Media Wiki - User contributions [en]

Adopt Universal Screening for Pregnant Women

2018-12-03T20:42:55Z

KaralynK:

<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">
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]]

<span style="background-color: #ffffff">Return to </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]]

__TOC__

<br/> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':

*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

  To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

 

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div> </div> </div> </div> </div> </div>

Adopt Universal Screening for Pregnant Women

2018-12-03T20:42:25Z

KaralynK:

<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">
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]]

<span style="background-color: #ffffff">Return to </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/> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':

*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div> </div> </div> </div> </div>

Adopt Universal Screening for Pregnant Women

2018-12-03T20:42:18Z

KaralynK:

<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">
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]]
<span style="background-color: #ffffff">Return to </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]] <div id="toc">
__ TOC__
</div> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':
*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div> </div> </div> </div>

Adopt Universal Screening for Pregnant Women

2018-12-03T20:42:06Z

KaralynK:

<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[[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]]
<span style="background-color: #ffffff">Return to </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]] <div id="toc">
 

__ TOC__

</div> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':
*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div> </div> </div>

Adopt Universal Screening for Pregnant Women

2018-12-03T20:41:18Z

KaralynK:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
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]]
<span style="background-color: #ffffff">Return to </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]] <div id="toc">
 

</div> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':
*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div> </div>

Adopt Universal Screening for Pregnant Women

2018-12-03T20:40:59Z

KaralynK:

<div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
 
<span style="background-color: #ffffff">Return to</span>[[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]]<br/> <span style="background-color: #ffffff">Return to </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]] <div id="toc">
 
</div> Another potential strategy is to universally screen all pregnant women for substance abuse. In Kaiser Permanente's [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start ]program, pregnant women were screened for substance abuse risk at the first prenatal visit by a self-administered questionnaire and by urine toxicology testing (with signed consent). Universal screening facilitates early identification and treatment of substance use.<sup class="reference">[1]</sup><br/> <br/> '''[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057720/ Early Start: An Integrated Model of Substance Abuse Intervention for Pregnant Women] - Kaiser Permanente'''<br/> ''Overview of program'':
*Universally screen all pregnant women
*No mandated reporting for toxicology
*Mental health provider apart of obstetric care
*Use video conferencing and telephone to provide care to immediate and remote care

''Outcome Successes'':

*Show decrease in morbidity for mothers and babies
*Cost beneficial
*Reduces all barriers to care, including in prenatal care

<br/> '''[http://www.ajog.org/article/S0002-9378(16)30383-0/fulltext#tbl4 The role of screening, brief intervention, and referral to treatment in the perinatal period -- Tricia E. Wright, MD, MS]'''<br/> ''Method'':

*SBIRT -- Screening, Brief Intervention, and Referral to Treatment --> Figure 2: SBIRT Flow Chart
<div class="objectEmbed">[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 2.ppt]]] <div>[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Figure 2.ppt]]
*[[File/detail/Figure_2.ppt|Details]]
*[[File/view/Figure_2.ppt/614158923/Figure_2.ppt|Download]]
*659 KB
</div> </div>  
*Components of Interview: raise subject, provide feedback, enhance motivation, negotiate plan
*Purpose of screening for substance abuse is to stratify women into zones of risk given their pattern of use --> Use "risk pyramid" seen in Figure 1.
<div class="objectEmbed">[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|[File:http://www.wikispaces.com/i/mime/32/application/vnd.ms-powerpoint.png Figure 1.ppt]]] <div>[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Figure 1.ppt]]
*[[File/detail/Figure_1.ppt|Details]]
*[[File/view/Figure_1.ppt/614158873/Figure_1.ppt|Download]]
*1 MB
</div> </div> <br/> ''Screening Instruments:''
*
**CAGE -- Cut down, Annoyed, Guilt, Eye opener
**T-ACE -- Takes, Annoyed, Cut down, Eye opener
**TWEAK -- Tolerance, Worry, Eye opener, Amnesia, Cut down
**4Ps -- Past, Present, Parents, Partner
**NIDA Quick Screen -- Uses 3 open-ended questions regarding alcohol, tobacco, and other drugs

''Key Screening Conclusions:''

*Screening should be done for all pregnant women and throughout pregnancy for those at risk
*Screening can be done by a provider using a validated instrument during follow-up or by asking standardized questions during interview
*Screening must be nonjudgemental and open-ended
*Urine toxicology should not be used in place of screening

 

= Promising Practices for Standardized Screening =

== Indiana State Department of Health ==

In 2014, because of the high rate of opioid prescriptions, the Indiana General Assembly charged the Indiana State Department of Health (ISDH) to: develop a standard clinical definition of NAS and a standardized process of identifying it, identify the resources hospitals need to do this, and then establish a voluntary pilot program with hospitals to implement this standardized NAS identification. As of 2016, 26 of 89 Indiana Birthing Hospitals are taking part in this pilot screening program

To understand and address perinatal substance use, accurate data needed to be collected through '''standardized screening and testing:'''

*When any pregnant arrives at the hospital for delivery, hospital personnel conduct a standardized and validated verbal screening regarding substance use.
*Any woman with a positive verbal screen at any point during pregnancy, including at presentation for delivery, is requested to consent to a urine toxicology screening.
*Babies whose mothers had a positive verbal screen or toxicology screen, or babies whose mothers did not consent to the toxicology screen will be tested for evidence of maternal substance use using the infant’s umbilical cord.
**Note: Umbilical cord testing, not meconium stool, was used on all infants.
*Babies also have modified Finnegan scoring initiated to observe for signs and symptoms of NAS.

<br/> ISDH noted that universal screening in a [[Shift_from_Punishment_to_Treatment_Approach_for_Opioid_Users|non-punitive]] environment would allow us to understand the true prevalence of Perinatal Substance Use and NAS.<sup class="reference">[2]</sup><br/> <br/> ''See [[Improve_Identifying_and_Data_Collection_on_NAS|Improve Identifying and Data Collecting on NAS]] for more information on defining, testing, and reporting data about NAS.''<br/>  

= Tools & Resources =

[[TR_-_Adopt_Universal_Screening_for_Pregnant_Women|TR - Adopt Universal Screening for Pregnant Women]]

= Scorecard Building =

[[PO_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Objective Details]]<br/> [[PM_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Universal_Screening_for_Pregnant_Women|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Universal_Screening_for_Pregnant_Women|More RTI on Adopt Universal Screening 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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12531/full [1]]
#[http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Perinatal%20Substance%20Use.pdf [2]]
</div> </div>

Supporting Key Legislative and Policy Changes

2018-12-03T20:31:39Z

KaralynK:

<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]]<span style="font-size: 13px;">or the </span>[[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]

= State Policy Guide =

The National Center on Addiction and Substance Abuse produced a[https://www.centeronaddiction.org/addiction-research/reports/ending-opioid-crisis-practical-guide-state-policymakers Practical Guide for State Policymakers] that was released in October of 2017

  Addiction Policy Forum released a report on [https://www.addictionpolicy.org/blog/addiction-policy-forum-releases-report-on-policy-responses-to-addiction Policy Responses to Addiction]

 

= General Information =

A policy can allow doctors to hold patients who show signs of opioid misuse. This was proposed, but not passed in Massachusetts<sup class="reference">[1]</sup>

  In June 2016, the American Medical Association (AMA) held its annual conference and discussed ways in which healthcare professionals could address the opioid epidemic. The AMA's new president, Dr. Andrew Gurman, acknowledged that physicians have played a key role in creating the opioid epidemic. The AMA House of Delegates called for measures that would oppose barriers that can limit patient access to evidence-based, non-opioid and non-pharmaceutical therapies. In addition, they also called for having pain removed as a vital sign in professional standards, and to disconnect patient satisfaction scores from questions related to evaluation and management of pain in order to minimize prescribing opioids. The AMA also discussed increasing access to Naloxone, a drug that can counter the effect of an opioid overdose. In order to increase access to Naloxone, they called for public and private payers to include the drug on their preferred drug lists and formularies with little to no cost-sharing, liability protections for healthcare professionals who administer, prescribe, or dispense the drug, and to make the drug available at all pharmacies, at community-based organizations, correctional settings, schools, and law enforcement agencies.<sup class="reference">[2]</sup>

  There are contrasting reports on the effectiveness of policies on opioid prescribing and opioid and heroin overdose rates. In June 2016, UC Irvine Health reported that between 2006 and 2012, states enacted 81 laws to control use of powerful opioids such as Oxycontin and Vicodin. But even with these new prescription-drug monitoring programs and other regulations, researchers at Dartmouth Institute for Health Policy and Clinical Practice found that 45% of disabled Medicare beneficiaries were still using opioids in 2012. The same study found no discernible difference in opioid use or overdose as a result of tighter regulations. <sup class="reference">[3]</sup> In contrast, a study published in the October 2016 issue of Health Affairs reported that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent form 2006-2013.<sup class="reference">[4]</sup>

  In their 2015 report, the National Heroin Task Force stated that policies regarding opioid and heroin use must be grounded in scientific understanding that substance use disorders are a chronic brain disease that can be prevented and treated, leading to recovery.<sup class="reference">[5]</sup>

 

= Promising Legislation =

Laws that give police, first responders, or family members, the ability to carry and administer naloxone (Narcan).

  Good Samaritan Laws provides immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose.<sup class="reference">[6]</sup> The Policy Surveillance Program provides an [http://lawatlas.org/query?dataset=good-samaritan-overdose-laws interactive database] of current Good Samaritan Laws in the U.S. As of July 2016, 35 states and Washington D.C. had Good Samaritan Laws in place.<sup class="reference">[7]</sup><br/>  

 

