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  • November 22, 2017 1:51 PM | Deleted user

    By Amy Norton

    HealthDay Reporter

    TUESDAY, Nov. 21, 2017 (HealthDay News) -- The U.S. opioid epidemic seems to be taking its biggest toll on the baby boomer and millennial generations, a new study suggests.

    Researchers found that since 2010, boomers -- born between 1946 and 1964 -- have had heightened rates of death from prescription opioids and heroin. Meanwhile, millennials -- people in their 20s and 30s -- also have been hard hit by heroin overdoses.

    "The opioid epidemic has affected everyone," said senior researcher Dr. Guohua Li. "But what we're seeing is that these two generations are at highest risk," said Li, a professor of epidemiology at Columbia University.

    Li said he could only speculate on the reasons.

    But the findings on boomers were not surprising, he noted. That generation is known to have a relatively high rate of drug abuse, versus other generations. Plus, Li said, they were middle-aged when prescriptions for opioids were taking off in the 1990s -- which means they were a "primary target" for the medications.

    According to the U.S. National Institute on Drug Abuse, more than 2 million Americans were abusing opioids in 2015. That included heroin and prescription opioids, such as painkillers like Vicodin (hydrocodone), OxyContin (oxycodone) and codeine.

    Recent research has found that Americans' prescription opioid abuse has leveled off. But overdose deaths are still climbing.

    Earlier this year, a U.S government study highlighted the toll that heroin alone is taking. Between 2002 and 2016, deaths from the drug soared by 533 percent nationwide -- from just under 2,100 deaths to more than 13,200.

    So while efforts to curtail opioid prescriptions have worked, opioid deaths overall have not yet declined, said Robert Heimer, a professor of epidemiology at Yale School of Public Health.

    Unfortunately, some people addicted to prescription opioids switch to heroin or, more recently, illicitly made "synthetic" opioids such as fentanyl.

    "Often, people on heroin started with prescription opioids," Heimer said. However, he added, these are typically illegally sold prescription drugs.

    Heimer, who was not involved in the new study, said the findings are "useful."

    "It really suggests it's the older and younger generations that are being most affected by this epidemic," he said.

    The study analyzed national vital statistics for the years 1999 to 2014.

    Li's team found that compared with people born in the late-1970s, boomers were up to 27 percent more likely to die of a prescription opioid overdose. And they were up to one-third more likely to die of a heroin overdose.

    Meanwhile, the rate of heroin overdose death accelerated most among millennials -- people born in the 1980s to early '90s. For example, those born in 1989 and 1990 were 23 percent more likely to die of a heroin overdose compared with Americans born in the late 1970s.

    According to Li, it's not clear why millennials face a higher risk than their "Generation X" predecessors. But he speculated that they have had relatively less economic security than Gen Xers.

    On the prevention side, various medical groups have changed guidelines to rein in opioid prescriptions.

    Also, U.S. states have launched drug monitoring programs, which electronically track prescriptions for controlled substances. Doctors can check them before prescribing opioids, to help catch "doctor shoppers" -- people who go from one provider to the next, seeking a new opioid prescription.

    But those efforts only go so far, Heimer pointed out.

    To cut down overdose rates, access to addiction treatment is vital, Heimer and Li agreed.

    "Medication-assisted treatment" -- with the drugs methadone, buprenorphine or naltrexone -- is considered the most effective therapy for opioid dependence. The medications act on the same brain targets as opioids do, and help suppress withdrawal symptoms and cravings.

    But there are big barriers to receiving that kind of treatment. Only a small number of U.S. doctors prescribe them, and lack of training is one reason, according to Heimer.

    "Stigma" is a wider, underlying issue, he said. The drugs used to treat opioid addiction are sometimes seen as nothing more than a substitution, and there is still a belief that total abstinence should be the goal.

    "The biggest problem is that medication-based therapy is stigmatized," Heimer said. "We don't do that with any other chronic disease, and addiction is a chronic disease."

