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While Wisconsin and other states have made progress snuffing out cigarette smoking, youth vaping is on the rise. One in five high school students regularly used e-cigarettes in 2018, a jump in use the Department of Health Services has called an epidemic.
What led to this rise? And what are its overall health implications? What’s being done to address the issue?
A Wisconsin Health News panel on July 9 in Madison will tackle these questions and more.
Panelists:
Register now.
June 4, Wisconsin Health News
The federal government awarded two Wisconsin groups with $200,000 one-year grants to develop plans to provide treatment for those impacted by the opioid epidemic, according to a recent statement.
The Health Resources and Services Administration's Federal Office of Rural Health Policy provided $24 million across 40 states for the programs.
One of the grants will head to HSHS St. Vincent Hospital in Green Bay. The hospital runs the Libertas Treatment Center in Marinette, which will use the grant, as well as $20,000 from the Hospital Sisters of St. Francis Foundation, to operate the Heroin Opioid Prevention Education Consortium.
The consortium will assess resources available for prevention and treatment of substance use disorders in Oconto, Marinette, Menominee, Shawano and Florence counties. It’ll identify what else is needed and develop a plan to build on current services.
“The HOPE Consortium will allow us to ramp up our efforts in preventing and treating these disorders that are having devastating effects on people of all ages and all walks of life,” Paula Manley, executive director at Libertas, said in a statement.
The other $200,000 grant will head to the Family Health Center of Marshfield at Marshfield Clinic Health System. It’ll conduct an analysis in Wood and Clark counties to identify gaps in substance use disorder treatment and create plans to support those services.
Greg Nycz, executive director of the center, wrote in an email that they applied for the grant “because there are many in our community who need help with substance use disorders and access to the continuum of services that lead to success is problematic all across northern and central Wisconsin."
May 30, Wisconsin Health News
There's been an increase in the prescribing of medication used in medication-assisted treatment for opioid use disorder, according to a recent report.
The number of pharmacy-dispensed prescriptions for suboxone increased 21 percent between the first quarter of 2018 and the first quarter of this year, noted a quarterly report from the state’s Prescription Drug Monitoring Program.
The number of prescriptions went from 36,828 to 44,561 over the period. That doesn't include dispensing that occurs at a federally funded opioid treatment program.
Suboxone was the fourteenth most dispensed drug monitored by the program, according to the report.
Hello WISAM members,
With the end of the academic year fast upon us, many of us will be taking time off. I just returned from a three week trip to Egypt. While there, my partner and I found ourselves among an amazing group of people from around the globe, all of whom were doing their part to make the world a better place. It expanded my mind on multiple fronts as we met a banker from Luxembourg during our first night in Cairo. I hadn't considered that anyone in the banking profession would be doing anything of a world-healing nature, but this man spent most of his time in his native South Africa providing loans for projects that would help people rise out of poverty.
We also met people in the healthcare field and on comparing notes, the similarities of the challenges treating patients with addiction issues far outweigh the differences in rich vs poor countries, religious affiliations, and different cultural and ethnic groups. There were some interesting differences as well, such as Tramadol being one of the most abused opioids in Egypt, possession of which is punishable by long imprisonment.
So, as we start our summer excursions, our connectedness to those around us matters, as does our willingness to learn. This is as true for those we talk to during an unexpected encounter as it is for those we treat clinically.
WISAM will be a little quieter during the summer months as we take time off from our monthly teleconferences after the May call. However, we continue to plan for the WISAM 2019 Annual Conference taking place September 26-27 in Madison.
Please stay connected! As an organization, WISAM is only as strong as our involvement with all of you, our members.
Matt Felgus, MD FASAM President
On May 8, 2019, Citizen Action of Wisconsin, State Representatives Chris Taylor (D-Madison), Melissa Sargent (D-Madison) and Senator Jeff Smith (D-Brunswick) released a report documenting that expanding Medicaid would reduce financial barriers to accessing critical anti-opioid medications for working Wisconsinites.
WISAM Public Policy Chair, Michael Miller, MD, participated in the news conference, which took place in the Senate Parlor at the Wisconsin State Capitol in Madison, WI.
