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  • March 13, 2020 3:56 PM | Anonymous

    *NOTE: The following information and the attached document are from Wisconsin's State Opioid Authority (download the full document here)

    The following information is meant to support opioid treatment programs (DHS 75.15 certified agencies) in their response to COVID-19. This guidance contains recommendations and resources that will be updated as this is an evolving situation. All OTPs are to contact the state opioid treatment authority (SOTA) if they have a patient that tests positive for COVID-19.

    How do we reduce transmission in our program facility?

    The Centers for Disease Control and Prevention has provided interim infection prevention and control recommendations in health care settings.

    https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html

    SAMHSA has issued guidance for specifically for OTPs.

    https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines/covid-19-guidance-otp

    The Wisconsin Department of Health Services has a COVID-19 webpage that is updated daily. It includes materials created by DHS for partners and providers.

    https://www.dhs.wisconsin.gov/disease/covid-19.htm

    Anyone with a respiratory illness (e.g., cough, runny nose) should be given a mask before entering your facility.

    Provide hand sanitizer at the front desk.

    Clean all surfaces and knobs several times each day with EPA-approved sanitizers.

    Can we dose someone in a separate room if they present with a fever or cough?

    Yes.

    Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and cough to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.

    OTP staff should use interim infection prevention and control recommendations in health care settings published by the Centers for Disease Control and Prevention.

    If someone presents and is diagnosed with or directed to self-quarantine, can we provide them with take-home dosing?

    Individuals who present with symptoms of a respiratory infection and cough and fever may be eligible for up to two weeks of take-home dosing at the discretion of their OTP physician.

    For individual client cases, please submit exceptions through the SAMHSA OTP extranet website. Consider communication outreach to clients through phone calls, emails, and signage on-site to let them know if they become sick to contact the OTP before coming on-site, so take-home approval can be prepared in advance for dispensing.

    Can we provide delivery of medication to our clients who are diagnosed with COVID-19 or ask to self-quarantine if they cannot leave their home, or a controlled treatment environment?

    This may be possible with appropriate staff to transport the medication (at least 2 staff one being a nurse) that have appropriate personal protective equipment (PPE) and can secure the medication (locked container), although resources to offer this level of service may vary by program. For information on how to attain approval for take-home dosing please see previous question and answers.

    What should we do if we need to allow for more take-homes than permitted by state rule or do not have the ability to meet state staffing requirements due to illness, etc.?

    All state certified entities have the ability to request a variance or waiver to state rules that govern their programs.

    https://www.dhs.wisconsin.gov/regulations/waiver-variance-behavioral-health.htm

    What warrants a shutdown of an OTP?

    You must consult with both your local public health jurisdiction and the Wisconsin State Opioid Treatment Authority (Elizabeth Collier) before making decisions about operations.

    OTPs are considered essential public facilities and should make plans to stay open in most emergency scenarios to be able to induct new clients. No OTP can hold new client admissions at this time.

    What else should my OTP be doing to prepare for or respond to COVID-19?

    Ensure you have up-to-date emergency contacts for your employees and your clients.

    Ensure your program leadership has the contact information of the State Opioid Treatment Authority Elizabeth Collier:

    Develop procedures for OTP staff to take clients who present at the OTP with respiratory illness symptoms, such as fever and coughing to a location other than the general dispensary and/or lobby, to dose clients in closed rooms as needed.

    Develop protocols for provision of take-home medication if a client presents with respiratory illness such as fever and coughing.

    Develop a communications strategy and protocol to notify clients who are diagnosed with or exposed to COVID-19, and/or clients who are experiencing respiratory illness symptoms such as fever and coughing, that whenever possible the client should call ahead to notify OTP staff of their condition. This way OTP staff can have a chance to prepare to meet them upon their arrival at an OTP with pre-prepared medications to be dispensed in a location away from the general lobby and/or dispensing areas.

    Develop a plan for possible alternative staffing/dosing scheduling in case you experience staffing shortages due to staff illness. Develop a plan for criteria for staff members who may need to stay home when ill and/or return to the workforce when well.

