidence based practices for the treatment of SUDs need to be provided, and programs to support the adoption of MAT, screening, brief intervention and referral to treatment need to be identified and implemented. <br />
<br />
More information can be seen in this [[File/view/HCHBrief.pdf/614804863/HCHBrief.pdf|Policy Brief Document]].<br/> &nbsp;<br />
<br />
= Financial Incentives for MAT training =<br />
<br />
'''Neighborhood Health Plan''' (NHP) of Massachusetts has announced a series of initiatives to increase access to Substance Use Disorder treatments. This non-profit health plan is providing financial incentives to encourage more prescribers to train and be certified to prescribe buprenorphine products. NHP will reimburse prescribers $500, which is roughly the cost of required training, for earning their certification in buprenorphine product dispensing. Prescribers can receive an additional $2,000 if they provide documentation showing that at least 10 patients have been treated after becoming certified. This financial incentive has become increasingly popular, as NHP has received several inquiries about the program from prospective prescribers within days of its announcement. Other initiatives include hiring recovery coaches to work with patients as part of their follow-up care as well as waiving member copays for naloxone. "Pharmacists will be reminded to notify plan members that they are eligible for free naloxone supplies when they pick up high-dose narcotic painkilling prescription medications."<sup class="reference">[43]</sup> Another initiative is to offer a benefit design that encourages plan members to seek alternatives to opioid medications. NHP waives copays for alternative treatments to prescription painkillers including chiropractic care, acupuncture and physical therapy.<br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Access_to_Medication-Assisted_Treatment|TR - Expand Access to Medication-Assisted Treatment]]<br/> <br/> PCSS<br/> The Provider's Clinical Support System offers a [[File/view/StigmaandMethadone.pdf/614518761/StigmaandMethadone.pdf|module]] for CME credit on the Stigma on Maintenance Treatment. This can address the primary perceived and actual stigmas from patients as well as follow professionals. <sup class="reference">[44]</sup><br/> <br/> [http://www.buppractice.com/ BupPractice]<br/> is a DATA 2000 accredited resource for providing either an 8 hour training for Physicians or 24 training session for Physician Assistants and Nurse Practitioners, both for $199 per full series. Offers up to 9 AMA PRA Category 1 Credits, and is further supported by the ASAM (American Society of Addiction Medicine).<br/> <br/> [[File/view/ADAPTINGPRACTICE.pdf/614804967/ADAPTINGPRACTICE.pdf|HCH Clinician's Network]]<br/> This resource provides recommendations for one's practice when dealing with opioid addicted patients, particularly those who also happen to be homeless.<br/> <br/> [[File/view/BHSHomeless.pdf/614805019/BHSHomeless.pdf|SAMSHA's Treatment Improvement Protocol for Homeless Persons]]<br/> This document shows current resources for those attempting to handle behavioral health topics, particularly in homeless populations as well as strategies to develop one's own programs.<br/> <br/> Where Can Clinicians Get Training and Support? Buprenorphine trainings are offered at several locations and websites. The training takes about eight hours and can be attended in person, online, or a combination of both. Buprenorphine waiver training can be valuable to any clinician (medical or behavioral) as it covers the basics of opioid addiction and how buprenorphine works. Clinicians can only prescribe buprenorphine for addiction after receiving certified training and a Drug Enforcement Administration (DEA) waiver. However, any DEA-licensed clinician can prescribe buprenorphine for pain. Training opportunities are posted on the following websites: Substance Abuse and Medical Health Services Administration (SAMHSA),American Academy of Addiction Psychiatry (AAAP), American Osteopathic Academy of Addiction Medicine (AOAAM), and Providers’ Clinical Support System (PCSS).24-27 Some sites also offer other tools and resources. PCSS offers online mentorship, and Project ECHO28 offers video telementoring and monthly case review. The Clinicians Consultation Center at UCSF offers expert clinical advice, Monday through Friday, 7 a.m. to 3 p.m. PST.29 Substance Use Warmline: (855) 300-3595.<sup class="reference">[45]</sup><br/> &nbsp;<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources (Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Access_to_Optimized_Medication-Assisted_Treatment|More RTI on MAT]]<br/> <br/> PAGE MANAGER: [insert name here]<br/> SUBJECT MATTER EXPERT: [fill out table below]<br />
<br />
{| class="wiki_table"<br />
|-<br />
| Reviewer<br />
| Date<br />
| Comments<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[http://www.samhsa.gov/medication-assisted-treatment [4]] <br />
#[https://www.whitehouse.gov/sites/whitehouse.gov/files/ondcp/commission-interim-report.pdf [5]] <br />
#[https://education.psychiatry.org/Users/ProductDetails.aspx?ActivityID=6092 [6]] <br />
##<br />
##*<br />
##**<br />
##***<br />
##****<br />
##*****<br />
##******<br />
##*******<br />
##********<br />
##*********<br />
##**********<br />
##***********<br />
##************<br />
##*************<br />
##**************[https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.PP3a2 [7]] <br />
##***************<br />
##****************<br />
##*****************<br />
##******************<br />
##*******************[http://avalere.com/expertise/life-sciences/insights/midwest-and-mid-atlantic-states-face-provider-shortage-to-address-opioid-ep [8]] <br />
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016 <br />
#[https://www.naabt.org/faq_answers.cfm?ID=5 [9]] <br />
#[https://www.ncbi.nlm.nih.gov/pubmed/22065255 [10]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [11]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [12]] <br />
