Wednesday, April 19, 2017 | 8:30 am - 10:00 am
Presenters:
Rewriting the Prescription for Treating Opioid Addiction
Presenters:
The path to long-term opioid recovery is mired in regulatory, legislative and ideological barriers that prevent people from accessing evidence-based treatments proven to lead to long-term recovery. With only 3 out of 100 people living with opioid addiction receiving the standard of care—medication assisted treatment—the rate of opioid overdose deaths is not surprising, regardless of how tragic it may be. Society would be outraged if this statistic applied to diabetes, cancer, or heart disease, but with addiction, many still suffer in silence, struggling to get the broken system to work for them at the height of personal crisis. Former Speaker Newt Gingrich and former Congressman Patrick Kennedy are outraged and have joined up with Advocates for Opioid Recovery to break down barriers to treatment. During this plenary session, they will discuss the epidemic from as former policy leaders and advocates while sharing their strategies for helping more people achieve long-term recovery.
Wednesday, April 19, 2017 | 10:45 am - 12:00 pm
State Innovations in Addressing the Opioid Crisis
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
States are the “laboratories of innovation,” and nowhere has this been more evident than in their recent efforts to combat the opioid crisis. The National Governors Association (NGA) has worked with more than 20 states through in-depth technical assistance to develop strategies to fight Rx opioid misuse, heroin and now illicit fentanyl. This work, along with consultation of national experts on evidence-based and promising practices, has been condensed into Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States, which focuses on the most promising state level health care and law enforcement strategies to address the epidemic along the continuum of prevention through treatment and recovery. This session will overview the NGA Road Map and key state innovations that are focused on outcomes.
The session will feature cases studies and implementation details from two innovator states. New Jersey’s innovation is using data to provide real-time monitoring of the spread of the opioid epidemic. The presenter will describe New Jersey’s multi-state, multi-agency Drug Monitoring Initiative and explain how states can harness existing data sets and ensure collaboration.
Rhode Island’s goal is to cut deaths from opioid overdoses by one-third within three years through a comprehensive plan of prevention, treatment, rescue and recovery. The speaker will focus on two approaches in the state’s Rescue and Recovery Plan, which is unique for its strong focus on metrics and evaluation: (1) making naloxone available whenever and wherever it is needed, and (2) using peer recovery coaches in emergency departments, high-risk communities and the criminal justice system.
Upon completion of this course, participants will be able to:
- Identify health and public safety best practices at the state level to address the opioid crisis.
- Explain state-level best practices on data, naloxone and recovery services.
- Apply health and public health best practices in their own states or communities.
PDMPs as Investigative and Probative Tools: Lessons from Arkansas and California
(FOR LAW ENFORCEMENT AND PROSECUTORIAL PERSONNEL ONLY - CREDENTIALS REQUIRED)
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
For law enforcement agencies across America, Rx drug abuse, misuse, fraud, diversion, doctor shopping and related issues have become frontline concerns. Prescription drug monitoring programs (PDMPs) can present criminal diversion investigative assistive features providing, among other things, indicators of outlier activities indicative of actionable criminal activity. In this session, representatives from Arkansas will lay out their legislative effort to gain PDMP access and training for investigations. From California, participants will take away detailed information about the probative value of PDMP analytics.
The Arkansas presentation will describe the evolution of state law to enable law enforcement access to the state’s PDMP. Presenters will demonstrate the improved ability of Arkansas law enforcement agencies to investigate Rx drug-related crimes through establishing and training Certified Law Enforcement Prescription Drug Diversion Investigators. The presenters will explain why it is imperative that law enforcement have equal access to PDMPs as an investigative roadmap to put prescribers, pharmacists and law enforcement at the table together to face the challenges of Rx drug abuse and related crime. When such access is granted, and when cooperative efforts engage all aspects of healthcare and law enforcement, prescribers are better able to make appropriate care decisions, pharmacists are better equipped to prevent diversion and law enforcement investigators are better able to target those that intentionally abuse the system to illegally obtain Rx drugs.
The California presentation will guide investigators to understand and articulate the probative value of PDMP outlier indicators for search warrant affidavits and court testimony. Two tools will be detailed. First, summary datasets demonstrate normative dispensing and prescribing behavior for a large number of metrics, including morphine milligram equivalents prescribed by zip code and month, total pill and Rx counts, and counts of high-/low-frequency opioid prescribers. Normative data provide a context to compare aberrant behavior for questionable prescribers and dispensers. They also can be used to identify areas of the state where unusual prescribing/dispensing behavior may be occurring. Second, anomaly detection scenarios test prescribing and dispensing behavior for violations of specific rules (e.g., dispensing both opioids and benzodiazepines to a large number of the same patients) and as outliers (e.g., total pills dispensed is extremely unusual). A combination of scenarios is used to assign an anomaly score to each prescriber and dispenser.
Upon completion of this course, participants will be able to:
- Specify the methods by Arkansas legislative acts to train law enforcement officers to investigate Rx drug crimes which allow access to the Arkansas Prescription Monitoring Program.
- Outline results of Arkansas’ training efforts to improve Rx drug cases through establishing Certified Law Enforcement Prescription Drug Diversion Investigators.
- Describe how advanced PDMPs can routinely perform big data computations to provide real time outlier indicators sufficient to initiate criminal diversion investigations.
- Explain how to use PDMP-generated outlier indicators to rule-in/rule-out initiation of a criminal diversion investigation and articulate probative value in search warrant affidavits and court testimony.
Opioid Overdose Education and Naloxone Distribution: Lessons from the VA’s Healthcare System-Based Program
Wenesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
From 2000 to 2014 nearly half a million people died from drug overdoses, according to the CDC — more than the total number of Americans killed in World War I, Korean War and Vietnam War combined. Veterans are particularly vulnerable given that their rate of fatal overdose is nearly twice that of the general U.S. population and many have pain conditions treated with opioid analgesics. In light of promising evidence supporting the effectiveness of training laypersons to administer naloxone and to reduce veterans’ risk for opioid-related death, the U.S. Department of Veterans Affairs (VA) launched a national Opioid Overdose Education and Naloxone Distribution (OEND) program in 2014 — the first integrated healthcare system in the U.S. to do so.
This session will describe VA’s approach to developing its OEND program, strategies employed to facilitate OEND implementation and lessons learned. Presenters will detail three important areas that were emphasized when VA’s program offices worked together with national and international experts to create the program: (1) logistics related to naloxone distribution, (2) patient education, and (3) provider education. They will describe the methods to evaluate OEND implementation and impact nationally. A key factor to success has been support by the VA Academic Detailing (clinical pharmacists conducting targeted provider training), with VA facilities exposed to academic detailing dispensing 45% more naloxone then facilities without exposure.
The session also will review and discuss an empirical investigation of VA medical providers’ naloxone prescribing practices and general knowledge and concerns regarding the provision of overdose education and naloxone to veterans at risk of experiencing or witnessing an opioid overdose. The study within the VA St. Louis Health Care System surveyed providers and tracked naloxone Rx rates and sources before and after initiation of OEND educational training. Prior to training, providers endorsed concerns related to iatrogenic effects of OEND (e.g., patients will use more opioids and/or be less likely to see treatment) and lack of knowledge/familiarity/comfort with OEND more than concerns related to giving impressions of unsafe opioid prescribing. Following OEND initation, system-wide naloxone Rx rates and sources increased over 320% — demonstrating that targeted provider training efforts can improve receptivity to OEND. Specific training recommendations will be made.
Upon completion of this course, participants will be able to:
- Define the tenets of healthcare system-based Opioid Overdose Education and Naloxone Distribution (OEND), including the two target patient populations for OEND — patients with opioid use disorders and patients prescribed opioid analgesics.
- Describe models of how to train the two target patient populations in OEND.
- Compare at least three strategies for healthcare system-based OEND implementation, including how to identify patients prescribed opioid analgesics who may be at increased risk for an opioid overdose.
- Identify risk factors for opioid overdose that might be seen in a primary care setting, other than opioid use disorder symptoms.
- Explain the types of concerns held by medical providers regarding providing overdose education and naloxone to patients.
