Latest News

  • 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.

  • February 03, 2020 1:16 PM | Anonymous

    Wisconsin Health News

    Rogers Behavioral Health has gained approval to break ground this spring on a new location in Sheboygan, according to a statement released last week.

    The $4 million facility is expected to open late this year or early 2021. Its support comes from an anonymous donor.

    The location will include a 10,000-square-foot outpatient clinic to treat OCD, anxiety, depression, other mood disorders and co-occurring substance use disorder in adults and adolescents.

    It'll be able to serve up to 12 teenagers and 28 adults at a time.

    A living space adjacent to the clinic will provide supportive living services for up to 12 adults at a time.
  • January 31, 2020 12:56 PM | Anonymous

    Wisconsin Medical Society - Medigram

    More than 260 people have taken the new online Bucket Approach training for clinicians to learn how to help patients with serious or significant mental illness quit smoking. The course, developed by UW-CTRI Researcher Dr. Bruce Christiansen, offers 8.25 free continuing education credits.

    The project is funded by the State of Wisconsin Department of Health Services Division of Care and Treatment Services. Donna Reimer, the grant administrator, serves with Christiansen on a steering committee focusing on helping patients with behavioral health issues to quit smoking (WiNTiP).

    Read More.

  • January 30, 2020 1:37 PM | Anonymous

    Wisconsin Health News

    The Department of Health Services is planning to re-work a benefit for residential treatment for substance use disorder that was set to start Feb. 1. The agency delayed implementation last Friday.

    Curtis Cunningham, assistant administrator for long-term care benefits and programs at the Division of Medicaid Services, said during a Wednesday webinar they consider the review a “fresh restart” on the policy. 

    “This is the start of a conversation, not an end,” Cunningham said.

    There’s no new timeline on implementing the benefit, but they’re hoping to start a work group in the next 30 days to weigh in, he said.

    Pam Appleby, director of the Bureau of Benefits Management at the Division of Medicaid Services, said they heard concerns about the benefit, including requests that the agency ensure rates cover costs, provide reimbursement timely and have a fast, streamlined authorization process.

    “We understand that delays can cause a member to walk away and never come back,” Appleby said.

    Other concerns were about housing for members, discharge requirements for patients who don't have homes and how the benefit would work with those in the corrections system.

    The agency also heard that some providers who offer specialized services that go beyond the basic benefit requirements need a reimbursement system that would cover their cost.

    They’ve also heard feedback from counties support the benefit and its impact. And they’ve also had conversations about funding for room and board and how to keep local governments involved in the treatment, Appleby said.

  • January 27, 2020 1:11 PM | Anonymous

    Centers for Disease Control and Prevention

    Most of the 34 million adult Americans who smoke cigarettes want to quit. But smoking will remain the leading preventable cause of disease and death in the U.S. unless more is done to help them quit. In his new report, Smoking Cessation: A Report of the Surgeon General, VADM Dr. Jerome M. Adams calls on everyone, including healthcare professionals, health systems, employers, insurers, public health professionals, and policy makers, to take action to put an end to the staggering—and completely preventable—human and financial tolls that smoking takes on our country.

    This feature article introduces the 2020 Surgeon General’s Report, the first one since 1990 to focus solely on the health benefits of quitting smoking. Since 1990, more research is available that confirms quitting smoking entirely is still the best way to improve your current and future health.

    Read more.


  • January 22, 2020 9:27 AM | Anonymous

    On January 21, 2020 Wisconsin Society of Addiction Medicine President David Galbis-Reig, MD, DFASAM and Wisconsin State Representative John Nygren were able to speak at a press conference with the announcement of eliminating prior authorization for medication assisted treatment for opioid use disorder patients.

    You can read more in the AP article here or the Wisconsin Health News article here.

  • January 09, 2020 4:06 PM | Anonymous

    Wisconsin Health News

    Officials from the Department of Health Services expressed broad support for the latest package of bills from Rep. John Nygren’s Heroin, Opioid Prevention and Education Agenda but called for some modifications, during a Senate Committee on Health and Human Services hearing on Wednesday.

    Earlier in the hearing, Nygren said he was open to changes.

    “We’ve been working with DHS,” said the Marinette Republican. “These issues are some of the remaining pieces that we have been working on with our friends from the Pew Charitable Trusts to address the gaps in our system.”

    Paul Krupski, director of opioid initiatives for DHS, said that a measure requiring the department to reimburse peer recovery coaches as a Medicaid benefit would, as written, have to be paid for with all state dollars. That’s because the federal government won’t provide matching funds for peer-provided services unless that individual is supervised by a licensed mental health professional, Krupski said. The bill proposes that they are supervised by another peer with certain training.

    “With some changes, there may be opportunity to draw down federal matching funds and better preserve the existing workforce by either building upon our existing certified peer specialists infrastructure, or by providing DHS with additional oversight of the training and other requirements so that the department can align it with the existing infrastructure,” he said.

    Nygren said that adding the supervision is “something we are willing to look at to make sure we maximize our federal dollars.” He said the state has seen a spike in peer recovery coaches because they are an effective tool in navigating the complicated system of addiction. 