== Federal Bills ==

'''S. 1455 - The Recovery Enhancement for Addiction Treatment (TREAT) Act:''' Bipartisan legislation introduced by U.S. Senators Edward Markey and Rand Paul on May 22, 2015, this bill will expand treatment for those suffering from prescription drug and heroin addiction. A companion bill was introduced in the House of Representatives by Brian Higgins, Richard Hanna, Paul Tonko, and John Katko. The legislation would expand the ability of addiction medical specialists and other trained medical professionals to provide life-saving medication-assisted therapies such as buprenorphine for patients battling opiate addiction. The bill will raise the limits on the number of patients a physician or nurse practitioner may treat from 30 to 100 in the first year and with no limit thereafter. Those providing treatment must receive additional training in addiction, use the Prescription Drug Monitoring Program (PDMP) and administer treatment in a qualified practice setting with defined oversight.<br/> <br/> '''S. 954 - The FDA Accountability Act:''' Bipartisan legislation introduced by Senator Joe Manchin on April 15, 2015. Co-sponsors include Tim Kaine, David Vitter, and Shelley Moore Capito. The bill requires the FDA to establish an advisory panel for each application submitted to the FDA for approval of an opioid drug and report to congress on any instance where approval is recommended when inconsistent with the advice of the panel. A drug approved inconsistent with the recommendations of the advisory panel shall not be introduced or delivered for introduction into interstate commerce until the report describing the approval has been submitted to Congress.<br/> <br/> '''S. 1913 - The Stopping Medication Abuse and Protecting Seniors Act:''' Bipartisan legislation introduced on July 30, 2015, by Senator Pat Toomey with co-sponsors Joe Manchin, Tim Kaine, Sherrod Brown, Rob Portman. This bill would authorize the use of patient review and restriction (PRR) programs in Medicare, which can help prevent prescription drug abuse among beneficiaries. The use of PRR programs will assign patients who are at-risk for opioid dependence to predesignated pharmacies and prescribers to better manage appropriate care and monitor prescriptions of opioid drugs for Medicare beneficiaries.<br/> <br/> '''S. 524 - 2015 Comprehensive Addiction Recovery Act:''' This legislation was re-introduced on February 15, 2015, by U.S. Senators Sheldon Whitehouse and Rob Portman and was co-sponsored by 13 additional Senators. A House of Representatives companion bill, HR 953 has also been introduced. This legislation will expand prevention and education efforts, expand access to the overdose-reversing drug Naloxone, support alternative treatment in lieu of incarceration, strengthen the Prescription Drug Monitoring Program and support expansion of the use of evidence-based treatment medications. CARA 2015 designates up to $80 million toward these efforts. This Bill became law in the summer of 2016.<br/> <br/> '''S. 799 - The Protecting our Infants Act:''' Bipartisan legislation introduced on March 19, 2015, by Senator Mitch McConnell and Casey with co-sponsors Kelley Ayotte, Rob Portman and others. Companion bill introduced in the House by Representative Clark with 72 co-sponsors. This bill requires the Agency for Healthcare Research and Quality to report on prenatal opioid abuse and neonatal abstinence syndrome (symptoms of withdrawal in a newborn). The report must include an assessment of existing research on neonatal abstinence syndrome, an evaluation of the causes, and barriers to treatment, an evaluation of treatment for pregnant women with opioids use disorders and infants with neonatal abstinence syndrome, and recommendations on preventing, identifying, and treating opioid dependency in women and neonatal abstinence syndrome. HHS is directed to develop a strategy to address gaps in research and programs and the CDC must provide technical assistance to states to improve neonatal abstinence syndrome surveillance and make surveillance data publicly available. This Bill became law on November 25th 2015.<br/>  

= Examples of State Legislation =

== California (Alameda County) ==

*Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<sup class="reference">[8]</sup>
*California legislation has is in process for reducing treatment fraud and waste: [https://www.behavioral.net/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries [1]]

== Connecticut ==

*[https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm Statute] enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[9]</sup>

== Illinois ==

*[http://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf Statue] enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<sup class="reference">[10]</sup>

== Kentucky ==

*Board rules required by [http://kbml.ky.gov/hb1/Documents/House-Bill-1.pdf statute] enacted September 2012: 48 hour limit on dispensing Schedule II and III controlled substances by physicians. No limit on opioid prescriptions.<sup class="reference">[11]</sup>

== Massachusetts ==

*[https://malegislature.gov/Laws/SessionLaws/Acts/2016/Chapter52 Statute] enacted March 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[12]</sup>
*[http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf Recommendations of the Governor's Opioid Working Group]

== North Carolina ==

*[https://www.ncleg.net/gascripts/billlookup/billlookup.pl?Session=2017&BillID=H243 Statute] enacted January 1, 2017: The Strengthen Opioid Misuse Prevention (STOP) Act of 2017, or STOP Act, is intended to reduce the supply of unused, misused and diverted opioids circulating in NC, reduce “doctor shopping” and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing. NCMB supported passage of the STOP Act.
**Limits on the number of days worth of opioids that may be lawfully prescribed upon initial consultation for acute injuries (no more than a five day supply allowed) and following surgeries (no more than a seven day supply allowed). The STOP Act does NOT limit the amount of opioids that may be prescribed to a chronic pain patient;
**A requirement that prescribers use the NC Controlled Substances Reporting System (NCCSRS), the prescription database that records all controlled substance prescriptions dispensed in outpatient pharmacies across NC. The STOP Act requires prescribers to review the patient’s 12-month history with the NCCSRS before issuing an initial prescription for a Schedule II or Schedule III opioid, and subsequent reviews every three months thereafter, for as long as the patient continues on the drug;
**A requirement that PAs and NPs practicing at pain clinics consult with their supervising physicians prior to prescribing opioids. NOTE: The Board has not determined how it will define “consult”. The most important thing is that a meaningful consultation about the patient and recommended treatment occurs and is documented in the medical record; the Board may ultimately leave it up to PAs, NPs and their supervisors to determine exactly how consultations occur, consistent with its current approach towards physician supervision of PAs and NPs.<sup class="reference">[13]</sup>

== Washington ==

*[http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf Guidelines] and board rules required by [http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Laws/House/2876-S.SL.pdf statute]. Guidelines revised June 2015, board rules implemented between July 2011 and January 2012, and statute enacted January 2010: Pain specialist consultation required prior to prescribing daily morphine equivalent doses of 120mg or greater (with exceptions).<sup class="reference">[14]</sup>
*[http://leadkingcounty.org/about/ Law Enforcement Assisted Diversion]

== Rhode Island ==

*[http://www.health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf Rhode Island's Strategic Plan on Addiction and Overdose]

== New Jersey ==

*[http://www.nj.gov/lps/ca2/pmp/ New Jersey's Prescription Monitoring Program]
*[http://www.pdmpassist.org/pdf/PPTs/DataDrivenPilots/Sources_Usage_LE_Data.pdf Regional Drug Monitoring Initiative]

<br/> [http://www.naco.org/ National Association of Counties ]<br/>  

= Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis =

<br/> Grant Waivers to all 50 States for the IMD Exclusion<br/> [https://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf [2]]<br/>  

*Mandate Prescriber Education
*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses

 

= Federal Legislation =

*'''Affordable Care Act (2010)''' - More than 20 million people received support to get mental health and substance abuse treatment through the 2010 ACA.<sup class="reference">[15]</sup> If it is repealed and its replacement does not offer the same coverage many people will be unable to get to access treatment for addiction. The New York Time's Editorial Board states that "repealing the health care law is likely to exacerbate the crisis."<sup class="reference">[16]</sup>

 

= Sample Protocol for State Law Adoption =

'''[[Illinois_SB2928|Illinois]]''' '''[[Illinois_SB2928|SB2928]]''' is a current law with the common name '''"'''Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. <sup class="reference">[17]</sup><sup class="reference">[18]</sup> It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. <sup class="reference">[19]</sup> The lead Project Coordinator Bill Gentes has as a result been awarded CADCA's Advocate of the Year.<sup class="reference">[20]</sup> The following steps were used in the creation, adoption and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

#Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one review current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
#Partnering with Local Law Enforcement - As stated by Gentes at an interview "“''circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process''."<sup class="reference">[21]</sup> In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more. <sup class="reference">[22]</sup>
#Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference...''.'look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process.'''"<sup class="reference">[23]</sup>
#Securing Public-Private Partnerships - Walgreens has been approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be issue with a need to review current laws regarding drug disposal. <sup class="reference">[24]</sup> This has as a result increased the capacity of the project and accompanying police force in collection efforts.
#Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support. <sup class="reference">[25]</sup>
#Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments. <sup class="reference">[26]</sup><sup class="reference">[27]</sup>

 

= Lobbying Legally =

501(c)3 organizations (tax-exempt non-profits) have some restrictions on lobbying in the government. [http://www.cadca.org/sites/default/files/resource/files/strat31.pdf This guide] explains federal laws on non-profit lobbying for policy changes.

[[File:LegalLobbying.PNG|LegalLobbying.PNG]]<sup class="reference">[28]</sup>

== Key Lobbying Rules ==

*The IRS defines '''direct lobbying''' as: "A direct lobbying communication is any attempt to influence any legislation through communication with:Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation."
**Direct Lobbying Communication is defined as: "Referring to specific legislation and reflects a view on such legislation"
*The IRS defines '''grassroots lobbying''' as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof"
**Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation"

<br/> Lobbying that falls under either the grassroots or direct lobbying definition is restricted, but not prohibited. See Tools & Resources.<br/>  

== Key Lobbying Groups ==

=== FedUp! ===

*A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids
*FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies

<br/> To learn more go to: [http://feduprally.org/ [3]]

= Tools & Resources =

[[TR_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|TR - Adopt Key Legislative & Policy Changes to Address the Opioid Crisis]]

= Scorecard Building =

<span style="background-color: #ffffff">[[PO_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Objective Details]]</span><br/> <span style="background-color: #ffffff">[[PM_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Measures and Data Sources]]</span><br/> <span style="background-color: #ffffff">[[PA_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Actions and Partners]]</span>

= Resources to Investigate =

[[RTI_-_Adopt_Key_Legislative_&_Policy_Changes|RTI - Adopt Key Legislative & Policy Changes]]<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>

{| class="wiki_table"
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| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
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|}

= Sources =

----

#[http://www.cnn.com/2016/04/28/opinions/massachusetts-opioid-treatment-prince-vox/?iid=ob_article_organicsidebar_expansion [4]]
#[http://www.modernhealthcare.com/article/20160615/NEWS/160619941?utm_source=modernhealthcare&utm_medium=email&utm_content=20160615-NEWS-160619941&utm_campaign=am [5]]
#[http://www.ucirvinehealth.org/health-library/content/?contentTypeID=6&contentID=712214 [6]]
#[http://content.healthaffairs.org/content/35/10/1876.abstract [7]]
#[https://www.justice.gov/file/822231/download [8]]
#[http://www.countyhealthrankings.org/policies/good-samaritan-drug-overdose-laws [9]]
#[http://lawatlas.org/query?dataset=good-samaritan-overdose-laws [10]]
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [11]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [12]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [13]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [14]]
##
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##**
##***
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##******
##*******
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##*********
##**********
##***********
##************[https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act [15]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [16]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [17]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [18]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [19]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [20]]
#[http://police.mundelein.org/content/pill-disposal-program [21]]
#[http://www.cadca.org/resources/coalitions-action-how-bill-helped-pass-law [22]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [23]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [24]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [25]]
#[http://police.mundelein.org/content/pill-disposal-program [26]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [27]]
#[http://police.mundelein.org/content/pill-disposal-program [28]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [29]]
#[http://www.cadca.org/sites/default/files/resource/files/strat31.pdf [30]]
</div> </div> </div> </div>
[[Category:Pages with broken file links]]

Supporting Key Legislative and Policy Changes

2018-12-03T20:31:29Z

KaralynK:

<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]]<span style="font-size: 13px;">or the </span>[[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]
<div id="toc">
 
</div>
= State Policy Guide =

The National Center on Addiction and Substance Abuse produced a[https://www.centeronaddiction.org/addiction-research/reports/ending-opioid-crisis-practical-guide-state-policymakers Practical Guide for State Policymakers] that was released in October of 2017

  Addiction Policy Forum released a report on [https://www.addictionpolicy.org/blog/addiction-policy-forum-releases-report-on-policy-responses-to-addiction Policy Responses to Addiction]

 

= General Information =

A policy can allow doctors to hold patients who show signs of opioid misuse. This was proposed, but not passed in Massachusetts<sup class="reference">[1]</sup>

  In June 2016, the American Medical Association (AMA) held its annual conference and discussed ways in which healthcare professionals could address the opioid epidemic. The AMA's new president, Dr. Andrew Gurman, acknowledged that physicians have played a key role in creating the opioid epidemic. The AMA House of Delegates called for measures that would oppose barriers that can limit patient access to evidence-based, non-opioid and non-pharmaceutical therapies. In addition, they also called for having pain removed as a vital sign in professional standards, and to disconnect patient satisfaction scores from questions related to evaluation and management of pain in order to minimize prescribing opioids. The AMA also discussed increasing access to Naloxone, a drug that can counter the effect of an opioid overdose. In order to increase access to Naloxone, they called for public and private payers to include the drug on their preferred drug lists and formularies with little to no cost-sharing, liability protections for healthcare professionals who administer, prescribe, or dispense the drug, and to make the drug available at all pharmacies, at community-based organizations, correctional settings, schools, and law enforcement agencies.<sup class="reference">[2]</sup>

  There are contrasting reports on the effectiveness of policies on opioid prescribing and opioid and heroin overdose rates. In June 2016, UC Irvine Health reported that between 2006 and 2012, states enacted 81 laws to control use of powerful opioids such as Oxycontin and Vicodin. But even with these new prescription-drug monitoring programs and other regulations, researchers at Dartmouth Institute for Health Policy and Clinical Practice found that 45% of disabled Medicare beneficiaries were still using opioids in 2012. The same study found no discernible difference in opioid use or overdose as a result of tighter regulations. <sup class="reference">[3]</sup> In contrast, a study published in the October 2016 issue of Health Affairs reported that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent form 2006-2013.<sup class="reference">[4]</sup>

  In their 2015 report, the National Heroin Task Force stated that policies regarding opioid and heroin use must be grounded in scientific understanding that substance use disorders are a chronic brain disease that can be prevented and treated, leading to recovery.<sup class="reference">[5]</sup>

 

= Promising Legislation =

Laws that give police, first responders, or family members, the ability to carry and administer naloxone (Narcan).