- Define the fear of risk compensation as it relates to expanded naloxone access.
Combating Opioid Abuse through U.S. Medical, Pharmacy and Nursing Schools: What Are We Teaching Our Students?
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
vendome.swoogo.com/2017-rx-summit/Speakers-A-C#Ciccarone
Approximately 50 million people in the United States suffer from persistent pain, and pain treatment cuts across most medical, pharmacy and nursing disciplines. Despite huge strides in understanding the physiological aspects of pain, there is a major gap between that understanding and pain diagnosis and treatment. In the 21st Century, pain management is being accepted as a basic human right. Thus, it is even more important to train medical, pharmacy and nursing students to be competent in the areas of pain assessment and management. However, few students graduating from U.S. schools have had comprehensive interdisciplinary pain education as part of their curricula.
This session will present the findings of an assessment of the quality and depth of pain management education among health professionals who have direct interaction with patients. The questionnaire consisted of three phases targeted to medical, pharmacy and nursing schools in the U.S. The objective was to comprehensively quantify pain management education among health professionals who have responsibility for management, monitoring or patient education. The reported consensus was that formal pain management education should be established in each year of curricula. This will equip graduating medical professionals to overcome challenges associated with appropriate pain management, while mitigating abuse.
Upon completion of this course, participants will be able to:
- Describe current practices in pain-management education in U.S. medical, pharmacy and nursing schools.
- Identify recommendations to address gaps in pain-management education in U.S. medical, pharmacy and nursing schools.
- Explain the rationale for and scope of overdose education and naloxone distribution programs.
Use this Research in Your Communication and Social Media Campaigns
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
Do you want to create an attention-grabbing, on-point communications campaign that prevents opioid abuse and overdose deaths? Are you sure social media is an important piece of the puzzle, but you are not sure where it fits? Then attend this session to take advantage of lessons learned by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).
The CDC is preparing to launch a pilot health communication campaign with two goals: (1) reduce the number of opioid overdose deaths by changing social norms, perceived benefits and risks associated with Rx opioids; and (2) reduce initiation of use among those at highest risk of overdose death. Research conducted to inform the campaign has provided vital insights for determining audience segments with the most need, developing appropriate messaging for key audiences, and identifying strategic placement for this messaging. The CDC learned that an effective communications campaign, with appropriate, strategically placed messaging could do much to change the culture around Rx drug misuse and overdose. This presentation will review key findings from the CDC research and offer insights for future efforts to inform communication activities that address the Rx drug overdose epidemic.
The FDA conducted two analyses of social media to understand what is being discussed about opioid-related topics. Presenters will highlight results. They analyzed blogs, Facebook, forums, news and Twitter from July 31, 2010 to March 19, 2015, using Crimson Hexagon’s ForSight platform, and from Jan. 1 to June 30, 2016, using Brandwatch Analytics Social Media Listening Tool. They found constant conversation about opioids, ranging from about 6,000 to nearly 44,000 posts per day. Most conversations occurred on Twitter (76%). Relatively few included the term "opioid”; most used "painkillers.” Conversations focused on day-to-day experiences and seeking pain relief, including about alternatives such as music and marijuana. Opioids were considered as pain relievers; however, authors seemed to be aware of their addictive potential and voiced skepticism that their benefits outweighed the risks. Opioid-related topics are common on social media, and this content can help enhance understanding of users’ knowledge, attitudes and behaviors, which can be used to improve health outcomes.
Upon completion of this course, participants will be able to:
- Describe a range of useful research activities to inform a thoughtful communication campaign.
- Outline key messaging preferred by 45-54 year old adults and 25-34 year old adults that focus on the risks and reality of opioid overdose.
- Identify multiple media channels for strategic placement of messaging preferred by 45-54 year old adults and 25-34 year old adults for a launch of materials.
- Discuss the positive and negative effects that conversations occurring on social media platforms is having on opioid-related issues.
- Explain how the insight gained from these online conversations can inform efforts to address the opioid epidemic and improve public health.
- Recognize how social media can be used to communicate about the opioid epidemic, including to correct misperceptions about these drugs and related matters.
Promoting PDMP Use by Prescribers: PDMPs in 2020 and Outcomes in Oregon
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
PDMPs have been implemented throughout the United States as a public health intervention to help address the Rx opioid epidemic but, thus far, have had limited uptake by prescribers. To engage prescribers, states are seeking mechanisms to increase the clinical utility of PDMPs and researchers are collecting evidence of improved outcomes.
In this session, clinician-researchers will discuss the ideal use of PDMPs in the clinical setting, overcoming barriers to regular use and possible future design characteristics of the next generation of PDMPs. Most studies of PDMPs to date have been epidemiological, but the presenters will take the next logical step: evaluating PDMP use in clinical encounters, the impact of PDMP use on prescribing decisions and patient outcomes related to PDMP use. They also will consider a redesign of PDMPs in a way that more efficiently provides information to prescribers in an evidence-based fashion. Real-world solutions will be based on their personal experience with PDMP integration.
In Oregon, researchers initially found that prescribers who registered for the PDMP did not appear to decrease prescibing. In this presentation, they will discuss refinements to their analysis and the results. Funded by the National Institutes of Health, their study found that prescribers who registered in the first 12 months of the PDMP had significantly different prescribing behavior than the prescribers who registered in the second 12 months of the PDMP. Accordingly, the researchers compared changes in prescribing behavior after registering and over time, in addition to examining trends in patient overdose and opioid-related hospitalizations among the matched prescriber cohorts.
Upon completion of this course, participants will be able to:
- Identify the characteristics of an ideal PDMP for clinicians.
- Describe barriers and opportunities to improving PDMP use in the clinical setting.
- Disginguish differences in providers who registered to use the Oregon PDMP in the first year of its existence, compared to providers who registered later.
- Explain the impact of the Oregon PDMP on prescriber behavior, among “early adopters” and “later adopters” and their matched cohorts.
Tools and Training to Optimize Pharmacist Decision-Making
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Moderator:
Pharmacists often are considered the “last line of defense” in the medication use process and occupy a crucial role in reducing risks of adverse drug events. Yet, the role of pharmacists in mitigating opioid-related morbidity and mortality has not reached its full potential. This session will address: (1) PDMP educational tools for pharmacists, and (2) gray-area decision-making strategies for pharmacists when they encounter dispensing dilemmas.
Presenters will describe current and proposed educational tools and strategies to improve opioid safety-oriented knowledge, attitudes and skills for community pharmacists, with emphasis on using a prescription drug monitoring program (PDMP). They will report on a project, funded by the Agency for Healthcare Quality and Research, to develop a PDMP toolkit, entitled Resources Encouraging Safe Opioid medicatioN Dispensing (RESPOND). The toolkit — which includes an interactive online training module and printed materals — covers identifying patients at risk for opioid-related safety issues, communicating with patients about opioid prescriptions, and coordinating with prescribers. Based on research for the project, presenters will summarize stakeholder attitudes and perceptions about the role of pharmacists surrounding opioid use, implications for pharmacy practice, use of the PDMP, and communication with patients and other healthcare providers.
The next presentation will examine common gray areas of community pharmacy practice. For example: under what circumstances do pharmacists fill early, transferred controlled substance prescriptions for out-of-town patients; when do pharmacists sell syringes to patients without proof of medical need; and how do pharmacists determine that a buprenorphine prescriber is acting in a patient's best interest? These and other ethical or legal dilemmas challenge pharmacists as they try to balance identifying and preventing potential drug abuse and diversion with providing evidence-based, quality patient care. Based on data from pharmacists and pharmacy students, as well as established theory, presenters will describe typical approaches to decision-making. Multiple pharmacy cases will be discussed. Participants will learn how to integrate best-practice patient care systematically into common practice scenarios.
Upon completion of this course, participants will be able to:
- Explain the utility of PDMPs in community pharmacies and common barriers to use.
- Apply RESPOND toolkit training techniques in pharmacy and clinical practice.
- Describe common behaviors of pharmacists and pharmacy students during gray dispensing scenarios.