    Krupski also pushed back against legislation that would require the department to establish and maintain a registry of approved recovery residencies. Under the bill, DHS may not include a recovery residence in the registry if it excludes any resident solely on the basis that the resident participates in medication-assisted treatment. 

    Krupski said that while DHS recognizes medication-assisted treatment as a “valid, evidence-based therapy,” many of the residencies do not accept individuals receiving the treatment.

    “We must carefully consider the impact of creating a statewide registry of residencies which, as a prerequisite to receiving state or federal pass through funding, must not exclude a resident solely on the basis that they are participating in MAT,” Krupski said. “The Legislature will need to weigh the potential unintended consequences of eliminating state funding for current sober housing options that do not allow their residents to use MAT.”

    Nygren said he would be open to an amendment phasing in the requirements.

    “[DHS] has a concern about putting existing houses that may discriminate currently with someone on medication-assisted treatment out of business,” Nygren said. “That is not the goal of myself or anyone who supports this bill.”

    Meanwhile, Krupski praised legislation that would allow for the Medicaid reimbursement of acupuncturists and increase the Joint Finance Committee’s supplemental appropriation by $1 million to boost payments for chiropractors and physical therapists. Gov. Tony Evers vetoed a similar measure in the budget that did not include reimbursement for acupuncture. 

    “The Department supports efforts to reimburse providers for non-opioid and non-pharmacological pain management techniques,” Krupski said.

    Other bills in the package would:

    • Require DHS to study the availability of medication-assisted treatment for opioid use disorder in prisons and jails.
    • Extend a sunset to 2025 for a law requiring prescribers to check a patient’s records in the state’s prescription drug monitoring program before issuing a prescription order.
    • Repeal a sunset for a law that grants immunity from prosecution for certain controlled substance crimes and from having probation, parole or extended supervision revoked for possessing a controlled substance for those calling for help for another person suffering an overdose and overdose victims who complete a drug treatment program.
    • Require the Medical Examining Board to issue guidelines on the best practices for treating neonatal abstinence syndrome.
  • January 03, 2020 12:42 PM | Anonymous

    Austin S. Kilaru, MD; Jeanmarie Perrone, MD; David Kelley, MD; Sari Siegel, PhD; Su Fen Lubitz, MPH; Nandita Mitra, PhD; Zachary F. Meisel, MD

    Introduction

    Pennsylvania experienced an 80% increase in emergency department (ED) visits for opioid overdose from 2016 to 2017.1 The engagement of patients with opioid use disorder (OUD) in treatment after hospital discharge is a key strategy in preventing subsequent opioid overdose.2,3 The Pennsylvania Department of Human Services established an incentive program to improve the rate of OUD follow-up treatment among Medicaid recipients.4 In the Opioid Hospital Quality Improvement Program, hospitals earned payment for designing and attesting to 4 distinct clinical pathways: (1) ED initiation of buprenorphine treatment, (2) warm handoff to community resources, (3) referral and treatment for pregnant patients, and (4) inpatient initiation of medication treatment. Payment of the full incentive ($193 000) was contingent on participation and attestation of all 4 pathways, with smaller incentives for partial participation.We evaluated participation in this program among hospitals.

    Methods

    This study was deemed to be exempt from review by the institutional review board at the University of Pennsylvania. Because this study was done with publicly reported data, no informed consent was required by the institutional review board.We conducted a cross-sectional analysis of all hospitals with an ED in Pennsylvania.We excluded pediatric, federal, and specialty hospitals. Participation in the program was publicly reported in January 2019.4 We obtained publicly reported data on hospital characteristics from the Pennsylvania Department of Health and county-level data from the Pennsylvania Open Data Portal.5,6 We used a multivariable logistic regression model with robust SEs to compare differences in characteristics of hospitals that fully participated with those that declined or partially participated.We report adjusted risk differences (ARDs) and corresponding 95%CIs. A 2-sided P < .05 was deemed to be statistically significant. Analyses were conducted using Stata, version 14 (StataCorp LLC). This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    Read the full article which includes results, tables and discussion (plus references) here!

  • December 06, 2019 4:29 PM | Anonymous

    Submitted By David “Mac” Macmaster, CSAC, PTTS - Wisconsin Nicotine Treatment Integration Project (WINTIP)

    Who is responsible for treating tobacco use disorders (TUD)?

    Typically the programs created to treat substance use disorders, and TUD is by definition a substance use disorder—do NOT accept people with a sole or primary diagnosis of TUD for treatment.  For example, in Wisconsin TUD exclusion is confirmed in DHS75-86, the rule that governs substance use disorders in our state.  As far as I know the only state that has completely integrated TUD treatment in their statewide addiction services is New York State since 2008 under their rule 856. Other states like Wisconsin are seeking tobacco integration into behavioral health treatment services.

    FACT: The American Society of Addiction Medicine (ASAM) includes Tobacco Use Disorder as a legitimate substance use disorder and provides intervention and treatment practices in their ASAM CRITERIA manual

    FACT: The Diagnostic and Statistical Manuals that identifies psychiatric related disorders includes ”Nicotine Dependence and Abuse” as a substance dependence and abuse disorder in (DSM1V.) In 2015 (DSM1V) was updated to (DSM5) that includes “Tobacco Use Disorder” as a substance use disorder.