#<u>[http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20B/PDF%20BuprenorphineFAQ.pdf [13]]</u> <br />
#<u>[http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20B/PDF%20BuprenorphineFAQ.pdf [14]]</u> <br />
#[https://www.nhchc.org/wp-content/uploads/2016/05/policy-brief-buprenorphine-in-the-hch-community-final.pdf [15]] <br />
#<u>[http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20B/PDF%20BuprenorphineFAQ.pdf [16]]</u> <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [17]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [18]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [19]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [20]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [21]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [22]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [23]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [24]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [25]] <br />
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [26]] <br />
#*<br />
#**<br/> [https://www.chcf.org/wp-content/uploads/2017/12/PDF-Why-Health-Plans-Should-Go-to-the-MAT.pdf [27]] <br />
#[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014027/ [28]] <br />
#[https://www.chcf.org/blog/moving-from-stigma-to-science-in-treating-addiction/ [29]] <br />
#[http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2017/02/the-case-for-medication-assisted-treatment [30]] <br />
#[https://www.asam.org/resources/publications/magazine/read/article/2016/07/06/summary-of-the-major-components-of-the-hhs-final-rule-which-will-be-effective-on-august-5-2016 [31]] <br />
#Type the content of your reference here. <br />
#Frank J. Vocci et al., "The Extended-Release Naltrexone (XR-NTX) Opioid Dependence Registry: Clinical and Functional Effectiveness" (presentation at the American Society of Addiction Medicine conference, Orlando, FL, April 13, 2014),<br/> [https://www.asam.org/education/live-online-cme/the-asam-annual-conference-2017/archives/2014-medical-scientific-conference/program-schedule [32]]. <br />
#[https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12600-1/fulltext [33]] <br />
#[https://www.naabt.org/documents/TIP40.pdf [34]] <br />
#[https://www.tandfonline.com/doi/full/10.1080/00952990.2017.1295459 [35]] <br />
#[https://www.complex.care/courses/medication-assisted-treatment-mat-buprenorphine-induction-and-maintenance-management-kayla-late-adult/enrollments/1753/content_item/151 [36]] <br />
#[http://fox61.com/2017/01/13/addiction-experts-look-to-new-and-expanded-opioid-treatment-options-in-2017/ [37]] <br />
#[http://legislature.vermont.gov/assets/Documents/2014/WorkGroups/Senate%20Health%20and%20Welfare/Substance%20Abuse%20Treatment/W~Beth%20Tanzman~Vermont%20Health%20Homes%20for%20Opioid%20Addiction¦%20Hub%20and%20Spoke~4-23-2014.pdf [38]] <br />
#[https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/vt/vt-global-commitment-to-health-fs.pdf [39]] <br />
#[http://jamanetwork.com/journals/jama/fullarticle/2279713 [40]] <br />
#[http://news.yale.edu/2015/04/28/emergency-department-treatment-opioid-addiction-better-referrals [41]] <br />
#[http://www.nbcphiladelphia.com/news/local/Philly-Removes-Access-to-Medication-Assisted-Treatment-for-Opioid-Addiction-420079383.html [42]] <br />
#[https://www.ncbi.nlm.nih.gov/pubmed/25818060 [43]] <br />
#[https://www.behavioral.net/article/policy/health-plan-offers-financial-incentives-mat-training?utm_campaign=Enews&utm_source=hs_email&utm_medium=email&utm_content=63239116&_hsenc=p2ANqtz-9kYGQSHsPf_7pE4fb9BzHUSPFhPtJlcmR2jcKZfhzha9nw1f3vJ8ohyXC8gbLNB-kdacF_vxdUVyw8WgUulrPD-NXFhOUIL09CrzbjdBFf5AY7Lto&_hsmi=63239116 [44]] <br />
#[http://pcssmat.org/stigma-in-methadone-and-buprenorphine-maintenance-treatment/ [45]] <br />
#[http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20B/PDF%20BuprenorphineFAQ.pdf [46]] <br />
</div> </div> </div> </div> </div> </div> </div> </div></div> <br />
[[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Access_to_Naloxone_Kits&diff=19296Expand Access to Naloxone Kits2019-11-24T23:35:25Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp; or&nbsp;&nbsp;[[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that Prevent Overdose Deaths]]<br />
<br />
= Tools & Resources =<br />
<br />
TR - ___<br />
<br />
&nbsp;<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> &nbsp; Potential Measures and Data Sources(Under Construction)&nbsp;<br/> &nbsp; Potential Actions and Partners(Under Construction)&nbsp;<br />
<br />
&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Access_to_Naloxone_Kits|More RTI on Expanding Access to Naloxone Kits in]]&nbsp;<br />
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&nbsp;<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
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{| class="wiki_table"<br />
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| '''Date'''<br />
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= Sources =<br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Access_to_MAT_for_Pregnant_Women&diff=19295Expand Access to MAT for Pregnant Women2019-11-24T23:35:08Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">__NOTOC__ <div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to&nbsp; [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;or&nbsp;[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]__TOC__<br />
<br />
= Background =<br />
<br />