  Good Samaritan Laws provides immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose.<sup class="reference">[6]</sup> The Policy Surveillance Program provides an [http://lawatlas.org/query?dataset=good-samaritan-overdose-laws interactive database] of current Good Samaritan Laws in the U.S. As of July 2016, 35 states and Washington D.C. had Good Samaritan Laws in place.<sup class="reference">[7]</sup><br/>  

 

== Federal Bills ==

'''S. 1455 - The Recovery Enhancement for Addiction Treatment (TREAT) Act:''' Bipartisan legislation introduced by U.S. Senators Edward Markey and Rand Paul on May 22, 2015, this bill will expand treatment for those suffering from prescription drug and heroin addiction. A companion bill was introduced in the House of Representatives by Brian Higgins, Richard Hanna, Paul Tonko, and John Katko. The legislation would expand the ability of addiction medical specialists and other trained medical professionals to provide life-saving medication-assisted therapies such as buprenorphine for patients battling opiate addiction. The bill will raise the limits on the number of patients a physician or nurse practitioner may treat from 30 to 100 in the first year and with no limit thereafter. Those providing treatment must receive additional training in addiction, use the Prescription Drug Monitoring Program (PDMP) and administer treatment in a qualified practice setting with defined oversight.<br/> <br/> '''S. 954 - The FDA Accountability Act:''' Bipartisan legislation introduced by Senator Joe Manchin on April 15, 2015. Co-sponsors include Tim Kaine, David Vitter, and Shelley Moore Capito. The bill requires the FDA to establish an advisory panel for each application submitted to the FDA for approval of an opioid drug and report to congress on any instance where approval is recommended when inconsistent with the advice of the panel. A drug approved inconsistent with the recommendations of the advisory panel shall not be introduced or delivered for introduction into interstate commerce until the report describing the approval has been submitted to Congress.<br/> <br/> '''S. 1913 - The Stopping Medication Abuse and Protecting Seniors Act:''' Bipartisan legislation introduced on July 30, 2015, by Senator Pat Toomey with co-sponsors Joe Manchin, Tim Kaine, Sherrod Brown, Rob Portman. This bill would authorize the use of patient review and restriction (PRR) programs in Medicare, which can help prevent prescription drug abuse among beneficiaries. The use of PRR programs will assign patients who are at-risk for opioid dependence to predesignated pharmacies and prescribers to better manage appropriate care and monitor prescriptions of opioid drugs for Medicare beneficiaries.<br/> <br/> '''S. 524 - 2015 Comprehensive Addiction Recovery Act:''' This legislation was re-introduced on February 15, 2015, by U.S. Senators Sheldon Whitehouse and Rob Portman and was co-sponsored by 13 additional Senators. A House of Representatives companion bill, HR 953 has also been introduced. This legislation will expand prevention and education efforts, expand access to the overdose-reversing drug Naloxone, support alternative treatment in lieu of incarceration, strengthen the Prescription Drug Monitoring Program and support expansion of the use of evidence-based treatment medications. CARA 2015 designates up to $80 million toward these efforts. This Bill became law in the summer of 2016.<br/> <br/> '''S. 799 - The Protecting our Infants Act:''' Bipartisan legislation introduced on March 19, 2015, by Senator Mitch McConnell and Casey with co-sponsors Kelley Ayotte, Rob Portman and others. Companion bill introduced in the House by Representative Clark with 72 co-sponsors. This bill requires the Agency for Healthcare Research and Quality to report on prenatal opioid abuse and neonatal abstinence syndrome (symptoms of withdrawal in a newborn). The report must include an assessment of existing research on neonatal abstinence syndrome, an evaluation of the causes, and barriers to treatment, an evaluation of treatment for pregnant women with opioids use disorders and infants with neonatal abstinence syndrome, and recommendations on preventing, identifying, and treating opioid dependency in women and neonatal abstinence syndrome. HHS is directed to develop a strategy to address gaps in research and programs and the CDC must provide technical assistance to states to improve neonatal abstinence syndrome surveillance and make surveillance data publicly available. This Bill became law on November 25th 2015.<br/>  

= Examples of State Legislation =

== California (Alameda County) ==

*Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<sup class="reference">[8]</sup>
*California legislation has is in process for reducing treatment fraud and waste: [https://www.behavioral.net/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries [1]]

== Connecticut ==

*[https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm Statute] enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[9]</sup>

== Illinois ==

*[http://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf Statue] enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<sup class="reference">[10]</sup>

== Kentucky ==

*Board rules required by [http://kbml.ky.gov/hb1/Documents/House-Bill-1.pdf statute] enacted September 2012: 48 hour limit on dispensing Schedule II and III controlled substances by physicians. No limit on opioid prescriptions.<sup class="reference">[11]</sup>

== Massachusetts ==

*[https://malegislature.gov/Laws/SessionLaws/Acts/2016/Chapter52 Statute] enacted March 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[12]</sup>
*[http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf Recommendations of the Governor's Opioid Working Group]

== North Carolina ==

*[https://www.ncleg.net/gascripts/billlookup/billlookup.pl?Session=2017&BillID=H243 Statute] enacted January 1, 2017: The Strengthen Opioid Misuse Prevention (STOP) Act of 2017, or STOP Act, is intended to reduce the supply of unused, misused and diverted opioids circulating in NC, reduce “doctor shopping” and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing. NCMB supported passage of the STOP Act.
**Limits on the number of days worth of opioids that may be lawfully prescribed upon initial consultation for acute injuries (no more than a five day supply allowed) and following surgeries (no more than a seven day supply allowed). The STOP Act does NOT limit the amount of opioids that may be prescribed to a chronic pain patient;
**A requirement that prescribers use the NC Controlled Substances Reporting System (NCCSRS), the prescription database that records all controlled substance prescriptions dispensed in outpatient pharmacies across NC. The STOP Act requires prescribers to review the patient’s 12-month history with the NCCSRS before issuing an initial prescription for a Schedule II or Schedule III opioid, and subsequent reviews every three months thereafter, for as long as the patient continues on the drug;
**A requirement that PAs and NPs practicing at pain clinics consult with their supervising physicians prior to prescribing opioids. NOTE: The Board has not determined how it will define “consult”. The most important thing is that a meaningful consultation about the patient and recommended treatment occurs and is documented in the medical record; the Board may ultimately leave it up to PAs, NPs and their supervisors to determine exactly how consultations occur, consistent with its current approach towards physician supervision of PAs and NPs.<sup class="reference">[13]</sup>

== Washington ==

*[http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf Guidelines] and board rules required by [http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Laws/House/2876-S.SL.pdf statute]. Guidelines revised June 2015, board rules implemented between July 2011 and January 2012, and statute enacted January 2010: Pain specialist consultation required prior to prescribing daily morphine equivalent doses of 120mg or greater (with exceptions).<sup class="reference">[14]</sup>
*[http://leadkingcounty.org/about/ Law Enforcement Assisted Diversion]

== Rhode Island ==

*[http://www.health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf Rhode Island's Strategic Plan on Addiction and Overdose]

== New Jersey ==

*[http://www.nj.gov/lps/ca2/pmp/ New Jersey's Prescription Monitoring Program]
*[http://www.pdmpassist.org/pdf/PPTs/DataDrivenPilots/Sources_Usage_LE_Data.pdf Regional Drug Monitoring Initiative]

<br/> [http://www.naco.org/ National Association of Counties ]<br/>  

= Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis =

<br/> Grant Waivers to all 50 States for the IMD Exclusion<br/> [https://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf [2]]<br/>  

*Mandate Prescriber Education
*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses

 

= Federal Legislation =

*'''Affordable Care Act (2010)''' - More than 20 million people received support to get mental health and substance abuse treatment through the 2010 ACA.<sup class="reference">[15]</sup> If it is repealed and its replacement does not offer the same coverage many people will be unable to get to access treatment for addiction. The New York Time's Editorial Board states that "repealing the health care law is likely to exacerbate the crisis."<sup class="reference">[16]</sup>

 

= Sample Protocol for State Law Adoption =

'''[[Illinois_SB2928|Illinois]]''' '''[[Illinois_SB2928|SB2928]]''' is a current law with the common name '''"'''Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. <sup class="reference">[17]</sup><sup class="reference">[18]</sup> It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. <sup class="reference">[19]</sup> The lead Project Coordinator Bill Gentes has as a result been awarded CADCA's Advocate of the Year.<sup class="reference">[20]</sup> The following steps were used in the creation, adoption and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

#Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one review current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
#Partnering with Local Law Enforcement - As stated by Gentes at an interview "“''circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process''."<sup class="reference">[21]</sup> In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more. <sup class="reference">[22]</sup>
#Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference...''.'look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process.'''"<sup class="reference">[23]</sup>
#Securing Public-Private Partnerships - Walgreens has been approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be issue with a need to review current laws regarding drug disposal. <sup class="reference">[24]</sup> This has as a result increased the capacity of the project and accompanying police force in collection efforts.
#Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support. <sup class="reference">[25]</sup>
#Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments. <sup class="reference">[26]</sup><sup class="reference">[27]</sup>

 

= Lobbying Legally =

501(c)3 organizations (tax-exempt non-profits) have some restrictions on lobbying in the government. [http://www.cadca.org/sites/default/files/resource/files/strat31.pdf This guide] explains federal laws on non-profit lobbying for policy changes.