    The findings were published online Nov. 21 in the American Journal of Public Health.

    More information

    The U.S. National Institute on Drug Abuse has more on treating opioid addiction.

    SOURCES: Guohua Li, M.D., Dr.PH., professor, epidemiology, Columbia University Mailman School of Public Health, New York City; Robert Heimer, Ph.D., professor, epidemiology, Yale School of Public Health, New Haven, Conn.; Nov. 21, 2017, American Journal of Public Health, online

    Last Updated: Nov 21, 2017

    Copyright © 2017 HealthDay. All rights reserved.

  • November 20, 2017 1:50 PM | Deleted user
    • The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars.
    • In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate.
    • The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion.
    Published 5 Hours AgoThe Associated Press Jim Watson | AFP | Getty Images

    President Donald Trump delivers remarks on combatting drug demand and the opioid crisis on October 26, 2017 in the East Room of the White House in Washington, DC.

    The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars.

    In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate. The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion. Most of that was attributed to health care and criminal justice spending, along with lost productivity.

    The council said its estimate is significantly larger because the epidemic has worsened, with overdose deaths doubling in the past decade, and that some previous studies didn't reflect the number of fatalities blamed on opioids, a powerful but addictive category of painkillers.

    The council also said previous studies focused exclusively on prescription opioids, while its study also factors in illicit opioids, including heroin.

    "Previous estimates of the economic cost of the opioid crisis greatly underestimate it by undervaluing the most important component of the loss — fatalities resulting from overdoses," said the report, which the White House released Sunday night.

    Last month at the White House, President Donald Trump declared opioid abuse a national public health emergency. Trump announced an advertising campaign to combat what he said is the worst drug crisis in the nation's history, but he did not direct any new federal funding toward the effort.

    Trump's declaration stopped short of the emergency declaration that had been sought by a federal commission the president created to study the problem. An interim report by the commission argued for an emergency declaration, saying it would free additional money and resources.

    But in its final report earlier this month, the panel called only for more drug courts, more training for doctors and penalties for insurers that dodge covering addiction treatment. It did not call for new money to address the epidemic.

    More than 64,000 Americans died from drug overdoses last year, most involving a prescription painkiller or an illicit opioid like heroin.

  • November 20, 2017 11:15 AM | Deleted user
    November 3, WMS Medigram

    The Wisconsin Medical Society Board of Directors has named Clyde “Bud” Chumbley, MD, MBA, chief executive officer of the Wisconsin Medical Society.

    “I’m excited to have the opportunity to serve as the next CEO of the Wisconsin Medical Society; I consider it a tremendous honor,” said Dr. Chumbley, who will begin on November 27. “Having been a Society member for 37 years, I’m a firm believer in its mission to advance the health of the people of Wisconsin by ensuring access to high-quality, cost-efficient care. And I look forward to drawing on my experience to further strengthen the Society so we can continue to make a difference for our patients and our profession.”

    In addition to caring for patients as a board-certified obstetrician/gynecologist throughout his 36-year medical career, Dr. Chumbley has held numerous leadership and management positions, including serving nearly 20 years as president and CEO of a large, independent multi-specialty medical group practice. He currently serves as chief medical adviser for Wisconsin Medical Society Holdings and as chief medical officer for the Wisconsin Medical Society Holdings Association Health Plan.

    Past leadership roles in Wisconsin include serving as chief medical officer/chief clinical integration officer for Aspirus Health and president of Aspirus Clinics, and as president and CEO of ProHealth Care Medical Associates. He also has served on the board of directors and as past chair and treasurer for the Wisconsin Collaborative for Healthcare Quality. In Texas, he served as chief medical officer for Scott & White Healthcare in the Austin region.  

    Doctor Chumbley is a graduate of the University of Missouri School of Medicine and the Kellogg School of Management at Northwestern University and holds medical licenses in Wisconsin and Texas.

