Tuesday, April 18, 2017 | 8:00 am – 8:45 am

Vision Session
Lessons Learned in Using Social Media to Address Prescription Drug Abuse in Appalachia
Hosted by the Appalachian Regional Commission in cooperation with the CDC National Center for Injury Prevention and Control
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenters:
 
In 2016, five community-based organizations working to address substance abuse problems in Appalachia participated in a pilot Social Media Technical Assistance and Training Program. Sponsored by the CDC Injury Center, Appalachian Regional Commission, and ORAU, the program aimed to develop successful social media strategies for each organization and to identify social media best practices for communicating about substance abuse issues in Appalachia. Each organization received onsite training and technical assistance to develop effective content, increase reach and engagement, launch new social media channels (e.g., Instagram, Snapchat), and monitor metrics to continuously improve their strategies. This session will provide an opportunity for the organizations to share their experiences and lessons learned in developing and implementing a successful social media strategy. This session will also introduce an opportunity for five additional organizations to participate in the 2017 Social Media Training and Technical Assistance Program.
 
Upon completion of this course, participants will be able to:
  • Recognize challenges unique to the Appalachian Region in using social media to communicate about prescription drug abuse
  • Discuss strategies that have worked for community-based organizations in Appalachia to increase reach and engagement
  • Determine ways to incorporate strategies and lessons learned into your own social media program
 
Vision Session
Alternatives to Opioids in Acute-Care Settings: An Invitation for Discussion to All Stakeholders
Hosted by COMPAS Foundation (Coalition to Optimize the Management of Pain Associated with Surgery), a nonprofit foundation
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenter:
 
Acute postsurgical pain is a predictive factor for the development of chronic pain. It is also a fact that management of acute postsurgical pain remains a major challenge for many patients. There are over 100 million inpatient and outpatient surgical procedures performed in the U.S. annually. However, up to 40% of patients report severe or extreme postsurgical pain, leading to the initiation of short-term opioid therapy. Although opioids remain the cornerstone of postsurgical pain management, a high potential for opioid misuse or dependency starts in the acute care setting. Opioids are associated with risk of adverse drug events, which are costly to both patients and hospitals, and delay recovery. Multiple organizations, such as the Joint Commission and the Centers for Disease Control and Prevention, as well as medical societies such as the American Society of Anesthesiologists, American Pain Society, and the American College of Surgeons, have urged a shift toward multimodal analgesic strategies for the treatment of postsurgical pain. Multimodal analgesia is defined as the use of two or more therapies for the management of pain, with the intent being twofold: (1) to use therapies that disrupt different aspects of pain and inflammation that may contribute to postsurgical pain and (2) to reduce the overall dose of any one therapy in order to minimize the risk of side effects. 
 
Founded in 2016, COMPAS is a nonprofit foundation with a mission to increase the awareness and adoption of opioid-sparing pain relief options before, during, and after surgery.  The purpose of this educational session, to be presented by the founding president of COMPAS, Gregory J. Mancini, MD, is to raise awareness regarding the risk of exposure to opioids in the acute setting, as well as to provide strategies for optimal pain control following surgery. The presentation will discuss approaches to implementing new strategies and how to measure patient success and overall benefits to the healthcare system when opioid-minimizing analgesic strategies are employed.
 
Upon completion of this course, participants will be able to:
  • Discuss the risk related to opioid exposure in the postsurgical acute care setting, including opioid-related adverse drug events during recovery and the potential for misuse or abuse of opioids following patient discharge
  • Understand multimodal analgesic strategies that support an opioid-sparing approach by relying on a targeted combination of systemic and local/regional therapies that can provide optimal analgesia, while reducing the risk of opioid-related complications
  • Describe optimal approaches to implementing multimodal strategies for measuring patient success and associated benefits to the healthcare system following implementation of opioid minimization strategies
 
 
Vision Session
Case Study and Outcomes Presentation: Office-Based, ASAM-Consistent Opioid Treatment
Hosted by CleanSlate Centers
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenters:
 
Too many parts of our nation continue to rely on treatment care models shown to have poor outcomes for opioid addiction. One reason is the lack of access to the kinds of opioid treatment which are scientifically and medically shown to be effective. This session will present a case study of delivering effective medication- and evidence-based psychosocial treatment consistent with the ASAM guidelines. Outcomes of care, including 80% decreased risk of hepatitis C, 35% decreased emergency department utilization, and 25% decreased inpatient utilization, will be described, as well as how the program is working with its many partners to make clinically and cost-effective care more accessible.
 
Upon completion of this course, participants will be able to:
  • Describe evidence-based elements of effective office-based opioid treatment practices
  • Understand appropriate outcomes measures for treating opioid addiction
  • Determine ways to ensure access to effective and cost-effective treatment in their communities
 
Vision Session
Working Together to Address the Opioid Crisis: The Wisconsin Experience
Hosted by the National Association of Attorneys General
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenter:
 
By focusing on what actions are needed to solve the nation’s opioid crisis, and not on who’s to blame, partners from many disciplines across Wisconsin have been willing to step forward and contribute to reducing the state’s dependence on heroin and prescription opioids. Policy makers, law enforcement, healthcare professionals, and non-profit organizations have made Wisconsin a leader in policies and strategies, prescriber education, expansion of the prescription drug monitoring program, awareness, treatment alternatives and diversion programs, drug disposal, and harm reduction. Wisconsin Attorney General Brad Schimel created Dose of Reality, an awareness campaign focused on debunking the myths surrounding substance abuse and destroying the stigma associated with addiction. This presentation focuses on the importance of coalition building and provides examples of the innovation that results from collaboration.
 
Upon completion of this course, participants will be able to:
  • Discuss the importance of coalition building to address the opioid crisis
  • Share strategies for bringing together disparate communities
  • Identify key challenges--and ways to address them--when building a coalition
 
Vision Session
Implementing Supervised Injection Sites in the United States
Hosted by RTI International
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenters:
 
Supervised injection sites (also called safer injection facilities or drug consumption rooms) are legally sanctioned locations that provide a hygienic space for people to inject pre-obtained drugs while observed by trained (usually healthcare staff) staff. These sites have the dual aims of increasing the health and safety of people who inject drugs and reducing the public nuisance of having people injecting drugs in public spaces, including on the street or in public restrooms where needles are often discarded. They provide a non-judgmental environment; protected time and space for injecting; appropriate guidance and equipment (e.g., clean needles, naloxone) to reduce harms; proper disposal of used equipment; and onsite or linkage to medical care, substance use treatment, and social services. Ten countries currently allow legal operation of such sites with approximately 98 facilities operating in 66 cities worldwide. The USA is poised to implement this intervention in several cities. This session, chaired by Dr. Kral of RTI International, will provide (1) an overview of how supervised injection sites work (Davidson), (2) an overview of extant supervised injection site research in the USA (Kral), (3) an update on Seattle’s implementation process (Finegood), and (4) an overview of the potential legal issues (Burris). 
 
Upon completion of this course, participants will be able to:
  • Discuss the current state of implementation of supervised injection sites in the USA
  • Uunderstand more about the extant research on supervised injection sites in the USA
  • Explore and understand the legal context for supervised injection sites in the USA
 
Vision Session
Prevention in a Recovery-Oriented System of Care
Hosted by WestCare Foundation
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Presenter:
 
Implementing promising prevention programs and strategies provides opportunities for communities to go “up-stream” and address the risk factors and signs of addiction and mental illness before individuals and families reach a point of crisis. This vision session will focus on the promotion of prevention and its importance alongside the framework of recovery-oriented systems of care for the overall wellness of the community.
 
Upon completion of this course, participants will be able to:
  • Develop an understanding of prevention’s role alongside a recovery-oriented system of care
  • Identify the conceptual areas of agreement between a public health approach and a systems of care approach
  • Take away specific examples of how evidence-based practices can be infused across the continuum of care to provide an integrated service system
 
Vision Session
PATHways Clinic for Pregnant Women With Opioid Use Disorder:  A Tale of Four Passionate Disciplines
Hosted by UK HealthCare
 
 
The Perinatal Assistance and Treatment Home (PATHways) Program, developed in 2013 at the University of Kentucky, is a thriving multidisciplinary and community-based program. This program arose organically in midst of the opioid crisis in Kentucky and in response to the rising number of pregnant women presenting with opioid use disorder and babies born with neonatal opioid withdrawal syndrome at our hospitals. This presentation will describe how a handful of committed professionals with limited resources but a unified mission worked together to develop this program from the ground up. This complex problem required coalescence of obstetrics/gynecology, neonatology, nursing and addiction medicine knowledge/psychiatry, along with commitment, esprit de corps and volunteerism from the individual contributors.  Our program incorporates the best practices in the field, adhering to federal guidelines for office-based buprenorphine treatment. Over the past 2.5 years, PATHways has served over 150 women with high impact results. Both the unique and collaborative developmental history of this program and recent treatment outcomes data will be shared during this interactive panel discussion.
 
Upon completion of this course, participants will be able to:
  • Describe a collaborative care model caring for pregnant women with opioid use disorder
  • Identify key features of the standard of care for pregnant mothers and neonates with opioid use disorder
  • Describe the extent wrap-around support services  are necessary to operationalize evidenced-based perinatal medication-assisted treatment
 
 
Vision Session
HIDTA Heroin Response Strategy: Take-Home Strategies for Your Community
Hosted by the High Intensity Drug Trafficking Areas (HIDTA) program
 
Tuesday, April 18, 2017 | 8:00 am – 8:45 am
 
Panelists:
 
Moderator:
 
The High Intensity Drug Trafficking Areas (HIDTA) program invests in federal, state, local, and tribal law enforcement partnerships to build safe and healthy communities. In this session, attendees from all U.S. communities will take home lessons from the HIDTA Heroin Response Strategy (HRS)--an innovative platform designed to enhance public health-public safety collaboration across eight HIDTA regions, covering 20 states, with the goal of reducing drug overdose deaths. The presenters will explain the structure and key components of HRS, as well as steps taken to ensure successful implementation. The HRS leverages a network of Public Health Analysts (PHAs) and Drug Intelligence Officers (DIOs) in 20 states, spanning Georgia and the Carolinas, Appalachia, the Mid-Atlantic, and the Northeast. Public Health Analysts gather, analyze, and distribute health and safety drug-related data; develop and support data-driven policy and programming initiatives; and facilitate interagency public health-public safety collaboration. Drug Intelligence Officers are experienced law enforcement officers who establish points of contact and facilitate seamless information sharing across jurisdictional boundaries. The presenters will also discuss key HRS partnerships with the Centers for Disease Control and Prevention (CDC), the U.S. Department of Justice's Organized Crime Drug Enforcement Task Force program, and the Partnership for Drug-Free Kids. Based on lessons learned and successes from these partnerships, session participants will be able to take away several strategies to combat heroin use in their own communities.
 
Upon completion of this course, participants will be able to:
  • Describe the HIDTA Heroin Response Strategy
  • Explain how to enhance public health-public safety collaboration to reduce drug overdose deaths
  • Identify effective heroin response strategies that can be replicated in non-HIDTA communities
  • Provide accurate and appropriate counsel as part of the public health-public safety team
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
Track: Heroin
Heroin in Transition: U.S. Regional Differences and Novel Forms
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
The “Heroin in Transition” study investigates new heroin supplies and their relationship to overdose, using quantitative and qualitative methods. In this session, researchers will describe the study and its findings to date. Their analysis suggests that the “heroin” epidemic may not be a single phenomenon.
 