    OTPs may want to ensure they have enough medication inventory onsite for every client to have access to two weeks of take-home medication or more. Every Wisconsin OTP should be at least two weeks ready.

    Current guidelines recommend trying to maintain a six-foot distance between clients on-site in any primary care setting, as best as possible. We realize in an OTP setting that this guidance may be difficult to achieve, but should be attempted to the best of everyone’s ability in an aspirational sense, while considering the space and patient flow within your OTP’s physical location. OTPs may want to consider expanding dosing hours to help space out service hours to help mitigate the potential for individual clients queuing in large numbers in waiting room and dosing areas.

    Should your clinic experience an identified exposure to COVID-19, consider how you will continue to dose patients that are at risk and cannot safely manage their medications.  Referring patients to the hospital to be dosed is not an acceptable backup plan.

    Consider a plan for the self-pay patients who may not be able to work due to illness and/or business closures and have no sick/vacation pay or benefits.

    Prepare for periodic surges to help other clinics. Communicate with area clinics regarding your plans and how you can help one another. Review with staff how they will verify doses and identify patients.

    Ensure that all patient information is up to date in Lighthouse.

  • March 10, 2020 11:36 AM | Anonymous

    NEENAH, Wis. – ThedaCare serves more than 600,000 people throughout Northeast and Central Wisconsin and is committed to the mission of improving the health of the communities they serve. ThedaCare leaders and caregivers know it is a responsibility of the organization to understand health issues in those communities, including opioid dependency.

    “Opioid dependency is a national problem, and Northeast and Central Wisconsin are not immune to the issue,” said Dr. Kelli HeindelThedaCare’s Medical Director of Primary Care, Clinically Integrated Network. “We want to help patients, families and communities understand how to use opioids safely and where to find help if necessary.”

    Drug abuse was among the top three health problems identified in a ThedaCare Community Health Needs Assessment completed in 2016. To combat that emerging crisis, in 2018 ThedaCare created a multi-disciplinary team to develop a system-wide strategy to reduce opioid use and increase awareness of the risks of using opioids. It combined its efforts with the Centers for Disease Control’s (CDC) national campaign entitled “It Only Takes a Little to Lose a Lot.” The campaign included billboards, social media, medication takeback boxes and public service announcements across the service area.

    Dr. Heindel noted that ThedaCare physicians have adopted best practices as identified by the Centers for Disease Control and other organizations and guidelines around prescribing opioids. Doctors are using opioids less frequently for chronic pain, prescribing lower doses and searching out alternative treatments.

    In addition, ThedaCare is now increasing its capacity to provide medically assisted treatment (MAT) for those addicted to opioids.

    “Medically assisted treatment is effective for people who are currently addicted to opioids by treating them with medications that help them to stop using opioids,” Dr. Heindel said. “Some forms of MAT requires additional certification for the doctor or advanced practice clinician and a specific level of support staff for a clinic to qualify to provide services.”

    As a result, in April, ThedaCare will be hosting a Buprenorphine DEA X-Waiver training session. This series, managed by Wisconsin Society of Addiction Medicine (WISAM), is designed to increase treatment capacity for opioid use disorders by training more prescribers to be able to treat opioid use disorders with buprenorphine.

    Read more.

  • March 06, 2020 10:03 AM | Anonymous

    Wisconsin Health News

    Milwaukee County's Behavioral Health Division has received a $1.2 million, three-year federal grant to develop a plan to reduce the risk of overdose deaths and enhance treatment at the county's House of Correction.

    The funding comes from the Department of Justice Bureau of Justice Assistance.

    To be eligible for treatment, a person must be within 30 to 90 days of release and have an opioid addiction.

    The division will work with its partner agencies to develop care plans that include medication-assisted treatment, recovery housing, individual counseling, peer specialists, outpatient services and recovery support.

