Monday, April 17, 2017 | 1:00 pm – 2:45 pm

Pre-Conference Workshops

Monday, April 17, 2017 | 3:00 pm – 5:00 pm

Marijuana 101: Science-Based Messages and the Impact of Legalization in Colorado
 
Presenters:
 
Moderator:
Chris Gibson, MPA, Director, Oregon-Idaho High Intensity Drug Trafficking Area (HIDTA)
 
ln an update to their standing-room-only sessions at the 2015 and 2016 Rx Summits, CADCA’s Sue Thau will discuss the scientific studies related to the effects of marijuana on the adolescent brain, educational achievement, car accidents, employability and other issues. Rocky Mountain HIDTA Director Tom Gorman will provide an insider’s look at the impact of retail marijuana, based on his research and on-the-ground experience in Colorado.
 
Retail and “medical” cannabis have major implications for sectors such as law enforcement, substance abuse prevention and treatment, the judicial system, education, employers, parents and youth. The presenters will discuss the best approaches to use in addressing this increasingly challenging issue. Participants will gain a better understanding of the current science on the impact of marijuana use on: the adolescent brain; educational achievement; mental health; public safety; potential tax revenues; how to use data to track the actual impacts of medical marijuana and marijuana legalization on public health and public safety; and learn how to deliver science-based messages that resonate with the general public.
 
At the end of the session, attendees will be able to:
  • Describe the science-based effects of marijuana on the brain, body, and society.
  • Explain the impact of marijuana legalization in Colorado.
  • Identify the metrics that can be tracked to best evaluate the impact of marijuana legalization.
 
 
Teens and Substance Use: What’s Going on and How to Prevent It
 
Monday, April 17, 2017 | 3:00 pm – 5:00 pm
 
Presenters:
 
Moderator::
Carmen Ashley, MPH, MCHES, Senior Advisor, Substance Use Prevention, Division of Adolescent and School Health,
Centers for Disease Control and Prevention
 
In this highly interactive workshop, participants will engage in navigating data to determine trends, policies and practices related to teen substance use, with an emphasis on Rx drugs, heroin, and marijuana. The workshop will begin with an overview of three school-based surveillance systems that the Division of Adolescent and School Health (DASH) at the Centers for Disease Control and Prevention (CDC) manages, with special emphasis on applying substance use-related data to teen substance use prevention efforts. Participants will then learn about and discuss with DASH staff recent teen substance use-related findings, such as the relationship between Rx drugs, forced sex, and dating violence. Finally, participants will discuss lessons learned in addressing teen substance use and other risk behaviors together in a coordinated, community-based effort. Throughout the workshop participants will be involved in facilitated individual and group exercises, and will be asked to share data from their own jurisdictions and lessons learned to help inform the various exercises.
 
At the end of the session, attendees will be able to:
  • Identify the various types of teen substance use-related data provided by the Division of Adolescent and School Health’s three major school-based surveillance activities.
  • Describe the findings of recent data analyses related to teen substance use and other risk behaviors.
  • Apply lessons learned from current teen substance use prevention activities at the national level to local efforts.
 
Using a Comprehensive Approach to Prevent Rx Drug Abuse in Tribal Communities
 
Monday, April 17, 2017 | 3:00 pm – 5:00 pm
 
Presenters:
 
Rx drug abuse is not only a concern nationally, but particularly  in American Indian and Alaska Native(AI/AN) communities. As nonmedical use of Rx medications continues to rise, along with heroin use, many tribal communities are looking for ways to address this growing problem.
 
In this workshop, presenters will discuss a comprehensive approach to engage this issue at different levels. A multidisciplinary team, based in a tribally operated rural clinic in Southern California, will discuss these efforts in several capacities related to research, outreach and institutional policy change toward safe prescribing. Presenters will not only discuss how they worked interdepartmentally, but also across several agencies and by engaging local tribal stakeholders. This engagement provided depth in: developing better research assessments; providing culturally appropriate outreach materials; and creating liaisons that championed project efforts.
 
At the end of the session, attendees will be able to:
  • Explain roles each member of a multidisciplinary team (e.g., physician, pharmacist, researcher, community activist) can play in constructing a comprehensive approach to the preventing or reducing Rx drug abuse.
  • Describe how to tailor existing prevention materials to the needs of local AI/AN communities.
  • Identify stakeholders from different levels (e.g., community members, law enforcement, local governments) who could be brought in to expand local prevention efforts.
 
 
Getting to Zero Overdose Deaths Through Collective Impact
 
Monday, April 17, 2017 | 3:00 pm – 5:00 pm
 
Presenters:
 
Moderator:
Sharon Walsh, PhD, Professor of Behavioral Science, Psychiatry,
Pharmacology and Pharmaceutical Sciences in the Colleges of Medicine and Pharmacy,
Director of the Center on Drug and Alcohol Research, University of Kentucky
 
Most of rural California has no access to medication-assisted addiction treatment (MAT). There are no opioid treatment programs, and few doctors willing to prescribe buprenorphine.  These same regions have the highest prescribing and overdose death rates in the state.
 