Their conclusions indicate that the regional heroin crises require:
  • Tailored responses.
  • A multi-pronged, balanced response with evidence-based approaches to supply and demand reduction, treatment promotion and harm reduction.
  • Investment in heroin surveillance, including substances in circulation and the expansion and standardization of fentanyl toxicology, to assist in the deployment of locally tailored, evidence-based public health and clinical interventions.
 
Based on original research analyzing governmental data and reports, presenters will examine national trends in opioid pill-related overdose (OPOD) and heroin-related overdose (HOD) for the period of 2004-2013 and compare regional differences and changes in the rates of OPOD and HOD during the period of 2012-2013. HOD patterns show significant regional disparities. Feeding the regional heroin epidemics are emerging heroin source-types and mimics. The previously stable division of the U.S. heroin market between major producers Mexico and Colombia, with two distinct types of heroin, is now in flux. Mexican-sourced heroin has dramatically increased in supply with new routes and novel forms with likely adulteration. Heroin in combination with synthetic opioids (e.g., fentanyls) is so common in the eastern U.S., its presence is becoming acceptable, perhaps even desirable, to users. The presence of fentanyls makes heroin use more unpredictable and deadly than ever before.   
 
Presenters also will share findings from their original qualitative research. With the cooperation of local services, ethnographers conducted 60 semi-structured interviews with active heroin injectors across urban areas in Maryland, Massachusetts and New Hampshire in 2015 and 2016. Heroin injecting and sales were also observed. Users reported that heroin has changed significantly in recent years. For example, Baltimore’s “scramble” heroin has become highly unstable and heavily adulterated with such additives as fentanyl, benzodiazepines and crushed opioid pills, and it is gaining popularity among younger users for its intense rush and low price. Users in the three states live with great uncertainty and fear of overdose, often reporting recent losses of friends and relatives.    
 
Upon completion of this course, participants will be able to:
  • Distinguish regional differences in Rx opioid- and heroin-related overdose.
  • Describe recent changes in the heroin supply including published evidence for contamination/adulteration.
  • List the characteristics and effects of novel East Coast retail heroin.
  • Identify possible strategies for reducing the public health risks associated with heroin.
 
 
Track: Law Enforcement
Case Studies in Collaboration: Public Safety, Public Health and Community Leaders
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
Moderator: 
Connie Payne, JD, Executive Officer, Department of Specialty Courts, Kentucky Administrative Office of the Courts,
and Member, Operation UNITE Board of Directors
 
State and federal drug enforcement have identified Rx drug abuse as a top threat. From the public health perspective, Rx drug abuse has been defined as an epidemic. In addition to those stakeholders, a variety of governmental and community organizations tackle specific aspects of the problem. This session will examine how those efforts can be united for greater impact. While the goals of different organizations might seem irreconcilable at face value, effective interventions can be developed and deployed through frequent, open dialogue and facilitated discussions.
 
“Everything’s connected” is the theme of the first presentation. The speaker will lay out why and how law enforcement and correction officials should work with compassionate community leaders to establish community-based addiction, treatment and recovery support services. Inspiring examples of success will be shared. The presentation will feature case studies related to the Mississippi Department of Corrections’ prison recovery pilot program. That program features three satellite, community-based recovery resources centers, which connect communities with enforcement and correction policies.
 
The next case study will identify challenges in cross-field collaboration overcome by the RxStat public health/public safety partnership initiative in New York City. Now in its fourth year, the initiative’s success and methods employed to work across health and safety to reduce drug-related harms can serve as a model for other jurisdictions. Originally conceived as a data-sharing mechanism, as the relationship between public health and public safety deepened, RxState began pursuing overlapping policy goals and developing programs as the intersections of the fields. Group membership has grown to 37 municipal, state, and federal agencies representing greater New York and New Jersey.
 
Upon completion of this course, participants will be able to:
  • Describe state and national recovery advocacy movement trends that promote community-based peer support recovery resources and the innovative ways law enforcement and corrections officials are partnering with recovery community organizations to reduce recidivism.
  • Identify community coalition partners for the purpose of raising awareness of addiction as a chronic brain disease in order to build recovery resources.
  • Outline strategies to gain support from the public and local, state and federal policymakers for law enforcement and reentry policies.
  • Express differences and tensions that exist between public health and public safety partner agencies.
  • Explain how data sharing can be used to identify mutual policy goals
  • Define strategies to build and strengthen health/safety partnerships within participants' jurisdictions.
 
 
 
Track: Clinical
Four Ds To Success: Leveraging Innovation to Change Behaviors, Prevent Substance Use and Enhance Treatment
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
As Rx drug abuse and the use of illicit substances ravage U.S. families and communities, it is essential that the U.S. health care system support changes in the behaviors of providers, patients, payers and the public at large. This session will address the role technologies can play in preventing exposure and access to controlled substances, fostering interventions, and improving treatment for substance use disorders and related medical conditions. The speakers will cover four aspects of substance use prevention, intervention and treatment in which technology can support meaningful behavioral change:
  1. Diagnosis of risks and conditions.
  2. Displacement of controlled medications.
  3. Delivery, dispensing, and disposal of medications.
  4. Diligence of providers and patients.
 
The presenters will identify the steps that health care providers, policymakers and payers should take now to foster the effective use of emerging technologies. They will touch on the potential of genetic testing, the Internet of Things, big data and virtual reality to prevent adverse medication-related events, including addiction and overdose. They will cover the role of digital medicine, biometric tools and blockchain technology in coordinating care and improving treatment plan adherence. Additional potential benefits to health care consumers through disintermediation include better social connectedness, shorter wait times to access treatment, greater convenience, lower costs, and superior short- and long-term health outcomes.   
 
To achieve the optimal benefits of new technologies, regulatory clarity and flexibility are necessary. Implementation strategies must be person-centric and prioritize consumer awareness, informed consent, cybersecurity and individual privacy. Provider promotion and insurer integration are also vital to the success of these new methods of fostering widespread behavioral change to reduce Rx drug abuse and other substance use.
 
Upon completion of this course, participants will be able to:
  • Describe how greater social connectedness and better patient-provider communication can reduce Rx drug abuse and illicit substance use, including counterfeits and heroin.
  • List examples of how new technologies can help improve treatment plan adherence.
  • Explain the importance of protecting the privacy of individuals with substance use disorders and other stigmatized health conditions.
 
 
 
Track: Advocacy
Advocacy 101: Make your Voice Heard at the State and Federal Level
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
 
Moderator:
Grant T. Baldwin, PhD, MPH, Director, Division of Unintentional Injury Prevention,
National Center for Injury, Centers for Disease Control and Prevention,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
To bring the opioid epidemic to an end, urgent government action is required. To become a more effective advocate, attend this session to learn the different roles that state and federal agencies can play in responding to the crisis. Advocates who have proven track records in changing public policy will discuss their successes, failures and the challenges that lay ahead.
 
Presenters representing the FED UP! Coalition will instruct advocacy organizations on how to effectively have their voices heard in Washington, D.C. They will explain why advocacy efforts are needed to ensure a proper response to the opioid crisis from federal agencies. They will describe the formation of the FED UP! Rally by a coalition of advocacy organizations, addiction treatment providers, medical groups and survivor advocates. They will review FED UP’s past advocacy achievements and its future efforts to achieve a more effective federal response to the opioid addiction epidemic.
 
The Shatterproof presenter will walk through the steps to advocate successfully at the state or federal level. Case studies will show how Shatterproof advocated for PDMP laws passed in five states. The presenter will explain how to use Shatterproof’s robust toolkit (including sample legislation, op-eds and letters to the editor), testify on Capitol Hill, build an effective petition, use (or build) your constituent network and gain traction quickly. Evidence of established outcomes will be drawn from Shatterproof’s report, Prescription Drug Monitoring Programs: Critical Elements of Effective State Legislation.
 
Upon completion of this course, participants will be able to:
  • Explain how to begin to become an effective and successful advocate.
  • Outline an effective advocacy campaign regarding PDMPs that Shatterproof executed in 2016.
  • Distinguish the roles that the federal and state governments can play in helping communities tackle the Rx opioid and heroin crisis.
  • Describe how to advocate effectively for a more forceful federal response to the Rx opioid and heroin crisis.
 
 
 
Track: Prevention
Stop Them Before They Start: Best Practices in Primary Prevention
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
What are our communities doing to help prevent that initial use, which too often leads to serious addiction? In this session, two presentation teams will highlight best practices related to preventing substance abuse. Participants will leave ready to start building a plan for their own community.
 
From the Community Anti-Drug Coalitions of America (CADCA), the presenter will identify national best practices for community prevention coalitions to implement across CADCA’s Seven Strategies for Community Change to specifically impact population-level reductions in medicine misuse and abuse. Discussion will cover the tools and resources developed by CADCA to address the Rx drug issue with scale and scope in diverse communities. From Carter County, KY, which was at the epicenter of the opioid epidemic, the presenter will describe organization and funding to plan and implement evidence-based, data-driven, comprehensive strategies. The county’s Rx misuse and abuse rates for middle and high school students dropped from among the nation’s highest to below national averages. Secondary effects were seen in both school achievement and employability. Participants will learn which sectors need to be involved and how to effectively plan, implement and evaluate comprehensive evidence-based strategies to achieve population-level reductions in Rx misuse and abuse at the community level.
 
From the National Council for Behavioral Health and Illinois Association for Behavioral Health, presenters will lay out evidence-based strategies and programs designed to educate youth, young adults and parents while also developing environmental strategies to build individual and community resilience. The national models of prevention have been developed by the Institute of Medicine, National Institute on Drug Abuse and Substance Abuse and Mental Health Services Administration (SAMHSA). Comprehensive prevention approaches focus on implementing data-informed strategies and interventions based on an inclusive statewide and local assessment process, which defines the resources and gaps for services. Successful programs also view youth, parents and community members as resources, and incorporate meaningful youth, parent and community involvement in program planning, implementation and evaluation. SAMHSA’s Strategic Prevention Framework, a community planning process for preventing substance use and misuse, also will be covered.
 
Upon completion of this course, participants will be able to:
  • Identify best practices for comprehensively reducing Rx misuse and abuse at the community level.
  • List resources available from CADCA to use in addressing the Rx misuse and abuse issue.
  • Describe how the Carter County (KY) Drug Free Coalition has reduced RX misuse and abuse rates from among the highest in the nation to below national averages.
  • Explain the three categories of prevention strategies.
  • Differentiate between the prevention populations and match the appropriate strategies with each.
  • Prepare the beginnings of a community plan to prevent the use and misuse of drugs.
 
 
 
 
Track: PDMP
PDMPs at Work: Fentanyl Overdose Deaths and the “Holy Trinity”
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
PDMP data can be used to identify and prevent problematic Rx prescribing and misuse associated with fatal consequences. This session will demonstrate PDMPs at work in fighting overdose deaths related to fentanyl and the “holy trinity” combination of opioid analgesics, benzodiazepine and carisoprodol.
 