- Outline systematic decision-making approaches to common pharmacy scenarios.
Improving Access and Eliminating Fraud, Waste and Abuse
Wednesday, April 19, 2017 | 10:45 am – 12:00 pm
Presenters:
Louis Parrott, Jr., MD, PhD, Vice President Medical Director, Magellan Healthcare
Moderator:
This session will feature two presentations that make the case for improving access to treatment. One presentation will give a managed care perspective on improving access to medications for patients with substance use disorders (SUDs). The other presentation team will lay out why and how to increase access to quality care and cut costs by eliminating waste, fraud and abuse in addiction treatment.
Patients with SUDs have a lifelong, relapsing disease state, similar to diabetes. They frequently face complex treatment environments, which can impede treatment success. Research has shown that pharmacy benefits have an impact on patient access to medications to treat SUDs, also known as medication-assisted treatment. In response, the Academy of Managed Care Pharmacy appointed an Addiction Treatment Advisory Group in 2015 to be actively engaged in guiding policy, developing education, and supporting awareness and advocacy initiatives to ensure that medications used to treat SUDs and opioid overdose antidotes are readily accessible. These experts also developed formal recommendations for timely access to FDA-approved medications for SUDs through all private and public insurance. These recommendations are intended to support organizations working to enhance their benefit design and engage in best practices to support patients using medications for the treatment of SUDs. This presentation will review these recommendations, provide an overview of other initiatives designed to improve access to medications used to treat SUDs, and share examples of programs and best practices within the industry.
New clinics and rehabilitation facilities have opened nationwide to meet growing demand for addiction treatment. While the majority provide care in earnest, others exploit the system and national crisis rather than provide proper treatment. Third-party payers have taken measures to prevent such profiteering. However, some have used the activities of unethical parties, combined with deep-seated stigma, to justify treatment barriers that recently enacted laws intended to correct, thereby opening themselves up to litigation. It is imperative that third-party payers and practitioners work together to ensure access to treatment in a manner that reduces stigma, allows for quality care, and decreases the opportunity for waste, fraud and abuse. This presentation will overview recent developments in the law, as well as recent lawsuits and enforcement actions taken against bad actors. Presenters will discuss trends and challenges patients and well-intentioned providers and payers face in the addiction treatment field, as well as laws and regulations that protect against discrimination on the basis of practice area. They will conclude with policy recommendations to increase access to treatment while reducing the activities of bad actors and maximizing scarce health care resources.
Upon completion of this course, participants will be able to:
- Outline the Academy of Managed Care Pharmacy’s recommendations to improve access to medication assisted treatment for substance use disorder patients.
- Discuss ways to minimize barriers and ensure timely access for evidence-based treatments for patients with substance use disorders.
- Identify best practices for increasing access and availability of opioid overdose antidotes and medications used to treat substance use disorders through managed care.
- Describe recently enacted federal and state laws and regulations that have expanded access to addiction treatment.
- Explain several recent lawsuits and enforcement actions taken against addiction treatment providers who have taken advantage of federal and state parity laws.
- Discuss recommendations for advocacy efforts to work with state policymakers to expand access to addiction treatment while simultaneously limiting the activities of unethical health care providers in the addiction treatment industry.
Track: Treatment
Presenters:
Mary Bono, Principal, FaegreBD Consulting
Kelly J. Clark, MD, MBA, FASAM, DFAPA, President, American Society of Addiction Medicine,
and Member, Rx and Heroin Summit National Advisory Board
Moderator:
Nancy Hale, MA, President and CEO, Operation UNITE,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
In 2016, new federal legislation and regulations altered the requirements for prescribing of buprenorphine, including expanding qualifying prescribing clinicians to include nurse practitioners (NPs) and physician assistants (PAs), as well as increasing the numbers of patients to whom physicians may prescribe. These changes came with additional requirements for training, diversion control, and ensuring a biopsychosocial approach to treatment. System-wide changes in health care, which the new administration and congress have prioritized, can also be expected to impact opioid addiction payment and care delivery models. Responsive trends will likely include group medical practices with physicians, NPs, PAs, and other complementary disciplines; the movement toward outcomes-based treatment; and updates to definitions of recovery and affiliated outcome measures.
This presentation will explain the changes in buprenorphine delivery brought about by the new legislation and regulations. It will also discuss the availability of value-based contracting under Medicaid or Medicare models, and novel approaches to expanding access to medication treatment through the public and private sector.
Upon completion of this course, participants will be able to:
- Describe recent federal actions and their impact on treatment delivery models, including public and private sector approaches.
- Outline the required changes in the practice of buprenorphine treatment of opioid addiction under recent federal legislation and regulation.
- Define how financing mechanisms can impact a variety of delivery models for opioid addiction treatment.
Wednesday, April 19, 2017 | 12:00 pm – 1:30 pm
The New Heroin Epidemic in Camden County New Jersey: Heroin with Fentanyl, Fentanyl Analogues and/or Other Adulterants
Wednesday, April 19, 12:10 pm - 12:40 pm
Presenters:
Harry Earle, MA, Chief of Police, Gloucester Township Police Department
William Lynch, RPh, Clinical Staff Pharmacist, Kennedy University Hospital
Harry Earle, MA, Chief of Police, Gloucester Township Police Department
William Lynch, RPh, Clinical Staff Pharmacist, Kennedy University Hospital
In 2015 fentanyl-laced heroin hit our community. The impact was catastrophic with 22 deaths in June 2015 alone. An overdose alert program was initiated between hospital emergency room personnel and law enforcement to notify each other of an increase in overdose activity. In addition, law enforcement pursued the source of the fentanyl-laced heroin with an operation that lead to 53 arrests. Now a new heroin is attacking our community with fentanyl analogue laced heroin and other adulterants with heroin. In 2015 Camden County had 191 overdose deaths, a 38% increase from 2014 after a 13% decrease that year. Adulterated heroin with fentanyl, fentanyl analogues and other adulterants have been the major cause. Camden County averages four naloxone administrations per day and both our law enforcement and first responders lead the state for the most naloxone deployments of all 21 counties with 1504 in 2015. The State of New Jersey has seen a 216% increase in adulterant drugs from 2014 to 2015 and Camden County is experiencing the impact. A case history about how our medical and law enforcement community is pulling together to attack this new horrific deadly situation will be presented.
Upon completion of this course, participants will be able to:
- List the different adulterants that are now being used with heroin in Camden County, New Jersey.
- Describe the different fentanyl analogues that are being seen with heroin and other drugs in New Jersey and particularly Camden County.
- Prepare for the adulterant/analogue situation in your community by employing some of the response plan implemented in Camden County, New Jersey.
Lunch in Exhibit Hall/Community Response Theater Presentations
Wednesday, April 19, 2017 | 12:50 pm - 1:20 pm
Faced with the devastation of the Rx opioid and related heroin epidemic, a broad group of interested parties converged. In 2016, three county fiscal courts formed the Northern Kentucky Office of Drug Control Policy to develop a strategic plan. Working with courts, law enforcement, jails, hospitals, advocates and schools, county administrators, and legislators on state and federal levels, their efforts have reached “across the river” into Ohio, forming unlikely partnerships in advancing awareness and grassroots action, improving treatment options and education on best practices across all segments of the continuum. The director of this program will give an update on the issues, resistance, unlikely allies, successes (and less than successes) achieved as this hard-hit community tackles the epidemic head-on.
Upon completion of this course, participants will be able to:
- Describe the need for multi-disciplinary partnerships to create a robust regional continuum of care in the reduction of substance use disorders.
- Apply the knowledge gained in the planning and creation of a continuum in your community.
- Formulate a data-driven plan of action identifying gaps and barriers in education, awareness and prevention campaigns, and treatment protocols in your community.
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Case Studies in Partnership: County Health Department/University Health System and State Health Department/HIDTA
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Moderator:
Michael C. Barnes, JD, Executive Director, Center for Lawful Access and Abuse Deterrence,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
This session will feature two pairs of agencies that joined forces to reduce opioid overdose deaths. In Maryland, a health care system and government agency with a federal grant are producing positive outcomes for opiate users, families, community members and hospital administrators. In North Carolina, a law enforcement and public health partnership is starting up on a “shoestring” (i.e., no) budget.