Collective impact occurs when organizations from different sectors come together to solve a social problem, aligning efforts with a common vision and goals, using common measures of success. This workshop will describe the California collective impact approach — a partnership between public health, philanthropy, health plans and local coalitions — and successes to date.
 
Presenters will cover:
  • Managing Pain Safely program, which dropped opioid prescribing by 50% and the number of patients on high-dose opioids by 50% in 14 counties over 18 months, saving $1 million per month—reinvesting savings in provider training, technical assistance and mentoring, including incentivizing primary care providers to use buprenorphine in their practices.
  • Prescription Opioid Misuse and Overdose Prevention Workgroup, which unites agencies from different branches of government to find systematic ways to increase addiction treatment and lower overdose deaths across the state.
  • California Health Care Foundation (CHCF)’s Opioid Safety Coalitions Network, which catalyzed the rapid spread of local coalitions working on collective impact, and other CHCF efforts.   
  • Nuts and bolts of building a high-functioning community coalition, both in affluent Marin County and poverty-stricken rural northern counties, with hospitals, law enforcement, clinicians, drug treatment, advocates and others uniting to reduce stigma, increase access to treatment and improve community safety.
 
At the end of the session, attendees will be able to:
  • Describe how collective impact can be achieved through uniting diverse sectors under a common goal.
  • Explain strategies and tactics used by California health plans, public health leaders and coalitions to lower opioid over-prescribing and increase addiction treatment access.
  • Outline how these approaches can apply to various urban and rural regions across the U.S.
 
 
Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain:  Real-World Strategies
 
 
Monday, April 17, 2017 | 3:00 pm – 5:00 pm
 
Presenters:
 
CDC’s Guideline for Prescribing Opioids for Chronic Pain released in March 2016 is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. Four levers assist with implementing the recommendations in a comprehensive approach:  (1) translation and communication tools; (2) provider education and training, (3) health systems; and (4) private and public insurers. In this workshop, presenters will first outline each of these strategies, based on principles from dissemination and implementation science. Presenters will then provide examples of activities using the levers to enhance guideline implementation.
 
Specifically, presenters will share training for providers to aid them in applying the Guideline in their practice. Modules include a focus on nonopioid treatments for pain; assessing the benefits versus the risks of opioid therapy for patients; dosing and titration of opioids; risk mitigation strategies; assessment of opioid use disorder and referral to evidence-based treatment; effective patient communication, and strategies for applying the guideline including an overview of resources and tools to facilitate use of the guideline. The training includes extensive opportunities for physicians to practice using the guideline in a variety of situations through the use of interactions and realistic cases. Workshop participants will have an opportunity to practice applying the CDC recommendations using a patient case.
 
Next, presenters will describe the Coordinated Care Plan for Safer Practice (CCP) which is intended for health systems to encourage careful and selective use of opioids when initiating opioids for chronic pain and for patients on long-term opioid therapy. Preliminary results from a mixed-methods evaluation of CCP in ambulatory care practices will be presented, highlighting outcomes from nine intervention and nine comparison practices including use of high-dose opioids, co-prescribing of sedatives and opioids, use of urine drug testing and PDMPs, referrals to specialists, and use of non-opioid therapies. Discussion will provide insight into the effectiveness of these clinical and system-level strategies and highlight real-world implementation lessons from clinical practices.
 
Finally, presenters from Colorado will discuss their efforts to address implementation challenges and ways to improve Guideline compliance.  Presenters highlight practical tools and resources that work in a busy practice setting. These tools are evidence-based, save providers time, create additional revenue for providers and are accepted by patients. Presenters will also discuss a range of incentives that support physicians to use the CDC Guideline. Presenters will review data and key elements from one program in their state that has increased physician compliance with the CDC Guideline.
 
At the end of the session, attendees will be able to:
  • Describe education and training resources available to assist practitioners in effectively and safely treating patients with pain
  • Identify levers that can be used to support implementation of the CDC Guideline in clinical settings
  • Identify how to effectively implement coordinated care strategies in clinical settings and the outcomes that can be achieved
  • Describe tools, resources, and incentives to make it easier for physicians to follow the CDC Guideline
 
 
Substance Use and the Mother-Baby Dyad: Risk Assessment, Risk Reduction, and Collaborative Care Models to Management
 