Unintentional deaths related to fentanyl — a synthetic opioid 50-100 times more potent than morphine — increased in Ohio by 500% from 2013 to 2014, with over 500 cases in 2014. This trend coincided with a sharp rise in Ohio’s supply of illicitly made fentanyl, which is often sold as or mixed with heroin. In light of studies that show the misuse of Rx opioids is the greatest risk factor for initiation of heroin use, understanding Rx opioid histories among heroin/fentanyl decedents could inform efforts to reduce the risk of transitioning from use/abuse of Rx opioids to heroin or other illicit opioids. Accordingly, death certificates from overdose decedents in Ohio in 2014 were linked to controlled substance Rx data from the Ohio Automated Rx Reporting System. Presenters will detail the study and recommend prevention strategies based on its findings, including that 68% of those having unintentional fentanyl-related overdose deaths had a history of an opioid Rx, with 28% receiving an opioid Rx in the month prior to death.
 
Some state PDMPs monitor the high-risk behavior of writing concurrent prescriptions of oxycodone or hyrdrocodone, alprazolam and carisoprodol (OAC) to one patient within a 30-day period. Presenters will explain that OAC (or “holy trinity”) prescribing is associated with drug-related deaths, is rarely medically justified and is considered by some law enforcement officers as prima facie evidence of illegitimate prescribing. They will analyze the characteristics of prescribers, patients and pharmacies involved with OAC prescribing, based on PDMP data from Florida, California, Ohio and Kentucky. They will apply state-of-the-art measures and methods (e.g., rolling versus fixed windows) and visualizations (e.g. interactive patient Rx timelines). They will examine high-risk characteristics of the OAC-exposed population, such as veteran status and race/ethnicity (e.g. Native Americans). They will discuss the implications for PDMPs, pharmacoepidemiology, research and proactive patient reporting to clinicians and law enforcement.
 
Upon completion of this course, participants will be able to:
  • Describe prescribing indicators that can be used to gauge risk of poor outcome, and the epidemiology of these Rx risk factors among heroin and fentanyl decedents in Ohio.
  • Identify patients at risk for Rx opioid addiction while under medical supervision, prior to potential transition to heroin use and potential overdose.
  • Distinguish the characteristics of prescribers, patients and pharmacies associated with holy trinity prescribing behaviors.
  • Specify measures and methods that can be used with PDMP data to identify the high-risk groups associated with holy trinity prescribing.
 
 
 
 
Track: Treatment
The Role of Treatment in Response to the Opioid Epidemic
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
Moderator:
Kelly J. Clark, MD, MBA, FASAM, DFAPA, President-Elect, ASAM,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
This session will focus on the central goal of treatment for opioid use disorders as long-term recovery, including no use of alcohol, illegal or non-prescribed drugs. Most opioid dependent people initiated drug use —  usually non-opioids — in adolescence. Many have long periods of chronic use prior to being recognized and referred to treatment. But while most periods of opioid use are quite long and complex, virtually all substance use disorder treatments are brief. It is clinically and financially far more sensible to treat chronic opioid addiction using a chronic care management approach. This session illustrates sensible models for this type of more effective care.
 
Treatment is embroiled in an unnecessary, self-destructive battle between treatments that use and do not use medications to treat opioid use disorders. This presentation will take this battle head-on, concluding that when all treatments are assessed on their abilities to produce long-term recovery, the playing field is leveled and all treatments can work to improve their long-term outcomes of this chronic, serious disease. This builds on the new emphasis on finding common ground for both medication-assisted treatment and treatment that does not use medication to improve their long-term outcomes. This approach will encourage innovation and promote accountability that will permit patients, families and payers to make better decisions. It will also further the integration of substance use disorder treatment into mainstream health care with its new focus on the prevention, intervention, treatment and long-term monitoring of chronic, serious and highly prevalent disorders, including opioid use disorders.     
 
Upon completion of this course, participants will be able to:
  • Express the self-defeating conflict that exists between treatment programs that do and do not use medications.
  • Describe the concept of recovery which applies both to patients in medication-assisted treatment and those in programs that do not use medications.
  • Explain how 12-Step, abstinence-based treatment programs can successfully use buprenorphine and extended release naltrexone for opioid use disorders.
 
 
 
 
Track: Pharmacy
By the Numbers: Drug Trends, Predictive Analytics and PDMP Effects
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
In this session, two presentations will delve into data. From the nation’s largest pharmaceutical benefit management company, “Our Nation in Pain” will showcase the latest drug trends and the power of predictive modeling. From Oregon, “Evaluating PDMP Effects and Implications within the Trifecta of Critical Stakeholders” will present new insights into the interplay of prescription drug monitoring program (PDMP) data, physicians, prescribers and patients.
 
For more than 20 years, Express Scripts has delivered the industry’s most comprehensive, annual review and forecast of Rx medication use and spending, analyzing the impact current and future behaviors and market events will have on payers and patients. This presentation will reveal the findings of the Express Scripts 2016 Drug Trend Report, with an emphasis on the use of medications to treat pain. In addition, the presenter will discuss how predictive modeling tools (including pharmacy data, medical data, behavioral information and demographic information) take half the time and are five times more accurate at identifying potential misuse than the industry standards, which typically take 160 days and identify only 11% of the patients with opioid dependency. Another topic will be pharmacists’ interventions with at-risk patients that are most effective in reducing the risk of addiction.
 
For the first time, a study has addressed the “trifecta” of critical stakeholders who affect and are affected by the PDMP: prescribers, pharmacists and patients. Presenters will describe their research into the effects and implications of PDMP use as it impacts each party, both individually (e.g., workflow, training, communication) and on an interrelated level (e.g., between-party perceptions of knowledge, accountability, prescribing/dispensing barriers). Participants will gain a sense of the broad impact of PDMPs in both community pharmacy and clinical settings on patient outcomes at the state and national levels. They also will learn about the individual-level implications of PDMP use as it affects patients, prescribers and pharmacists regarding between-party opioid-related communication, prescribing and dispensing practices, and perceptions of patient criminalization and stigmatization.
 
Upon completion of this course, participants will be able to:
  • Identify trends in pharmaceutical cost and utilization of opioids.
  • Explain the application of predictive analytics to identify potential misuse of opioids.
  • Describe the impact of PDMP use on prescribers, patients and pharmacists.
  • Describe the impact of state-level variation in PDMP use on individual use and national-level evaluation.
 
 
 
Track: Third-Party Payer
Lessons from Medicare: Opioid Use and Adverse Events among Disabled and Older Americans
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
Certain populations have predisposing factors — such as age, polypharmacy and comorbid conditions — that likely increase their risk for opioid pain reliever (OPR) misuse and abuse, and as a result adverse health outcomes. Older adults and adults with disabilities in Medicare, for example, experience a higher prevalence of comorbidities than other populations. Additionally, their complex medical needs may disguise adverse events associated with opioid use. This session will feature two presentations on issues specific to the Medicare population.
 
The presention focused on the elderly will provide better insight into the population’s unique characteristics and needs, based on original analyses using Medicare claims. Presenters will detail opioid use in the population (e.g., MMEs/day, number of prescriptions, number of prescribers, pharmaceutical agents used, dosage changes) and compare these to previously-reported data in the non-elderly adult population. They will discuss how differing use patterns and harms can be incorporated into guidelines specific to older individuals. Their findings can be used to improve implementation of Comprehensive Addiction and Recovery Act policy recommendations, such as lock-in programs, intended to reduce opioid misuse among Medicare recipients.
 
The presentation comparing disabled and elderly Medicare beneficiaries will quantify understanding of OPR use, misuse and adverse health outcome for these two groups. Using Maine’s Health Data Organization all-payer claims data of 2012 and 2013, researchers analyzed various age-adjusted OPR use measures by year and quarter. Among the findings were that the under-65 disabled population, compared to the over-65 population, were more likely to have at least three OPR prescriptions in a quarter (63% vs. 38%), at least 90 day’s supply (44% vs. 24%), and at least 90 accumulative daily MME (20% vs. 8%). Recommendations will include better targeting prevention and intervention within Medicare to improve safety of OPR use and ensure better pain management.
 
Upon completion of this course, participants will be able to:
  • Recognize patterns of opioid use unique to the elderly Medicare population.
  • Describe opioid-related adverse events unique to the Medicare population.
  • Discuss how differing use patterns and adverse events can be translated into prescribing guidelines specific to the elderly population.
  • Distinguish differences in opioid use and misuse patterns between disabled and older adults paid by Medicare.
  • Identify the factors associated with high-risk of opioid misuse in Maine’s disabled and older adults paid by Medicare.
  • Apply use and misuse patterns and risk factors to better target and design prevention and intervention strategies.
 
 
Track: Heroin
Heroin in Transition: U.S. Regional Differences and Novel Forms
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
The “Heroin in Transition” study investigates new heroin supplies and their relationship to overdose, using quantitative and qualitative methods. In this session, researchers will describe the study and its findings to date. Their analysis suggests that the “heroin” epidemic may not be a single phenomenon.
 
Their conclusions indicate that the regional heroin crises require:
  • Tailored responses.
  • A multi-pronged, balanced response with evidence-based approaches to supply and demand reduction, treatment promotion and harm reduction.
  • Investment in heroin surveillance, including substances in circulation and the expansion and standardization of fentanyl toxicology, to assist in the deployment of locally tailored, evidence-based public health and clinical interventions.
 
Based on original research analyzing governmental data and reports, presenters will examine national trends in opioid pill-related overdose (OPOD) and heroin-related overdose (HOD) for the period of 2004-2013 and compare regional differences and changes in the rates of OPOD and HOD during the period of 2012-2013. HOD patterns show significant regional disparities. Feeding the regional heroin epidemics are emerging heroin source-types and mimics. The previously stable division of the U.S. heroin market between major producers Mexico and Colombia, with two distinct types of heroin, is now in flux. Mexican-sourced heroin has dramatically increased in supply with new routes and novel forms with likely adulteration. Heroin in combination with synthetic opioids (e.g., fentanyls) is so common in the eastern U.S., its presence is becoming acceptable, perhaps even desirable, to users. The presence of fentanyls makes heroin use more unpredictable and deadly than ever before.   
 
Presenters also will share findings from their original qualitative research. With the cooperation of local services, ethnographers conducted 60 semi-structured interviews with active heroin injectors across urban areas in Maryland, Massachusetts and New Hampshire in 2015 and 2016. Heroin injecting and sales were also observed. Users reported that heroin has changed significantly in recent years. For example, Baltimore’s “scramble” heroin has become highly unstable and heavily adulterated with such additives as fentanyl, benzodiazepines and crushed opioid pills, and it is gaining popularity among younger users for its intense rush and low price. Users in the three states live with great uncertainty and fear of overdose, often reporting recent losses of friends and relatives.    
 
Upon completion of this course, participants will be able to:
  • Distinguish regional differences in Rx opioid- and heroin-related overdose.
  • Describe recent changes in the heroin supply including published evidence for contamination/adulteration.
  • List the characteristics and effects of novel East Coast retail heroin.
  • Identify possible strategies for reducing the public health risks associated with heroin.
 
