Milwaukee County Executive David Crowley, Chief Health Policy Advisor Dr. Ben Weston, Department of Health & Human Services (DHHS) Executive Director Shakita LaGrant-McClain, and Behavioral Health Services (BHS) are announcing the placement of 11 Harm Reduction Vending Machines to reduce injury and death from overdose, at locations across the county, informed by data and need. The machines provide free access to harm reduction and prevention supplies, including fentanyl test strips, nasal naloxone, medication deactivation pouches, medication lock bags, and gun locks. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), harm reduction is an evidence-based practice to prevent death for people who use drugs. In 2022, there were 667 drug overdose deaths in Milwaukee County.

“The opioid epidemic reaches communities in all parts of the county. It crosses all socio-economic, demographic and age ranges – there is no ‘type’ of person who succumbs to opioid addiction. Last year’s opioid settlement allow us to get to work right away funding projects that will help save lives and mitigate continued suffering for residents and their loved ones,” said County Executive Crowley. “Milwaukee County has been on the frontlines of this battle for years in the court system, and now we take the next step in bringing crucial resources to the doorstep of the communities that need them the most. By following the data and investing in the communities with the highest need, I am optimistic we will make our communities safer and healthier and help residents begin or continue their road to recovery.”

Click Here for Vending Machine Locations

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August 31 is International Overdoes Awareness Day, the world’s largest annual campaign to end overdose.  Today we:

• Remember loved ones who have died from drug overdose and acknowledge the grief of the family and friends left behind;
• Take action to encourage support and recovery for everyone impacted by substance use and overdose; and
• End overdose by spreading awareness of overdose prevention strategies.

The following article was posted on the American Society of Addition Medicine on August 30.  It was written by Dr Nicholas Athanasiou (Editor-in-Chief) and summarizes the growing impact of overdoes in our world.

Drug use and overdose rates are a concern for the public’s health. A new report from the CDC looks at how overdose rates during the pandemic varied across different industries and work settings while highlighting significant health equity issues in the US (National Vital Statistics Report). It’s hard not to think about “deaths of despair” when reading this, but then an article from TIME reminds us that “deaths of despair” might be too narrow a view because there is more to "despair-ism" than originally conceptualized.

Data from Monitoring the Future found that young adults report using marijuana and hallucinogens at or near historically high levels while middle-aged adults report record levels of binge drinking (NIDA News). Maybe Generation X is responding to the difficulties of being sandwiched between two hippie generations. 

Cannabis is now the most commonly used illegal (federal) drug in pregnancy, which means that perinatal research needs to close the knowledge gap quickly -- both for maternal and paternal use -- so we can better guide clinicians, develop policy, and inform the public (JAMA). A review on nitrous oxide toxicity reminds us that use of a cheap and easily accessible substance should be included on our differentials, especially when seeing youth and young adults with unusual gait (CMAJ). 

More globally, Bashar al-Assad’s regime in Syria is looking to spread addiction and turmoil to global enemies by dealing a new amphetamine-type stimulant called captagon (The Messenger).  Evidently, drug use and overdose rates are a concern for geopolitical foes too.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD

Wisconsin Health News

A national philanthropic effort to fight the opioid crisis on Monday released more details on its work in Wisconsin.

The Bloomberg Philanthropies Overdose Prevention Initiative launched in 2018 in two states and expanded its work to five more, including Wisconsin, in 2021. To date, Bloomberg Philanthropies has put $170 million toward the overall initiative.

The initiative supports Vital Strategies, which is working in Wisconsin to help provide the anti-overdose reversal drug naloxone, fentanyl test strips and information resources. It's also supporting the Department of Health Services in how to best use funding and programming for overdose deaths. The effort also backs harm reduction services and awareness efforts in Black and Indigenous communities.

“Working together, we can avoid the loss of life from drug overdoses and help those with substance use disorder on the path to recovery,” DHS Secretary-designee Kirsten Johnson said in a statement.

On Monday, Vital Strategies said it is:

• Teaming up with Milwaukee radio stations on an educational campaign on how the overdose crisis is disproportionately impacting Black communities and how to access naloxone and other resources through the City of Milwaukee Office of African American Affairs.
• Providing technical assistance and funding to the Bad River Tribe's harm reduction supply delivery program and an initiative by NEXT Distro to expand access to harm reduction supplies in rural and Indigenous communities. 
• Supporting a workgroup composed of leaders on Milwaukee’s north side in disseminating a report they wrote on the unmet harm reduction and treatment needs in the city’s Black communities. 
• Partnering with Samad’s House, a Black-led organization that provides healthcare and supportive services to women in substance use disorder recovery, to support women with lived experience in distributing harm reduction supplies and providing information on treatment and referrals.
• Supporting Rebalanced-Life Wellness Association’s Black Barbershop Program to provide naloxone, fentanyl test strips, education and treatment referrals through its existing healthcare services in Black barbershops in Dane County.  

Wisconsin Medical Society | Medigram

The State of Wisconsin's Medical Examining Board (MEB) gave final approval to two administrative rules at its monthly meeting on August 16. One is the culmination of a multi-year exploration into establishing chaperone requirements; the other modifies current rules for physicians' continuing medical education (CME) responsibilities. 