Michael Miller, MD, DFASAM Chair, WISAM Public Policy Committee
In February, the U.S. Attorney’s Office for the Western District of Wisconsin sent letters to Wisconsin physicians encouraging them to take a step back and “take stock of” their practices and their prescribing patterns in light of the opioid epidemic. While the letter indicated the recipient was not under any sort of investigation by federal prosecutors, the outcomes left a chilling effect on physicians to receive such a letter from prosecutors in the U.S. Department of Justice. After hearing of these letters, I immediately reached out to Mark Grapentine, JD, Senior Vice President for Governmental Relations at the Wisconsin Medical Society, to gauge the reaction of the Wisconsin physician community and to discuss next steps. In short order, consensus developed to prepare a joint press release as well as a joint letter from WMS and WISAM to the U.S. Attorney’s office in Madison. Very quickly, a cordial response was received with a suggestion to meet in person and discuss each party’s respective perspectives. The U.S. Attorney’s office expressed a desire to be collaborative with the medical community regarding identifying solutions to the opioid overdose crisis. On April 1st, a meeting convened in Madison with representatives from WMS, WISAM and the Wisconsin Hospital Association, met with five attorneys from the Western District of Wisconsin, three attorneys from the U.S. Attorney’s office for the Eastern District of Wisconsin, three representatives from the Wisconsin Attorney General’s office including Deputy Attorney General Eric Wilson, and a representative of the Drug Enforcement Administration’s office in Milwaukee. Also in attendance was Tim Westlake, MD, from Wisconsin Medical Examining Board and the Wisconsin Controlled Substances Board, which overseas controlled substances prescribing within our state and which is the current administrator of the Wisconsin PDMP.
U.S. Attorney for the Western District, Scott Bader, provided opening comments and shared the directive received by DOJ from the White House to take immediate action to reduce opioid overdose deaths. Discussion ensued regarding the scope of the opioid problem and the current role of the U.S. Attorney’s offices around the country. Actions that have been taken by the DOJ, including the distribution of letters to various subsets of physician prescribers, were shared, and Mr. Bader made clear the intention of the U.S. Attorneys’ offices was to form a partnership with all aspects of the medical community in Wisconsin and collaborate to best address the opioid epidemic to generate positive public health outcomes.
The dialogue that has been established between the U.S. Attorney’s office has been very positive. Despite tensions that arose because of the DOJ letters being distributed to Wisconsin physicians without consultation with WMS or other physician groups, the collaboration that has developed through this effort marks a strong relationship for the future.
WISAM President-Elect Dr. David Galbis-Reig and I have both been invited to present and participate in planning the DOJ’s 2019 Opioid/Meth Summit, Making Progress through Collaboration and Prevention. The conference will take place October 15-16 at the Grand Geneva Resort in Lake Geneva. Last year’s Summit featured U.S. Senator Hal Rodgers from Kentucky and attracted over 700 attendees.
The American Society of Addiction Medicine (ASAM) recently commended a bipartisan group of US Senators calling for strategic investments to increase the ranks of qualified, well-trained addiction treatment professionals in high-need communities across the United States. Fifteen Senators from both sides of the aisle signed on to a letter urging the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies to prioritize funding in fiscal year 2020 for two addiction treatment workforce programs authorized in previous legislation.
“We applaud this bipartisan group of Senators for recognizing the need to invest in and expand our nation’s addiction treatment workforce so Americans all across the country can better access the high- quality, evidence-based care they need to continue down the path of recovery,” said Paul H. Earley, MD, DFASAM, president of ASAM. “By fully funding these two programs, which were previously authorized by Congress, lawmakers have the historic opportunity to help our country take a major step forward in addressing the deadly opioid overdose epidemic that is taking tens of thousands of lives every year.”
The letter, addressed to Subcommittee Chairman Roy Blunt (R-MO) and Ranking Member Patty Murray (D-WA), urged lawmakers to appropriate full funding for two key programs that will invest in the nation’s addiction treatment workforce during a time when the country is grappling with a deadly opioid overdose crisis, as well as a shortage of professionals trained to provide addiction treatments that are proven to save lives.
Specifically, the Senators highlighted the Loan Repayment Program for Substance Use Disorder Treatment Workforce, which was authorized in last year’s landmark SUPPORT for Patients and Communities Act, and the Mental and Substance Use Disorder Workforce Training Demonstration Program, which was authorized in the 21st Century Cures Act.
The Senators called for $25 million in funding for the Loan Repayment Program for Substance Use Disorder Treatment Workforce, which would provide student loan relief to addiction treatment professionals who commit to working in designated Mental Health Professional Shortage Areas or in counties where the average overdose death rate is higher than the national average.
Additionally, the Senators urged their colleagues to appropriate $10 million in funding for grants to institutions that provide training opportunities for medical residents and fellows in psychiatry and addiction medicine, as well as nurse practitioners, physician assistants and others who are willing to provide SUD treatment in underserved communities.
“Funding these programs would allow more individuals to pursue and afford SUD treatment education and training, and would significantly increase the number of qualified experts available to help the more than 20 million Americans in need of care,” the Senators wrote.
The Senate letter follows two bipartisan House letters sent earlier this month calling for House
Appropriations Committee members to prioritize funding for these two programs.