[[File:LegalLobbying.PNG|LegalLobbying.PNG]]<sup class="reference">[28]</sup>

== Key Lobbying Rules ==

*The IRS defines '''direct lobbying''' as: "A direct lobbying communication is any attempt to influence any legislation through communication with:Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation."
**Direct Lobbying Communication is defined as: "Referring to specific legislation and reflects a view on such legislation"
*The IRS defines '''grassroots lobbying''' as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof"
**Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation"

<br/> Lobbying that falls under either the grassroots or direct lobbying definition is restricted, but not prohibited. See Tools & Resources.<br/>  

== Key Lobbying Groups ==

=== FedUp! ===

*A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids
*FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies

<br/> To learn more go to: [http://feduprally.org/ [3]]

= Tools & Resources =

[[TR_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|TR - Adopt Key Legislative & Policy Changes to Address the Opioid Crisis]]

= Scorecard Building =

<span style="background-color: #ffffff">[[PO_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Objective Details]]</span><br/> <span style="background-color: #ffffff">[[PM_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Measures and Data Sources]]</span><br/> <span style="background-color: #ffffff">[[PA_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Actions and Partners]]</span>

= Resources to Investigate =

[[RTI_-_Adopt_Key_Legislative_&_Policy_Changes|RTI - Adopt Key Legislative & Policy Changes]]<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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://www.cnn.com/2016/04/28/opinions/massachusetts-opioid-treatment-prince-vox/?iid=ob_article_organicsidebar_expansion [4]]
#[http://www.modernhealthcare.com/article/20160615/NEWS/160619941?utm_source=modernhealthcare&utm_medium=email&utm_content=20160615-NEWS-160619941&utm_campaign=am [5]]
#[http://www.ucirvinehealth.org/health-library/content/?contentTypeID=6&contentID=712214 [6]]
#[http://content.healthaffairs.org/content/35/10/1876.abstract [7]]
#[https://www.justice.gov/file/822231/download [8]]
#[http://www.countyhealthrankings.org/policies/good-samaritan-drug-overdose-laws [9]]
#[http://lawatlas.org/query?dataset=good-samaritan-overdose-laws [10]]
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [11]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [12]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [13]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [14]]
##
##*
##**
##***
##****
##*****
##******
##*******
##********
##*********
##**********
##***********
##************[https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act [15]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [16]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [17]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [18]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [19]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [20]]
#[http://police.mundelein.org/content/pill-disposal-program [21]]
#[http://www.cadca.org/resources/coalitions-action-how-bill-helped-pass-law [22]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [23]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [24]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [25]]
#[http://police.mundelein.org/content/pill-disposal-program [26]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [27]]
#[http://police.mundelein.org/content/pill-disposal-program [28]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [29]]
#[http://www.cadca.org/sites/default/files/resource/files/strat31.pdf [30]]
</div> </div> </div>
[[Category:Pages with broken file links]]

Supporting Key Legislative and Policy Changes

2018-12-03T20:30:03Z

KaralynK:

<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]]<span style="font-size: 13px;">or the </span>[[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]
<div id="toc">
 
</div>
= State Policy Guide =

The National Center on Addiction and Substance Abuse produced a[https://www.centeronaddiction.org/addiction-research/reports/ending-opioid-crisis-practical-guide-state-policymakers Practical Guide for State Policymakers] that was released in October of 2017

Addiction Policy Forum released a report on [https://www.addictionpolicy.org/blog/addiction-policy-forum-releases-report-on-policy-responses-to-addiction Policy Responses to Addiction]

= General Information =

A policy can allow doctors to hold patients who show signs of opioid misuse. This was proposed, but not passed in Massachusetts<sup class="reference">[1]</sup>

In June 2016, the American Medical Association (AMA) held its annual conference and discussed ways in which healthcare professionals could address the opioid epidemic. The AMA's new president, Dr. Andrew Gurman, acknowledged that physicians have played a key role in creating the opioid epidemic. The AMA House of Delegates called for measures that would oppose barriers that can limit patient access to evidence-based, non-opioid and non-pharmaceutical therapies. In addition, they also called for having pain removed as a vital sign in professional standards, and to disconnect patient satisfaction scores from questions related to evaluation and management of pain in order to minimize prescribing opioids. The AMA also discussed increasing access to Naloxone, a drug that can counter the effect of an opioid overdose. In order to increase access to Naloxone, they called for public and private payers to include the drug on their preferred drug lists and formularies with little to no cost-sharing, liability protections for healthcare professionals who administer, prescribe, or dispense the drug, and to make the drug available at all pharmacies, at community-based organizations, correctional settings, schools, and law enforcement agencies.<sup class="reference">[2]</sup>

There are contrasting reports on the effectiveness of policies on opioid prescribing and opioid and heroin overdose rates. In June 2016, UC Irvine Health reported that between 2006 and 2012, states enacted 81 laws to control use of powerful opioids such as Oxycontin and Vicodin. But even with these new prescription-drug monitoring programs and other regulations, researchers at Dartmouth Institute for Health Policy and Clinical Practice found that 45% of disabled Medicare beneficiaries were still using opioids in 2012. The same study found no discernible difference in opioid use or overdose as a result of tighter regulations. <sup class="reference">[3]</sup> In contrast, a study published in the October 2016 issue of Health Affairs reported that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent form 2006-2013.<sup class="reference">[4]</sup>

In their 2015 report, the National Heroin Task Force stated that policies regarding opioid and heroin use must be grounded in scientific understanding that substance use disorders are a chronic brain disease that can be prevented and treated, leading to recovery.<sup class="reference">[5]</sup>

= Promising Legislation =

Laws that give police, first responders, or family members, the ability to carry and administer naloxone (Narcan).

Good Samaritan Laws provides immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose.<sup class="reference">[6]</sup> The Policy Surveillance Program provides an [http://lawatlas.org/query?dataset=good-samaritan-overdose-laws interactive database] of current Good Samaritan Laws in the U.S. As of July 2016, 35 states and Washington D.C. had Good Samaritan Laws in place.<sup class="reference">[7]</sup>

== Federal Bills ==

'''S. 1455 - The Recovery Enhancement for Addiction Treatment (TREAT) Act:''' Bipartisan legislation introduced by U.S. Senators Edward Markey and Rand Paul on May 22, 2015, this bill will expand treatment for those suffering from prescription drug and heroin addiction. A companion bill was introduced in the House of Representatives by Brian Higgins, Richard Hanna, Paul Tonko, and John Katko. The legislation would expand the ability of addiction medical specialists and other trained medical professionals to provide life-saving medication-assisted therapies such as buprenorphine for patients battling opiate addiction. The bill will raise the limits on the number of patients a physician or nurse practitioner may treat from 30 to 100 in the first year and with no limit thereafter. Those providing treatment must receive additional training in addiction, use the Prescription Drug Monitoring Program (PDMP) and administer treatment in a qualified practice setting with defined oversight.<br/> <br/> '''S. 954 - The FDA Accountability Act:''' Bipartisan legislation introduced by Senator Joe Manchin on April 15, 2015. Co-sponsors include Tim Kaine, David Vitter, and Shelley Moore Capito. The bill requires the FDA to establish an advisory panel for each application submitted to the FDA for approval of an opioid drug and report to congress on any instance where approval is recommended when inconsistent with the advice of the panel. A drug approved inconsistent with the recommendations of the advisory panel shall not be introduced or delivered for introduction into interstate commerce until the report describing the approval has been submitted to Congress.<br/> <br/> '''S. 1913 - The Stopping Medication Abuse and Protecting Seniors Act:''' Bipartisan legislation introduced on July 30, 2015, by Senator Pat Toomey with co-sponsors Joe Manchin, Tim Kaine, Sherrod Brown, Rob Portman. This bill would authorize the use of patient review and restriction (PRR) programs in Medicare, which can help prevent prescription drug abuse among beneficiaries. The use of PRR programs will assign patients who are at-risk for opioid dependence to predesignated pharmacies and prescribers to better manage appropriate care and monitor prescriptions of opioid drugs for Medicare beneficiaries.<br/> <br/> '''S. 524 - 2015 Comprehensive Addiction Recovery Act:''' This legislation was re-introduced on February 15, 2015, by U.S. Senators Sheldon Whitehouse and Rob Portman and was co-sponsored by 13 additional Senators. A House of Representatives companion bill, HR 953 has also been introduced. This legislation will expand prevention and education efforts, expand access to the overdose-reversing drug Naloxone, support alternative treatment in lieu of incarceration, strengthen the Prescription Drug Monitoring Program and support expansion of the use of evidence-based treatment medications. CARA 2015 designates up to $80 million toward these efforts. This Bill became law in the summer of 2016.<br/> <br/> '''S. 799 - The Protecting our Infants Act:''' Bipartisan legislation introduced on March 19, 2015, by Senator Mitch McConnell and Casey with co-sponsors Kelley Ayotte, Rob Portman and others. Companion bill introduced in the House by Representative Clark with 72 co-sponsors. This bill requires the Agency for Healthcare Research and Quality to report on prenatal opioid abuse and neonatal abstinence syndrome (symptoms of withdrawal in a newborn). The report must include an assessment of existing research on neonatal abstinence syndrome, an evaluation of the causes, and barriers to treatment, an evaluation of treatment for pregnant women with opioids use disorders and infants with neonatal abstinence syndrome, and recommendations on preventing, identifying, and treating opioid dependency in women and neonatal abstinence syndrome. HHS is directed to develop a strategy to address gaps in research and programs and the CDC must provide technical assistance to states to improve neonatal abstinence syndrome surveillance and make surveillance data publicly available. This Bill became law on November 25th 2015.<br/>  

= Examples of State Legislation =

== California (Alameda County) ==

*Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<sup class="reference">[8]</sup>
*California legislation has is in process for reducing treatment fraud and waste: [https://www.behavioral.net/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries [1]]

== Connecticut ==

*[https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm Statute] enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[9]</sup>

== Illinois ==

*[http://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf Statue] enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<sup class="reference">[10]</sup>

== Kentucky ==

*Board rules required by [http://kbml.ky.gov/hb1/Documents/House-Bill-1.pdf statute] enacted September 2012: 48 hour limit on dispensing Schedule II and III controlled substances by physicians. No limit on opioid prescriptions.<sup class="reference">[11]</sup>

== Massachusetts ==

*[https://malegislature.gov/Laws/SessionLaws/Acts/2016/Chapter52 Statute] enacted March 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.<sup class="reference">[12]</sup>
*[http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf Recommendations of the Governor's Opioid Working Group]

== North Carolina ==

*[https://www.ncleg.net/gascripts/billlookup/billlookup.pl?Session=2017&BillID=H243 Statute] enacted January 1, 2017: The Strengthen Opioid Misuse Prevention (STOP) Act of 2017, or STOP Act, is intended to reduce the supply of unused, misused and diverted opioids circulating in NC, reduce “doctor shopping” and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing. NCMB supported passage of the STOP Act.
**Limits on the number of days worth of opioids that may be lawfully prescribed upon initial consultation for acute injuries (no more than a five day supply allowed) and following surgeries (no more than a seven day supply allowed). The STOP Act does NOT limit the amount of opioids that may be prescribed to a chronic pain patient;
**A requirement that prescribers use the NC Controlled Substances Reporting System (NCCSRS), the prescription database that records all controlled substance prescriptions dispensed in outpatient pharmacies across NC. The STOP Act requires prescribers to review the patient’s 12-month history with the NCCSRS before issuing an initial prescription for a Schedule II or Schedule III opioid, and subsequent reviews every three months thereafter, for as long as the patient continues on the drug;
**A requirement that PAs and NPs practicing at pain clinics consult with their supervising physicians prior to prescribing opioids. NOTE: The Board has not determined how it will define “consult”. The most important thing is that a meaningful consultation about the patient and recommended treatment occurs and is documented in the medical record; the Board may ultimately leave it up to PAs, NPs and their supervisors to determine exactly how consultations occur, consistent with its current approach towards physician supervision of PAs and NPs.<sup class="reference">[13]</sup>