'''Maintenance Therapy Drugs'''<br/> Medically supervised tapering of opioids in pregnant women is associated with high relapse rates as compared to methadone maintenance.<sup class="reference">[1]</sup><br/> <br/> Women who need maintenance therapy drugs often struggle to get them. To get buprenorphine, they must go to one of the state's few doctors with a special license. To get methadone, they must go regularly to a clinic — in Middle Tennessee there's one in Nashville and one in Columbia. Women must often pay out of pocket. And many women of child-bearing age don't qualify for TennCare until they find themselves pregnant. That makes it difficult for an addict to access family planning or mental health preventive care before becoming pregnant.<sup class="reference">[2]</sup><br/> <br/> Tennessee's three managed care companies — Amerigroup, UnitedHealthcare's Medicaid subsidiary and BlueCross BlueShield's BlueCare program — are trying to reach these women earlier to ensure that more babies are born healthy. All have flagged drug-dependent babies as a major cost issue. BlueCross, for example, covered 775 such babies in 2013 [must be nationwide]. [at $50,000 each, which is a low estimate of incremental cost over a normal birth, that cost BlueCross about 38 million.] All three have launched efforts to help expectant mothers beat their addictions.<sup class="reference">[3]</sup><br/> &nbsp;<br />
<br />
= Current Status =<br />
<br />
*There are often long waiting periods to get women into treatment.<sup class="reference">[4]</sup> <br />
**Although pregnant women actually receive priority for methadone treatment, once they are not pregnant they return tot the long waiting periods and the motivation to pursue treatment may be deterred by these waits<sup class="reference">[5]</sup> <br />
*Women often experience anxiety about what will happen if they can no longer pay for their methadone treatments<sup class="reference">[6]</sup> <br />
**There is a need for increased grant funding to help women stay in treatment once they are enrolled<sup class="reference">[7]</sup> <br />
*Women have misconceptions about methadone and are unclear about the treatment process<sup class="reference">[8]</sup> <br />
*13 states give pregnant women priority access to general programs for drug treatment.<sup class="reference">[9]</sup> <br />
*4 states protect pregnant women from discrimination in publicly funded programs.<sup class="reference">[10]</sup> <br />
*18 states consider substance abuse during pregnancy to be grounds for child abuse.<sup class="reference">[11]</sup> <br />
<br />
&nbsp;<br />
<br />
= Educate Medical Providers =<br />
<div class="_">A 2012 study of medical students in an obstetrics and gynecology rotation found that when students are placed in a residential treatment center for pregnant women (i.e. specialized training) they showed greater comfort in assessing and educating patients about substance abuse during pregnancy compared to those in a regular rotation.<sup class="reference">[12]</sup>[http://pcssmat.org/ Provider's Clinical Support System] (PCSS) fpr MAT provides many free online trainings and resources to help address the opioid crisis, including "[http://pcssmat.org/opioid-dependence-in-pregnancy-clinical-challenges/ Opioid Dependence in Pregnancy: Clinical Challenges]."</div> <div class="_">&nbsp;</div> <br />
= New 2018 Clinical Guide by SAMHSA =<br />
<div class="_">This new. detailed, 165-page guide has SAMHSA's latest recommendations on [https://store.samhsa.gov/shin/content//SMA18-5054c/SMA18-5054.pdf Clinical Guidance for Treating Pregnant Women with OUD and their Infants].<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Split Dosing to Reduce Risk =<br />
<div class="_">The following quote shares some insights and potential benefits of "split dosing" of methadone. The article has more details.<sup class="reference">[13]</sup></div> <div class="_">&nbsp; "Part of the confusion relates to the question of whether giving the mother high doses of methadone worsens NAS. A recent meta-analysis of 67 studies found this not to be the case.* The fetus is not exposed to the maternal dose; it is exposed to the maternal plasma level. We know that plasma levels vary significantly, depending on genetics. And pregnant women metabolize methadone more quickly, necessitating dose increases—but these increases do not necessarily increase fetal exposure to methadone.</div> <div class="_">&nbsp; One mother in our pregnancy program required 270 mg/day of methadone, in four divided doses. Her plasma level, before the morning dose one week before delivery, was undetectable. After birth, the baby required no treatment for NAS. We don’t know how many physicians are willing to prescribe these high, split doses to keep the mother and fetus out of withdrawal. We don’t know whether programs use maternal plasma methadone levels to monitor changes in maternal metabolism and fetal exposure.<br/> &nbsp; In pregnancy, split doses of methadone protect the fetus from exposure to daily cycles of peaks and troughs, which have been shown to have negative physiologic effects on the fetus.* Even high doses, when given as single daily doses, can result in fetal withdrawal distress before the next day’s dose. That may be why high doses, at times, seem to cause more cases of NAS: The fetus may be sensitized to daily episodes of withdrawal.* Some mothers, like our patient who received 270 mg daily, are ultra-rapid metabolizers; the methadone exposure for their fetuses is far more consistent and physiologic when dosing is four times a day."<sup class="reference">[14]</sup></div> <div class="_">&nbsp; The approach used in one study for women on methadone (that used higher doses split into 2 or 4 doses per day yielded significantly lower rates of NAS.<sup class="reference">[15]</sup></div> <div class="_">&nbsp; Another s[http://atforum.com/2015/10/methadone-split-dosing-less-nas-better-maternal-recovery/ tudy on split dosing] also showed benefits. More research is needed.</div> <div class="_">&nbsp; Since DNA tests can help to understand the way a person will metabolize different drugs, it could be tested to advance a precision medicine approach to MAT for pregnant women. . More research is needed on this issue.</div> <div class="_">&nbsp;</div> <br />
= Methadone Clinics =<br />
<div class="_">Methadone clinics should provide information sessions and materials to help pregnant women prepare for the experience of delivering their babies at hospitals. These should include the following:<sup class="reference">[16]</sup></div> <div class="_">&nbsp;</div> <br />
*What to expect in regards to pain management <br />
*Infant withdrawal symptoms <br />
*CPS involvement <br />