    “We were fortunate to have a number of highly qualified candidates interested in this position,” said Jerry Halverson, MD, chair of the Society’s Board of Directors and co-chair of the search committee. “Doctor Chumbley is an excellent advocate for physicians and the patients we serve, and with his extensive administrative experience and medical expertise, we believe he is an outstanding choice to lead the Society. We look forward to all we can accomplish under his leadership.”

    Doctor Chumbley is the eighth Society CEO in its 176-year history. Susan L. Turney, MD, MS, FACMPE, FACP, was the first physician to hold the position from 2004 to 2011.

  • November 16, 2017 11:29 AM | Deleted user
    by Alexandria Bachert MPH, Staff Writer, MedPage Today November 15, 2017

    WASHINGTON -- A first-in-class neurostimulation device to relieve symptoms of opioid withdrawal is approved for marketing, the FDA announced Wednesday.

    The NSS-2 Bridge device is a small, battery-powered electrical nerve stimulator that is placed behind a patient's ear and emits electrical pulses to stimulate branches of certain cranial nerves. Patients can use the device for up to 5 days during the acute physical withdrawal phase.

    The device, made by Innovative Health Solutions, was previously cleared by the FDA in 2014 for use in acupuncture.

    "Given the scope of the epidemic of opioid addiction, we need to find innovative new ways to help those currently addicted live lives of sobriety with the assistance of medically assisted treatment," said FDA Commissioner Scott Gottlieb, MD, in an agency press release. "While we continue to pursue better medicines for the treatment of opioid use disorder, we also need to look to devices that can assist in this therapy."

    Device approval was based on a study that evaluated the clinical opiate withdrawal scale (COWS) score -- measuring symptoms on a scale of 0 to more than 36 (0 being the least severe) -- in 73 patients undergoing opioid physical withdrawal. Study results showed that all patients had a reduction in COWS of at least 31% within 30 minutes of using the device and that 88% of patients transitioned to medication-assisted therapy after 5 days.

    The device is available only by prescription and is contraindicated for patients with hemophilia, cardiac pacemakers, and psoriasis vulgaris.

    Learn more

  • November 06, 2017 2:38 PM | Deleted user

    Lagisetty P, et al. PLOS One. 2017;doi:10.1371/journal.pone.0186315.

    November 3, 2017

    Multidisciplinary and coordinated care delivery models effectively provide opioid use disorder treatment and increase access to medication-assisted treatment in primary care, according to data published in PLOS One.

    “It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience,” Pooja Lagisetty, MD, from the division of general internal medicine and the Institute for Health Policy and Innovation at the University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System, said in a press release. “But, if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible. There is a major need to do this.”


    People who need addiction care outnumber the physicians willing to provide medication-assisted treatments (MATs) like buprenorphine and methadone in primary care, despite prior research showing that MAT can reduce mortality for patients with opioid use disorder. Researchers compiled data on evidence-based, primary care MAT interventions and program structures and processes that were associated with improved patient outcomes using clinical databases. They reviewed randomized controlled trials and observational studies that assessed MAT for adult patients with opioid use disorder to determine what kinds of primary care-based models may help guide future policy and implementation in primary care settings.

    Lagisetty and colleagues included 35 interventions that tested MAT in primary care settings across eight countries in their systematic review. Analysis showed that patients were more likely to have successful opioid addiction treatment when their PCP worked with teams of nurses, medical assistants, social workers and pharmacists to deliver MAT. The successful interventions featured joint multidisciplinary and coordinated care by physician and nonphysician provider delivery models to offer MAT. Seven studies showed that 60% or more of patients continued their MAT regimen for 3 months or longer. Not all successful programs were the same in reported patient outcomes, processes and tools used, but they used similar key design factors, such as:

    • integrated clinical teams with support staff — usually advanced practice nurses and pharmacists — as clinical care managers;
    • patient agreements with providers that outlined consequences for continued drug misuse; and
    • home inductions of buprenorphine to make treatment more convenient.