Opioid CME Requirements

The new rule alters the current requirement that a physician complete two credits of coursework each reporting period in a specific area of controlled substances prescribing; the specific subject area has varied over the previous cycles. Under the new rule, the two-credit requirement can be fulfilled with coursework pertaining to "prescribing opioids and other controlled substances." While previous cycles required those courses to be approved by the MEB, the new rule eliminates that requirement. 

Since first establishing this subject-specific requirement, the MEB created each version of the rule with a sunset clause, meaning the requirement would expire if the MEB determined that specific prescribing education was no longer needed. As the state continues to experience overdose-related deaths – including an increase in synthetic opioid-related abuse – the MEB decided not to include a sunset clause for the new rule. Therefore, the requirement will remain until such time as the MEB decides to alter the rule. 

The new rule is expected to take effect on October 1, 2023, which means it applies to the current CME cycle. 

WI 2023 SB332 proposes to significantly change the alcohol laws in Wisconsin. If enacted, the bill would change Wisconsin laws for the production, regulation, and distribution of alcohol beverages and change how alcohol is regulated and oversight is provided. The attached memo, created by Wisconsin Alcohol Advocacy Project, outlines ten significant changes this bill creates for alcohol regulation.

The public hearing on AB 304/SB332 has been scheduled for Thursday, August 17, 2023, at the State Capitol at 9:30 am, 411 South. There are several bills in this hearing. AB 304/SB332 is third on the docket.

CLICK HERE to view the video from the Wisconsin Alcohol Policy Project webinar last week entitled “Changes to Alcohol Regulation in Wisconsin: Proposed increases to availability, accessibility and production of alcohol.”

Racial Equity Training - Announcement from the Overdose Prevention Program

WISAM is sharing this racial equity training designed for organizations and providers working with people who use drugs. The training, "Taking Action on Racial Equity in Drug User Health Programs," was developed in collaboration with In the Works and Reframe Health. It consists of three modules: 

• Racial Equity in Overdose & Drug User Health—This module will discuss race, racism and how overlapping systems of oppression can impact the lives of people who use substances, including its important to drug user health. 

• Addressing Institutional Racism within Organizations—This module will focus on institutional racism within organizations, specifically which practices and policies create inequity for BIPOC staff, and further explore how interpersonal interactions can contribute to inequity.

• Racial Equity in Planning, Data, and Action—This module will discuss integration of racial equity into service provision and external facing work, what kind of information can inform our work and how to identify goals and targets and work with community partners

The modules are available as a free e-course and can be taken at your own pace. The total course, including supplemental sections, will take approximately six hours to complete. There are supplemental resources provided, including downloadable handouts, worksheets, and a glossary. In order to access the course, you must enroll for the course through this link. 

We encourage you to also share this opportunity with other groups that you think will benefit from this resource. Please feel free to share any thoughts or suggestions you may have after accessing the modules. We hope this course will help meet the needs of your organization and improve programming.

Wisconsin DHS News Release

Wisconsinites can call, text, and chat for free, 24/7 mental health and substance use support  

The Wisconsin Department of Health Services (DHS) today is recognizing the positive impact the 988 Wisconsin Lifeline has had in the year since the service began taking calls, texts, and online chats. From July 2022 through June 2023, the 988 Wisconsin Lifeline received 91,834 contacts for mental health and substance use support.  

“The 988 Wisconsin Lifeline is a critically important resource for Wisconsinites to be able to talk to someone when they need to,” said Gov. Tony Evers. “We are proud of the work the 988 Wisconsin Lifeline team has done over the last year to provide hope, help, and support for tens of thousands of Wisconsinites experiencing mental and behavioral health challenges.

View full press release.

Dear WISAM Members,

Happy July- we can celebrate freedom in many ways, and recall Maya Angelou’s dictum that if we are free, we can work to free others.

The FDA has issued draft guidance on clinical trials with psychedelic drugs here. Please submit comments by August 25, 2023 at this website.

Please join us in July for the Open Exchange with Dr. Trost- see here. As we did last year, we will be offering a complimentary WISAM Annual Conference registration to one person, drawn from all attendees who join the monthly Open Exchange sessions. We are looking forward to convening on the 4th Monday of the month from 7-8 pm through September.

Sincerely,
Dr. Ritu Bhatnagar, MD MPH FASAM DFAPA

ATLAS is in Wisconsin! This searchable database went live in June 2023. Please see their website Home | ATLAS (treatmentatlas.org) to share information about your program with people who are looking for treatment.

A press conference for the launch was held June 27, 2023 and Society President, Ritu Bhatnagar, MD MPH, is shown here with Attorney General Josh Kaul. It was great to see bipartisan support for this effort.

The Wisconsin Society of Addiction Medicine’s Nominating Committee is now accepting nominations of any member in good standing interested in serving in WISAM leadership.

WISAM’s Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the organization. Board members are expected to participate in all Board meetings, the Open Exchange Series and Fall Conference, and to volunteer for other activities that will help advance the organization's strategic priorities.

Nominations are being accepted for Board of Director officers and director at-large to serve a two-year term beginning after the Fall Conference in October 2023.

Open positions include:

• President-Elect
• Treasurer
• Secretary
• Director-at-Large
• Early Career Physician (ECP) Director

If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved.

Nominations are due by August 13, 2023. 

Nominate Here Board Description