*Treatment approaches for withdrawing infants <br />
*How to work with doctors and nurses to help the process go smoothly <br />
*Advice for comforting methadone-exposed babies once they come home <br />
<br />
&nbsp;<br />
<br />
= Funding =<br />
<div class="_">SAMHSA’s Substance Abuse Prevention and Treatment block grants have recently been revised to strengthen capacity to deliver MAT for pregnant women with substance use disorders.<sup class="reference">[17]</sup></div> <div class="_">&nbsp;</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_Access_to_MAT_for_Pregnant_Women|TR - Expand Access to MAT for Pregnant Women]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_Access_to_MAT_for_Pregnant_Women|More RTI on Expand Access to MAT for Pregnant Women]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
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= Sources =<br />
<br />
----<br />
<br />
#ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG committee opinion no. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119:1070–6 <br />
#[http://www.usatoday.com/story/news/nation/2014/06/15/drug-dependent-babies-challenge-doctors-politicians/10526103/ [1]] <br />
#[http://www.usatoday.com/story/news/nation/2014/06/15/drug-dependent-babies-challenge-doctors-politicians/10526103/ [2]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [3]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [4]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [5]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [6]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [7]] <br />
#[http://www.washingtonexaminer.com/west-virginia-tackles-opioid-abuse-during-pregnancy/article/2610403 [8]] <br />
#[http://www.washingtonexaminer.com/west-virginia-tackles-opioid-abuse-during-pregnancy/article/2610403 [9]] <br />
#[http://www.washingtonexaminer.com/west-virginia-tackles-opioid-abuse-during-pregnancy/article/2610403 [10]] <br />
#[https://www.ncbi.nlm.nih.gov/pubmed/23154692 [11]] <br />
#ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG committee opinion no. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119:1070–6 <br />
#[http://www.usatoday.com/story/news/nation/2014/06/15/drug-dependent-babies-challenge-doctors-politicians/10526103/ [12]] <br />
#[http://www.usatoday.com/story/news/nation/2014/06/15/drug-dependent-babies-challenge-doctors-politicians/10526103/ [13]] <br />
#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [14]] <br />
#[https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm [15]] <br />
</div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Treatment and Recovery]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_%26_Enhance_Prescription_Drug_Monitoring_Program_(PDMP)&diff=19294Expand & Enhance Prescription Drug Monitoring Program (PDMP)2019-11-24T23:34:50Z<p>Josiebeets: </p>
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<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP)&nbsp;]]&nbsp;or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]&nbsp;or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]]&nbsp;or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''<br />
<br />
----<br />
<br />
(PDMP) allows pre-registered users including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards to access timely patient controlled substance history information.<sup class="reference">[1]</sup><br/> <br/> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<sup class="reference">[2]</sup><br />
<br />
= Background =<br />
<br />
== The Purpose of PDMPs ==<br />
<br />
The main objectives of PDMP programs are to:<br />
<br />
*Improve patient safety. <br />
*Build a data collection and analysis system at a state level. <br />
*Enhance existing programs' ability to analyze and use collected data. <br />
*Facilitate the exchange of collected prescription data among states. <br />
*Assess the efficiency and effectiveness of the programs funded under this initiative.<sup class="reference">[3]</sup> <br />
<br />
<br/> PDMPs can alert Healthcare Providers to provide potentially lifesaving information and interventions.<br />
<br />
*They DO for those using prescription opioids <br />
**Help collaborate with the patient to taper to a safer dosage <br />
**Consider offering naloxone <br />
**Communicate with other providers managing the patient <br />
**Weigh patient goals, needs, risks <br />
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<sup class="reference">[4]</sup> <br />
*They DO NOT dismiss patients from care <br />
<br />
<br/> With this in mind, states are trying to find ways to increase use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<sup class="reference">[5]</sup><br/> &nbsp; [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]<br />
<br />
__TOC__<br />
<br />
== Examples of Positive Impact ==<br />
<br />
*Between the years of 2010-2012 Florida implemented a PDMP and other "pill mill" policies that had an positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<sup class="reference">[6]</sup> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<sup class="reference">[7]</sup> <br />
*New York Experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<sup class="reference">[8]</sup> <br />
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<sup class="reference">[9]</sup> <br />
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<sup class="reference">[10]</sup> <br />
<br />
&nbsp;<br />
<br />
== Examples of Negative Impact ==<br />
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<sup class="reference">[11]</sup></div> <div class="_">&nbsp;</div> <br />
== Legislation ==<br />
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <sup class="reference">[12]</sup><br/> <br/> Opportunities to Enhance PDMPs</div> <br />
== TTAC ==<br />
<br />
[http://www.pdmpassist.org/ Training Technical Assistance Center ]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.<br />
<br />
== Third Party Patient Monitoring ==<br />
<br />
'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<sup class="reference">[17]</sup> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.<sup class="reference">[18]</sup><br />