 
Monday, April 17, 2017 | 3:00 pm – 5:00 pm
 
Presenters:
Melinda Campopiano, MD, Medical Officer, Division of Pharmacologic Therapies, Branch Chief for Regulatory Programs, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration
Susan Ford, MSN, RN, CPNP, State Quality Improvement Coordinator-Ohio Perinatal Quality Collaborative
Stephen Patrick, MD, MPH, MS, Assistant Professor of Pediatrics and Health Policy, Division of Neonatology, Vanderbilt University School of Medicine
Maggie Schroeder, MA, LCADC, Adult Substance Use and Recovery Services Branch Manager, Kentucky Department for Behavioral Health
Ruth Ann Shepherd, MD, FAAP, Former Director of Maternal and Child Health, Kentucky Department for Public Health
Scott Wexelblatt, MD, Regional Medical Director for Newborn Services, Cincinnati Children's Hospital Medical Center
 
Moderator:
Carla Saunders, NNP-BC, Advance Practice Coordinator, Pediatrix Medical Group, Neonatal Nurse, 
and Member, National Rx Drug Abuse & Heroin Summit Advisory Board
 
Neonatal Abstinence Syndrome (NAS) is a constellation of symptoms that can occur in a newborn who is exposed to an opioid while in the mother’s womb. The exposure may be from illicit drug use, misuse of Rx opioids or medication-assisted treatment with methadone or buprenorphine. The National Institute on Drug Abuse reported a five-fold increase from 2000 to 2012 in the proportion of babies born with NAS — equivalent to one baby suffering from opiate withdrawal born every 25 minutes. The immediate and long-term consequences are significant. With an average hospital stay of 16.9 days for NAS newborns, this alone costs hospitals an estimated $1.5 billion a year. An intense effort is underway by clinicians, researchers and social service professionals to develop effective responses. In this workshop, leading experts will examine strategies for management of pregnant women with opioid use and identification and management of the infant at risk for NAS. The use of innovative interdisciplinary collaborative care management teams to improve immediate and long-term outcomes for mothers and babies will be discussed.
 
Dr. Melinda Campopiano and Dr. Stephen Patrick will present recommendations for reducing and treating NAS in infants of mothers with opioid use disorder (OUD), based on a clinical guide being developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) for providers, program directors and policymakers. Effective treatments are available to improve outcomes for the infant, but clinical evidence from randomized controlled trials is limited. To develop recommendations, SAMHSA implemented the RAND/UCLA Appropriateness Method (RAM). Using current scientific evidence and clinical judgment, expert panel members rated the appropriateness of clinical scenarios describing a patient and potential procedure for treatment. The presenters will outline the panel’s conclusions. They also will address using collaborative care techniques to enhance the prenatal and postnatal care for the mother and infant.
 
Dr. Scott Wexelblatt and Ms. Susan Ford will present findings from the Ohio Statewide Quality Collaborative to improve treatment of infants with NAS. They will describe their multisite, interrupted time-series quality improvement (QI) initiative among 54 NICUs over a 21-month intervention period. They will conclude that the statewide QI collaborative showed that standardized training for neonatal nurses in scoring abstinence symptoms, and trauma-informed care, together with standardized non-pharmacologic and pharmacologic bundles, reduced the duration of opiate exposure and hospital stay in a large number of opioid exposed newborns. Other states and institutions treating opioid exposed infants may benefit from the adoption of these practices.
 
Dr. Ruth Ann Shepherd and Ms. Maggie Schroeder will present Kentucky’s multi-disciplinary approach to support infants diagnosed with NAS and their mothers after discharge from the hospital. The federal Child Abuse Prevention and Treatment Act requires states to have policies and procedures to implement and monitor multidisciplinary plans of safe care for infants who were exposed prenatally to alcohol and other drugs. Kentucky is piloting a “Plan of Safe Care” to identify and provide services and supports to the mother and infant, as well as deliniate who is responsible for ensuring that the mother is able to and does access those services and supports. Presenters will detail the plan, which strives to stabilize the mother in the post-partum period, provide ongoing supports for positive parenting and a safe home environment, create opportunities to reduce adverse childhood experiences, thereby improving long-term outcomes, and reduce the risks of repeating the cycle of substance abuse as the infant grows.  
 
Upon completion of this course, participants will be able to:
 
  • Identify potentially better practices for providing MAT for opioid-dependent pregnant women.
  • Identify potenially better practices, including pharmacological and nonpharmacological treatments, for infants with NAS.
  • Explain the collaborative care model for treating pregnant women with opioid use disorder.
  • Describe the Ohio Statewide Quality Collaborative to improve treatment of infants with NAS
  • Discuss the practice of standardized care and the impact on decreasing duration of opioid treatment and length of stay for NAS.
  • Define adverse childhood experiences and their relationship to substance exposed infants.
  • Identify the components of the Kentucky Plan of Safe Care for suporting infants diagnosed with NAS and their mothers after hospital discharge.