 
Track: Law Enforcement
Case Studies in Collaboration: Public Safety, Public Health and Community Leaders
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
Moderator: 
Connie Payne, JD, Executive Officer, Department of Specialty Courts, Kentucky Administrative Office of the Courts,
and Member, Operation UNITE Board of Directors
 
State and federal drug enforcement have identified Rx drug abuse as a top threat. From the public health perspective, Rx drug abuse has been defined as an epidemic. In addition to those stakeholders, a variety of governmental and community organizations tackle specific aspects of the problem. This session will examine how those efforts can be united for greater impact. While the goals of different organizations might seem irreconcilable at face value, effective interventions can be developed and deployed through frequent, open dialogue and facilitated discussions.
 
“Everything’s connected” is the theme of the first presentation. The speaker will lay out why and how law enforcement and correction officials should work with compassionate community leaders to establish community-based addiction, treatment and recovery support services. Inspiring examples of success will be shared. The presentation will feature case studies related to the Mississippi Department of Corrections’ prison recovery pilot program. That program features three satellite, community-based recovery resources centers, which connect communities with enforcement and correction policies.
 
The next case study will identify challenges in cross-field collaboration overcome by the RxStat public health/public safety partnership initiative in New York City. Now in its fourth year, the initiative’s success and methods employed to work across health and safety to reduce drug-related harms can serve as a model for other jurisdictions. Originally conceived as a data-sharing mechanism, as the relationship between public health and public safety deepened, RxState began pursuing overlapping policy goals and developing programs as the intersections of the fields. Group membership has grown to 37 municipal, state, and federal agencies representing greater New York and New Jersey.
 
Upon completion of this course, participants will be able to:
  • Describe state and national recovery advocacy movement trends that promote community-based peer support recovery resources and the innovative ways law enforcement and corrections officials are partnering with recovery community organizations to reduce recidivism.
  • Identify community coalition partners for the purpose of raising awareness of addiction as a chronic brain disease in order to build recovery resources.
  • Outline strategies to gain support from the public and local, state and federal policymakers for law enforcement and reentry policies.
  • Express differences and tensions that exist between public health and public safety partner agencies.
  • Explain how data sharing can be used to identify mutual policy goals
  • Define strategies to build and strengthen health/safety partnerships within participants' jurisdictions.
 
 
 
Track: Clinical
Four Ds To Success: Leveraging Innovation to Change Behaviors, Prevent Substance Use and Enhance Treatment
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
As Rx drug abuse and the use of illicit substances ravage U.S. families and communities, it is essential that the U.S. health care system support changes in the behaviors of providers, patients, payers and the public at large. This session will address the role technologies can play in preventing exposure and access to controlled substances, fostering interventions, and improving treatment for substance use disorders and related medical conditions. The speakers will cover four aspects of substance use prevention, intervention and treatment in which technology can support meaningful behavioral change:
  1. Diagnosis of risks and conditions.
  2. Displacement of controlled medications.
  3. Delivery, dispensing, and disposal of medications.
  4. Diligence of providers and patients.
 
The presenters will identify the steps that health care providers, policymakers and payers should take now to foster the effective use of emerging technologies. They will touch on the potential of genetic testing, the Internet of Things, big data and virtual reality to prevent adverse medication-related events, including addiction and overdose. They will cover the role of digital medicine, biometric tools and blockchain technology in coordinating care and improving treatment plan adherence. Additional potential benefits to health care consumers through disintermediation include better social connectedness, shorter wait times to access treatment, greater convenience, lower costs, and superior short- and long-term health outcomes.   
 
To achieve the optimal benefits of new technologies, regulatory clarity and flexibility are necessary. Implementation strategies must be person-centric and prioritize consumer awareness, informed consent, cybersecurity and individual privacy. Provider promotion and insurer integration are also vital to the success of these new methods of fostering widespread behavioral change to reduce Rx drug abuse and other substance use.
 
Upon completion of this course, participants will be able to:
  • Describe how greater social connectedness and better patient-provider communication can reduce Rx drug abuse and illicit substance use, including counterfeits and heroin.
  • List examples of how new technologies can help improve treatment plan adherence.
  • Explain the importance of protecting the privacy of individuals with substance use disorders and other stigmatized health conditions.
 
 
 
Track: Advocacy
Advocacy 101: Make your Voice Heard at the State and Federal Level
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
 
Moderator:
Grant T. Baldwin, PhD, MPH, Director, Division of Unintentional Injury Prevention, National Center for Injury,
Centers for Disease Control and Prevention,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
To bring the opioid epidemic to an end, urgent government action is required. To become a more effective advocate, attend this session to learn the different roles that state and federal agencies can play in responding to the crisis. Advocates who have proven track records in changing public policy will discuss their successes, failures and the challenges that lay ahead.
 
Presenters representing the FED UP! Coalition will instruct advocacy organizations on how to effectively have their voices heard in Washington, D.C. They will explain why advocacy efforts are needed to ensure a proper response to the opioid crisis from federal agencies. They will describe the formation of the FED UP! Rally by a coalition of advocacy organizations, addiction treatment providers, medical groups and survivor advocates. They will review FED UP’s past advocacy achievements and its future efforts to achieve a more effective federal response to the opioid addiction epidemic.
 
The Shatterproof presenter will walk through the steps to advocate successfully at the state or federal level. Case studies will show how Shatterproof advocated for PDMP laws passed in five states. The presenter will explain how to use Shatterproof’s robust toolkit (including sample legislation, op-eds and letters to the editor), testify on Capitol Hill, build an effective petition, use (or build) your constituent network and gain traction quickly. Evidence of established outcomes will be drawn from Shatterproof’s report, Prescription Drug Monitoring Programs: Critical Elements of Effective State Legislation.
 
Upon completion of this course, participants will be able to:
  • Explain how to begin to become an effective and successful advocate.
  • Outline an effective advocacy campaign regarding PDMPs that Shatterproof executed in 2016.
  • Distinguish the roles that the federal and state governments can play in helping communities tackle the Rx opioid and heroin crisis.
  • Describe how to advocate effectively for a more forceful federal response to the Rx opioid and heroin crisis.
 
 
 
Track: Prevention
Stop Them Before They Start: Best Practices in Primary Prevention
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
What are our communities doing to help prevent that initial use, which too often leads to serious addiction? In this session, two presentation teams will highlight best practices related to preventing substance abuse. Participants will leave ready to start building a plan for their own community.
 
From the Community Anti-Drug Coalitions of America (CADCA), the presenter will identify national best practices for community prevention coalitions to implement across CADCA’s Seven Strategies for Community Change to specifically impact population-level reductions in medicine misuse and abuse. Discussion will cover the tools and resources developed by CADCA to address the Rx drug issue with scale and scope in diverse communities. From Carter County, KY, which was at the epicenter of the opioid epidemic, the presenter will describe organization and funding to plan and implement evidence-based, data-driven, comprehensive strategies. The county’s Rx misuse and abuse rates for middle and high school students dropped from among the nation’s highest to below national averages. Secondary effects were seen in both school achievement and employability. Participants will learn which sectors need to be involved and how to effectively plan, implement and evaluate comprehensive evidence-based strategies to achieve population-level reductions in Rx misuse and abuse at the community level.
 
From the National Council for Behavioral Health and Illinois Association for Behavioral Health, presenters will lay out evidence-based strategies and programs designed to educate youth, young adults and parents while also developing environmental strategies to build individual and community resilience. The national models of prevention have been developed by the Institute of Medicine, National Institute on Drug Abuse and Substance Abuse and Mental Health Services Administration (SAMHSA). Comprehensive prevention approaches focus on implementing data-informed strategies and interventions based on an inclusive statewide and local assessment process, which defines the resources and gaps for services. Successful programs also view youth, parents and community members as resources, and incorporate meaningful youth, parent and community involvement in program planning, implementation and evaluation. SAMHSA’s Strategic Prevention Framework, a community planning process for preventing substance use and misuse, also will be covered.
 
Upon completion of this course, participants will be able to:
  • Identify best practices for comprehensively reducing Rx misuse and abuse at the community level.
  • List resources available from CADCA to use in addressing the Rx misuse and abuse issue.
  • Describe how the Carter County (KY) Drug Free Coalition has reduced RX misuse and abuse rates from among the highest in the nation to below national averages.
  • Explain the three categories of prevention strategies.
  • Differentiate between the prevention populations and match the appropriate strategies with each.
  • Prepare the beginnings of a community plan to prevent the use and misuse of drugs.
 
 
 
 
Track: PDMP
PDMPs at Work: Fentanyl Overdose Deaths and the “Holy Trinity”
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
PDMP data can be used to identify and prevent problematic Rx prescribing and misuse associated with fatal consequences. This session will demonstrate PDMPs at work in fighting overdose deaths related to fentanyl and the “holy trinity” combination of opioid analgesics, benzodiazepine and carisoprodol.
 
Unintentional deaths related to fentanyl — a synthetic opioid 50-100 times more potent than morphine — increased in Ohio by 500% from 2013 to 2014, with over 500 cases in 2014. This trend coincided with a sharp rise in Ohio’s supply of illicitly made fentanyl, which is often sold as or mixed with heroin. In light of studies that show the misuse of Rx opioids is the greatest risk factor for initiation of heroin use, understanding Rx opioid histories among heroin/fentanyl decedents could inform efforts to reduce the risk of transitioning from use/abuse of Rx opioids to heroin or other illicit opioids. Accordingly, death certificates from overdose decedents in Ohio in 2014 were linked to controlled substance Rx data from the Ohio Automated Rx Reporting System. Presenters will detail the study and recommend prevention strategies based on its findings, including that 68% of those having unintentional fentanyl-related overdose deaths had a history of an opioid Rx, with 28% receiving an opioid Rx in the month prior to death.
 
Some state PDMPs monitor the high-risk behavior of writing concurrent prescriptions of oxycodone or hyrdrocodone, alprazolam and carisoprodol (OAC) to one patient within a 30-day period. Presenters will explain that OAC (or “holy trinity”) prescribing is associated with drug-related deaths, is rarely medically justified and is considered by some law enforcement officers as prima facie evidence of illegitimate prescribing. They will analyze the characteristics of prescribers, patients and pharmacies involved with OAC prescribing, based on PDMP data from Florida, California, Ohio and Kentucky. They will apply state-of-the-art measures and methods (e.g., rolling versus fixed windows) and visualizations (e.g. interactive patient Rx timelines). They will examine high-risk characteristics of the OAC-exposed population, such as veteran status and race/ethnicity (e.g. Native Americans). They will discuss the implications for PDMPs, pharmacoepidemiology, research and proactive patient reporting to clinicians and law enforcement.
 
Upon completion of this course, participants will be able to:
  • Describe prescribing indicators that can be used to gauge risk of poor outcome, and the epidemiology of these Rx risk factors among heroin and fentanyl decedents in Ohio.
  • Identify patients at risk for Rx opioid addiction while under medical supervision, prior to potential transition to heroin use and potential overdose.
  • Distinguish the characteristics of prescribers, patients and pharmacies associated with holy trinity prescribing behaviors.
  • Specify measures and methods that can be used with PDMP data to identify the high-risk groups associated with holy trinity prescribing.
 