    “This grant will help us take a practiced and proven approach when it comes to ensuring every resident in every community across Milwaukee County has what they need to thrive," Milwaukee County Executive Chris Abele said in a statement.

  • March 04, 2020 2:16 PM | Anonymous

    Wisconsin Health News

    Gov. Tony Evers signed into law four bills on Tuesday that target substance use disorder and opioid use in Wisconsin.

    Evers said more needs to be done to expand access to healthcare across the state and bolster treatment and recovery services.

    “Folks have seen firsthand how substance use disorder—especially opioid use—has torn apart families and communities across our state, and we need to get serious about tackling this issue in Wisconsin," Evers said in a statement. "I am proud to sign these bipartisan bills into law today that are a step in the right direction, but we know that there is more work we have yet to do."

    The bills are part of Marinette Republican Rep. John Nygren's Heroin, Opioid Prevention and Education Agenda. The four bills bring the total number of HOPE Agenda laws to 34.

    “While there is always more work to be done, more lives to save, and more avenues to recovery that need opening, today’s actions are another arrow in the state’s quiver to combat substance abuse," Nygren said in a statement.

    Nygren also called on the Senate to act on two more bills that passed the state Assembly.

    One bill would repeal a sunset for a law that provides some legal immunity for aiders who help a person experiencing an overdose as well as overdose victims. 

    The other would create a Medicaid benefit for acupuncture and increase rates for chiropractors and physical therapists.

    The bills signed by Evers will:

    • Allow county jails to enter into agreements to obtain naloxone and training and require the Department of Health Services to study the availability of medication-assisted treatment for opioid use disorder in county jails and prisons.
    • Prevent state employees from being disciplined for using or possessing a controlled substance if they're using it as part of their treatment, require DHS to maintain a registry of recovery residencies and mandate that the residencies allow residents to participate in medication-assisted treatment.
    • Extend a sunset date on a mandate that prescribers check the prescription drug monitoring program before issuing a prescription order through April 1, 2025.

    Create a Medicaid benefit for peer recovery coach services and mandate that DHS establish a program to coordinate and continue care following an overdose. 

    Evers also signed into law additional healthcare-related bills that will:

    • Allow medication or treatment records administered at a recreational camp to be maintained electronically.
    • Allow for changes in the supervision of physical therapy and physical therapy assistant students.
    • Increase the amount of funding for an award grant program for retired volunteer firefighters, first responders and emergency medical technicians.
    • Allow physician assistants, registered nurses and nurse anesthetists to perform official duties of the armed services or federal health services in Wisconsin without being licensed by the state.
    • Clarify that reimbursement of patient-incurred expenses in cancer clinical trials aren't considered undue inducement to participate.
    • Require the DHS to implement a diabetes care and prevention plan.
    • Update state law for respiratory therapists.
    • Create a Lyme disease awareness campaign.
    • Allow municipalities to increase levy limits to pay for charges assessed by a joint emergency medical services district. 
  • February 27, 2020 1:36 PM | Anonymous

    Wisconsin Health News

    Attorney General Josh Kaul said Wednesday that an agreement with a generic drugmaker will help provide more resources to fight the opioid epidemic. 

    Ireland-based Mallinckrodt, currently the largest generic opioid manufacturer in the United States, announced Tuesday that it's tentatively agreed to pay $1.6 billion to settle thousands of lawsuits related to the epidemic. 

    Under the deal, the company's future generics opioid business would be subject to strict rules that prevent marketing. The company would also have to ensure systems are in place to prevent diversion. 

    “Getting accountability from pharmaceutical companies is an important part of our strategy for fighting the opioid epidemic,” Attorney General Josh Kaul said in a statement. “With this agreement, more resources will be available to help combat this crisis.”

    Mallinckrodt is the subject of a multi-state investigation that Wisconsin is participating in, said DOJ spokeswoman Rebecca Ballweg.

    Negotiation of how the funds will be distributed is ongoing, she added. The agency is focused on ensuring that the money goes to addressing the opioid epidemic. 