In Anne Arundel County, Maryland, the number of heroin-related deaths increased nearly three-fold between 2010 and 2014. In response, the Overdose Survivor’s Outreach Services (ODSOS) program was launched in April 2015 with funding from a Substance Abuse and Mental Health Administration’s Medication Assisted Treatment-Prescription Drug and Opioid Addiction grant. ODSOS is a partnership between the University of Maryland Baltimore Washington Medical Center and the Anne Arundel County Department of Health. ODSOS Peer Support Specialists support opioid overdose survivors and encourage them to access treatment. ODSOS stives to fast track all patients onto a methadone or buprenorphine protocol within two days. ODSOS uses an integrated care model, including assessment, methadone maintenance, individual and group counseling, and care by a physician specializing in addiction medicine. Presenters will cover the development, implementation and evaluation of ODSOS.
Historically, there has been limited interaction between the law enforcement community and state public health around drug overdoses. However, in 2016 the Atlanta-Carolinas High Intensity Drug Trafficking Area (ACHIDTA) and the North Carolina Division of Public Health began working to promote the exchange of information and collaboration with state and local prevention efforts. ACHIDTA staff now work directly with local health departments and community coalitions as a ground-level effort. Presenters will highlight results, as well as the obstacles to building the partnership, such as: lack of funding to ensure the effort is consistent and a strategic priority; aligning various agencies’ priorities and perspectives; identifying, collecting and sharing data; finding a common language and/or platform to facilitate exchange. Despite these challenges, the entities remain committed to finding specific projects for collaboration and information sharing.
Upon completion of this course, participants will be able to:
- Identify key stakeholders embedded in the healthcare system and public entities that are needed for successful development and implementation of novel approaches to combat opiate use and opiate overdose deaths.
- Explain the structure and roles of Peer Support Specialists to embolden opioid dependent users to enter in MAT programs.
- Outline the managed care and service coordination issues, linkages with other county service agencies, and program evaluations for clients with special needs.
- Identify potential challenges related to public health and HIDTA collaboration.
- Describe small pilot projects at the state or local level related to public health and HIDTA collaboration.
Drug-Related Homicides: Investigative and Prosecutorial Strategies
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Milwaukee County’s rate of drug intoxication deaths is double the national average. Addressing this epidemic has created challenges for law enforcement and led to the development of investigative and prosecutorial strategies designed to maximize the likelihood of a successful resolution.
This presentation — based on 100-plus overdose investigations — will equip attendees with tools to identify the source of the fatal drug, including how to “work up the chain” of distribution to target higher-level drug suppliers. The presentation also includes a discussion of death-scene investigation techniques, the use of investigative court orders, cellular telephone records, interview techniques, toxicology and the use of confidential informants. This presentation will discuss how to use these tools to build prosecutable cases. The challenges of prosecuting these cases, strategies for presenting these cases in court, and other topics will be discussed. Presenters will conclude with several case studies to highlight how all of these tools can be used together successfully.
Upon completion of this course, participants will be able to:
- Identify strategies for investigating and prosecuting drug-related homicides.
- Explain how multiple tools can be utilized to build prosecutable cases in drug-related homicides.
- Distinguish these investigation and prosecution techniques in relevant case studies.
Pain Management Outside of Narcotic Therapy
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Moderator:
Kathy D. Doran, Writer/Instructional Specialist, National HIDTA Assistance Center/Monroe County (FL) Sheriff’s Office
More than 100 million Americans have pain that persists for weeks to years, according to the National Institutes of Health. Rx opioids were once considered the first-line treatment for pain. Now, with opioid use and abuse at staggeringly high levels, physicians are seeking alternative, non-narcotic pain-management methods. This session will discuss those options.
From his firsthand experiece with the nation’s Rx opioid epidemic, a practicing anesthesiologist, pain physician and addictionologist will discuss the aftermath for patients who unknowingly and unwittingly become addicted to opiate-based medications. For patients who can no longer receive opiate-based medicine due to abuse or misuse concerns, he will outline their treatment options for chronic illness. He will educate participants about the role of appropriate pain diagnosis, appropriate use of non-opiate-based medications and appropriate interventional procedures.
Upon completion of this course, participants will be able to:
- Explain how the disease of chronic pain can be treated appropriately outside of narcotic management.
- Identify the role of co-analgesic medication for these patients who had issues/dependency on narcotic therapy.
- Describe the role of an anesthesiologist/pain physician for appropriate medical referrals for care of these challenging patients.
Creating Connections for the Many Pathways of Recovery
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
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
In the recovery community, an important issue is the lack of awareness of the variety of recovery options that are available. When helping someone with a substance-use disorder, most people and courts think of mutual aid support groups, such as Narcotics Anonymous. In reality, there are many pathways to recovery; it is not just a one-size-fits-all model. As multiple paradigm shifts have occurred within the treatment of behavioral health concerns (substance use disorders, mental health challenges and co-occurring disorders), it is paramount that all practitioners of wellness become well-educated on integrating long-term, sustained recovery practices into each level of care and promoting a person-centered continuum of care.
This session will expand upon self-directed care, building on an individual’s strength to choose the pathway he or she sees fit for his or life and recovery process. The presenters will identify and describe multiple pathways to recovery, as well as provide tips to providers on how to offer a menu of options to individuals who are in or seeking recovery. Participants will learn to create a culture that empowers individuals and families in or seeking recovery from substance use disorder to lead secure, healthy and self-sufficient lives through a person-centered, holistic and family-centered recovery-oriented system of care so that individuals enter long-term recovery through a self-directed, strength-based pathway for a healthier individual, family and community overall. Other topics will include utilizing peers and building allies in recovery and promoting recovery-oriented language.
Upon completion of this course, participants will be able to:
- Explain the rationale for multiple pathways of recovery.
- Distinguish the multiple pathways of recovery.
- Identify resources for providers to help individuals choose their own successful pathway.
Quaternary Prevention: Four States’ Approaches to Naloxone Dissemination
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Moderator:
John J. Dreyzehner, MD, MPH, FACOEM, Commissioner, Tennessee Department of Health,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
Naloxone has received increased public health attention in recent years given its effectiveness in the reversal of opioid overdoses. Despite continued increases in overdose death rates attributable to opioids, approaches to naloxone dissemination, prescribing and dispensing are quite variable across states. On the public health prevention continuum, naloxone dissemination and use could be considered quaternary prevention —actions taken to identify individuals at risk of over-medication, protect them from new medical invasion and suggest interventions which are ethically acceptable.
This presentation will describe approaches to overdose death prevention with naloxone in four states: Maine, Tennessee, Texas and Virginia. Particular emphasis will be placed on the role of community pharmacies in increasing naloxone dissemination. Attendees will be informed about recent legislative, educational and profession-specific prevention strategies and will thereafter engage in active learning to apply prevention strategies in their respective states. In addition to discussing barriers to and suggestions for increased naloxone uptake, presenters will describe assessments that can be used to evaluate overdose risk and subsequent naloxone co-prescribing/dispensing.
Upon completion of this course, participants will be able to:
- Describe the role of naloxone in opioid overdose prevention.
- Compare and contrast approaches to overdose prevention with naloxone across multiple states.
- Create a state-specific plan to increase uptake of naloxone dissemination.
Innovations: California’s Clinically Assistive PDMP Features and Wisconsin’s Reimagined PDMP Role
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Moderator:
John Eadie, Coordinator, Public Health and Prescription Drug Monitoring Program Project,
National Emerging Threat Initiative, National HIDTA Assistance Center,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
Recent innovations in California and Wisconsin offer insights into promising new directions for PDMPs.
From California, participants will learn about the clinically assistive features of CURES 2.0, as well as the de-duplication and medicinal computations that underpin its patient safety alerts generation and de-identified data set production. The advanced clinically assistive features offers prescribers, among other things: a post-Rx patient safety status monitoring and alerting functionality, the option to flag in the PDMP system patients with treatment exclusivity compacts, secure peer-to-peer communication capability, user delegation authority and fully automated user registration. CURES 2.0 provides systematic de-duplicated/de-identified data set production assistive to public health agencies and research. CURES 2.0’s big data engine also produces far-reaching trend data results down to the zip code level on a quarterly basis for public consumption.