== Washington ==

*[http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf Guidelines] and board rules required by [http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Laws/House/2876-S.SL.pdf statute]. Guidelines revised June 2015, board rules implemented between July 2011 and January 2012, and statute enacted January 2010: Pain specialist consultation required prior to prescribing daily morphine equivalent doses of 120mg or greater (with exceptions).<sup class="reference">[14]</sup>
*[http://leadkingcounty.org/about/ Law Enforcement Assisted Diversion]

== Rhode Island ==

*[http://www.health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf Rhode Island's Strategic Plan on Addiction and Overdose]

== New Jersey ==

*[http://www.nj.gov/lps/ca2/pmp/ New Jersey's Prescription Monitoring Program]
*[http://www.pdmpassist.org/pdf/PPTs/DataDrivenPilots/Sources_Usage_LE_Data.pdf Regional Drug Monitoring Initiative]

<br/> [http://www.naco.org/ National Association of Counties ]<br/>  

= Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis =

<br/> Grant Waivers to all 50 States for the IMD Exclusion<br/> [https://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf [2]]<br/>  

*Mandate Prescriber Education
*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses

 

= Federal Legislation =

*'''Affordable Care Act (2010)''' - More than 20 million people received support to get mental health and substance abuse treatment through the 2010 ACA.<sup class="reference">[15]</sup> If it is repealed and its replacement does not offer the same coverage many people will be unable to get to access treatment for addiction. The New York Time's Editorial Board states that "repealing the health care law is likely to exacerbate the crisis."<sup class="reference">[16]</sup>

 

= Sample Protocol for State Law Adoption =

'''[[Illinois_SB2928|Illinois]]''' '''[[Illinois_SB2928|SB2928]]''' is a current law with the common name '''"'''Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. <sup class="reference">[17]</sup><sup class="reference">[18]</sup> It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. <sup class="reference">[19]</sup> The lead Project Coordinator Bill Gentes has as a result been awarded CADCA's Advocate of the Year.<sup class="reference">[20]</sup> The following steps were used in the creation, adoption and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

#Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one review current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
#Partnering with Local Law Enforcement - As stated by Gentes at an interview "“''circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process''."<sup class="reference">[21]</sup> In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more. <sup class="reference">[22]</sup>
#Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference...''.'look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process.'''"<sup class="reference">[23]</sup>
#Securing Public-Private Partnerships - Walgreens has been approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be issue with a need to review current laws regarding drug disposal. <sup class="reference">[24]</sup> This has as a result increased the capacity of the project and accompanying police force in collection efforts.
#Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support. <sup class="reference">[25]</sup>
#Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments. <sup class="reference">[26]</sup><sup class="reference">[27]</sup>

 

= Lobbying Legally =

501(c)3 organizations (tax-exempt non-profits) have some restrictions on lobbying in the government. [http://www.cadca.org/sites/default/files/resource/files/strat31.pdf This guide] explains federal laws on non-profit lobbying for policy changes.

[[File:LegalLobbying.PNG|LegalLobbying.PNG]]<sup class="reference">[28]</sup>

== Key Lobbying Rules ==

*The IRS defines '''direct lobbying''' as: "A direct lobbying communication is any attempt to influence any legislation through communication with:Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation."
**Direct Lobbying Communication is defined as: "Referring to specific legislation and reflects a view on such legislation"
*The IRS defines '''grassroots lobbying''' as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof"
**Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation"

<br/> Lobbying that falls under either the grassroots or direct lobbying definition is restricted, but not prohibited. See Tools & Resources.<br/>  

== Key Lobbying Groups ==

=== FedUp! ===

*A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids
*FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies

<br/> To learn more go to: [http://feduprally.org/ [3]]

= Tools & Resources =

[[TR_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|TR - Adopt Key Legislative & Policy Changes to Address the Opioid Crisis]]

= Scorecard Building =

<span style="background-color: #ffffff">[[PO_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Objective Details]]</span><br/> <span style="background-color: #ffffff">[[PM_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Measures and Data Sources]]</span><br/> <span style="background-color: #ffffff">[[PA_-_Adopt_Key_Legislative_&_Policy_Changes_to_Address_the_Opioid_Crisis|Potential Actions and Partners]]</span>

= Resources to Investigate =

[[RTI_-_Adopt_Key_Legislative_&_Policy_Changes|RTI - Adopt Key Legislative & Policy Changes]]<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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[http://www.cnn.com/2016/04/28/opinions/massachusetts-opioid-treatment-prince-vox/?iid=ob_article_organicsidebar_expansion [4]]
#[http://www.modernhealthcare.com/article/20160615/NEWS/160619941?utm_source=modernhealthcare&utm_medium=email&utm_content=20160615-NEWS-160619941&utm_campaign=am [5]]
#[http://www.ucirvinehealth.org/health-library/content/?contentTypeID=6&contentID=712214 [6]]
#[http://content.healthaffairs.org/content/35/10/1876.abstract [7]]
#[https://www.justice.gov/file/822231/download [8]]
#[http://www.countyhealthrankings.org/policies/good-samaritan-drug-overdose-laws [9]]
#[http://lawatlas.org/query?dataset=good-samaritan-overdose-laws [10]]
#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [11]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [12]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [13]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [14]]
##************ [https://www.ncmedboard.org/resources-information/professional-resources/publications/forum-newsletter/notice/new-summary-of-ncs-new-opioids-law-the-stop-act [15]]
#[https://www.nga.org/files/live/sites/NGA/files/pdf/2016/1607NGAOpioidRoadMap.pdf [16]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [17]]
#[https://www.nytimes.com/2017/01/16/opinion/young-victims-of-the-opioid-epidemic.html [18]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [19]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [20]]
#[http://police.mundelein.org/content/pill-disposal-program [21]]
#[http://www.cadca.org/resources/coalitions-action-how-bill-helped-pass-law [22]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [23]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [24]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [25]]
#[http://police.mundelein.org/content/pill-disposal-program [26]]
#[http://www.ilga.gov/legislation/98/SB/09800SB2928.htm [27]]
#[http://police.mundelein.org/content/pill-disposal-program [28]]
#[http://www.routefifty.com/2016/04/illinois-county-provides-model-get-pill-disposal-program-and-running/127855/ [29]]
#[http://www.cadca.org/sites/default/files/resource/files/strat31.pdf [30]]
</div> </div>
[[Category:Pages with broken file links]]

Adopt Harm Reduction Practices in Jails and Prisons

2018-12-03T20:23:33Z

KaralynK:

<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]] or [[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]

= Background =

Hepatitis C

Hepatitis C is more than three times more prevalent among people who inject drugs than HIV. In most countries, more than half the people who inject drugs live with Hepatitis C.<br/>   The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population: between 12 and 35 percent of prison inmates are infected with hepatitis C, compared to between 1 and 2 percent of the general population.<sup class="reference">[1]</sup><br/>   Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C."<sup class="reference">[2]</sup>

  One way to prevent the spread of Hepatitis C is to treat infected prisoners.<br/>   WHO, the United Nations Office on Drugs and Crime and UNAIDS recommended in 2007 that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs (NSPs) urgently."<sup class="reference">[3]</sup>

  An analysis of studies of European Prison NSPs "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy."<sup class="reference">[4]</sup>

  There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hep C transmission for the individual prisoners. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, during which they are unable to access long term drug treatment, and return to the wider community having been at significantly higher risk of Blood Borne Virus transmission and subsequently more likely to pass on Blood Borne Viruses. For this reason prisons have been called HIV and Hep C incubators.<sup class="reference">[5]</sup><br/>  

 

=== Syringe Economy ===

Syringes in prisons without Needle Syringe programs are sold on illicit markets and very expensive, given high demand and scarcity. In prisons where NSPs operate however, there has not been any illicit market reported where needles and syringes are accessible.<sup class="reference">[6]</sup><br/>  

 

= Prison Needle Syringe Program Studies =

These findings come from a Harm Reduction International study on HIV, Hep C, TB and Harm Reduction in Prisons<sup class="reference">[7]</sup> . This 2016 study found that:

 

*Prison NSPs are feasible and affordable across a wide range of prison settings
*Prison NSP are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood borne virus transmission between prisoners and from prisoners to prison staff
*Prison NSP are not associated with increased attacks on prison staff or other prisoners
*Prison NSP do not lead to increased initiation of drug consumption or injection
*Prison NSP contribute to workplace safety
*Prison NSP can reduce the incidence of acscesses
*Prison NSP facilitate referral to available drug-dependence treatment programs
*Prison NSP can be delivered successfully via a range of methods in response to staff and inmate needs
*Prison NSP are effective in a wide range of prison systems
*Prison NSP can successfully coexist with other drug prevention and drug dependence treatment programs

<br/> Important factors in the success of prison NSPs include:

*Easy and confidential access to the service
*Providing the right type of syringes
*Building trust with the prisoners accessing the program

<br/> Germany, Switzerland, and Spain had 19 programs in total by 2000. Evaluations of these pilot programs have shown that the aims of the programs have been achieved. These include:

*Reduction in syringe sharing
*Subsequent reduction in Blood borne Virus rates
*No increase in drug use
*No syringes used as weapons

= Models of Prison NSPs =

There are four main models of prison needle exchange programs

 

#'''Hand-to-hand distribution by prison health staff, social workers, physicians, or nurses'''. This method is used in several Spanish and Swiss prisons. The used syringes are either exchanged at the cell door or in the medical unit.
#'''Hand-to-hand distribution by trained peers''' (i.e., prisoners) to ensure confidential contact with prisoners who use drugs as well as access at almost all times. This system is mostly used in Moldovan prisons.
#'''Hand-to-hand distribution by external personnel or NGOs''' who also provide other harm reduction services.
#'''Automated dispensing machines''' e.g., Germany and Hindelbank women's prison, Switzerland (one-for-one exchange, starting with a dummy syringe as the first device).