 
 
 
Track: Treatment
The Role of Treatment in Response to the Opioid Epidemic
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
Moderator:
Kelly J. Clark, MD, MBA, FASAM, DFAPA, President-Elect, ASAM,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
This session will focus on the central goal of treatment for opioid use disorders as long-term recovery, including no use of alcohol, illegal or non-prescribed drugs. Most opioid dependent people initiated drug use —  usually non-opioids — in adolescence. Many have long periods of chronic use prior to being recognized and referred to treatment. But while most periods of opioid use are quite long and complex, virtually all substance use disorder treatments are brief. It is clinically and financially far more sensible to treat chronic opioid addiction using a chronic care management approach. This session illustrates sensible models for this type of more effective care.
 
Treatment is embroiled in an unnecessary, self-destructive battle between treatments that use and do not use medications to treat opioid use disorders. This presentation will take this battle head-on, concluding that when all treatments are assessed on their abilities to produce long-term recovery, the playing field is leveled and all treatments can work to improve their long-term outcomes of this chronic, serious disease. This builds on the new emphasis on finding common ground for both medication-assisted treatment and treatment that does not use medication to improve their long-term outcomes. This approach will encourage innovation and promote accountability that will permit patients, families and payers to make better decisions. It will also further the integration of substance use disorder treatment into mainstream health care with its new focus on the prevention, intervention, treatment and long-term monitoring of chronic, serious and highly prevalent disorders, including opioid use disorders.     
 
Upon completion of this course, participants will be able to:
  • Express the self-defeating conflict that exists between treatment programs that do and do not use medications.
  • Describe the concept of recovery which applies both to patients in medication-assisted treatment and those in programs that do not use medications.
  • Explain how 12-Step, abstinence-based treatment programs can successfully use buprenorphine and extended release naltrexone for opioid use disorders.
 
 
 
 
Track: Pharmacy
By the Numbers: Drug Trends, Predictive Analytics and PDMP Effects
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
 
In this session, two presentations will delve into data. From the nation’s largest pharmaceutical benefit management company, “Our Nation in Pain” will showcase the latest drug trends and the power of predictive modeling. From Oregon, “Evaluating PDMP Effects and Implications within the Trifecta of Critical Stakeholders” will present new insights into the interplay of prescription drug monitoring program (PDMP) data, physicians, prescribers and patients.
 
For more than 20 years, Express Scripts has delivered the industry’s most comprehensive, annual review and forecast of Rx medication use and spending, analyzing the impact current and future behaviors and market events will have on payers and patients. This presentation will reveal the findings of the Express Scripts 2016 Drug Trend Report, with an emphasis on the use of medications to treat pain. In addition, the presenter will discuss how predictive modeling tools (including pharmacy data, medical data, behavioral information and demographic information) take half the time and are five times more accurate at identifying potential misuse than the industry standards, which typically take 160 days and identify only 11% of the patients with opioid dependency. Another topic will be pharmacists’ interventions with at-risk patients that are most effective in reducing the risk of addiction.
 
For the first time, a study has addressed the “trifecta” of critical stakeholders who affect and are affected by the PDMP: prescribers, pharmacists and patients. Presenters will describe their research into the effects and implications of PDMP use as it impacts each party, both individually (e.g., workflow, training, communication) and on an interrelated level (e.g., between-party perceptions of knowledge, accountability, prescribing/dispensing barriers). Participants will gain a sense of the broad impact of PDMPs in both community pharmacy and clinical settings on patient outcomes at the state and national levels. They also will learn about the individual-level implications of PDMP use as it affects patients, prescribers and pharmacists regarding between-party opioid-related communication, prescribing and dispensing practices, and perceptions of patient criminalization and stigmatization.
 
Upon completion of this course, participants will be able to:
  • Identify trends in pharmaceutical cost and utilization of opioids.
  • Explain the application of predictive analytics to identify potential misuse of opioids.
  • Describe the impact of PDMP use on prescribers, patients and pharmacists.
  • Describe the impact of state-level variation in PDMP use on individual use and national-level evaluation.
 
 
 
Track: Third-Party Payer
Lessons from Medicare: Opioid Use and Adverse Events among Disabled and Older Americans
 
Tuesday, April 18, 2017 | 11:15 am – 12:30 pm
 
Presenters:
Certain populations have predisposing factors — such as age, polypharmacy and comorbid conditions — that likely increase their risk for opioid pain reliever (OPR) misuse and abuse, and as a result adverse health outcomes. Older adults and adults with disabilities in Medicare, for example, experience a higher prevalence of comorbidities than other populations. Additionally, their complex medical needs may disguise adverse events associated with opioid use. This session will feature two presentations on issues specific to the Medicare population.
 
The presention focused on the elderly will provide better insight into the population’s unique characteristics and needs, based on original analyses using Medicare claims. Presenters will detail opioid use in the population (e.g., MMEs/day, number of prescriptions, number of prescribers, pharmaceutical agents used, dosage changes) and compare these to previously-reported data in the non-elderly adult population. They will discuss how differing use patterns and harms can be incorporated into guidelines specific to older individuals. Their findings can be used to improve implementation of Comprehensive Addiction and Recovery Act policy recommendations, such as lock-in programs, intended to reduce opioid misuse among Medicare recipients.
 
The presentation comparing disabled and elderly Medicare beneficiaries will quantify understanding of OPR use, misuse and adverse health outcome for these two groups. Using Maine’s Health Data Organization all-payer claims data of 2012 and 2013, researchers analyzed various age-adjusted OPR use measures by year and quarter. Among the findings were that the under-65 disabled population, compared to the over-65 population, were more likely to have at least three OPR prescriptions in a quarter (63% vs. 38%), at least 90 day’s supply (44% vs. 24%), and at least 90 accumulative daily MME (20% vs. 8%). Recommendations will include better targeting prevention and intervention within Medicare to improve safety of OPR use and ensure better pain management.
 
Upon completion of this course, participants will be able to:
  • Recognize patterns of opioid use unique to the elderly Medicare population.
  • Describe opioid-related adverse events unique to the Medicare population.
  • Discuss how differing use patterns and adverse events can be translated into prescribing guidelines specific to the elderly population.
  • Distinguish differences in opioid use and misuse patterns between disabled and older adults paid by Medicare.
  • Identify the factors associated with high-risk of opioid misuse in Maine’s disabled and older adults paid by Medicare.
  • Apply use and misuse patterns and risk factors to better target and design prevention and intervention strategies.
 
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
Track: Heroin
Case Studies in Collaboration: Worcester, MA, and Colorado
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters
Communities are finding that fighting the heroin crisis requires an “all hands on deck” approach. Despite the urgent need to meet a common goal, forging a team effort among multiple disparate agencies can be tough. This session will feature a city and a state that are making it work.
 
In Massachusetts, the City of Worcester has established an interdepartmental collaborative to respond to the local increase in heroin abuse and overdose. Great strides have been made over the past two years, thanks to a joint effort by the Health and Human Services Department and the Police Department to implement public health strategies to monitor overdoses, reduce mortality and improve access to care. Presenters will explain the partnership and systems changes that have impacted attitudes and perceptions, data collection, training, referral to services, and availability of supportive services. Topics will include: real-time overdose alert and tracking, outreach to addicted and homeless individuals, post-overdose intervention by trained and equipped officers, and enhancing naloxone use through training.
 
In Colorado, the statewide Heroin Response Working Group was formed in May 2016 and includes 27 subject matter experts from the Attorney General’s Office, University of Colorado, Denver Drug Enforcement Agency, Rocky Mountain High Intensity Drug Trafficking Area, state agencies, and multiple recovery and harm reduction agencies. Presenters will cover the group’s progress and data-driven approach, as well as intervention strategies informed by its threat assessment report on the epidemiology of, and health inequities associated with, heroin use disorders. They will illustrate the opportunities and challenges of creating sustainable partnerships, particularly strategies for building consensus around problem identification and program planning among multi-disciplinary partners.
 
Upon completion of this course, participants will be able to:
  • Explain how law enforcement and public health agencies together can reduce opioid overdose deaths.
  • Describe partnerships required to implement successful overdose interventions at the local level.
  • Outline the process for executing a collective impact approach at the state-level to address heroin use disorders.
  • Identify challenges and solutions for implementing successful heroin strategies when working with multi-disciplinary partners.
 
 
Track: Law Enforcement
Community Policing and Public Health: Developing a Holistic Response to the Opioid Epidemic
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
J. Kevin Massey, Business and Program Development Specialist, Weitzman Quality Institute,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
In this session participants will learn about the Winthrop Recovery Model, an innovation of the City of Winthrop, Massachusetts. This model uses an intra-departmental and community team-based approach, filling gaps in service with home visits (pre- and post-emergency incident), prescriptive treatment, clinician-supervised recovery coach outreach, and drop-in services. Presenters will share preliminary results that point to an effectiveness not yet seen in the field of recovery. To equip participants to replicate the model, presenters will describe its development in the police department and public health department, highlight problems and solutions that occurred along the way, and distribute police policy detailing the procedures related to the model. Presenters will explain why they feel the police have a moral and ethical obligation to be a key player in the model.
 
Upon completion of this course, participants will be able to:
  • Describe the phases of development and components of the Winthrop Recovery Model.
  • Explain the length, depth and breath of the Winthrop Recovery Model.
  • Outline police policy related to the Winthrop Recovery Model.
 
 
Track: Clinical
Project POINT: A New Collaborative Approach to Improving Care for Opiate Overdose Patients Presenting to the Emergency Department
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
John J. Dreyzehner, MD, MPH, FACOEM, Commissioner, Tennessee Department of Health,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
In 2015, rural southeast Indiana faced an HIV outbreak that made national headlines. Fueled almost entirely by high-risk injection drug use, that outbreak led Indianapolis Emergency Medical Service (IEMS), to design and implement Project POINT: Planned Outreach, Intervention, Naloxone and Treatment. POINT connects a trained social worker or paramedic from IEMS’ community-based paramedicine team with patients who have suffered an opioid overdose requiring Naloxone rescue. POINT team members provide a range of services including education on home administration of naloxone, referrals to health system navigators (to help with enrolling in the state’s expanded Medicaid program), as well as community-based substance misuse treatment referrals. To improve referral rates, each dose of naloxone administered by IEMS’ ambulances triggers an alert to the POINT team, rather than relying on busy Emergency Department staff for initiation.  
 
This session will explain how POINT works and share preliminary results from the project, including 90-day follow-up outcomes for patients referred to care by the POINT team. Early indications are that most post-overdose patients were interested in engaging with the outreach team on some level. The presenters will conclude with overall lessons learned in this pilot project and plans for preventing recurrent overdoses by improving both the initial evaluation of opioid misusing patients and the ability to efficiently link them with ongoing care.
 
Upon completion of this course, participants will be able to:
  • Identify features that make project POINT an innovative approach to the treatment of opioid overdose patients treated in the Emergency Department.
  • Describe the basic outcomes of the first several months of project POINT.
  • Outline ongoing barriers to brief interventions and referral to care interventions as they apply to opioid misusing patients seen in the Emergency Department.
 
 
Track: Advocacy
Physicians Leading the Fight in the Clinic and Statehouse
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
Mark D. Birdwhistell, MPA, Vice President for Administration and External Affairs, University of Kentucky HealthCare
 
Physicians hold frontline positions in the nation’s battle against opioid misuse and abuse. This session will identify their contributions and recommendations for fighting the epidemic, as well as explain the importance of advocacy and policy in addiction medicine.
 