From Wisconsin, participants will benefit from a case study of the state’s experience with significant legislative and technological changes that reimagine the role of the PDMP as an inimitable central hub for healthcare professionals, law enforcement agencies and public health officials. The presenter will explain and share early results from two unique statutory changes: (1) requiring law enforcement agencies to submit reports to the PDMP about suspected opioid overdoses, stolen controlled substance prescriptions, and suspected violations of the controlled substances act involving Rx drugs, and (2) overhauling the entire operation of the PDMP and creating new categories of PDMP users (e.g., medical directors) beyond the prescriber, pharmacist and delegate roles common among PDMPs. The custom-built Enhanced Prescription Drug Monitoring Program (ePDMP) also will be covered.
Upon completion of this course, participants will be able to:
- Explain how PDMPs assist clinicians to recognize patients iatrogenically addicted or at risk of addiction when contemplating prescribing a narcotic, and identify at-risk medicinal thresholds post-prescription.
- Prepare to initiate more clinically assistive PDMP informational delivery.
- Describe the regulatory changes to the Wisconsin PDMP that require law enforcement agencies to submit reports in certain circumstances and grant PDMP access to new roles (e.g., medical directors).
- Explain the purposes for the data analytics and visualization tools available in the Wisconsin PDMP.
MAT and Drug Courts: Successes, Barriers and Lessons Learned
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
Moderator:
Robert DuPont, MD, President, Institute for Behavior and Health, Inc.,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
Since 1989, drug courts have been at the forefront of providing research-based options for justice system-involved individuals who are living with crippling substance use disorders. Through drug courts, individuals who are at high risk for treatment failure, repeat incarceration and drug-related deaths find paths of long-term recovery. This session will discuss implementation of medication-assisted treatment (MAT) into drug court programs, including steps to target diversion of buprenoprhine.
The Greater Cleveland Drug Court launched key initiatives that are improving effectiveness. Substance use treatment, including MAT, is provided now to addicted high risk/high need offenders participating in drug court. Additional court programming includes increased judicial supervision, frequent urinalyses, case management services for court participant mental health treatment, housing, employment, educational improvements and recovery environment engagements. The presenters will explain how to implement and evaluate a MAT protocol successfully in a community-controlled court experience. Topics will include lessons learned, drug court MAT client profile, most utilized services, and court outcomes, including case disposition, employment status, housing status, access to substance use treatment, mental health treatment and medical care, recidivism and recovery environment supports. The findings have implications for state legislatures, courts, law enforcement, treatment systems, addiction advocates, criminologists and public health personnel.
In Kentucky, buprenorphine is widely diverted and abused, especially in the areas where Rx opioids were heavily abused. Beginning in 2015, BJA and SAMHSA specifically required that programs receiving grant funding for treatment courts could not prohibit or limit MAT when prescribed. In order to help ensure participants were using MAT appropriately, Kentucky Specialty Courts developed a protocol that utilized the recently enacted Kentucky Administrative Regulation (KAR). The KAR has a number of requirements that must be met prior to prescribing buprenorphine and requirements that continue while the client is receiving the medication. Thus, Specialty Courts ensure better outcomes for the participants and ensure that the continued assessment for the need of the MAT is met.
Upon completion of this course, participants will be able to:
- Identify the key elements, facilitators and barriers of a drug court MAT model.
- Distinguish the strengths and limitations of the outcome data suggesting the effectiveness of MAT for opiate- and heroin-addicted drug-court participants.
- Describe the protocol used by Kentucky’s specialty courts to control diversion of buprenorphine by participants.
Naloxone: Academic Detailing, Prescribing Practices and Pharmacy School Training
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
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
When administered in time, naloxone saves lives by reversing the effects of Rx opioid and heroin overdoses. Ensuring ready access to naloxone is one of the strategies to prevent overdose deaths identified in the Substance Abuse and Mental Health Administration’s Opioid Overdose Prevention Toolkit. In this session, two presentations will explore naloxone issues important to pharmacists: academic detailing for pharmacy naloxone, predictors of likelihood to prescribe naloxone, and educating pharmacy students to reduce Rx drug overdose deaths.
Academic detailing (face-to-face education of prescribers by trained healthcare professionals) is an evidence-based approach to improving healthcare promotion and changing provider and patient behaviors. Participants will take away information and tools to conduct academic detailing and pharmacist-community outreach, with the goal of improving local access to naloxone through community pharmacies. Presenters will cover basic principles of academic detailing, pharmacy naloxone models, critical components of academic detailing for pharmacy naloxone, academic detailing tools being trialed in two states, and novel “crowdsourcing” approaches. Data from more than 130 academic detailing visits to pharmacies by research and community partners from two states will be presented. All materials shared and tools introduced will be made freely available.
The second presentation will review predictive factors associated with the likelihood of prescribing naloxone to populations at risk of opioid overdose, including: perceptions of professional responsibility; knowledge of risk factors and assessment of persons at risk; awareness of state naloxone-related legislation; and confidence in dosing, administration and writing prescribing protocols for naloxone. The presenters will discuss roles for pharmacists to facilitate naloxone prescribing. In addition, this presentation will describe curriculum changes at a college of pharmacy to increase awareness and knowledge to prevent overdose-related deaths. The case-based approach educates pharmacy students on predictive overdose risk factors, barriers to naloxone prescribing, using an Rx drug monitoring system, naloxone formulations, pharmacokinetics, administration and patient counseling.
Upon completion of this course, participants will be able to:
- Identify components of academic detailing to improve pharmacy naloxone access.
- Outline tools and messages for improving patient-pharmacist communications around pharmacy naloxone.
- Specify risk factors predictive of drug overdose and legislative changes pertaining to naloxone distribution.
- Explain the predictive factors associated with the likelihood of prescribing naloxone to populations at risk of opioid overdose.
- Describe an educational approach to increase professional pharmacy students’ awareness and knowledge of risk factors, naloxone-related legislation, barriers to nalonone distribution, and the role of the pharmacist to prevent overdose-related deaths.
Lessons from Private Insurers: Case Studies from Michigan and Tennessee
Wednesday, April 19, 2017 | 1:30 pm – 2:45 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
The opioid epidemic has challenged health plans to implement programs to address appropriate use of opioids. This session will share ideas that are working for a Michigan and a Tennessee provider.
BlueCross BlueShield of Michigan (BCBSM) has developed a multi-disciplinary, collaborative approach to addressing the Rx drug and opioid abuse and overdose epidemic. Presenters will describe the programs and workgroups implemented to address the appropriate use of opioids within our population with significant success. They also will show how leveraging pharmacy and medical claims data led to investigations of suspect prescribers and pharmacies, leading to arrests and charges of health care fraud and supporting nonmedical use of opioids. Since implementation of opioid-related programs in 2010, BCBSM reduced overall opioids dispensed with its health plan by 30% and cut related costs by 50%. In addition, prescriptions for non-dermal formulations of fentanyl were reduced by 90%, and long-acting opioid usage was decreased more than 80%.
BlueCross BlueShield of Tennessee (BCBST), the state’s the largest health insurance carrier, is taking a clinical and social approach to combat the misuse and unintentional overuse of Rx painkillers. In 2014, BCBST began a focused investigation into the Rx drug utilization in the state. Presenters will lay out what BCBST found and how it responded. For example, based on an external evaluation of its Medicaid members, BCBST implemented the Pain Management and Care Improvement Program for them. With the help of an independent panel of external medical experts, BCBST is placing additional controls on the quantities of opioid prescriptions that may be dispensed, in line with identified best practices. In response to an elevenfold increase since 1999 in the number of babies born in Tennessee with neonatal abstinence syndrome, BCBST has engaged in several partnerships with providers, such as the Mothers and Infants Sober Together program.