= Tools & Resources =

[[TR_-_Adopt_Harm_Reduction_Practices_in_Prisons|TR - Adopt Harm Reduction Practices in Prisons]]

= Scorecard Building =

[[PO_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Objective Details]]<br/> [[PM_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Harm_Reduction_Practices_in_Prisons|More RTI on Adopt Harm Reduction Practices in Prisons]]<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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.globalcommissionondrugs.org/hepatitis/gcdp_hepatitis_english.pdf [1]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [2]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [3]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [4]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [5]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [6]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [7]]
</div> </div> </div> </div>

Adopt Harm Reduction Practices in Jails and Prisons

2018-12-03T20:22:59Z

KaralynK:

<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]] or [[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]

= Background =

Hepatitis C

Hepatitis C is more than three times more prevalent among people who inject drugs than HIV. In most countries, more than half the people who inject drugs live with Hepatitis C.
The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population: between 12 and 35 percent of prison inmates are infected with hepatitis C, compared to between 1 and 2 percent of the general population.<sup class="reference">[1]</sup>
Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C."<sup class="reference">[2]</sup>

One way to prevent the spread of Hepatitis C is to treat infected prisoners.
WHO, the United Nations Office on Drugs and Crime and UNAIDS recommended in 2007 that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs (NSPs) urgently."<sup class="reference">[3]</sup>

An analysis of studies of European Prison NSPs "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy."<sup class="reference">[4]</sup>

There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hep C transmission for the individual prisoners. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, during which they are unable to access long term drug treatment, and return to the wider community having been at significantly higher risk of Blood Borne Virus transmission and subsequently more likely to pass on Blood Borne Viruses. For this reason prisons have been called HIV and Hep C incubators.<sup class="reference">[5]</sup>

=== Syringe Economy ===

Syringes in prisons without Needle Syringe programs are sold on illicit markets and very expensive, given high demand and scarcity. In prisons where NSPs operate however, there has not been any illicit market reported where needles and syringes are accessible.<sup class="reference">[6]</sup>

= Prison Needle Syringe Program Studies =

These findings come from a Harm Reduction International study on HIV, Hep C, TB and Harm Reduction in Prisons<sup class="reference">[7]</sup> . This 2016 study found that:

*Prison NSPs are feasible and affordable across a wide range of prison settings
*Prison NSP are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood borne virus transmission between prisoners and from prisoners to prison staff
*Prison NSP are not associated with increased attacks on prison staff or other prisoners
*Prison NSP do not lead to increased initiation of drug consumption or injection
*Prison NSP contribute to workplace safety
*Prison NSP can reduce the incidence of acscesses
*Prison NSP facilitate referral to available drug-dependence treatment programs
*Prison NSP can be delivered successfully via a range of methods in response to staff and inmate needs
*Prison NSP are effective in a wide range of prison systems
*Prison NSP can successfully coexist with other drug prevention and drug dependence treatment programs

<br/> Important factors in the success of prison NSPs include:

*Easy and confidential access to the service
*Providing the right type of syringes
*Building trust with the prisoners accessing the program

<br/> Germany, Switzerland, and Spain had 19 programs in total by 2000. Evaluations of these pilot programs have shown that the aims of the programs have been achieved. These include:

*Reduction in syringe sharing
*Subsequent reduction in Blood borne Virus rates
*No increase in drug use
*No syringes used as weapons

= Models of Prison NSPs =

There are four main models of prison needle exchange programs

#'''Hand-to-hand distribution by prison health staff, social workers, physicians, or nurses'''. This method is used in several Spanish and Swiss prisons. The used syringes are either exchanged at the cell door or in the medical unit.
#'''Hand-to-hand distribution by trained peers''' (i.e., prisoners) to ensure confidential contact with prisoners who use drugs as well as access at almost all times. This system is mostly used in Moldovan prisons.
#'''Hand-to-hand distribution by external personnel or NGOs''' who also provide other harm reduction services.
#'''Automated dispensing machines''' e.g., Germany and Hindelbank women's prison, Switzerland (one-for-one exchange, starting with a dummy syringe as the first device).

= Tools & Resources =

[[TR_-_Adopt_Harm_Reduction_Practices_in_Prisons|TR - Adopt Harm Reduction Practices in Prisons]]

= Scorecard Building =

[[PO_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Objective Details]]<br/> [[PM_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Harm_Reduction_Practices_in_Prisons|More RTI on Adopt Harm Reduction Practices in Prisons]]<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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.globalcommissionondrugs.org/hepatitis/gcdp_hepatitis_english.pdf [1]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [2]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [3]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [4]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [5]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [6]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [7]]
</div> </div> </div>

Adopt Harm Reduction Practices in Jails and Prisons

2018-12-03T20:22:47Z

KaralynK:

<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]] or [[ZOOM_Map_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]]

= Background =
<div id="toc">
 
</div>
=== Hepatitis C ===

Hepatitis C is more than three times more prevalent among people who inject drugs than HIV. In most countries, more than half the people who inject drugs live with Hepatitis C.
The level of Hepatitis C infection amongst US prisoners is substantially higher than the general population: between 12 and 35 percent of prison inmates are infected with hepatitis C, compared to between 1 and 2 percent of the general population.<sup class="reference">[1]</sup>
Global HIV prevalence is up to 50 times higher among the prison population than in the general public, while one in four detainees worldwide is living with Hepatitis C."<sup class="reference">[2]</sup>

One way to prevent the spread of Hepatitis C is to treat infected prisoners.
WHO, the United Nations Office on Drugs and Crime and UNAIDS recommended in 2007 that "prison authorities in countries experiencing or threatened by an epidemic of HIV infections among people who inject drugs should introduce and scale up Needle and Syringe Programs (NSPs) urgently."<sup class="reference">[3]</sup>

An analysis of studies of European Prison NSPs "Ten Year of Experience with Needle and Syringe Exchange Programs in European Prisons" concluded that prison NSPs are not only feasible but effective, especially when embedded within a comprehensive prison-based harm reduction and health-promotion strategy."<sup class="reference">[4]</sup>

There is increasing evidence that experience of imprisonment is a strong predictor of HIV and Hep C transmission for the individual prisoners. Nor is this an issue confined to prison. A majority of prisoners serve short-term sentences, during which they are unable to access long term drug treatment, and return to the wider community having been at significantly higher risk of Blood Borne Virus transmission and subsequently more likely to pass on Blood Borne Viruses. For this reason prisons have been called HIV and Hep C incubators.<sup class="reference">[5]</sup>

=== Syringe Economy ===

Syringes in prisons without Needle Syringe programs are sold on illicit markets and very expensive, given high demand and scarcity. In prisons where NSPs operate however, there has not been any illicit market reported where needles and syringes are accessible.<sup class="reference">[6]</sup>

= Prison Needle Syringe Program Studies =

These findings come from a Harm Reduction International study on HIV, Hep C, TB and Harm Reduction in Prisons<sup class="reference">[7]</sup> . This 2016 study found that:

*Prison NSPs are feasible and affordable across a wide range of prison settings
*Prison NSP are effective in decreasing syringe sharing among people who inject drugs in prison, thereby decreasing the risk of blood borne virus transmission between prisoners and from prisoners to prison staff
*Prison NSP are not associated with increased attacks on prison staff or other prisoners
*Prison NSP do not lead to increased initiation of drug consumption or injection
*Prison NSP contribute to workplace safety
*Prison NSP can reduce the incidence of acscesses
*Prison NSP facilitate referral to available drug-dependence treatment programs
*Prison NSP can be delivered successfully via a range of methods in response to staff and inmate needs
*Prison NSP are effective in a wide range of prison systems
*Prison NSP can successfully coexist with other drug prevention and drug dependence treatment programs

<br/> Important factors in the success of prison NSPs include:

*Easy and confidential access to the service
*Providing the right type of syringes
*Building trust with the prisoners accessing the program

<br/> Germany, Switzerland, and Spain had 19 programs in total by 2000. Evaluations of these pilot programs have shown that the aims of the programs have been achieved. These include:

*Reduction in syringe sharing
*Subsequent reduction in Blood borne Virus rates
*No increase in drug use
*No syringes used as weapons

= Models of Prison NSPs =

There are four main models of prison needle exchange programs

#'''Hand-to-hand distribution by prison health staff, social workers, physicians, or nurses'''. This method is used in several Spanish and Swiss prisons. The used syringes are either exchanged at the cell door or in the medical unit.
#'''Hand-to-hand distribution by trained peers''' (i.e., prisoners) to ensure confidential contact with prisoners who use drugs as well as access at almost all times. This system is mostly used in Moldovan prisons.
#'''Hand-to-hand distribution by external personnel or NGOs''' who also provide other harm reduction services.
#'''Automated dispensing machines''' e.g., Germany and Hindelbank women's prison, Switzerland (one-for-one exchange, starting with a dummy syringe as the first device).

= Tools & Resources =

[[TR_-_Adopt_Harm_Reduction_Practices_in_Prisons|TR - Adopt Harm Reduction Practices in Prisons]]

= Scorecard Building =

[[PO_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Objective Details]]<br/> [[PM_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Measures and Data Sources]]<br/> [[PA_-_Adopt_Harm_Reduction_Practices_in_Prisons|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Adopt_Harm_Reduction_Practices_in_Prisons|More RTI on Adopt Harm Reduction Practices in Prisons]]<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>

{| class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.globalcommissionondrugs.org/hepatitis/gcdp_hepatitis_english.pdf [1]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [2]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [3]]
#[http://www.aivl.org.au/wp-content/uploads/NSP-in-Prisons-An-International-Review.pdf [4]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [5]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [6]]
#[https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf [7]]
</div> </div>

Accelerate the Development of New MAT Approaches

2018-12-03T16:40:06Z

KaralynK:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
Return to [[ZOOM_Map_-_Expand_Access_to_MAT|the Zoom Map (Expand Access to Optimized MAT)]]<span style="font-size: 13px;"></span><span style="font-size: 13px;">or </span>[[Expand_Access_to_Medication-Assisted_Treatment|Expand Access to Optimized Medication-Assisted Treatment]]

__TOC__

= Background =

The role of medications in helping people with Substance Use Disorders is significant. It is logical to think that all the potential options of Medication-Assisted Treatments (MAT) have not yet been discovered and researched. Rather than just limit our thinking to those that have been discovered and researched, a comprehensive strategy should include efforts to expand innovation and research to add new MAT options to the toolkit for helping people.

  FDA is loosening the standards to speed the development of new practices to the market.<br/> [https://www.healthaffairs.org/do/10.1377/hblog20180320.58853/full/ https://www.healthaffairs.org/do/10.1377/hblog20180320.58853/full/]

 

= Promising Options for New Approaches =

== The Sinclair Method ==

[https://www.the-sinclair-method.com/ The Sinclair Method] has shown significant success in helping people achieve long-lasting success over alcoholism. This approach focuses on retraining the brain to reduce or eliminate the cravings that people have by having them take Naltrexone before drinking so their brain learns that alcohol no longer provides the effect it previously did, and the cravings dissipate. The Sinclair Method has been very effective in helping people recover from alcoholism (with claims up 80% success rates), and it is the standard approach to treating alcoholism in Finland.<sup class="reference">[1]</sup> More information is needed on whether this approach has been shown to be effective in helping people with Opioid Use Disorder (OUD). The [http://www.cthreefoundation.org/home.html 3-C Foundation] provides resources on this approach for dealing with alcoholism.<br/> <br/> One topic that needs research but could be very powerful is to use an approach similar to the Sinclair Method that seems to have a high track record of success to help break people's cravings for opioid drugs. Here are some articles on the Sinclair Method as a way to treat alcohol addiction.<br/> [https://www.the-sinclair-method.com/ [1]]<br/> [https://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone [2]]<br/> [http://www.centersite.net/poc/view_doc.php?type=doc&id=11132&cn=14 [3]]<br/> [http://addictionthenextstep.com/blog/new-vancouver-based-companys-innovative-approach-makes-treatment-naltrexone-available-every-canadian-battling-alcohol-problem/ [4]]<br/> [https://contral.com/?lang=en [5]]<br/> [http://www.sinclairmethod.com/index_files/Page399.htm [6]]

== Add Other Promising New Approaches... ==

 

= Universities =

Specific universities and colleges have centers and professors that focus on research in the area of addiction and treatment

 

*[https://medicine.umich.edu/dept/psychiatry/programs/addiction-center University of Michigan Addiction Center (UMAC)]
*[https://med.virginia.edu/uva-clear/ University of Virginia: Center for Leading Edge Addiction Research]

= Tools & Resources =

[[TR_-_Accelerate_the_Development_of_New_MAT_Approaches|TR - Accelerate the Development of New MAT Approaches]]

= Scorecard Building =

[[PO_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Objective Details]]<br/> [[PM_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Measures and Data Sources]]<br/> [[PA_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Accelerate_the_Development_of_New_Mat_Approaches|More RTI on Accelerate the Development of New Mat Approaches]]<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>

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone [7]]
</div> </div> </div>

Accelerate the Development of New MAT Approaches

2018-12-03T16:39:43Z

KaralynK:

<div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
= Accelerate the Development of New MAT Approaches =
<span style="background-color: #ffffff">Return to </span>[[ZOOM_Map_-_Expand_Access_to_MAT|the Zoom Map (Expand Access to Optimized MAT)]] <span style="background-color: #ffffff">or </span>[[Expand_Access_to_Medication-Assisted_Treatment|Expand Access to Optimized Medication-Assisted Treatment]] <div id="toc">
=   =
</div>

__TOC__
= Background =

The role of medications in helping people with Substance Use Disorders is significant. It is logical to think that all the potential options of Medication-Assisted Treatments (MAT) have not yet been discovered and researched. Rather than just limit our thinking to those that have been discovered and researched, a comprehensive strategy should include efforts to expand innovation and research to add new MAT options to the toolkit for helping people.

