Latest News

  • May 02, 2019 2:04 PM | Sally Winkelman (Administrator)

    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.  

  • April 30, 2019 11:26 AM | Sally Winkelman (Administrator)

    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.

  • April 30, 2019 11:13 AM | Sally Winkelman (Administrator)

    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 18, 2019 5:43 PM | Sally Winkelman (Administrator)

    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.”

  • April 11, 2019 5:32 PM | Sally Winkelman (Administrator)

    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.”

  • April 11, 2019 8:45 AM | Sally Winkelman (Administrator)

    February 21, U.S. News & World Report

    If states want to drastically improve access to opioid addiction treatment, expanding Medicaid is the best place to start, a new analysis indicates.

    Medicaid expansion draws a clear divide along state lines in terms of who has access to opioid use disorder treatment and who does not – despite some federal action in recent years to try to make treatment more accessible to all Americans, according to the report, published Thursday by the Urban Institute, an economic and social policy think tank based in the nation's capital.

    Researchers measured Medicaid spending and prescriptions from 2010 to 2017 for the opioid overdose reversal medication naloxone, as well as buprenorphine and naltrexone, two drugs that can blunt opioid cravings and are often paired with counseling for an approach called medication-assisted treatment. While both Medicaid expansion and non-expansion states saw gains in prescriptions to treat opioid use disorder during the time period studied, patients in states that had expanded Medicaid may have been better off.

    "There were increases in almost every state for the treatment of opioid use disorder using buprenorphine and naltrexone, but the states that expanded Medicaid more rapidly had higher treatment rates per enrollee," says Lisa Clemans-Cope, a principal research associate and health economist in the Health Policy Center at the Urban Institute.

    Between 2013 – the year before major Affordable Care Act provisions went into effect – and 2017, Medicaid spending on opioid treatment prescriptions climbed 171 percent in states that had expanded the federal health program, compared with 72 percent in states that had not expanded Medicaid by 2017, the analysis shows.

    The study's authors also cited previous research that found "no evidence of large-scale substitution from cash or other payers to Medicaid" – indicating most of the gains were among patients who previously had no access to treatment.

    "In the non-expansion states, they're really leaving their people without a good option for affordable treatment," Clemans-Cope says. "These medications are really effective, and part of more comprehensive care for many individuals that can really make a big difference in mortality, as well as the experience of their families and their communities."

    Overall spending on the three medications rose from $190 million in 2010 to $887.6 million in 2017, after researchers adjusted for the average rebates drugmakers paid to states. The fastest growth was between 2014 and 2016, when most states adopted Medicaid expansion.

    As of January 2019, 17 states had not enacted Medicaid expansion, though three – IdahoNebraska and Utah – have approved expansion via ballot measure. Several of the non-expansion states saw an above-average number of opioid deaths in 2017, including FloridaMissouriNorth CarolinaSouth CarolinaTennessee, Utah and Wisconsin. Taken together, those seven states saw 10,502 opioid deaths that year, roughly a fifth of the national total.

    Yet the number of overdose deaths remained high in some expansion states as well – such as Ohio and West Virginia – indicating that while expanding Medicaid is a major step policymakers can take to improve access to treatment, it isn't enough to ensure access for covered patients, who are disproportionately affected by opioid use disorder.

    Some expansion states also have been hit hard by street fentanyl, a synthetic substance that is significantly more potent than heroin. In 2017, for example, the majority of Ohio's 4,293 opioid overdose deaths involved fentanyl and related substances.

    That means more people could be getting into treatment in an area, but parallel to those gains, others could be dying at a rapid pace as fentanyl and its analogues creep into the drug supply, sometimes without users realizing, Clemans-Cope says.

    "It's a little bit of a complicated picture to separate treatment from what's basically a poisoning of the opioid supply," she says.