Upon completion of this course, participants will be able to:
- Identify pharmacy and medical data elements that can support identification and monitoring of opioid use.
- Discuss clinical and operational interventions to address unsafe or non-medically necessary opioid use.
- Explain collaborative processes to manage opioid use within a patient population.
- Describe health plan strategies to implement safe prescribing efforts.
- Specify the components of the health plan’s Pain Management and Care Improvement Program for Medicaid members.
- Outline various ways health plans can partner with providers in order to reduce neonatal abstinence syndrome.
Leveraging Federal and Community Leadership to Prevent Opioid Misuse
Wednesday, April 19, 2017 | 1:30 pm – 2:45 pm
Presenters:
General Arthur T. Dean, MA, Major General, U.S. Army, Retired, Chairman and CEO, Community Anti-Drug Coalitions of America
Frances M. Harding, Director, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration
Moderator:
This workshop will introduce many proven strategies to prevent opioid misuse. Prevention strategies are critical to working upstream to address the issue of prescription drug misuse. States, communities, and families can intervene to reduce inappropriate access to prescription drugs, thus significantly reducing the impact of the opioid crisis. Attendees will learn valuable insights about collaboration from a successful public-private partnership (SAMHSA/CSAP-CADCA); understand the importance of data-driven planning (e.g., Strategic Prevention Framework); and hear community-driven recommendations for reducing prescription drug misuse and improving the safety, health and well-being of our citizens. Join us to learn new ways to work together to prevent opioid misuse.
Upon completion of this course, participants will be able to:
- Understand the critical role prevention plays in addressing the opioid epidemic, in partnership with clinical, treatment, and law enforcement initiatives.
- Recognize how prevention data and program resources can inform planning efforts.
- Identify opportunities to collaborate with prevention partners.
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Heroin, HIV and Hepatitis C: Weathering the Perfect Storm
Wednesday, April 19, 2017 | 3:15 pm – 4:30 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
As injection drug use spreads, so do infectious diseases. A highly publicized example occurred in rural Indiana in 2015, when a dramatic spike in HIV diagnoses was linked to individuals sharing syringes to inject an Rx opioid. This session will overview the trends in infectious diseases related to the opioid crisis and detail two responses: Georgia’s Imagine Hope program and Maryland’s syringe service programs.
One strategy to stop the spread of infectious disease among IDUs is to provide them with sterile syringes. The presenter will introduce syringe service programs and describe how the Maryland Department of Health and Mental Hygiene (DHMH) is expanding access to them, in order to stay ahead of future potential outbreaks. DHMH worked closely with advocates to pass a law in 2016 that allows for community-based organizations and local health departments to launch programs upon approval by state and local public health authorities. Participants will learn lessons from a relatively rapid statewide scale-up of harm reduction services with particular focus on the role of state and local government. Topics will include recognizing the significance of SSPs as both a public health initiative and a behavioral health service, confronting questions about the effectiveness of harm reduction services, and evaluating the significance of state government leadership in driving expansion of harm reduction services.
Georgia is experiencing an Hepatitis C (HCV) crisis, especially among young injection drug users (IDUs). The state’s incidence of HCV cases in people under the age of 30 increased more than 200% from 2006 to 2012. In response, the Imagine Hope project includes 20 agencies (eight medication assisted treatment programs and 12 abstinence focused centers) serving substance-using populations. Presenters will detail Imagine Hope’s innovative HCV screening and care-linkage program. The screening program, as a case study, provides successes, challenges and lessons learned for working with hard-to-reach populations, primarily IDUs, at risk for HCV infection. Specifically, the embedding of routine HCV screening in existing MAT programs combined with care linkage, tandem HIV testing, and access to support groups represents an innovative approach to treating HCV among IDUs. All of the HVC positive clients have reported injection drug use as their risk factor and many were injecting heroin.
Upon completion of this course, participants will be able to:
- Categorize three barriers and solutions to screening for Hepatitis C (HCV) in injection drug users and linking to HCV care.
- Outline strategies for improving the provision of health services to injection drug users in community based settings.
- Explain the significance of harm reduction approaches to addiction prevention, including syringe service programs, with examples from peer-reviewed literature.
- Identify three ways a government can support effective models of syringe services programs.
Rx Drug Diversion within a Managed Care Organization
Wednesday, April 19, 2017 | 3:15 pm – 4:30 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
This session will give attendees a rare glimpse inside the fraud control, special investigations and information analytics units of a large managed care organization. Representatives of Kaiser Permanente will explain the company’s advanced efforts in the areas of drug diversion investigations. As payer and provider, they will share their analytics related to internal Rx drug diversion. They will discuss from cradle to grave the internal investigation to the law enforcement referrals of the cases investigated. The presentation will include case studies of selected law enforcement referrals.
Upon completion of this course, participants will be able to:
- Describe the investigative process to identify internal drug diversion.
- Explain investigative techniques to successfully investigate internal drug diversion both in the inpatient and outpatient settings.
- Outline the steps to package a law enforcement referral to help ensure a successful prosecution.
Buprenorphine among Substance Use Disorder Treatment Clients and in Abstinence-Based Treatment
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Moderator:
Kelly J. Clark, MD, MBA, FASAM, DFAPA, President, ASAM,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
Buprenorphine, a semisynthetic opioid formulated in 1966 and first offered as an analgesic, has been marketed in the U.S. since 2002 as a long-termed medication assisted treatment (MAT) for people addicted to Rx opiates and heroin. In this session, two presentations will examine: (1) experiences with prescribed and non-prescribed buprenorphine use among three statewide samples of substance abuse treatment clients, and (2) the role of buprenorphine in abstinence-based treatment programs.
There has been limited examination of access, barriers and experiences with buprenorphine among substance abuse treatment clients. In reponse, researchers recently completed a statewide study in Kentucky. They conducted structured interviews about buprenorphine use with clients entering: (a) residential recovery communities in Kentucky, (b) the Kentucky Drug Court programs, and (c) clients screened by Operation UNITE for substance abuse treatment vouchers. The majority of clients were polysubstance abusers and had used buprenorphine before entering the program. The survey assessed: (1) access (prescribed, non-prescribed, both prescribed and non-prescribed); (2) perceptions of doctors’ recommended use and barriers to maintaining use; (3) experiences of diversion, euphoria, use with other drugs and overdose; and (4) reports of how buprenorphine did or did not help with addiction. The study suggests that the decision to offer MAT with buprenorphine should be stringently guided by the cohort-characteristics of the addicted individuals who present for help.
There has been controversy about the use and usefulness of buprenorphine in abstinence-based treatment. This presentation will review the literature on the successes of abstinence-based treatment for opioid addiction and maintenance therapy with buprenorphine and then report successful treatment protocols that combine the modalities. The presenter will describe a practice that uses policies and protocols to support the individualized Rx of buprenorphine for patients with opioid addiction, who are participating in this abstinence-based, 12-Step oriented treatment for addiction. Success is noted in the completion of treatment by patients who previously were unable to complete and the initiation of treatment by those who previously were unwilling to begin. The difficulties have been messages received in 12-Step meetings and from treatment program peers that buprenorphine is “just another drug” — resulting in premature discontinuation and, often, subsequent relapse, requiring re-initiation of medication and subsequent re-stabilization in most cases.
Upon completion of this course, participants will be able to:
- Describe the prevalence among substance abuse treatment clients of having achieved euphoria with buprenorphine or diverted legally prescribed buprenorphine.
- Express whether buprenorphine assisted or hindered recovery among clients with prior buprenorphine experience.
- Apply the use of buprenorphine management in an abstinence-based treatment program.
- Prepare staff for the introduction of buprenorphine therapy into existing treatment settings.
-
Explain the advantages of buprenorphine in appropriately selected patients.
Community Leadership: Engaging Faith Leaders and Women
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Moderator:
Gary Enos, Editor, Addiction Professional
To win the battle against the U.S. opioid epidemic, advocates for change are needed at all levels — from Capitol Hill to the home. This session will encourage participants to engage two critical allies in their communities: faith leaders and women.