<br />
== Provider Challenges to Effective Use of PDMPs ==<br />
<br />
*<u>Insufficient Resources:</u> Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "it's too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.") <br />
*<u>Patient Provider Relationship:</u> The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.") <br />
*<u>Data Management:</u> There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated. <br />
*<u>Consistency:</u> Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<sup class="reference">[19]</sup> <br />
<br />
<br/> '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; a common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<sup class="reference">[20]</sup><br />
<br />
== Use PDMPs to Improve Patient Safety ==<br />
<br />
== National Alliance for Model State Drug Laws ==<br />
<div class="_">View [http://www.namsdl.org/prescription-monitoring-programs.cfm model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_">&nbsp;</div> <br />
*Annual summaries or highlights <br />
*Administration of PDMPs <br />
*Data Reporting and Retention <br />
*Types of Authorized Recipients <br />
*Access and Registration <br />
*PDMPs and Privacy <br />
*Miscellaneaous Documents <br />
<br />
= State PDMPs =<br />
<br />
#<span style="background-color: #ffffff">[https://oag.ca.gov/cures CURES ]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]</span> <br />
#<span style="background-color: #ffffff">[http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie EDIE ]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as patient visits ER.</span> <br />
#<span style="background-color: #ffffff">[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE ]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of it's [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources ].</span> <br />
#<span style="background-color: #ffffff">[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via user name and password.</span> <br />
#<span style="color: #fa1048">[http://www.worxpdmp.com/ WORx]</span><span style="background-color: #ffffff">Wyoming's active PDMP system.</span> <br />
<br />
&nbsp;<br />
<br />
== Find Your State's PDMP ==<br />
<div class="_">Use this [http://mytopcare.org/resources/using-the-state-prescription-monitoring-program-pmp-effectively/find-your-states-pmp/ link] to find your state's Prescription Drug Monitoring Program.<br/> &nbsp;</div> <div class="_">&nbsp;</div> <br />
= Innovative Use of PDMP Data =<br />
<br />
== Notify the Care Team that Prescribed the Opioids of the Overdose Death ==<br />
<div class="_">In Monterey County, CA, Coroners who identify that a person has died after misusing prescription opioids make use of data in the PDMP to identify and notify the care team that prescribed the opioids that their patient died. This seems to have had a big impact on prescribers and seems to have contributed to significant reductions in opioid prescription rates and increased use of non-opioid treatments for pain. (Need details and source.)</div> <div class="_"><br />
= Funding Opportunities =<br />
<br />
=== Current Funding Methods ===<br />
<br />
*Federal grants <br />
*Private/Non-federal grants <br />
*General revenue funds <br />
*Controlled substance registration fees <br />
*Professional licensing fees <br />
*Regulatory board funds <br />
<br />
=== Potential Funding Methods ===<br />
<br />
*Legal settlements <br />
*PDMP licensing fees <br />
*Health insurance licensing fees <br />
*Private donations <br />
*Medicaid fraud settlements <br />
*Assessed fines <br />
*Asset Forfeiture <br />
*Drug manufacturers' assessment <br />
*Prescription fees <br />
*Private third party payers or health insurers <br />
*PDMP authorized users <sup class="reference">[13]</sup> <br />
*see the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions.<br/> <br/> <u>The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program</u> is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<sup class="reference">[14]</sup> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals due April 25, 2017.<sup class="reference">[15]</sup><br/> <br/> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects<br/> Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders.The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program will be applied by April 25, 2017.<sup class="reference">[16]</sup> <br />
</div> <div class="_">&nbsp;</div> <br />
= Tools & Resources =<br />
<br />
[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]]<br/> <br/> The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures & Data Sources(Under Construction)&nbsp;<br />
<br />
= Actions to Take =<br/> Potential Coalition Actions & Partners Potential Actions for Individuals(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|More Resources to Investigate on PDMP Use and Impact]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html [1]] <br />
#[https://www.bja.gov/Funding/CARA17.pdf [2]] <br />
#[https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1 [3]] <br />
#[https://www.cdc.gov/drugoverdose/pdmp/providers.html [4]] <br />
#[https://www.behavioral.net/article/how-monitor-prescription-drugs?page=3 [5]] <br />
#[https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm [6]] <br />
#[http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2429105 [7]] <br />
#[http://www.insurancefraud.org/IFNS-detail.htm?key=22343 [8]] <br />
#[http://www.insurancefraud.org/IFNS-detail.htm?key=22343 [9]] <br />
#[http://www.insurancefraud.org/IFNS-detail.htm?key=22343 [10]] <br />
#[http://www.drugwarfacts.org/chapter/diversion [11]] <br />
#[https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1 [12]] <br />
#[http://www.pdmpassist.org/pdf/PDMP_Funding_Options_TAG.pdf [13]] <br />
#[https://www.bja.gov/ProgramDetails.aspx?Program_ID=72 [14]] <br />
#[https://www.bja.gov/Funding/COAPTTA17.pdf [15]] <br />
#[https://www.bja.gov/Funding/CARA17.pdf [16]] <br />
#[https://guidemed.com/about-guidemed/ [17]] <br />