    The agreementsubject to court approval and other conditions, is backed by a group of 47 state and U.S. territory attorneys general. 

    The majority of payments would go to a trust that would establish an abatement fund to cover the cost of opioid-addiction treatment and provide support to communities impacted by the crisis. 

    The settlement would become effective after the company’s subsidiaries focused on specialty generics go through a court-supervised bankruptcy process. 

    Mallinckrodt CEO Mark Trudeau said that reaching the agreement and associated debt refinancing activities will help resolve uncertainties in their business related to the litigation and provide a “clear path forward to achieving our long-term strategy.”

    Last May, Kaul announced Wisconsin filed lawsuits against two Purdue Pharma entities and Richard Sackler, alleging deceptive and false marketing practices in the sale of opioids.

    Wisconsin is part of multi-state investigations of opioid distributors Amerisource Bergen, Cardinal Health and McKesson.

    Wisconsin counties have sued over the opioid crisis.
  • February 21, 2020 1:44 PM | Anonymous

    Wisconsin Health News

    The Assembly signed off on raising the tobacco purchase age to 21 during a floor session on Thursday.

    The federal government raised the age last year, but state and local law enforcement don't have the authority to enforce federal law.

    States have to comply with the federal law or else risk losing funding on a block grant for mental health services that relies on compliance with the policy.

    Lawmakers approved an amendment to the original bill striking the mention of the age 21 and instead referencing the age set by federal law.

    Bill author Rep. John Spiros, R-Marshfield, said that would ensure that lawmakers won't have to modify state law if federal law changes again.

    "By passing this bill, not only are we ensuring that Wisconsin does not lose federal funding, but we are also helping to stop the public health crisis in its tracks," Spiros said.

    Rep. Jill Billings, D-La Crosse, offered an amendment voted down by Republicans that would provide $2 million for smoking cessation and education.

    For some young adults who smoke, raising the age could cut off access to tobacco purchase, she said.

    "We'll have a ton of people who are addicted, who have been smoking legally for years, who will need smoking cessation help," she said.

    A coalition of health groups and educational groups applauded the chamber for taking action.

    "Youth use of e-cigarettes is an epidemic,"” Brad Gast, member of the American Heart Association’s Advocacy Committee, said in a statement. “Once fully implemented, this legislation will help us curb youth usage of e-cigarettes and keep e-cigarettes and vaping out of our schools.” 

    Lawmakers also approved legislation that would:

    • Allow family farms and other small businesses to deduct the cost of health insurance from their income taxes. 
    • Create a pilot program reimbursing hospitals in Barron, Burnett, Dunn, Pierce, Polk, St. Croix and Washburn counties for housing patients for emergency detention.
    • Allow complementary and alternative healthcare providers to practice without having to obtain a credential as a healthcare provider.
    • Provide grants for organizations like the Marshfield Clinic Research Institute's National Farm Medicine Center that retrofit tractors with roll bars that prevent life-threatening injuries in case a tractor rolls over.

    The bills head to the Senate for consideration.

    The Assembly also passed a bill that the Senate approved allowing law enforcement and firefighters diagnosed with post-traumatic stress disorder to submit workers’ compensation claims. They amended the plan to make additional changes to workers’ compensation law.

    The Assembly also passed bills that the Senate has already green lit. Those bills now head to Gov. Tony Evers for his consideration. They would:

    • Require the Department of Health Services to develop a plan to address diabetes in the state.
    • Allow reimbursement for expenses incurred by patients participating in a clinical trial. 
    • Update state law on training for respiratory therapists.
    • Extend a licensure exemption for military physicians to include military nurses and physician assistants who come to the state as part of their duties.
    • Require Medicaid to cover standing technology for power wheelchairs. 
  • February 19, 2020 1:40 PM | Anonymous

    Wisconsin Health News

    Ned Daniels Jr., chairman of the Forest County Potawatomi Community, called for more action on the opioid epidemic during the annual State of the Tribes address Tuesday.