Based on the Substance Abuse and Mental Health Service Adminstration’s long-standing promotion of Faith-Based and Community Initiatives in the fight against mental health and substance misuse and the significance that religion plays in the southeast region of the United States, the Southeast Addiction Technology Transfer Center (SATTC) has targeted the faith community as a training group for substance use disorder prevention, identification and referral education. Using the Extension for Community Healthcare Outcomes (ECHO) model, SATTC established an ongoing learning community where knowledge and skills are transferred to predominantly minority serving, Christian denominational, established faith leaders and graduating theology students in the areas of substance-use disorder prevention, identification and referral. As the ECHO model expands, it will address some intractable issues around mental health and substance misuse training and care, such as workforce capacity. Ultimately, faith leaders will be first responders of sorts for their communities, which traditionally have resisted conventional methods of engaging in prevention, diagnosis and care.
Women may be disproportionately affected by Rx opioid abuse, and yet, they are also uniquely positioned to wield influence to implement gender-neutral policies and practices to reduce opioid abuse and other substance use. The presenters will address the genetic distinctions of women and the related challenges of treating them for pain, anxiety, ADHD, addiction and other conditions for which controlled medications may be medically necessary. They will identify ways women can bring about meaningful change to reduce Rx drug abuse and other substance use. They will emphasize eliminating laws that punish women for having the disease of addiction and other institutionalized forms of stigma against people with substance use disorders (SUDs). They will make evidence-based practice recommendations and examine policy proposals in the areas of substance-related education and prevention; screening, diagnosis and intervention; treatment; and chronic care management. Topics will include emergency department screening, brief intervention and referral to treatment protocols, healthcare access in jails, and economic sanctions against people whose SUDs are managed as a chronic disease.
Upon completion of this course, participants will be able to:
- Outline risk factors and best practices for engaging the faith community around substance misuse training.
- Identify appropriate point of entry for involvement in/replication of the Southeast Addiction Technology Transfer Center’s Faith Leaders’ ECHO Training Model.
- Describe how gender differences play an important role in addiction and other disease progression, effects of medications and barriers to treatment.
- Identify laws and other institutionalized sanctions that are levied against people with substance use disorders — especially against women with addiction.
- Recommend gender-neutral solutions that can help reduce stigma, reduce societal costs and improve treatment.
Prevention for Youth, by Youth
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Moderator:
Carla Saunders, NNP-BC, Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
This session will feature two programs that empower youth to prevent substance abuse among their peers.
Rise Above Colorado employs positive youth development — a public health prevention approach that engages youth as partners to promote skill-building and authentic relationships — to create teen-tested campaigns and educational resources that address the risk and protective factors related to the prevention of drug misuse. The resources are built for a variety of youth-service professionals to use in diverse situations (e.g., social media, classroom, peer-led settings). Presenters will briefly describe adolescent brain development as it relates to susceptibility for addiction, and then explore more deeply the resulting opportunities for practitioners working with youth to help build skills and knowledge designed to enhance healthy decision-making and prevent drug misuse. With a critical framework for analyzing the media and culture around drugs and medicines, youth have the opportunity to contribute to a powerful social media campaign as a complementary skill-building resource.
Project Amp is an experimental, brief peer-mentorship intervention to extend the support available to adolescents at moderate risk of substance use, under the integrated health care model Screening, Brief Intervention, and Referral to Treatment (SBIRT). It offers a non-punitive, early intervention option for families, schools and communities. The Center for Social Innovation — funded by the Conrad N. Hilton Foundation and in partnership with Young People in Recovery — is conducting feasibility research for Project Amp, exploring the role young adults in recovery can play in supporting prevention and early intervention. Eligible youth (13 to 17 years old) will be connected with a young adult (18 to 28 years old) in active recovery from substance use to engage in four one-hour mentoring interventions in school or primary health care settings. The goal is to establish an SBIRT-based, peer-delivered brief intervention approach that can be widely replicated. Presenters will share preliminary results.
Upon completion of this course, participants will be able to:
- Identify tools and resources for knowledge and skill-building around youth drug misuse/addiction prevention.
- Discuss risk and protective factors that impact youth drug use in prevention activities.
- Apply unique opportunities and vulnerabilities of adolescent brain development to prevention activities.
- Outline the key components of Project Amp as a prevention intervention in primary health care and school settings.
- Identify the assets young adults with lived experience of substance use recovery can bring to school substance use prevention and early intervention programming.
- Describe the importance of partnerships with recovery networks, youth organizations and other key stakeholders in the success of Project Amp.
PDMP Best Practices: Prescriber Mandates and Beyond
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Moderator:
John Eadie, Coordinator, Public Health and Prescription Drug Monitoring Program Project,
National Emerging Threat Initiative, National HIDTA Assistance Center,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
This session will prepare attendees to design effective, highly utilized PDMPs to maximize their potential in addressing Rx drug misuse and improving patient care.
One presentation will outline 12 best practices to guide states when drafting PDMP laws, based on Shatterproof’s experiences in advocating improvements to PDMPs across the country, including a case study of its aggressive 2016 campaign to strengthen PDMP reporting requirements in California. When properly used, PDMPs identify and prevent drug misuse or diversion, identify polypharmacy, and offer treatment to patients in need of support, while ensuring the legitimate medical use of painkillers. The data collected can also be used more broadly to analyze prescribing patterns and trends in use, and ultimately inform patient centered public health initiatives. The objective of using a PDMP is to protect people from being prescribed opioids they do not need, or in volumes that are unnecessary, or in combination with benzodiazepines, thus minimizing the potential for developing an addiction and/or death from an overdose.
The other presentation will focus on statutory mandates for prescribers to query the PDMP under certain circumstances. Adopted in some form by at least 30 states, such mandates are seen as among the most promising state practices to promote consistent use of PDMPs by prescribers and realize the associated benefits, including decreases in patient risk measures and prescribing of commonly misused controlled substances, as well as reduced morbidity and mortality related to Rx drug misuse. Based on the PDMP Center for Excellence Briefing on Prescriber Mandates, the presenter will describe: (1) the status of prescriber mandates, (2) the variation in their strength and comprehensiveness, (3) evidence for the effectiveness of a strong mandate in promoting PDMP utilization and impact, (4) barriers to their adoption, and (5) promising approaches to building support for and implementing strong mandates.
Upon completion of this course, participants will be able to:
- Explain the importance of designing an effective PDMP that is highly utilized by prescribers to maximize the impact on the Rx epidemic.
- Identify 12 best practices for states to use to draft laws regarding PDMPs.
- Differentiate types of prescriber mandates according to the strength, comprehensiveness and effectiveness of their use requirements.
- Apply evidence of the effectiveness of strong prescriber mandates and their successful implementation in efforts to increase utilization of their state’s PDMP.
Expanding Access to Treatment in Underserved Areas: Video Therapy and TeleECHO
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
States with proportionally large rural populations compared to urban populations have greater shortages of mental health providers, according to the Substance Abuse and Mental Health Services Administrations. This session will feature two programs that overcome that barrier with technology: video therapy and TeleEcho.
Thanks to ubiquitous videoconferencing technology, long drives are no longer an obstacle for patients who live far from treatment facilities. The presenters will explain how video therapy works and how it can be implemented when treating substance abuse and/or dual diagnosis population. Topics will include HIPPA compliance, state regulations and insurance billing. The presenters, who trained in this niche area through National Frontier and Rural Addiction Technology Transfer Centers, will differentiate between video and live therapy from a therapist’s perspective. They also will highlight outcomes from implementing video therapy treatment with the opiate addiction population.