#[https://guidemed.com/about-guidemed/how-it-works/ [18]] <br />
#[https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost [19]] <br />
#[https://www.bja.gov/programs/pmixarchitecture.pdf [20]] <br />
</div> </div> </div> </div> </div> <br />
&nbsp;<br />
</div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Enhance_Treatment_and_Recovery_Support_During_Incarceration&diff=19291Enhance Treatment and Recovery Support During Incarceration2019-11-24T23:33:35Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|Zoom Map - (Shift from Punishment to Treatment Approach for Opioid Users)]]<br/> &nbsp;<br />
<br />
= Current Status =<br />
<br />
*<span style="background-color: #ffffff; font-family: Merriweather,serif; font-size: 18px">65 percent of the nation’s 2.3 million inmates are addicted to drugs or alcohol</span> <br />
*Of the roughly 3,200 jails, 40 provide <br />
*<span style="background-color: #ffffff; font-family: Merriweather,serif; font-size: 18px">The biggest challenge is getting inmates to continue taking the medication once they leave the facility: "</span>The physical symptoms of their addiction clear up pretty quickly and they feel like they’ve licked it, so they stop showing up for the monthly injections,” Klein said. “That’s when they tend to relapse.”<br/> &nbsp; <br />
<br />
= Benefits =<br />
<br />
&nbsp;<br />
<br />
= Training =<br />
<br />
Residential Substance Abuse Training RSAT training and technical assistance tool<br />
<br />
<br />
<br />
<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Enhance_Treatment_During_Incarceration|TR - Enhance Treatment During Incarceration]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Enhance_Treatment_During_Incarceration|More RTI on Enhance Treatment During Incarceration]]<br/> <br/> <br/> <br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> </div> <br />
[[Category:SAFE-Law Enforcement and Criminal Justice]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Community_Support_for_Families_of_People_with_SUDs&diff=19289Expand Community Support for Families of People with SUDs2019-11-24T23:32:55Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
<span style="background-color: transparent; color: #000000; font-family: arial,helvetica,sans-serif; font-size: 13px; text-decoration: none">Return to&nbsp;[[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]&nbsp;</span><span style="background-color: transparent; color: #000000; font-family: arial,helvetica,sans-serif; font-size: 13px; text-decoration: none">or&nbsp;</span>[[ZOOM_MAP_-_Improve_Treatment_&_Enable_Recovery_for_People_with_SUDs|Zoom Map (Improve Treatment & Enable Recovery for People with SUDs)]] __TOC__<br />
<br />
= &nbsp; =<br />
<br />
= Background =<br />
<div class="_">Addiction impacts the entire family and families can be a key part of successful recovery.&nbsp;[https://www.addictionpro.com/article/treatment/create-newer-normal-help-families-heal [1]]</div> <div class="_">&nbsp;</div> <br />
= Programs to Support Families =<br />
<br />
== Shatterproof Family Programs ==<br />
<br />
The Shatterproof Family Program ([https://www.shatterproof.org/family https://www.shatterproof.org/family])&nbsp;provides education and support in a safe and caring setting where families who are suffering can share experiences, build new relationships, and learn more about addiction, treatment, and recovery. Shatterproof offers training (live or on-line) for fhttps://www.shatterproof.org/familyacilitators who can then lead groups of families dealing with Substance Use Disorders.&nbsp;<br />
<br />
== Addiction Resource Center ==<br />
<div class="_">This online portal at ([https://www.addictionresourcecenter.org/ https://www.addictionresourcecenter.org/])&nbsp;is a comprehensive resource to assist patients and their loved ones with substance use disorders. The new platform, with support from the Chris and Vicky Cornell Foundation, will guide patients through a validated self-assessment tool, help them develop a proposed treatment plan, and provide a guide to reliable, evidence-based information about resources in their local area. Initially, the Forum will host a database of local resources in Ohio, Maryland and Minnesota. Over the coming months, new states will be added so that more and more Americans suffering with substance use disorder will have a place to turn for help.</div> <div class="_">&nbsp;</div> <br />
== The Grayken Center for Addiction -- Resources for Parents in MA ==<br />
<div class="_">The Grayken Center for Addiction of the Boston Medical Center ([[Www.graykenaddictioncenter.org|www.graykenaddictioncenter.org]])&nbsp;has teamed with the Partnership for Drug-Free Kids to offer free resources to parents in MA who have children struggling with addiction and misuse of substances.<sup class="reference">[1]</sup></div> <div class="_">&nbsp;</div> <div class="_">Perhaps other states could build on this model and cost-effectively offer similar programs without having to create them from scratch.</div> <div class="_">&nbsp;</div> <br />
== Thrive Family Support ==<br />
<br />
Thrive&nbsp;Family Support ([http://www.ThriveFamilySupport.org http://www.ThriveFamilySupport.org]) provides...<br/> Thrive has a help line staffed by trained volunteer family members who have been there. 1-844-349-2911<br/> <br/> Thrive also has an on-line support community that meets on Mondays using Zoom technology.<br/> Register here. [https://zoom.us/meeting/register/8453621d589d975466858a512be5123a [4]]<br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Enhance_Support_for_Families_of_People_with_SUDs|TR - Enhance Support for Families of People with SUDs]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Enhance_Support_for_Families_of_People_with_SUDs|More RTI on Enhance Support for Families of People with SUDs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
<br />
----<br />
<br />
#[https://www.addictionpro.com/news-item/education/partners-offer-free-support-massachusetts-families https://www.addictionpro.com/news-item/education/partners-offer-free-support-massachusetts-families]&nbsp;&nbsp;[https://www.addictionpro.com/news-item/education/partners-offer-free-support-massachusetts-families [5]] <br />