    IMPRESSION: The Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Administration (SAMHSA) supports tobacco integration in behavioral health services.

    FACT: Substance Use Disorder treatment providers do not identify tobacco use disorders as being within their scope of practice and do not accept those with TUD for SUD treatment

    CONCLUSIONS:
    Disease and death from tobacco in behavioral health populations can be reduced when:

    1.  Substance Use Disorder providers expand their scopes of practice to include treatment of tobacco use disorder with the best practices they provide for treating other SUDs2.
    2. Mental health providers diagnose and either treat TUD with smoking cessation evidence-based practices or refer those with TUD to SUD providers as an option when a TUD is confirmed through tobacco use assessments

    The public health model of smoking cessation that has successfully reduced smoking in America from 42% to the current 15% was established by the Centers for Disease Control and Prevention (CDC.) The CDC created the Office of Smoking and Health (OSH) in 1965 and established single state Tobacco Prevention and Control (TPCP) agencies in every state.

    One of the OSH mission objectives was, and is, address disparity populations that smoke more; develop more tobacco caused and related diseases, and die prematurely from tobacco than in the general population.  The Wisconsin Tobacco Prevention and Control Program has included behavioral health populations (substance use and mental health disorders) as disparity populations and included behavior and tobacco issues as a priority in Wisconsin’s TPCP’s strategic plan.

    Smoking cessation has always been a priority for the CDC/OSH and TPCP services. The internationally accepted Clinical Practice Guideline for Treating Tobacco Use and Dependence provides evidence-based practices for treating TUD and establishes that these clinical practice guidelines are effective for smoking and tobacco cessation.

    A review of evidence-based effective treatment practices for substance abuse disorders and a review of evidence-based TUD disorders reveals these practices are essentially identical. In other words, what works to achieve successful abstinence and harm reduction treatment outcomes for alcohol, opiates, cocaine and other substance use disorders also work for those with tobacco use disorders.

    My observation is that the tobacco programs do not diagnose tobacco use disorders (TUD) using DSM5 assessment criteria and do not make referrals to addiction/SUD treatment providers. This has been typical practice since the Tobacco Prevention and Control Programs were established.

    SUMMARY
    The opening question for this opinion article was:
    Who is responsible for treating tobacco use disorders (TUD?)

    Should the addiction/substance use disorder treatment providers treat TUD? Of course they should, but they aren’t. They can but they don’t.  Yet, these SUD providers have successfully integrated alcohol and other drugs and treat them at the same time. They have not gone out of business doing it. They can treat TUD. There is no evidence to the contrary.

    Should the Tobacco Prevention and Control Programs treat tobacco use disorders? They already are. They call it cessation. They use a public health model that research reports is effective for many with tobacco use disorders.

    However tobacco use disorders are on a continuum of severity. Public health smoking cessation is effective, but is not always enough for those with a severe TUD. They might be more successfully treated in substance use disorder treatment programs when access to addiction/SUD treatment becomes available.  Addiction treatment and smoking cessation programs provide two effective options for treating tobacco use disorders. Two viable options are better than only one.

    I am motivated by this vision.

    When we successfully integrate tobacco use disorder treatment and tobacco free recovery we will open the door to addiction treatment that has been closed too long.  In Wisconsin we have more than 3,500 alcohol and other drug counselors who have the skills to treat all the substance use disorders including TUD. We have social workers, therapists, doctors and many more that can improve treatment opportunities for those with TUD. This would be true in every state when access to tobacco use disorder treatment and tobacco free recovery support expands dramatically.  We would double, triple and provide even more opportunities for smoking cessation and tobacco free recovery.

    Addiction treatment providers will discover they can readily treat patients with TUD harmoniously with other SUD’s. New York State and one of our Wisconsin programs have done it successfully for more than a decade.

    Smoking cessation programs will have an option for Wisconsin residents with tobacco use disorders they haven’t had before. They can refer people to our established substance use disorder treatment programs.

    It is time to integrate effective tobacco use disorder in our substance use disorder treatment and other behavioral health programs. It is time to lead and make this integration in behavioral health happen. Lives will be saved. That is why we created WINTIP in the first place.

    __

    Our Wisconsin Nicotine Treatment Integration Project (WINTIP) is a strong advocate for tobacco cessation, treatment, and tobacco free recovery support. WINTIP was created to integrate evidence-based Tobacco Use Disorder treatment in our Wisconsin behavioral health programs and services. Our strong advocacy for tobacco integration in behavioral health will make it easier for decision makers to finally assure this gap in tobacco treatment is closed for the good of those suffering from tobacco use disorders and their families.  Tobacco integration in behavioral health is the ethical and clinically responsible improvement in Wisconsin’s public health strategic plan we need to make.  There is no longer any viable excuse for not doing it.

    Contact Information:
    David “Mac” Macmaster
    Managing Consultant – Wisconsin Nicotine Treatment Integration Project (WINTIP)
    608-393-1556
    creativerep@mac.com

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