Despite federal policy changes to expand access to medication-assisted treatment (MAT), relatively few eligible primary care physicians actually prescribe MAT. Two barriers are lack of adequate training and support and lack of access to addiction specialists. To train and mentor primary care teams, the University of New Mexico Health Sciences Center (UNMHSC) uses Project ECHO (Extension for Community Healthcare Outcomes) — a distance education model that connects specialists with numerous primary care physicians via simultaneous video link for the purpose of facilitating case-based learning. Since 2005, specialists in treatment of SUDs and behavioral health disorders have offered a weekly two-hour Integrated Addictions and Psychiatry TeleECHO Clinic focused on supporting evaluation and treatment of SUDs and behavioral health disorders by primary care teams. Primary care physicians present de-identified patient cases for discussion and feedback from specialists — which leads to changes in treatment plans in 77% of cases. Since 2008, approximately 950 patient cases have been presented, and more than 9,000 hours of CME/CEU have been awarded. This TeleECHO clinic network, which reaches rural and remote areas of the state, has also been used to recruit 480 physicians to participate in DATA-2000 buprenorphine waiver trainings. New Mexico’s U.S. ranking increased from 13th to 4th in the number of waivered physicians per capita, and it has had much more rapid growth in waivered physicians practicing in traditionally-underserved areas compared with the rest of the U.S. Participants will learn how to implement this low-cost, high-impact model to promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.
Upon completion of this course, participants will be able to:
- Distinguish when video therapy is the best practice for their client population.
- Explain how to implement video therapy services into their own practices.
- Describe how the ECHO model can be used to expand access to care for common complex conditions and support primary care teams in treating opioid use disorders.
- Outline the steps in implementing a teleECHO program for treatment of opioid use disorder.
DEA Update: Pharmacy Diversion Awareness
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenter:
James “Jim” Arnold, Chief, Policy & Liaison Section, Diversion Control Division, Drug Enforcement Administration, U.S. Department of Justice
Moderator:
Chad C. Corum, PharmD, Pharmacist, Rite-Aid Pharmacy, and Member, Kentucky Pharmacists Association Board of Directors
and Operation UNITE Board of Directors
This session will describe the current opioid abuse trends throughout the U.S., as well as provide an overview of current diversion trends. The presenter will discuss the basic responsibilities for pharmacists under federal law and regulations, the checks and balances of the Controlled Substances Act, the legal obligations of DEA registrants, and DEA’s response to the current opioid epidemic. The presenter will address new regulations, such as the Comprehensive Addiction and Recovery Act. The presentation will demonstrate how the current public health epidemic has impacted society and provide tips for pharmacists to respond, such as measures for preventing Rx drug misuse and securing pharmacies from drug theft and robberies.
Upon completion of this course, participants will be able to:
- Outline the corresponding responsibility of pharmacists.
- Describe three “red flags” that may indicate pharmaceutical diversion.
- Discuss Effective Controls and Preventative Measures against pharmacy diversion.
Lessons from Medicaid: Prior Authorization Policy and Addiction Treatment Expansion
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Moderator:
Daniel Blaney-Koen, JD, Senior Legislative Attorney, American Medical Association,
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
This session will give participants the opportunity to sample new policy developments in two state Medicaid programs: Maine’s prior authorization (PA) policy for opioid prescribing and Virginia’s statewide expansion of addiction treatment.
In January 2013, Maine’s Medicaid (MaineCare) implemented an opioid PA policy to reduce inappropriate opioid prescribing and improve pain management by encouraging other therapies. The policy covers both acute and chronic pain conditions, with specified requirements for each condition. Because evidence of the effectiveness for controlling opioid prescribing is limited, the Centers for Disease Control and Prevention (CDC) is evaluating MaineCare’s PA policy to determine if the policy resulted in changes in: (1) opioid prescribing and inappropriate use; and (2) use of other therapies including non-opioid medications (e.g. NSAIDs, tricyclic antidepressants, SNRIs) and nonpharmacologic treatments. Researchers will present their results, which showed, among other things, post-PA decreases in the opioid prescribing rate, mean daily dosage, and prevalence of inappropriate opioid use.
Virginia is implementing one of the most comprehensive Medicaid addiction treatment benefits in the country, designing an innovative substance use disorder (SUD) waiver, and deploying innovative statewide medication-assisted treatment training. Presenters will describe Virginia’s experiences to inspire and inform other state Medicaid programs, Medicaid Managed Care Organizations and state health officials seeking to expand access to addiction treatment and reverse the opioid epidemic. They will detail features of Virginia’s initiatives, such as expanding coverage of short-term inpatient detox and residential treatment to Virginia’s 1.1 million Medicaid members, a new peer recovery support service, licensing align with American Society of Addiction Medicine criteria, and Medicaid reimbursement for residential treatment facilities with greater than 16 beds. Presenters will describe how in three months they doubled the state’s outpatient based opioid treatment workforce, which is the foundation for addressing America’s addiction epidemic.
Upon completion of this course, participants will be able to:
- Describe MaineCare’s pain management program (opioid prior authorization).
- Identify the outcomes of MaineCare's prior authorization and their implications.
- Define the principles of evaluation of insurer strategies using insurance claims data.
- Describe how Virginia is addressing the opioid epidemic by designing and implementing a comprehensive Medicaid program to increase access to the full continuum of addiction treatment services based on the American Society of Addiction Medicine criteria.
- Explain how “carving in” community-based addiction treatment services into Medicaid Managed Care Organizations (MCOs) can promote full integration of physical health, traditional mental health, and addiction treatment services and engage the MCOs as partners in solving the opioid crisis.
- Summarize how Virginia’s interdisciplinary, statewide Addiction Disease Management training curriculum is developing a workforce with the knowledge and tools required to expand access to evidence-based MAT for opioid use disorder and recognize how this curriculum could be replicated in other states.
Electronic Systems to Help Identify Drug Hot Spots and Support Immediate Action
Wednesday, April 19, 2017 | 3:15 pm – 4:30 pm
Presenters:
Data collected on death certificates and compiled by CDC’s National Center for Health Statistics show that the nation’s Rx drug and heroin abuse epidemic is an evolving health threat. Medical examiners and coroners (ME/Cs) are on the front-lines of this epidemic, investigating the deaths as they occur, and thus are uniquely positioned to provide mission-critical data to local, state and federal partners to identify current hot-spots and support immediate action. Their official determinations are captured on death certificates, but often details of highest utility are stored locally in ME/C case management systems, and often paper files. To determine cause and manner of death, ME/Cs need access to multiple data streams (e.g., death scene investigation and autopsy reports, toxicology scans, and medical records). For drug overdose deaths, these data are necessary for proper interpretation of toxicology results. However, it can be difficult and time consuming to access and integrate multiple data sources. This is now made more challenging by the appearance in the street heroin supply of fentanyl and its designer drug analogs. Death investigators and medical examiners need to understand the technical limitations of the laboratories they work with, and escalate toxicology testing to ensure that the most current opioid agents are included in the scope. The unequal adoption of electronic ME/C case management systems and lack of interoperability between ME/C systems and other electronic systems (e.g., toxicology lab, electronic medical records, electronic death registration) is a major impediment to the effective exchange of mortality information. This undermines efforts to evaluate drug treatment effectiveness and to base guidance and policy on scientific evidence.
In this session, presenters will discuss best practices to improve the quality, timeliness and usability of data on drug overdose deaths. They will discuss current barriers, constraints, and opportunities to improve data quality and reduce reporting burden on ME/Cs. They will consider ways to get more value from mortality data and provide examples of how to strengthen existing infrastructure so that we can work together more effectively to fight the epidemic. The presenters will explain that there is room for significant innovation in this space, and their intent is to articulate priorities and help federal, state and local partners adopt solutions that work.
Upon completion of this course, participants will be able to:
- Identify current barriers, constraints and opportunities to improve mortality reporting data flow and reduce burden on data providers.
- Demonstrate an understanding the many sources of information needed to determine cause and manner of death for drug overdose.
- Describe the complexities and limitations of toxicology testing, and the impact on data quality.
- Describe solutions to help improve data access and integration among multiple data sources related to drug overdose deaths.
Wednesday, April 19, 2017 | 4:45 pm – 5:30 pm
Plenary Presentations
Wednesday, April 19, 2017 | 4:45pm - 5:30pm
Presenters:
Richard J. Baum, Acting Director, Office of National Drug Control Policy (ONDCP);
Kana Enomoto, Acting Deputy Assistant Secretary, Substance Abuse and Mental Health Services Administration (SAMHSA);
Thomas E. Price, MD, Secretary, U.S. Department of Health and Human Services (HHS)