    A slew of other state-level policies also affect patients' treatment access. While buprenorphine is covered by all state Medicaid programs, some require prior authorization to prescribe the medication. Others have enacted dosage limits for the drugs, or have limited formulations of the medications available.

    Still, Clemans-Cope says that as the epidemic continues to take its toll on the country, more doctors should be prepared to treat opioid use disorder, even if they aren't addiction specialists. In California, for example, a tiny share of prescribers had waivers to prescribe buprenorphine, according to Urban Institute researchers.

    "Mostly, prescribers are not stepping up to the plate to provide treatment," she says. While some patients will need more specialized treatment, "there are people who can be treated effectively in primary care office, by someone who isn't an addiction specialist but has received some special training to prescribe buprenorphine." 

  • April 10, 2019 8:56 AM | Sally Winkelman (Administrator)

    A strong showing of Wisconsin Chapter members attended ASAM's 50th Annual Conference in Orlando last week. During the meeting, WISAM past president Aleksandra Zgierska, MD led a meet-up of Wisconsin attendees.


    During the conference, WISAM was presented with an award certificate for the 25th anniversary of our chapter. Brian Lochen, MD, one of the original co-signers of the Wisconsin Chapter Charter agreement, was on hand to graciously accept the award and to safeguard its return to Wisconsin.

  • April 05, 2019 9:24 AM | Sally Winkelman (Administrator)

    Michael Miller, MD, DFASAM, DLFAPA, is among the physicians and leaders in the field of addition medicine being honored at the American Society of Addiction Medicine’s 50th Annual Conference this weekend in Orlando. 

    Doctor Miller will receive the John P. McGovern Award on Saturday. The award recognizes “an individual who has made highly meritorious contributions to public policy, treatment, research, or prevention which has increased our understanding of the relationship of addiction and society.” 

    Doctor Miller, a past president of the Wisconsin Chapter, ASAM,  currently serves as its Policy/Legislative Chair. 

  • March 21, 2019 1:09 PM | Sally Winkelman (Administrator)

    March 21, Wisconsin Health News

    The Department of Health Services is providing more money to help counties and tribes expand access to medication-assisted treatment for those with opioid use disorder, DHS Secretary-designee Andrea Palm announced Wednesday. 

    The grants, which come from federal money awarded to the state, will head to:

    • Manitowoc County ($145,130)
    • Menominee Tribe ( $47,515)
    • Sokaogan Chippewa Community/Mole Lake Band of Lake Superior Chippewa ($80,135)
    • Unified Community Services in Grant and Iowa counties ($235,500)
    • Washington County ($235,500)
  • March 21, 2019 1:06 PM | Sally Winkelman (Administrator)

    March 21, Wisconsin Health News

    Department of Health Services Secretary-designee Andrea Palm said Wednesday that the agency is hoping to build off former Gov. Scott Walker’s administration's work in addressing the opioid epidemic.

    “The previous administration called for all hands on deck in the response to the opioid problem and inspired the entire state with the mantra, ‘Hope. Act. Live,’” Palm said at a forum in Green Bay Wednesday. “That’s something DHS takes to heart.”

    Palm said Walker’s administration laid a “strong foundation” for addressing the epidemic.

    Gov. Tony Evers’ budget proposes taking more federal money to expand Medicaid, which Palm touted as a way to get more people medication-assisted treatment.

    The money would also go toward leveraging federal funding to pilot a hub-and-spoke model of care.

    A state commission proposed the model last year, which was detailed in a report released at the final meeting of the Governor's Task Force on Opioid Abuse last December.

    The model involves establishing a health home for people with substance use disorders, she said.

    “It’s important to me and the leadership at DHS that we don’t lose sight of other substance use disorders, even as we focus on ending the opioid epidemic,” she said. “We need to build a healthcare system that is prepared to address behavioral healthcare more broadly.”

    Palm said large parts of Wisconsin don’t have access to treatment and services. They’d pilot the model in two rural areas and one urban area in the state. 

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