Physicians continue to fine-tune their practices in the face of the national opioid epidemic. For example, physicians and other health care professionals checked state PDMPs more than 85 million times in 2015 and took tens of thousands of continuing medical education courses related to opioid prescribing and pain management. This presentation will detail the progress physicians have made in addressing the chief legislative and other requirements from policymakers — and make the case that there are additional areas where physician and policymaker focus is needed. Topics will include continuing improvements to PDMPs; furthering physician education; ensuring that patients can obtain naloxone at low- or no-cost sharing; and re-focusing efforts on three strategies that have widespread support but have not been widely implemented in a coordinated, national fashion: primary prevention, early intervention and comprehensive treatment.   
 
Physician advocacy has been proposed by medical organizations as a core component of medical professionalism. The role of the physician as an advocate is particularly important among patient populations who are marginalized or stigmatized. Yet, in spite of the tremendous stigma patients with substance-abuse disorders face, the role of the addiction medicine physician as an advocate has received minimal attention. This presentation will provide a framework for advocacy that defines its content, scope and practice within addiction medicine and explores the role of the addiction medicine physician as an advocate through case-based discussions. Through this framework, and using case or systems examples where physician advocacy has played an important role in shaping policy or care for an individual patient, participants will understand what makes effective advocacy and be inspired to advocate in their own practices.
 
Upon completion of this course, participants will be able to:
  • Express the commitment that physicians have made in helping reverse the nation’s opioid epidemic.
  • Identify key areas where physicians and other health care professionals need the commitment of policymakers to reverse the nation’s opioid epidemic.
  • Describe the importance of advocacy as a component of medical professionalism.
  • List three examples of how physicians have played important roles in advocating for change in substance use disorder practice.
  • Explain a model for how to implement effective advocacy in a practice in addiction medicine.
 
 
 
Track: Prevention
Can Novel Delivery Systems Deter Rx Drug Abuse?
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenter:
Robert Bianchi, Vice President and Chief of Scientific and Technical Affairs, Prescription Drug Research Center
FDA Representative TBA
 
Moderator:
Karen Perry, Co-Founder and Executive Director, Narcotics Overdose Prevention and Education (NOPE) Task Force,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
According to the National Safety Council “Prescription Nation 2016,” the U.S. makes up 4.6% of the world’s populations but consumes 81% of the world supply of oxycodone. The FDA is responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs while assuring patient access. This is a responsibility shared with the pharmaceutical industry, treatment facilities, educational institutions, and federal, state and local law enforcement agencies.
 
FDA is also responsible for advancing the public health by helping to speed innovations that make medicines more effective, safer and more affordable and by helping the public get the accurate, science-based information they need to use medicines and foods to maintain and improve their health. Toward that end, the FDA issued Guidance for Industry in April 2015 under the title, "Abuse-Deterrent Opioids-Evaluation and Labeling", which contains the following statement: “The goal of the laboratory-based studies, Category 1, should be to evaluate the ease with which the potentially abuse-deterrent properties of a formulation can be defeated or compromised. These studies are critical to the understanding of formulation characteristics and performance” The FDA also issued draft guidance for industry in March 2016 the “General Principles for Evaluating the Abuse Deterrence of Generic Solid Oral Opioid Drug Products.”
 
This session will compare the requirements of each guidance document to determine what must be demonstrated for a formulation to receive abuse deterrent labeling concessions from the FDA. Discussion will cover various abuse deterrent technology currently approved or in development and the required in vitro studies designed to evaluate the extractability or tamperability. It will also provide information on the efficacy of new formulations to deter abuse, comparing pre- and post-marketing abuse statistics.
 
Upon completion of this course, participants will be able to:
 
  • •    Identify steps being taken to reduce Rx drug abuse.
  • •    Describe current abuse deterrent delivery systems.
  • •    Outline the FDA position on abuse deterrent delivery systems.
 
 
 
 
Track: PDMP
Two Incentives to Engage Providers: Meaningful Use and Individual Prescriber Reports
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
Chad C. Corum, PharmD, Pharmacist, Rite-Aid Pharmacy,
and Member, Kentucky Pharmacists Association Board of Directors
and Operation UNITE Board of Directors
 
Participants who want more prescribers to buy into PDMP use will take away two strategies proving successful in Washington, Ohio and Virginia: facilitating easy PDMP access for prescribers and providing useful feedback to prescribers.
 
Washington improved convenience for prescribers by using the state’s Health Information Exchange (HIE) in combination with providing the PDMP connection as a “specialized registry” under Meaningful Use (MU). The HIE connection increases utilization by allowing providers more seamless access through the HIE into their Electronic Health Record (EHR) system. This was done by completing a build out of a transaction using NCPCP 10.6, piloting the connection with healthcare systems and EHR vendors. For providers who struggled to get buy-in from their health systems for this connection, the Washington State Department of Health approved the PDMP as an option for meeting public health objectives. With approval by the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology at the federal level, this incentive was offered to eligible professionals and hospitals — drastically increasing interest and progress in getting health systems on board.
 
Prescribers of controlled substances have long expressed interest in receiving information from their state’s PDMP regarding their own prescribing history and behavior. Ohio and Virginia were among the first states to implement PDMP prescriber reports to satisfy that request for feedback. The reports provide information elucidated from the PDMP directly to all controlled substance prescribers in the state regarding their prescribing behavior as it relates to “red flags” (e.g., high dose therapy, combo therapy, treatment duration). Other features include comparison of individual prescribers to others in their “specialty field,” patient and Rx volumes, and potential prescriber and pharmacy shoppers. Presenters will provide an overview of PDMP prescriber report functionality and subsequent changes in prescribing behavior and trends over time within two states. Ohio and Virginia case studies will cover implementation, experiences and metrics.
 
Upon completion of this course, participants will be able to:
  • Explain how Health Information Exchange connectivity can integrate PDMP data into the workflow of the provider, overcoming the limitations of using a standard PDMP web portal.
  • Prepare for their state to approve their PDMP as an offering under Meaningful Use to provide a good business case for the HIE connection.
  • Describe how educating prescribers and providing feedback to them can expand use of PDMPs and improve prescribing practices.
  • Identify the benefits of prescriber reports to state PDMP agencies and administrators.
 
 
 
Track: Treatment
Leveraging Federal and State Parity Laws
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
Michael C. Barnes, JD, Center for Lawful Access and Abuse Deterrence,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
Despite broad recognition that substance use disorders (SUD) are preventable and treatable chronic health conditions, there remains an unacceptably large gap between the millions of people who need care and those who actually receive it. In response, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 and then extended the federal parity requirements to health insurance plans offering SUD and mental health (MH) benefits through the Affordable Care Act’s essential benefit package. 170 million people have gained the protections of the federal MH/SUD parity law, and the law’s requirements now apply to most private and public insurance coverage.
 
However, actual parity has not yet been realized. The regulatory oversight structure of the federal parity law is complex, with multiple state and federal agencies sharing oversight and enforcement responsibilities. A parity analysis requires comparison of an insurer’s practices and coverage policies on MH and SUD benefits to the plan’s practices and policies for covered medical and surgical benefits. Determining compliance can be challenging, in part, due to a lack of transparency of plan benefit information. Insurance plans, too, are struggling with how to establish policies that comply with the parity law, including how to determine medical necessity. Strong oversight and enforcement of the federal parity law will better ensure that people with SUD care needs can receive the services and medications they need to become and remain well.
 
This session will describe the current parity landscape, including federal and state regulatory, legislative and legal strategies to ensure compliance. A state attorney general will describe a case in which state law was enforced by litigation.
 
Upon completion of this course, participants will be able to:
  • Outline the major provisions of the federal mental health and addiction parity law.
  • Explain how robust enforcement of the parity law can improve access to substance use disorder care, including medication-assisted treatment.
  • Categorize different ways in which states are monitoring parity compliance and enforcing the law through various legislative and regulatory activities.
  • Describe an example of legal action taken in response to a disparity case.
 
 
 
 
Track: Pharmacy
Pharmacists and Prescribers as a Team
 
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
This session will feature two presentations to increase teamwork among pharmacists and prescribers. The presentations are entitled, “Pharmacists and Prescribers Partnering as Controlled Substance Stewards” and “Don't Call Me, I'll Call You: Addressing Barriers to Collaboration Among Buprenorphine Providers and Community Pharmacists.”
 
Controlled substance stewardship, much in the same vein as antimicrobial stewardship, is a professional obligation for prescribers and pharmacists alike in today’s practice environment. This presentation will introduce this concept and present a model for pharmacist-led controlled substance prescribing interventions in a primary care clinic. The Controlled Substances Initiative (CSI) at Penobscot Community Health Care in Bangor, Maine, was implemented in 2013. The interprofessional CSI Committee meets weekly to review patient cases involving controlled substances and communicate best practice recommendations to prescribers. All committee operations are sustained by pharmacists participating in a postgraduate residency training program. To assess the organization-wide impact of the initiative, presenters will share data on controlled substance dose reductions and mortality trends. They will offer pearls for application of this model to other practice settings, including community pharmacies.
 
The Drug Addiction Treatment Act of 2000 (DATA) waivered physicians and community pharmacists play integral roles in office-based medication assisted treatment (MAT) for opioid addiction, but collaboration remains the exception rather than the norm. As a result, patients frequently report having to visit multiple pharmacies to find one that will accept their buprenorphine prescriptions. Fostering collaborative relationships is necessary to ensure that patients receive the medication they require as part of their office-based MAT. Presenters will describe the current climate of communication and collaborative experiences of DATA-waivered physicians and community pharmacists from the physicians' and pharmacists’ perspectives, based on a qualitative study involving 10 DATA-waivered physicians. Recommendations will be made regarding ways to foster collaboration between DATA-waivered physicians and community pharmacists.
 
Upon completion of this course, participants will be able to:
  • Identify unique barriers to communication and collaboration between DATA-waivered physicians and community pharmacists that negatively impact office-based MAT for opioid addiction.
  • Outline new methods for overcoming barriers to collaborative working relationships between DATA-waivered physicians and community pharmacists in order to improve office-based MAT for opiate addiction.
  • Explain the concept of controlled substance stewardship.
  • Describe a model for a pharmacist-led initiative that encourages appropriate controlled substance prescribing in primary care practice.
  • Distinguish elements of the featured model that can be applied to other pharmacist-prescriber models, including community pharmacies.
 
 
 
Track: Third-Party Payer
Lessons from Workers’ Comp: Mitigating Drug Therapy Risk and Reducing Opioid Use
                     
Tuesday, April 18, 2017 | 2:00 pm – 3:15 pm
 
Presenters:
 
Moderator:
Michelle Landers, JD, Executive Vice President & General Counsel, Kentucky Employers’ Mutual Insurance,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
While Rx drug misuse remains a broader national concern, those in the workers’ compensation industry have a unique opportunity to be at the forefront of preventive efforts, as many of the strategies developed to improve the patient’s recovery and return to work can also reduce risk for misuse and addiction of Rx opioid drugs. This session will feature lessons learned on two topics: mitigating drug therapy risk and reducing opioid use.
 