    Lagisetty noted that it makes sense to provide MAT in primary care because the results are similar to providing it in specialty care. In addition, patients may be more likely to seek help from their PCP because of the lack of stigma and their ability to address other health concerns as well, according to the release.

    “I don’t think that many primary care physicians went into medicine with a desire to focus on treating addiction. However, opioid addiction is increasingly becoming common in our practices and our patients are struggling to find help,” Lagisetty said. “Primary care doctors don’t need to all be treating 100 patients. It can just be five. We should just have the medication in our tool box and be able to screen and potentially treat patients in our own setting.” – by Savannah Demko

    Disclosures: The authors report no relevant financial disclosures.

  • November 02, 2017 10:31 AM | Deleted user

    Please note that ASAM physician members may apply for the Distinguished Fellow, American Society of Addiction Medicine (DFASAM) title until November 15, 2017. ASAM and the Board of Directors recognize these elite professionals as "Distinguished Fellows" because of their significant contributions to the field of addiction medicine and their work as outstanding, prominent, and distinguished professionals in the medical community. Authorized members may employ the DFASAM designation after their names as a mark of distinction and to provide a description of their unique position.

    We encourage you to apply (If you haven’t already) and remind physician members in your chapter that the DFASAM application period is open for only 2 more weeks.  Click here to access the DFASAM page.

  • October 30, 2017 3:31 PM | Deleted user

    Department of Health Services Names Paul Krupski as Director of Opioid Initiatives

    New position aimed at coordinating efforts to fight the state's opioid crisis

     The Wisconsin Department of Health Services (DHS) announced today Paul Krupski has been selected to serve as the new Director of Opiate Initiatives to coordinate the department’s efforts to end the state’s opioid crisis, effective today. 

    “Opioid overdoses and the misuse of opioids affects every corner of the state, and Paul’s experience and skills support our efforts to ensure that our response is as aggressive and effective as possible,” said DHS Secretary Linda Seemeyer. “Opioid use disorder, including heroin and prescription drugs, is destroying families, and we must do whatever we can to end the heartbreak affecting so many.” 

    View the entire news release.

  • October 30, 2017 10:26 AM | Deleted user

    by Ilene MacDonald | 

    Oct 27, 2017 9:17am

    President Donald Trump on Thursday declared a war on drug addiction and opioid abuse, saying he would mobilize his entire administration to address the crisis now that he has officially determined it is a national public health emergency.

    “We will defeat this opioid epidemic,” Trump said. “We will free our nation from the terrible affliction of drug abuse. And, yes, we will overcome addiction in America … We have fought and won many battles and many wars before, and we will win again.”

    Although he didn’t offer specific actions the administration would take during his remarks or how they will be funded, Trump said federal agencies are working with doctors and medical professionals to implement best practices for safe opioid prescribing, and requiring that federally employed prescribers undergo special training.

    The public health emergency directive allows the government to waive some restrictions, Trump said, such as a 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those who suffer from drug addiction. But it doesn’t come with a substantial amount of funding that would have been available had Trump declared a national emergency under the Stafford Act, which would have allowed access to funding under the Federal Emergency Management Agency.

    Later in the day the administration released a statement that provided some of the actions the government would take as a result of the declaration:

    • Expand access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.
    • Allow the Department of Health and Human Services to quickly make temporary appointments of specialists who can help the agency respond to the crisis.
    • Allow the Department of Labor to issue dislocated worker grants to help those who have been displaced from the workforce because of the opioid crisis (subject to available funding).
    • Shift resources within HIV/AIDS programs to help people eligible for those programs to receive substance abuse treatment, an action that the administration noted is vital given the connection between HIV transmission and substance abuse.

    Trump said during his remarks that he is awaiting a final report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis and the administration will act quickly to evaluate and implement its recommendations.