  FDA is loosening the standards to speed the development of new practices to the market.<br/> [https://www.healthaffairs.org/do/10.1377/hblog20180320.58853/full/ https://www.healthaffairs.org/do/10.1377/hblog20180320.58853/full/]

 

= Promising Options for New Approaches =

== The Sinclair Method ==

[https://www.the-sinclair-method.com/ The Sinclair Method] has shown significant success in helping people achieve long-lasting success over alcoholism. This approach focuses on retraining the brain to reduce or eliminate the cravings that people have by having them take Naltrexone before drinking so their brain learns that alcohol no longer provides the effect it previously did, and the cravings dissipate. The Sinclair Method has been very effective in helping people recover from alcoholism (with claims up 80% success rates), and it is the standard approach to treating alcoholism in Finland.<sup class="reference">[1]</sup> More information is needed on whether this approach has been shown to be effective in helping people with Opioid Use Disorder (OUD). The [http://www.cthreefoundation.org/home.html 3-C Foundation] provides resources on this approach for dealing with alcoholism.<br/> <br/> One topic that needs research but could be very powerful is to use an approach similar to the Sinclair Method that seems to have a high track record of success to help break people's cravings for opioid drugs. Here are some articles on the Sinclair Method as a way to treat alcohol addiction.<br/> [https://www.the-sinclair-method.com/ [1]]<br/> [https://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone [2]]<br/> [http://www.centersite.net/poc/view_doc.php?type=doc&id=11132&cn=14 [3]]<br/> [http://addictionthenextstep.com/blog/new-vancouver-based-companys-innovative-approach-makes-treatment-naltrexone-available-every-canadian-battling-alcohol-problem/ [4]]<br/> [https://contral.com/?lang=en [5]]<br/> [http://www.sinclairmethod.com/index_files/Page399.htm [6]]

== Add Other Promising New Approaches... ==

 

= Universities =

Specific universities and colleges have centers and professors that focus on research in the area of addiction and treatment

 

*[https://medicine.umich.edu/dept/psychiatry/programs/addiction-center University of Michigan Addiction Center (UMAC)]
*[https://med.virginia.edu/uva-clear/ University of Virginia: Center for Leading Edge Addiction Research]

= Tools & Resources =

[[TR_-_Accelerate_the_Development_of_New_MAT_Approaches|TR - Accelerate the Development of New MAT Approaches]]

= Scorecard Building =

[[PO_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Objective Details]]<br/> [[PM_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Measures and Data Sources]]<br/> [[PA_-_Accelerate_the_Development_of_New_Mat_Approaches|Potential Actions and Partners]]

= Resources to Investigate =

[[More_RTI_on_Accelerate_the_Development_of_New_Mat_Approaches|More RTI on Accelerate the Development of New Mat Approaches]]<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>

{| border="1" class="wiki_table"
|-
| '''Reviewer'''
| '''Date'''
| '''Comments'''
|-
|  
|  
|  
|}

= Sources =

----

#[https://www.psychologytoday.com/blog/overcoming-addiction/201307/drink-your-way-sober-naltrexone [7]]
</div> </div>

About SAFE Solutions

2018-12-03T16:38:35Z

KaralynK:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">

__TOC__

= Brief History =

The Opioid Coalition Resource Hub (OCRH) was created to help community coalitions and states more effectively respond to our nations sweeping opioid epidemic. No community or state has solved this crisis, so it is a "moon shot" that requires a blend of rapid learning, use of research, and unprecedented collaboration along wit continuous innovation and pro-active problem-solving to accelerate progress. In spite of many years working to address substance abuse in general and the various stages of the opioid crisis, communities and their local coalitions are still struggling to make significant progress.

  Some people working to address the crisis are still looking for a silver-bullet fix, the one program or effort that will solve this issue. The OCRH is based on the thinking that there is no silver-bullet intervention that will solve this crisis, but rather that a robust, multi-faceted strategy is needed to simultaneously address as many factors as practical and use as many available resources as can be harnessed to implement that strategy. Beginning in late 2015, a team of consultants at [http://www.insightformation.com InsightFormation, Inc.], who work on advanced practices in [https://www.insightformation.com/implementing-population-health-strategies/ community strategy implementation] began to review the growing number of "comprehensive" recommendations that were coming out from groups like the Governor's Council on Alcoholism and Drug Abuse, the U.S. Surgeon General's report, numerous strategic recommendations from states or large prescription drug abuse task forces, the DEA, SAMHSA, medical associations, the National Governor's Association, law enforcement groups, and other respected sources of information. Some reports were hundreds of pages long, and many had some similar recommendations but most had a variety of recommendations that were not included in other reports. Many recommendations were worded differently but essentially pointed in the same direction. Some were more high-level and others were focused on specific groups like pain professionals or local health departments. We initially started by developing a consolidated list of strategy recommendations and attempted to organize them in broad categories and then decided to develop a master "strategy map" template so states or coalitions that were working on a strategy would not have to expend precious time and resources repeating the exhausting task of trying to create a comprehensive framework.

  In early 2016, we realized that just having a strategy map would be helpful, but communities would either be stuck without a means to make progress on all the important objectives or they would spend their resources in re-creating the means for trying to advance various strategies. So, we decided to share the strategy map as a free, open source tool that would continue to be refined, and we decided to being building out a free, open-source knowledge repository structured around the strategy map. Since the top priority audience for these resources were state and community coalitions, we launched this as the '''Opioid Coalition Resource Hub'''. We chose to use a wiki platform and try to adopt practices (like using footnotes to link to the source of information as often as possible) to enable people to apply good judgement in how they rely on the information in the OCRH.

  The OCRH is a carefully-structured and continuously growing compilation of evidence-based strategies, innovative ideas, and lessons learned, and tools to help support understanding and implementation of plans to achieve positive change. When implemented in parallel and as a coordinated effort, these strategies can help communities make faster and more successful progress in achieving the important outcomes we hope to see: less people dying of overdoses, more people in successful recovery, and vibrant communities with hope.

  The OCRH is continually evolving as new tools, products, and ideas are developed and as new research emerges and communities gain experience attempting the various strategies. New information--including ideas and research or links to communities working on similar approaches--is added nearly every day. Communities do not have to wait for rigorous evidence-based practices to start taking action in their community. Many of the strategies that communities are using or may attempt to use may never be part of a rigorous research study because the problems and potential solutions are evolving so quickly and the factors are so complex that doing research is very difficult and expensive. Have you ever tried to get research funding for a new innovation that will likely evolve repeatedly as those attempting to use it learn and make adjustments?

  As the OCRH matures, each strategy page will equip communities with ideas to take immediate action, tools, lessons learned, options for creatively engaging under-utilized partners, and suggestions of ways to practically measure progress. The more organizations, coalitions, universities and other stakeholders use this an add information to it, the faster communities can learn and implement the most effective interventions in the most efficient ways. In 2018, we hope to have more and more pages adopted by individuals who care about the topic and who can identify an independent expert to periodically review and add comments to each significant page.<br/>  

 

= Are the Strategies and Ideas in the OCRH Evidence-Based? =

The OCRH has been influenced by a variety of national, state and local strategic plans including, but not limited to: [https://www.samhsa.gov/programs-campaigns SAMHSA], [http://www.cadca.org/resources CADCA], [https://www.cdc.gov/drugoverdose/prescribing/guideline.html CDC], [https://www.whitehouse.gov/ondcp/presidents-commission President's Commission]. In many ways, the strategy map framework is a robust and comprehensive Theory of Change to solve a problem that has never been solved (the opioid epidemic). So, it is technically impossible to have a comprehensive strategy map or theory of change that has been demonstrated to solve the problem we are facing. When NASA began plans to put a man on the moon and bring him back safely, they did not rely on only using evidence-based techniques but instead systematically broke the big challenge into many smaller challenges and brought the best combination of science, innovation and pro-active risk management to develop a strategy and them implement that strategy. We believe a similar mindset is appropriate here. (The opioid crisis is much harder to solve due to the complexity when compared to the Apollo mission, which was a big complicated engineering problem, but without as many constantly changing complexity of the opioid crisis.) There are some great management lessons from the Apollo program in [https://www.youtube.com/watch?v=RaskWhy5pYE this presentation].

  We want to see the OCRH grow as a dynamic platform that dramatically accelerates the learning of what is possible, what is being tried, what is working, how can interventions be improved, and what data is being collected for accelerated research. We are adding (and "crowd-sourcing" ideas for measures and hope that the most sensible measures will be highlighted and that many coalitions or regions would start measuring things in the same way to enhance data collection and subsequent research on the strategies that are being attempted.

  As much as we hope to bring visibility to interventions and innovations that work, we want to bring visibility to things that don't work and then determine if adjustments or "assists" could improve their success or if the evidence indicates that the idea should be abandoned.<br/>  

 

= Why Strategy Maps? =
<br/> There are several [[Why_Strategy_Maps?|reasons for using the Strategy Map format]] as opposed to logic models or driver diagrams to structure a strategy for an issues such as the opioid crisis. Strategy maps are a well-established tool for strategy implementation with over 20 years of success. They are therefore both a well-established evidence-based approach for improving the implementation of complex strategies (something very much needed for addressing the opioid crisis) and also a valuable innovation in that this proven technique and the rich body of knowledge of how to use it has not been used much in public health and for helping communities address the opioid crisis.</div> </div> </div> </div>

About SAFE Solutions

2018-12-03T16:37:17Z

KaralynK:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
= Brief History =

The Opioid Coalition Resource Hub (OCRH) was created to help community coalitions and states more effectively respond to our nations sweeping opioid epidemic. No community or state has solved this crisis, so it is a "moon shot" that requires a blend of rapid learning, use of research, and unprecedented collaboration along wit continuous innovation and pro-active problem-solving to accelerate progress. In spite of many years working to address substance abuse in general and the various stages of the opioid crisis, communities and their local coalitions are still struggling to make significant progress.