Despite the growing need, there are currently too few clinicians with the requisite knowledge and training to prevent, diagnose, and treat the disease of addiction. According to the latest estimates, nearly 21 million Americans needed treatment for SUD in 2017, but only 4 million received any form of treatment. Furthermore, addiction training is still too rare in American medical education. Since addiction medicine was only formally recognized as a medical subspecialty in 2016, the field is still catching up with other specialties in terms of available teaching and training opportunities. More investment is needed to close the existing treatment gap.
The ASAM Review Course in Addiction Medicine, "The Essential Primer in Addiction Medicine," takes place July 25 - July 27, 2019 at the Hilton Anatole in Dallas, TX.
The ASAM Review Course in Addiction Medicine is widely recognized as the essential primer for physicians and other healthcare professionals preparing for a career in addiction medicine, as well as for primary care providers who wish to increase their skills in identifying and managing patients whose medical problems are caused or exacerbated by substance use disorders. ASAM’s Review Course has had a major impact on advancing scientific knowledge among physicians and other healthcare professionals.
The course offers two-and-a-half days of sessions which are mapped to the addiction medicine exam blueprint of topics for the exam and feature an outstanding lineup of faculty.
Register by June 17 and save $200! Register online at: http://bit.ly/ReviewCourse2019
April 16, WTMJ News
Two faculty researchers at Marquette University have received a $1.9 million grant from the National Institutes of Health that will fund neuroscientific research into psychiatric disorders such as addiction and depression.
Drs. Robert Wheeler and John Mantsch will study how unpleasant experiences negatively impact people with underlying psychiatric disorders, with the goal of developing innovative behavioral and pharmacological therapies aimed at managing them.
Their project is titled “Aversion signals in the reward system.”
“Aversive life experiences are unavoidable and can vary widely, from very highly stressful events to more mildly negative experiences,” said Wheeler, an associate professor of biomedical sciences. “However, each of these experiences is represented by a neural aversion signal in the brain. In someone struggling with an underlying disorder like addiction, these signals can lead to relapse, and persistent aversive signals can also contribute to diseases like depression.”
The research team has identified the presence of aversion signals in the nucleus accumbens, an area of the brain also known for processing pleasurable stimuli.
Aversion signals in the nucleus accumbens are represented by a reduced concentration of a stress-sensitive neurotransmitter called dopamine. The researchers believe that, in people with underlying disorders, the dopamine response to stressful events triggers addiction and other harmful behaviors.
“Our purpose is to characterize how these signals are represented and how they change behavior,” said Mantsch, chair and professor of biomedical sciences. “We believe that decoding aversion signals will give us critical insight into both a fundamental aspect of the human condition and a range of stress-sensitive psychiatric disorders.”
The Wisconsin Medical Society Foundation honored Ritu Bhatnagar, MD, MPH, with the Superhero of Medicine Award during its Annual Fundraising Dinner and Silent Auction in Madison on April 5. The Superhero of Medicine Award is presented annually to a physician nominated for having superpower-like attributes and using them to go above and beyond the call of their profession.
Doctor Bhatnagar is an addiction psychiatrist and medical codirector of the NewStart addiction service within UnityPoint Health-Meriter in Madison and is a clinical professor at the University of Wisconsin School of Medicine and Public Health Department of Psychiatry. She is an active member of the Wisconsin Society of Addiction Medicine (WISAM), is the WISAM representative to the Council on Legislation for the Wisconsin Medical Society and is a member of the University of Wisconsin Opioid Treatment Task Force.
To support patients beyond clinical care, she has initiated and maintained a Mindfulness-Based Relapse Prevention Group at NewStart over the last three years. She also volunteers for various organizations, including Safe Communities of Madison-Dane County, where she seeks to develop innovative ways to address the impact of substance use and mental health disorders.
Doctor Bhatnagar was nominated for the award by Nameeta Dookeran, MD, an addiction medicine colleague, who praised her efforts to “improve patient access to treatment and increase clinician engagement in addiction care beyond addiction specialty settings and across different health systems.” Doctor Dookeran also cited Dr. Bhatnagar’s leadership in developing and implementing a continuing medical education webinar series on evidence-based treatment of substance use disorders to empower primary care clinicians to treat substance use disorders—especially those providers in rural areas of Wisconsin.
“Doctor Bhatnagar has shown dedication to building treatment capacity and improving access to care,” said Dr. Dookeran. “She is not just a ‘hero,’ she is a tireless champion for the underserved and for capacity building in health care. I cannot think of a more outstanding member of our Wisconsin Medical Society to be nominated for this award.”
Wisconsin Society of Addiction Medicine563 Carter Court, Suite B,Kimberly, WI 54136