    The administration later said in a statement that since Trump took office the government has allocated or spent more than $1 billion to address drug addiction and the opioid crisis. That funding includes $800 million for prevention, treatment, first responders, prescription drug monitoring programs, recovery and other care in communities, inpatient settings, and correctional systems. It also includes $254 million in funding for high-risk communities, law enforcement, and first responder coordination and work.

  • October 25, 2017 12:49 PM | Deleted user

    The Hill
    BY RACHEL ROUBEIN - 10/24/17 12:44 PM EDT

    As America grapples with an opioid epidemic, senior citizens are often overlooked.

    Yet, older adults are highly susceptible to chronic pain and the prescription painkiller addiction is hitting this population.

    “We really are looking at the opioid epidemic, we know how destructive it is, but we think of its younger victims,” Rep. Katherine Clark (D-Mass.) said at an event on aging and addiction, hosted by The Hill and sponsored by Surescripts. “This is more of a quiet, more silent, but equally deadly part of the opioid epidemic,” she said.

    Roughly one in three beneficiaries in Medicare’s prescription drug program received a prescription for opioids in 2016. About half a million received high amounts of opioids. And nearly 90,000 are at “serious risk” of opioid misuse or overdose, according to a July report by the inspector general of the Department of Health and Human Services (HHS).

    “What the data really revealed — the final takeaway — is that Medicare may be paying for opioids that are not medically necessary and in fact Medicare may be paying for opioids that are doing harm to seniors and perhaps even others as the drugs are diverted into the street for resale,” said Ann Maxwell, assistant inspector general for evaluations at the HHS Office of Inspector General.

    At the event, Clark and Rep. Markwayne Mullin (R-Okla.) touted their bill requiring e-prescriptions for controlled substances under Medicare.

    Of potential opposition to the measure, Clark said, “the burden is really going to come to doctors, to hospitals, to upgrade their technology to be able to do the e-prescribing.” She added the legislation includes built in ways to give them time to meet this criteria.

    But, she said, “this is worth it,” calling it a “critical tool going forward.” Mullin added that the bill doesn’t go into effect until 2020.

    A panel of experts discussed their views on how Congress and the administration can help combat the rates of opioid addiction among older adults. These recommendations included an infusion of federal funds, regulations from the Centers for Medicare and Medicaid Services on pharmacy and prescriber lock-in programs under Medicare, cautious prescribing of opioids and more.

  • October 24, 2017 11:01 AM | Deleted user

    Under the leadership of Governor Walker, the Department of Health Services (DHS) Division of Medicaid Services (DMS) is pleased to announce that effective January 1, 2018, we will increase reimbursement for outpatient mental health (MH) and substance use disorder (SUD) treatment.

    We have heard the feedback from our partners in the MH and SUD provider community regarding the barriers they face in meeting the demand for these important services. Generally, financial mechanisms alone will not resolve many of the health care challenges of our state.  However, by increasing Medicaid rates and removing the administrative burden of prior authorization for outpatient mental health providers, we expect that our members will have improved access to treatment services by encouraging licensed providers to enroll with Wisconsin Medicaid. To enroll in the Medicaid program, go to the ForwardHealth Portal.

    DMS will invest $7 million GPR annually to increase rates for MH and SUD. This substantial investment will make Wisconsin Medicaid a rate leader in the Great Lakes region in terms of provider reimbursement for MH and SUD treatment.

    This announcement will be followed soon by a ForwardHealth Update with additional details of the rate increase and billing guidance for fee-for-service providers. DMS will provide guidance to HMOs on the rate/billing guidance changes and will adjust our HMO capitation rates (and encounter data submission process) effective January 1, 2018, to assure alignment.

    I hope this investment by Governor Walker will spur you to enhance and expand mental health and substance abuse services to our residents in need.  We look forward to our continued partnership and collaboration on behalf of our members.

    Michael Heifetz

    Medicaid Director

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