Regarding strategies to reduce opioid use, best practices by several workers’ compensation insurance companies and other payers will be presented, with the theme, “What the Real World Can Learn from Workers’ Compensation.” Opioid management is especially important in workers’ comp as employees taking opioids usually cannot return to work. Workers’ compensation payers and regulators have focused on reducing opioid use among worker’s comp patients for more than a decade. During the past few years, substantial progress has been made in both limiting initial use and reducing the number of patients who are long-term users of opioids. Best practices include, among others: prior authorization on all long-acting opioids, limiting initial prescriptions for opioids to three to seven days, pre-prescribing drug tests, opioid agreement, and cognitive behavioral therapy.
 
Regarding strategies to mitigate therapy risk, presenters will use a case study representing a patient type typically seen within the workers’ compensation space to illustrate how certain factors (e.g., dangerous drug combinations, comorbidities and polypharmacy) can put the patient at risk, as well as how stakeholders can work together to prevent and mitigate this risk. Developing effective medical-management strategies requires a deep understanding of drivers impacting patient care and clinical outcomes. A comprehensive understanding  of a patient’s entire medical history — inclusive of drug therapies for a work-related injury, along with other comorbid conditions and corresponding treatments — is critical. This includes determining how complex challenges such as drug use and misuse, comorbid conditions, chronic pain, psychosocial factors, and adherence can be addressed.    
 
Upon completion of this course, participants will be able to:
  • Outline therapy risks associated with polypharmacy consisting of opioids and other maintenance medications used to treat common comorbidities such as heart disease, hypertension and diabetes.
  • Explain how close collaboration between all stakeholders can ensure appropriate decisions are made to result in optimal patient care.
  • Describe the impact of Rx drugs, physical medicine, imaging and other ancillary medical services on treatment success.
  • Identify best practices of pain management in workers’ compensation that can be incorporated into group health/benefit plans.
  • Discuss the impacts of specific steps used to address opioid prescribing and potential overuse.
  • Specify ways opioid addiction and dependency must be handled differently than other kinds of medical benefits.
Tuesday, April 18, 2017 | 3:45 pm – 5:00 pm
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Julie Miller, Editor in Chief, Behavioral Healthcare Executive and Addiction Professional
 
Fentanyl, a powerful synthetic opioid, has emerged as a new lethal component to the already deadly opioid epidemic. In some parts of the country, fentanyl involvement exceeds 80% of overdose deaths, suggesting an extensive penetration into local illicit drug markets. Prescribing of pharmaceutical fentanyl has remained stable, so the sharp increase in fentanyl-involved deaths is linked to illicitly-manufactured fentanyl (IMF), which includes fentanyl analogues, and is commonly mixed with and sold as heroin. Two presentations will delve into the fentanyl crisis.
 
One presentation will compare national and state trends from 2013 to 2015 in fentanyl law enforcement seizures (FS), rate of fentanyl prescriptions, and synthetic opioid-involved (excluding methadone) overdose deaths (SOD). Preliminary findings indicate a relationship between the national SOD rate and FS from 2013-2014. Geographic patterns suggest a growing problem among states particularly in the Northeast and Midwest, with emerging problems in the South. The researchers will discuss the need for timely surveillance, increased collaboration between public health and public safety, targeted intervention approaches, and community access to naloxone.
 
The other presentation will focus on new data, emerging epidemiologic patterns, and aspects of fentanyl overdose amendable to intervention, with the over-arching aim of providing an evidence-based approach to reducing overdose mortality.  The presentation will describe concerted interventions and polices undertaken in one state, Rhode Island, and promising progress to date in shifting the course of the epidemic curve. Both fentanyl-specific and broader overdose prevention efforts will be discussed.  Finally, because fentanyl presents as a regional crisis, and no one state can reduce fentanyl overdose fatality alone, specific recommendations for a national response are outlined.
 
Upon completion of this course, participants will be able to:
  • Explain the rise in synthetic-opioid involved overdoses in the United States.
  • Identify the high burden geographic areas in the rise in synthetic-opioid involved overdoses.
  • Outline recommendations to address the rapid increase in synthetic-opioid involved overdoses.
  • Categorize promising interventions and approaches for fentanyl involved overdose prevention.
  • Describe one state’s progress in addressing fentanyl involved overdose.
  • Outline three emergency measures that the federal government could take to meaningfully and immediately address fentanyl overdose.
 
 
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Chauncey Parker, JD, Director, New York/New Jersey HIDTA, 
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
An increasing number of jurisdictions across the country are exploring innovative approaches to reduce the number of people unnecessarily entering the maze of the criminal justice system. This session will showcase two pre-arrest diversion programs. Outside Chicago, a county-wide program focuses on moving individuals into treatment quickly. Several cities use the other program, which targets the underlying problems (e.g., untreated mental health problems, housing) that lead some individuals to cycle in and out of incarceration.
 
In Lake County, IL, "A Way Out” allows persons struggling with substance use disorders (SUD) to present themselves to a police station and be assisted in accessing a treatment program as soon as possible, most often within hours. The program launched on June 1, 2016, and within two months nearly 20 persons (all but one were opioid users) had been placed in treatment settings. Based on a similar program in Gloucester, MA, A Way Out was created by Lake County’s multidiscplinary opioid task force, which included seven police departments, four hospital systems, several treatment providers, members of the 12-Step community, the health department, the state’s attorney, and an advocacy/community support agency. The core group meets often to streamline processes and enhance communication. Pillars to the program’s initial success were: collaboration among core group organizations, commitment to helping persons suffering from SUD, and effective community outreach. A Way Out has no specific funding.
 
In 2011, Seattle pioneered the Law Enforcement Assisted Diversion (LEAD) program. Santa Fe implemented LEAD in 2014, followed by Albany, Huntington, Canton and Atlanta in 2016. Many other jurisdictions including New York City, Los Angeles, San Francisco, Philadelphia, and Houston, have expressed interest in implementing LEAD-like programs. LEAD is unique in its harm reduction-oriented approach to addressing low-level crimes related to drug use, mental health challenges and poverty, and breaking the cycle of addiction, joblessness and homelessness. Under LEAD, police officers exercise discretion to divert individuals for certain criminal offenses (including low-level drug sales) to a case manager and facilitate access to a comprehensive network of services. Seattle LEAD participants were up to 60% less likely to be re-arrested, based on an independent study by the University of Washington. It concluded that LEAD shows dramatically more favorable recidivism outcomes compared to the system as usual, including various therapeutic courts. Participants will learn how different jurisdictions have supported and implemented LEAD.
 
Upon completion of this course, participants will be able to:
  • Evaluate the potential for implementating A Way Out or LEAD in their jurisdictions.
  • Identify factors that impact an individual’s decision to seek treatment.
  • Categorize experiences in program development and community collaboration.
  • Explain why LEAD is a unique approach to low-level criminal offenses.
  • Distinguish individuals within their own jurisdiction who would be better served by LEAD than traditional criminal justice approaches.
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenter:
 
Moderator:
Carla Saunders, NNP-BC, Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse, 
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
Nearly all opioid use disorders can be traced to adolescence, when the vulnerable adolescent brain is first exposed to substances of abuse. Most adolescents have annual pediatric visits, presenting an important opportunity for pediatricians and adolescent medicine physicians to significantly impact the national opioid epidemic. Likewise, dentists interact with adolescents at a time — following surgical dental extraction — when they could be exposed to substances of abuse. This session will prepare pediatricians and dentists to make the most of their influence with this critical population.
 
In June 2016, the American Academy of Pediatrics (AAP) released a clinical report to guide physicians in implementing substance use prevention, detection, assessment and intervention in settings in which adolescent receive health care. The report presented a new vision for physicians to routinely address substance use, including opioid misuse, by their young patients, stressing the importance of not using any substances — from alcohol and marijuana to the nonmedical use of Rx opioids — for their health.
 
With a backdrop in brain biology, this presentation will present the clinical and policy implications for managing the highly prevalent chronic and serious problem of substance use disorders in this high-risk population. Presenters will review the AAP guidance and discuss strategies for providing SBIRT (Screening, Brief Intervention and Referral to Treatment) in the primary care clinical setting. Case studies will demonstrate implementation of screening and brief intervention techniques with adolescents and young adults using substances, including opioids.
 
Dentists — who are the fifth most frequent prescribers of opioid analgesics, according to the IMS Health National Prescription Audit, 2012 — also can play a significant role in preventing misuse of opioids among adolescents. In April 2016, research published in JAMA announced that 42% of patients filled an opioid Rx (hydrocodone, predominately) within seven days of surgical dental extraction, based on a national database of Medicaid transactions. Adolescents (ages 14 to 17 years) were the age group with the highest proportion (61%) of filled opioid prescriptions, followed by 18 to 24 year-old patients (52%). The presenter will explain steps dentists can take to minimize Rx opioid abuse among adolescents, including modifying prescribing practices and educating patients.
 
Upon completion of this course, participants will be able to:
  • Explain the prevention health goal for adolescent patients.
  • Differentiate the AAP guidelines for SBIRT from current pediatric practices with regard to screening for substance use problems.
  • Detail implementation of screening and brief intervention for substance use in clinical encounter.
  • Explain the need for dentists to play a role in preventing the diversion, misuse and abuse of Rx opioids.
  • Identify best practices for dentists to identify problems and minimize Rx opioid abuse.
 
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
 
Moderator:
Daniel Blaney-Koen, JD, Senior Legislative Attorney, American Medical Association,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
Scientifically valid legal data is the starting point for evaluation of the health impact of laws, policies and their implementation. Accordingly, this session will announce the latest developments in state Rx drug policies as of April 2017, based on Legal Science’s Prescription Drug Abuse Policy System (PDAPS) — funded by National Institute for Drug Abuse as a resource for research on Rx-drug-abuse policies.
 
Rigorous scientific methods will be used to create the legal data, which will capture variation in laws across time and geography. These data can be used in scientific evaluations on the outcomes of specific Rx drug abuse policies. Legal datasets will be presented for Naloxone Access, Good Samaritan Laws, Prescription Drug Monitoring Programs, Medical Marijuana Laws, Opioid Prescribing Guidelines, Prescriber Scope of Practice and Short-Term Civil Commitment Laws for Substance Abuse. The data, accompanied by codebooks and detailed research protocols, will be available for download and compatible with standard software for quantitative analysis.    
 
The presenters will overview recent developments and identify features that should be evaluated further. They then will examine two Naloxone Access and Rx Drug Monitoring laws as examples of how scientifically valid legal data has been utilized in the last year. Overall, these interventions could lead to a reduction in all drug overdose deaths if they were combined with effective treatment and a decrease in demand.    
 
Upon completion of this course, participants will be able to:
  • Describe the use of the NIDA-funded Prescription Drug Abuse Policy System for researchers to conduct policy evaluations using a reliable disclosed procedure that captures variation across jurisdictions.
  • Explain results of recent studies using longitudinal legal data.
  • Identify new areas for evaluation.
 
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Karen Perry, Co-Founder and Executive Director, Narcotics Overdose Prevention and Education (NOPE) Task Force,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
From 1999 until 2014, the number of overdose deaths involving Rx opioids and heroin nearly quadrupled, according to the Centers for Disease Control and Prevention. By 2014, 78 Americans were dying every day from an opioid overdose. This session will feature two case studies to inform participants’ efforts to prevent overdose deaths.
 