</div> </div> </div> </div> </div> </div> </div> </div> </div> <br />
[[Category:SAFE-Family Outreach and Support]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Enhance_Collaboration_among_Medical,_Behavioral_%26_Social_Services_for_Mothers_with_SUDs&diff=19286Enhance Collaboration among Medical, Behavioral & Social Services for Mothers with SUDs2019-11-24T23:31:48Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to&nbsp;[[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use&nbsp;]]<span style="font-size: 13px;">or </span>[[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]<br />
<br />
&nbsp;<br />
<br />
__TOC__&nbsp;<br />
<br />
= Educating Providers =<br />
<br />
<br/> see Tools & Resources for training examples<br />
<br />
= Promising Programs =<br />
<br />
== Project Nurture ==<br />
<br />
'''[http://www.healthshareoregon.org/transforming-health-together/care-innovations/maternal-child-and-family-wellness/project-nurture.html Project Nurture] - Health Share of Oregon'''<br/> ''Program Highlights (NUR)''<br />
<br />
*Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources <br />
*Clinic and organizational leadership with program accountability and resources <br />
*Transparent, standardized process for screening and monitoring for substance use and for DHS involvement <br />
*Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning <br />
*Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting <br />
<br />
''Outcomes Being Tracked''<br />
<br />
*Pre-term birth rates <br />
*Cost Savings <br />
<br />
<br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|TR - Enhance Collaboration among Medical, Behavioral & Social Services]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
</div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|More RTI on Enhance Collaboration among Medical, Behavioral & Social Services]]<br/> <br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
<br />
= Sources =<br />
</div> </div> </div> </div> <br />
[[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Enhance_Collaboration_among_Medical,_Behavioral_%26_Social_Services&diff=19285Enhance Collaboration among Medical, Behavioral & Social Services2019-11-24T23:31:29Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block"><br />
Return to[[Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_During_Opioid_Use|Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy During Opioid Use&nbsp;]]or [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]<br />
&nbsp; <br />
= Promising Programs =<br />
<br />
== Project Nurture ==<br />
<br />
'''[http://www.healthshareoregon.org/transforming-health-together/care-innovations/maternal-child-and-family-wellness/project-nurture.html Project Nurture] - Health Share of Oregon'''<br/> ''Program Highlights (NUR)''<br />
<br />
*Team-based approach to prenatal care that includes prenatal clinician, addictions specialist, mental health support, case management, peer support and parenting resources <br />
*Clinic and organizational leadership with program accountability and resources <br />
*Transparent, standardized process for screening and monitoring for substance use and for DHS involvement <br />
*Strong commitment to a planned, coordinated approach to the inpatient maternity stay, with protocols for pain management, DHS and social work involvement and discharge planning <br />
*Extended postpartum support lasting a full year, with pediatric care integrated with the mother’s care, ongoing addiction support, and peer support for parenting <br />
<br />
''Outcomes Being Tracked''<br />
<br />
*Pre-term birth rates <br />
*Cost Savings <br />
<br />
<br/> &nbsp;<br />
<br />
= Tools & Resources =<br />
<br />
[[TR_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|TR - Enhance Collaboration among Medical, Behavioral & Social Services]]<br />
<br />
<div class="mw-parser-output"><br />
= Scorecard Building =<br />
<br />
Potential Objective Details(Under Construction)&nbsp;<br/> Potential Measures and Data Sources(Under Construction)&nbsp;<br/> Potential Actions and Partners(Under Construction)&nbsp;<br />
<div class="mw-parser-output">&nbsp;</div> </div><br />
<br />
= Resources to Investigate =<br />
<br />
[[RTI_-_Enhance_Collaboration_among_Medical,_Behavioral_&_Social_Services|More RTI on Enhance Collaboration among Medical, Behavioral & Social Services]]<br/> <br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span><br />
<br />
{| class="wiki_table"<br />
|-<br />
| '''Reviewer'''<br />
| '''Date'''<br />
| '''Comments'''<br />
|-<br />
| &nbsp;<br />
| &nbsp;<br />
| &nbsp;<br />
|}<br />
</div><br />
<br />
= Sources =<br />
</div> </div></div>Josiebeetshttp://ifi-wikis.com/IFI-OpioidCrisis/index.php?title=Expand_Early_Intervention_in_Communities_for_Substance_Use_Disorder&diff=19281Expand Early Intervention in Communities for Substance Use Disorder2019-11-24T23:29:47Z<p>Josiebeets: </p>
<hr />
<div><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><br />
''Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]]''<br />
<br />
----<br />
<br />
Early interventions can help people how have started to misuse opioid make choices that help them avoid developing a dependence that can lead to a full Opioid Use Discorder or other form of SUD.&nbsp;<br />
<br />
&nbsp;<br />
<br />
&nbsp;<br />
<br />
= Background =<br />
<br />
The 2014 National Survey on Drug Use and Health<ref>https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf</ref>&nbsp;demonstrated that opioid misuse is more widespread than realized:<br />
<br />
*Approximately 1.9 million Americans met criteria for prescription painkillers use disorder based on their use of prescription painkillers in the past year. <br />
*1.4 million people used prescription painkillers non-medically for the first time in the past year. <br />
*The average age for first-time prescription painkiller misuse was 21.2 years old. <br />
<br />