  Some people working to address the crisis are still looking for a silver-bullet fix, the one program or effort that will solve this issue. The OCRH is based on the thinking that there is no silver-bullet intervention that will solve this crisis, but rather that a robust, multi-faceted strategy is needed to simultaneously address as many factors as practical and use as many available resources as can be harnessed to implement that strategy. Beginning in late 2015, a team of consultants at [http://www.insightformation.com InsightFormation, Inc.], who work on advanced practices in [https://www.insightformation.com/implementing-population-health-strategies/ community strategy implementation] began to review the growing number of "comprehensive" recommendations that were coming out from groups like the Governor's Council on Alcoholism and Drug Abuse, the U.S. Surgeon General's report, numerous strategic recommendations from states or large prescription drug abuse task forces, the DEA, SAMHSA, medical associations, the National Governor's Association, law enforcement groups, and other respected sources of information. Some reports were hundreds of pages long, and many had some similar recommendations but most had a variety of recommendations that were not included in other reports. Many recommendations were worded differently but essentially pointed in the same direction. Some were more high-level and others were focused on specific groups like pain professionals or local health departments. We initially started by developing a consolidated list of strategy recommendations and attempted to organize them in broad categories and then decided to develop a master "strategy map" template so states or coalitions that were working on a strategy would not have to expend precious time and resources repeating the exhausting task of trying to create a comprehensive framework.

  In early 2016, we realized that just having a strategy map would be helpful, but communities would either be stuck without a means to make progress on all the important objectives or they would spend their resources in re-creating the means for trying to advance various strategies. So, we decided to share the strategy map as a free, open source tool that would continue to be refined, and we decided to being building out a free, open-source knowledge repository structured around the strategy map. Since the top priority audience for these resources were state and community coalitions, we launched this as the '''Opioid Coalition Resource Hub'''. We chose to use a wiki platform and try to adopt practices (like using footnotes to link to the source of information as often as possible) to enable people to apply good judgement in how they rely on the information in the OCRH.

  The OCRH is a carefully-structured and continuously growing compilation of evidence-based strategies, innovative ideas, and lessons learned, and tools to help support understanding and implementation of plans to achieve positive change. When implemented in parallel and as a coordinated effort, these strategies can help communities make faster and more successful progress in achieving the important outcomes we hope to see: less people dying of overdoses, more people in successful recovery, and vibrant communities with hope.

  The OCRH is continually evolving as new tools, products, and ideas are developed and as new research emerges and communities gain experience attempting the various strategies. New information--including ideas and research or links to communities working on similar approaches--is added nearly every day. Communities do not have to wait for rigorous evidence-based practices to start taking action in their community. Many of the strategies that communities are using or may attempt to use may never be part of a rigorous research study because the problems and potential solutions are evolving so quickly and the factors are so complex that doing research is very difficult and expensive. Have you ever tried to get research funding for a new innovation that will likely evolve repeatedly as those attempting to use it learn and make adjustments?

  As the OCRH matures, each strategy page will equip communities with ideas to take immediate action, tools, lessons learned, options for creatively engaging under-utilized partners, and suggestions of ways to practically measure progress. The more organizations, coalitions, universities and other stakeholders use this an add information to it, the faster communities can learn and implement the most effective interventions in the most efficient ways. In 2018, we hope to have more and more pages adopted by individuals who care about the topic and who can identify an independent expert to periodically review and add comments to each significant page.<br/>  

 

= Are the Strategies and Ideas in the OCRH Evidence-Based? =

The OCRH has been influenced by a variety of national, state and local strategic plans including, but not limited to: [https://www.samhsa.gov/programs-campaigns SAMHSA], [http://www.cadca.org/resources CADCA], [https://www.cdc.gov/drugoverdose/prescribing/guideline.html CDC], [https://www.whitehouse.gov/ondcp/presidents-commission President's Commission]. In many ways, the strategy map framework is a robust and comprehensive Theory of Change to solve a problem that has never been solved (the opioid epidemic). So, it is technically impossible to have a comprehensive strategy map or theory of change that has been demonstrated to solve the problem we are facing. When NASA began plans to put a man on the moon and bring him back safely, they did not rely on only using evidence-based techniques but instead systematically broke the big challenge into many smaller challenges and brought the best combination of science, innovation and pro-active risk management to develop a strategy and them implement that strategy. We believe a similar mindset is appropriate here. (The opioid crisis is much harder to solve due to the complexity when compared to the Apollo mission, which was a big complicated engineering problem, but without as many constantly changing complexity of the opioid crisis.) There are some great management lessons from the Apollo program in [https://www.youtube.com/watch?v=RaskWhy5pYE this presentation].

  We want to see the OCRH grow as a dynamic platform that dramatically accelerates the learning of what is possible, what is being tried, what is working, how can interventions be improved, and what data is being collected for accelerated research. We are adding (and "crowd-sourcing" ideas for measures and hope that the most sensible measures will be highlighted and that many coalitions or regions would start measuring things in the same way to enhance data collection and subsequent research on the strategies that are being attempted.

  As much as we hope to bring visibility to interventions and innovations that work, we want to bring visibility to things that don't work and then determine if adjustments or "assists" could improve their success or if the evidence indicates that the idea should be abandoned.<br/>  

 

= Why Strategy Maps? =
<br/> There are several [[Why_Strategy_Maps?|reasons for using the Strategy Map format]] as opposed to logic models or driver diagrams to structure a strategy for an issues such as the opioid crisis. Strategy maps are a well-established tool for strategy implementation with over 20 years of success. They are therefore both a well-established evidence-based approach for improving the implementation of complex strategies (something very much needed for addressing the opioid crisis) and also a valuable innovation in that this proven technique and the rich body of knowledge of how to use it has not been used much in public health and for helping communities address the opioid crisis.</div> </div> </div>

About SAFE Solutions

2018-12-03T16:36:42Z

KaralynK:

<div class="mw-parser-output"><div class="wiki" id="content_view" style="display: block">
= Brief History =

The Opioid Coalition Resource Hub (OCRH) was created to help community coalitions and states more effectively respond to our nations sweeping opioid epidemic. No community or state has solved this crisis, so it is a "moon shot" that requires a blend of rapid learning, use of research, and unprecedented collaboration along wit continuous innovation and pro-active problem-solving to accelerate progress. In spite of many years working to address substance abuse in general and the various stages of the opioid crisis, communities and their local coalitions are still struggling to make significant progress.

  Some people working to address the crisis are still looking for a silver-bullet fix, the one program or effort that will solve this issue. The OCRH is based on the thinking that there is no silver-bullet intervention that will solve this crisis, but rather that a robust, multi-faceted strategy is needed to simultaneously address as many factors as practical and use as many available resources as can be harnessed to implement that strategy. Beginning in late 2015, a team of consultants at [http://www.insightformation.com InsightFormation, Inc.], who work on advanced practices in [https://www.insightformation.com/implementing-population-health-strategies/ community strategy implementation] began to review the growing number of "comprehensive" recommendations that were coming out from groups like the Governor's Council on Alcoholism and Drug Abuse, the U.S. Surgeon General's report, numerous strategic recommendations from states or large prescription drug abuse task forces, the DEA, SAMHSA, medical associations, the National Governor's Association, law enforcement groups, and other respected sources of information. Some reports were hundreds of pages long, and many had some similar recommendations but most had a variety of recommendations that were not included in other reports. Many recommendations were worded differently but essentially pointed in the same direction. Some were more high-level and others were focused on specific groups like pain professionals or local health departments. We initially started by developing a consolidated list of strategy recommendations and attempted to organize them in broad categories and then decided to develop a master "strategy map" template so states or coalitions that were working on a strategy would not have to expend precious time and resources repeating the exhausting task of trying to create a comprehensive framework.

  In early 2016, we realized that just having a strategy map would be helpful, but communities would either be stuck without a means to make progress on all the important objectives or they would spend their resources in re-creating the means for trying to advance various strategies. So, we decided to share the strategy map as a free, open source tool that would continue to be refined, and we decided to being building out a free, open-source knowledge repository structured around the strategy map. Since the top priority audience for these resources were state and community coalitions, we launched this as the '''Opioid Coalition Resource Hub'''. We chose to use a wiki platform and try to adopt practices (like using footnotes to link to the source of information as often as possible) to enable people to apply good judgement in how they rely on the information in the OCRH.

  The OCRH is a carefully-structured and continuously growing compilation of evidence-based strategies, innovative ideas, and lessons learned, and tools to help support understanding and implementation of plans to achieve positive change. When implemented in parallel and as a coordinated effort, these strategies can help communities make faster and more successful progress in achieving the important outcomes we hope to see: less people dying of overdoses, more people in successful recovery, and vibrant communities with hope.

  The OCRH is continually evolving as new tools, products, and ideas are developed and as new research emerges and communities gain experience attempting the various strategies. New information--including ideas and research or links to communities working on similar approaches--is added nearly every day. Communities do not have to wait for rigorous evidence-based practices to start taking action in their community. Many of the strategies that communities are using or may attempt to use may never be part of a rigorous research study because the problems and potential solutions are evolving so quickly and the factors are so complex that doing research is very difficult and expensive. Have you ever tried to get research funding for a new innovation that will likely evolve repeatedly as those attempting to use it learn and make adjustments?

  As the OCRH matures, each strategy page will equip communities with ideas to take immediate action, tools, lessons learned, options for creatively engaging under-utilized partners, and suggestions of ways to practically measure progress. The more organizations, coalitions, universities and other stakeholders use this an add information to it, the faster communities can learn and implement the most effective interventions in the most efficient ways. In 2018, we hope to have more and more pages adopted by individuals who care about the topic and who can identify an independent expert to periodically review and add comments to each significant page.<br/>  

 

= Are the Strategies and Ideas in the OCRH Evidence-Based? =

The OCRH has been influenced by a variety of national, state and local strategic plans including, but not limited to: [https://www.samhsa.gov/programs-campaigns SAMHSA], [http://www.cadca.org/resources CADCA], [https://www.cdc.gov/drugoverdose/prescribing/guideline.html CDC], [https://www.whitehouse.gov/ondcp/presidents-commission President's Commission]. In many ways, the strategy map framework is a robust and comprehensive Theory of Change to solve a problem that has never been solved (the opioid epidemic). So, it is technically impossible to have a comprehensive strategy map or theory of change that has been demonstrated to solve the problem we are facing. When NASA began plans to put a man on the moon and bring him back safely, they did not rely on only using evidence-based techniques but instead systematically broke the big challenge into many smaller challenges and brought the best combination of science, innovation and pro-active risk management to develop a strategy and them implement that strategy. We believe a similar mindset is appropriate here. (The opioid crisis is much harder to solve due to the complexity when compared to the Apollo mission, which was a big complicated engineering problem, but without as many constantly changing complexity of the opioid crisis.) There are some great management lessons from the Apollo program in [https://www.youtube.com/watch?v=RaskWhy5pYE this presentation].

  We want to see the OCRH grow as a dynamic platform that dramatically accelerates the learning of what is possible, what is being tried, what is working, how can interventions be improved, and what data is being collected for accelerated research. We are adding (and "crowd-sourcing" ideas for measures and hope that the most sensible measures will be highlighted and that many coalitions or regions would start measuring things in the same way to enhance data collection and subsequent research on the strategies that are being attempted.

  As much as we hope to bring visibility to interventions and innovations that work, we want to bring visibility to things that don't work and then determine if adjustments or "assists" could improve their success or if the evidence indicates that the idea should be abandoned.<br/>  

 

= Why Strategy Maps? =
<br/> There are several [[Why_Strategy_Maps?|reasons for using the Strategy Map format]] as opposed to logic models or driver diagrams to structure a strategy for an issues such as the opioid crisis. Strategy maps are a well-established tool for strategy implementation with over 20 years of success. They are therefore both a well-established evidence-based approach for improving the implementation of complex strategies (something very much needed for addressing the opioid crisis) and also a valuable innovation in that this proven technique and the rich body of knowledge of how to use it has not been used much in public health and for helping communities address the opioid crisis.</div> </div>