From Drexel University and Holcomb Behavioral Health System, presenters will share initial findings from their Interdisciplinary Community Based Participatory Research partnership. The qualitative research project focuses on the continued development of a multi-level opioid overdose prevention and intervention training protocol, which is delivered to first responders, community members, human service professionals, college students, etc., who could be responding to an opiate overdose, with the goal of preventing additional opioid overdoses and moving clients along a continuum of care (medication assisted treatment, detox, in-patient treatment, out-patient treatment, etc.). Topics will include factors that motivated naloxone recipients to change their behavior after an intervention and training variations across the Midwest, Northeast, South and West.
 
In Camden County, NJ, medical personnel and law enforcement employ the opioid antidote naloxone, as part of collaborative efforts with the Camden County Addiction Awareness Task Force (CCAATF). The task force’s next step was to make naloxone availabile in the schools with the school nurses. Delaware has already implemented a school nurse based naloxone program. By approaching county school superintendents, substance abuse counselors, nurses and advocates already implementing this program in Delaware, the task force is making this a reality. This presentation will review the arduous efforts to make this happen in both Delaware and Camden County, NJ.
 
Upon completion of this course, participants will be able to:
  • Describe current naloxone training protocols in the United States.
  • Apply research findings to inform naloxone training curriculum development.
  • Identify common objections and responsive solutions to implementing a naloxone program in schools.
  • Prepare to implement a school nurse based naloxone program in their community.
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Nancy Hale, MA, President and CEO, Operation UNITE,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
This session will explore two policy developments related to PDMPs: mandatory provider use of PDMP data prior to prescribing controlled substances and sharing PDMP data across state boundaries to improve treatment, justice and child welfare outcomes.
 
Participants will receive scientific evidence from the first-ever study to use a pre- and post-comparison approach with a control group to evaluate the effectiveness of the mandatory use policy. The study, funded by the CDC and conducted in collaboration with the PDMP Center for Excellence, includes all current mandate states, which will provide more robust results. The study uses PDMP data from 2011 to 2014 across Kentucky, Ohio, Tennessee and New York, all of which enacted mandatory-use policies between 2012 and 2013, and Virginia, Indiana, California and Washington, which do not have a mandate and serve as the control group. For both groups, researchers will report on process and outcome measures, including opioid Rx rates, opioid Rx dosage, overlapping Rx rates and doctor shopping rates. Understanding the effectiveness of the mandatory use policy intervention is important because it will help other states make informed prevention decisions.
 
In the spring of 2016, the Supreme Court of Ohio reached out to public health and justice professionals in Illinois, Indiana, Kentucky, Pennsylvania, Michigan, Tennessee, Virginia and West Virginia to launch an planning initiative to identify inter-state solutions to the opioid epidemic. Two important goals are: (1) assure appropriate PDMP access for justice professionals, and (2) create inter-state PDMP operability in the region. Presenters will explain how state and local justice and public health officials identified working principles for increased access to data and improved inter-state operability of PDMPs. They will identify challenges and actions underway to assure the effective use of PDMP data. The initiative builds on the PDMP Center for Excellence’s 2013 training guide for law enforcement professionals about the appropriate use of PDMP data in identifying and apprehending physicians engaging in dangerous prescribing practice patterns, while balancing the need to protect patient confidentialty.
 
Upon completion of this course, participants will be able to:
  • Describe the policy of mandatory checking PDMP data by providers prior to prescribing.
  • Explain the effectiveness of the mandatory use policy on promoting appropriate prescribing behaviors and preventing Rx drug overdose.
  • Outline the regional plan to improve PDMP data-sharing in a way that balances the confidentiality interests of patients with the need to identify and mitigate over-prescribing.
  • Identify challenges and barriers to sharing PDMP data across state boundaries.
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Gary Enos, Editor, Addiction Professional
 
In this session, two presentations will describe the unique challenges and solutions related to treating two distinct groups: U.S. veterans and older adults.
 
Co-occurring disorders in treating U.S. veterans with substance related disorders are the rule rather than the exception. Pain is the primary reason for active duty service members to seek medical attention. The high rates of opioid use in the military over the past decade are associated with high levels of substance misuse and unintentional overdoses. The presentation entitled “Pain and Addiction Issues in Veterans” will review the comprehensive evaluation and treatment of veterans with substance related disorders and chronic pain issues. The presentation will emphasize non-pharmacologic interventions and non-opioid pharmacologic care; the Opioid Safety Initiative (OSI); coordination with VA and non-VA care programs and Choice First; and rural and remote care of veterans in the medical centers, community based outpatient clinics (CBOCs) and the primary care telemedicine outpatient clinics (PTOCs). Integration with other care providers, including the Indian Health Service, will be included.
 
“Oxycontin and Whiskey Chaser: Substance Use Disorder in an Aging Population” will shift focus to older adults. Among older adults, addiction — often complicated with alcohol — has skyrocketed. Quality of life and saving lives are at issue when we explore holistic treatment of addiction, chronic pain management and personal recovery growth. This presentation will raise awareness of this topic with the stunning facts. Participants will take away generational, evidence-based treatment approaches that include ways in which older adults engage in their own treatment, chronic pain management and recovery.
 
Upon completion of this course, participants will be able to:
  • Describe screening techniques, non-pharmacologic interventions, and the use of non-opioid pharmacologic medications for veterans with co-occurring substance related and chronic pain presentations to enhance safer treatment of pain and addiction.
  • Identify appropriate use of opioid medications for veterans with co-occurring substance related and chronic pain presentations to minimize the misuse, abuse and diversion of controlled substances.
  • Explain the use of monitoring techniques for veterans with co-occurring substance related and chronic pain presentations and engage medication assisted therapies for this high risk population using the Opioid Safety Initiative to mitigate untoward events in veterans and their families.
  • Describe the generational and co-morbidity aspects of opioid addiction in older adults.
  • Explain dimensional addiction treatment for individuals who are over 50 years old with chronic pain.
  • Apply practical tools in older adult assessment and engagement in the recovery process and recovery growth.
 
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Richard W. Sanders, Commissioner, Kentucky State Police,
and Member, Operation UNITE Board of Directors
 
Between 10% and 43% of the approximately 4 billion prescriptions dispensed in the U.S. every year go unused and become waste. Removing unwanted and expired controlled and non-controlled Rx drugs from homes reduces the probability of Rx drug abuse and accidental poisonings. State and federal agencies promote collection and disposal programs for household pharmaceutical waste, commonly referred to as drug “take-back” programs, as a key strategy in preventing Rx drug abuse. This session will identify best practices for implementing pharmacy-based take-back programs in community pharmacies and highlight a community-wide medication disposal initiative involving a pharmacy school.
 
Pharmacy-based take-back programs are convenient for consumers and ensure high collection rates. For more than a decade, the Product Stewardship Institute has set up such programs in rural, suburban and urban areas. From that experience, presenters will outline best practices for implementing a cost-effective drug take-back program. Topics will include collection system options, implementation and promotion costs, collection volume trends, public outreach and education methods, and relevant state and federal regulatory requirements. A second emphasis will be the process for regulatory compliance for pharmacies collecting controlled and non-controlled substances. That discussion will cover modifying pharmacy registration for the collection of controlled substances, installing receptacles, placing mail-back envelopes, training pharmacy staff, and overcoming safety and liability concerns.
 
In 2011, St. Louis College of Pharmacy, the City of St. Louis and the regional Drug Enforcement Administration (DEA) came together to create the St. Louis Medication Disposal Initiative. In conjunction with the national DEA Drug Take-Back day, the initiative aimed to reach urban-dwelling senior citizens who lack transportation to participate at drop-off locations. To reach these seniors, law enforcement, professors and students went door-to-door at senior living facilities to collect unwanted and unused medications, as well as promote the take-back day to the greater metro population. The weight of disposed medications has increased each year, and the St. Louis Metro area has had the greatest returns of all cities in its DEA region. This is thought to be largely due to the initiative’s advertising and awareness campaigns, including widespread flyer distribution, radio ads and social media promotion.
 
Upon completion of this course, participants will be able to:
  • Explain how to implement a successful, cost-effective pharmacy-based take-back program.
  • Specify the rules and regulations related to running a drug take-back program.
  • Describe key factors for implementing a medication disposal initiative.
  • List barriers to collaborating with academic, government and federal organizations for medication disposal activities.
 
Appropriate Treatment: What Works and Where Coverage Gaps Exist in ACA Plans
 
Tuesday, April 18, 2017 | 3:45 – 5:00pm
 
Presenters:
 
Moderator:
Christopher Jones, PharmD, MPH, Director of the Division of Science Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
This session will feature two presentations that address appopriate treatment for substance use disorders: “Cleaning Up the Mess of Dangerous Prescribing Regimens” and “Uncovering Coverage Gaps in ACA Plans.”
 
The first presentation will probe the pros and cons of the generally accepted path to cleaning up the mess created by dangerous drug regimens: methodical dose de-escalation (titration) without additional medications versus medication-assisted treatment (MAT). If medications like buprenorphine are introduced, will they supplant the more dangerous drugs and become part of the individual’s lifelong drug regimen? Is recidivism higher without MAT? And, since the ultimate goal is recovery of function and quality of life, what is the best way to instill lifestyle choices to ensure the tapered drugs or equivalents never come back? The presenters will take a 360-degree view of a variety of recovery programs, cite case studies and discuss how to select the right program for a patient with the goal of facilitating life-long recovery. Additional discussion points will include managing withdrawal symptoms, determining which classes of drugs to reduce first, assessing drug interactions, and considering comorbidities. Addressing psychosocial issues and incorporating non-pharmaceutical tools such as physical activity, nutrition and mindfulness will also be covered.
 
The Affordable Care Act (ACA) mandates coverage of substance use disorder (SUD) services as an Essential Health Benefit (EHB) and requires that SUD benefits be provided at parity with comparable medical/surgical benefits. Each state defines the SUD benefits to be covered by selecting an existing employer-sponsored plan to serve as the EHB benchmark plan. Nearly all of the 2017 EHB benchmark plans were non-compliant with ACA requirements and/or provided inadequate coverage of addiction benefits, based on a comprehensive review by the National Center on Addiction and Substance Abuse. This presentation will outline the full findings of the report, as well as explain the ACA requirements for coverage of addiction benefits, including how parity applies to these benefits, define the critical benefits necessary to treat addiction, and provide recommendations for complying with the ACA and improving coverage of addiction treatment in ACA plans. Take-away points will include examples of model benefit language that insurers can use, as well as recommended federal and state government interventions.
 
Upon completion of this course, participants will be able to:
  • Describe the pros and cons of medication assisted and non-medication assisted tapering.
  • Cite the criteria need to determine if a patient needs medication-assisted treatment or not
  • Explain how to best facilitate life-long recovery.
  • Identify the Affordable Care Act’s requirements for coverage of addiction benefits.
  • Recognize the critical benefits needed for evidence-based addiction treatment and explain where coverage gaps typically occur.
  • Cite examples of model benefit language and describe actions that states can take to ensure comprehensive coverage of addiction benefits by the ACA plans sold in their state.