(as cited by the [http://(As%20cited%20by%20the%20 Substance Abuse and Mental Health Services Administration]).<br />
<br />
= Intervention =<br />
<br />
*Intervention can be an effective means for getting someone to accept treatment.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016</ref> <br />
*Interventions are most successful when conducted with the help of addiction experts and when users are coming down from a high.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016</ref> <br />
*During an intervention, close friends and family members tell their loved one how their drug use has affected them personally, and the person is presented with the opportunity to seek treatment.<ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016</ref> <br />
<br />
&nbsp;<br />
<br />
= Case Studies =<br />
<br />
== Project Engage - Delaware ==<br />
<br />
Project Engage is an early intervention and referral to substance use disorder treatment program designed to help hospital patients who may be struggling with alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.<br />
<br />
&nbsp; As part of the initiative, its founder, Dr. Terry Horton, worked to make questions about opioid use standard protocol for patients admitted to the ER. The goal is to identify patients going through withdrawal very quickly in order to treat it rapidly and break the vicious cycle they're in by immediately administering drugs like Suboxone. Health care workers also pair patients with addiction counselors and get them enrolled in community-based drug treatment program before they've even left the hospital. And so far, Christiana Care has been able to steer two-thirds of patients with opioid addiction into drug treatment.<ref>https://www.npr.org/sections/health-shots/2017/11/22/563815531/asking-about-opioids-a-treatment-plan-can-make-all-the-difference</ref><br />
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&nbsp; Project Engage integrates peers in recovery, who are called Engagement Specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol and/or drug use. The Engagement Specialists learn about the patient’s goals and coordinate treatment options that support the patient’s needs. The Engagement Specialists use motivational interviewing to empower each patient in the decision-making process, assisting them to take that critical first step to seek help for their substance use. Project Engage Social Workers are experts in community resources, in obtaining access to facilities in the area and in assisting the team to overcome barriers so patients can receive care and transition into treatment.<br />
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&nbsp; Simply put, Project Engage goes beyond just screening people. It treats opioid addiction as a disease, with medicine and in-house specialists, which is not common in screening programs, nor the American health system in general. The programs founders agree: the best way to curb opioid addiction is to connect patients directly with treatment, instead of leaving it up to patients to follow up on referrals, which is typically how it's done.<ref>https://www.npr.org/sections/health-shots/2017/11/22/563815531/asking-about-opioids-a-treatment-plan-can-make-all-the-difference</ref><br />
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&nbsp; In addition to working with the patient and the hospital clinical team, Project Engage also works with treatment providers and insurers to develop a discharge plan to achieve the best possible outcome for each patient. After leaving the hospital and engaging in treatment, patients may have the opportunity to continue to work with an Engagement Specialist to help them stay engaged in their treatment.<br />
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&nbsp; Learn more about Project Engage here: [https://christianacare.org/services/behavioralhealth/project-engage/ Project Engage]<br/> &nbsp;<br />
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= Tools + Resources =<br />
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[[TR_-_Increase_Early_Interventions_for_People_Misusing_Drugs|TR_-_Increase_Early_Interventions_for_People_Misusing_Drugs]]<br />
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= Scorecard Building =<br />
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[[PA_-_Increase_Early_Interventions_for_People_Misusing_Drugs|Actions for Coalitions]]<br/> &nbsp;<br />
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= Resources to Investigate =<br />
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[[RTI_-_Increase_Early_Interventions_for_People_Misusing_Drugs|More RTI on Increase Early Interventions for People Misusing Drugs]]<br/> <br/> '''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' <span style="color: #ff0000">[insert name here]</span><br/> '''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': <span style="color: #ff0000">[fill out table below]</span><br />
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= Sources =<br />
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#[https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE] <br />
#[https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE https://www.reuters.com/article/us-addiction-methadone-cost/substituting-methadone-for-opioids-could-save-billions-idUSKBN1DK2LE] <br />
#&nbsp; <br />
#Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. ''Harvard Review of Psychiatry.'' 2015 Mar-Apr;23(2):76-89. <br />
##doi: 10.1097/HRP.0000000000000052. <br />
##*[https://www.ncbi.nlm.nih.gov/pubmed/25747921 https://www.ncbi.nlm.nih.gov/pubmed/25747921] <br />
#Hser YI, Evans E, Grella C, Ling W, Anglin, D. Long Term Course of Opioid Addiction. ''Harvard Review of Psychiatry.'' 2015 Mar-Apr;23(2):76-89. <br />
##doi: 10.1097/HRP.0000000000000052. <br />
##*[https://www.ncbi.nlm.nih.gov/pubmed/25747921 https://www.ncbi.nlm.nih.gov/pubmed/25747921] <br />
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[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Prescriptions and Medical Response]]</div>Josiebeets