    “We must maintain a sharp focus on improving the lives of those we represent in the new decade as we grapple with the responsibility of addressing complex changes before us,” he told lawmakers. “And there is no challenge more complex than that of the opioid epidemic.”

    The crisis has hit native communities across the state especially hard, Daniels said.

    “Opioids are tearing apart our communities,” he said. “One by one, they are killing our people. They are leaving our families devastated, and our young ones without parents.”

    Daniels thanked Rep. John Nygren, R-Marinette, and other lawmakers for their work on the Heroin, Opioid Prevention and Education Agenda.

    He said it’s important that the approaches aren’t “one size fits all" and allow native communities to provide treatment according to their cultural beliefs.

    He noted there are few places that provide such treatment, leading Wisconsin tribes to work on developing a youth wellness and treatment center.

    They plan to locate the facility centrally between the tribal nations where it'll be a hub for children needing treatment. Lawmakers have supported the project.

    “This facility has the potential to do great things, and we hope that you will continue to work with us on this endeavor,” he said.

  • February 18, 2020 4:30 PM | Anonymous

    Wisconsin Health News

    One of the Northwestern Mutual Data Science Institute's first projects will be on the opioid crisis, according to a recent statement.

    The institute, a partnership between Northwestern Mutual, Marquette University and the University of Wisconsin-Milwaukee, announced its first projects last week.

    The opioid-focused project will involve using public data from local sources and "geospatial analysis" to study opioid overdoses in the city. That project will launch Feb. 21, and investigators hope it could provide insights to help other communities around the country.

  • February 07, 2020 10:57 AM | Anonymous

    JAMA - American Medical Association
    Sarah E. Wakeman, MD1,2Marc R. Larochelle, MD, MPH3,4Omid Ameli, MD, MPH5et al 

    The increasing burden of opioid use disorder (OUD) has resulted in increased opioid-related morbidity and mortality, with 47 600 overdose deaths in 2017 alone.1-3 From 2002 to 2012, hospitalization costs attributable to opioid-related overdose increased by more than $700 million annually.4 Associated health complications, such as hepatitis C infection, HIV infection, and serious injection-related infections, are also increasing.5-7 In addition, as rates of opioid-related death have increased despite decreases in prescription opioid supply, there is an increasing recognition that greater attention must be paid to improving access to effective OUD treatment.8,9

    Medication for opioid use disorder (MOUD) is effective and improves mortality, treatment retention, and remission, but most people with OUD remain untreated.10-15 Many parts of the United States lack access to buprenorphine prescribers, and only a few addiction treatment programs offer all forms of MOUD. 16-18 This lack of access has resulted in a treatment gap of an estimated 1 million people with OUD untreated with MOUD annually.19

    Nationally representative, comparative effectiveness studies of MOUD compared with nonpharmacologic treatment are limited. One prior study 12 compared MOUD with psychosocial treatments but was limited to a Massachusetts Medicaid population. Studies 20-23 examining OUD treatment among nationally representative populations have examined trends in MOUD initiation, patterns of OUD treatment, and effectiveness of different types of MOUD at reducing overdose using Medicaid and commercial claims data. However, none of those studies 20-23 compared the effectiveness of MOUD with nonpharmacologic treatments in a national sample. Despite better access to medical care, only a few commercially insured patients are treated with MOUD, and psychosocial-only treatments continue to be common, suggesting that greater understanding of the comparative effectiveness of these different treatments is needed.21

    In this study, we used a large, nationally representative database of commercially insured and Medicare Advantage (MA) individuals to evaluate the effectiveness of MOUD compared with nonpharmacologic treatment. This retrospective comparative effectiveness study was designed to inform treatment decisions made by policy makers, insurers, practitioners, and patients.

    Read more. 

  • February 03, 2020 5:29 PM | Anonymous

    The American Journal of Psychiatry / Nora D. Volkow, M.D. 

    You can read a glimpse of the article here and if you wish to read the entire article, you'll have to login or subscribe.

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