DC Update

July 8, 2014

 

News from the States

• NASADAD attends forum on opioids held in Vermont Statehouse
• Hayden Mathieson to serve as Florida’s Assistant Secretary for Substance Abuse and Mental Health

From the Administration

• White House releases report on the Medicaid expansion
• Surgeon General releases resources to promote 2014 report on smoking and health

Around the Agencies

• SAMHSA releases two resources for clinicians on managing chronic pain in adults in recovery
• CDC releases resources on opioid prescribing by State
• DEA publishes final rule to reschedule tramadol to Schedule IV

Capitol Hill News

• NH Senators introduce bills to fight prescription drug abuse

Events

• Addiction Technology Transfer Center (ATTC) hosts webinar on telehealth

In the News

• AATOD releases paper on increasing access to medication-assisted treatment
• Urban Institute releases report on the Medicaid expansion

 

News from the States

NASADAD attends forum on opioids held in Vermont Statehouse

On June 16, 2014, Robert Morrison, NASADAD Executive Director, traveled to Montpelier, Vermont to attend a day-long forum designed to spur additional action related to the State’s opioid problem. Governor Shumlin provided remarks to the standing-room-only crowd. The Governor has identified addiction as a top priority for his Administration and dedicated his entire State-of-the-State address to the topic. Barbara Cimaglio, State substance abuse director of Vermont and member of the NASADAD Board of Directors, served as the emcee of the day’s activities. Other plenary speakers included:

• Dr. Harry Chen, Commissioner, Vermont Department of Health, spoke about opioid trends in Vermont and actions taken by the Department on prevention, treatment, and recovery.
• Dr. Mark McGovern, Dartmouth, spoke about the science of addiction and implications for the service system.
• Mayor Christopher Louras, Mayor of Rutland, Vermont, discussed the cross-sector collaboration moving forward in his city.
• Raina Lowell, person in recovery spoke about her challenges and current opportunities.

After the plenary speakers, representatives from different sectors discussed actions they are taking in quick five minute segments. Perspectives were shared by representatives of community coalitions, students, mentorship groups, hospitals, groups of parents that lost a child, adolescent treatment service providers, law enforcement, housing, faith community, recovery groups, businesses that noted the benefit of hiring people in recovery, and many more.

Break-out groups then offered meeting participants an opportunity to discuss specific issue areas.  NASADAD attended a session that explored the work of law enforcement. The session included a discussion from Chief Baker of the Rutland Police Department where he reviewed project VISION (Viable Initiatives and Solutions through Involvement of Neighborhoods) that promotes a collaborative approach across many sectors. “All hands on deck” is the motto of the Police Chief and Mayor.

Next, the meeting prompted participants to organize by regions. NASADAD attended a meeting of attendees from the Burlington area. A number of sectors were represented, including housing, LGBT groups, Boys and Girls Clubs, a State Senator overseeing the Committee of Jurisdiction over health issues, a State Representative overseeing law enforcement issues, a student, employer, a nurse working in a Federally Qualified Health Center (FQHC), and more.

The meeting reconvened all participants and held a short debrief session.  The regional groups planned to convene again with the goal of tangible action steps that will help reduce the impact of the opioid problem in the State.

Special thanks to Barbara Cimaglio and the rest of the staff from Vermont’s State substance abuse agency.

The article below from a Vermont newspaper described the event.

Substance abuse issues aired and solutions shared at Statehouse forum By KATIE JICKLING / VTDigger Posted:   06/17/2014 08:05:24 AM EDT0 Comments | Updated:   about 2 hours ago MONTPELIER — Victor Twiggs says the addicts come for the pizza. The director of GYST – “Get Your Stuff Together” – Twiggs is building a support system for troubled young men, often with substance abuse issues, on Tuesday nights in Morrisville. “I just see a light come on in their eyes when they see that someone’s really listening to what they have to say,” Twiggs told a full Statehouse chamber Monday. Twiggs was one of nearly 200 participants in a community forum who came together to address problems associated with opiate addiction and trafficking on Monday. The purpose of the forum was to build a collaborative, statewide approach to solutions in local communities. Counselors, recovering drug addicts, law enforcement officers, nonprofit representatives and elected officials from around Vermont shared ideas and resources as they sorted through the causes of the state’s escalating drug problem. The forum – which included speakers, panels and community-based discussions – was commissioned by Gov. Peter Shumlin and organized by the Vermont Department of Health. Rutland Mayor Chris Louras spoke about Rutland’s comprehensive approach to substance abuse treatment. In 2013, the city launched Project Vision, a coalition of community groups that are working together to solve drug-related challenges. “The opiate epidemic is not a public health issue, it is not a law enforcement issue or a health care issue any more than it is a poverty issue or an issue of chaotic households. It is all of those. Unless you accept that, you are doomed to failure,” said Louras. The event provided a framework for an ongoing statewide discussion about opiate abuse that was launched in January when Shumlin drew national attention to Vermont’s drug problems in his State of the State address. At the forum, Shumlin touted that public discussion as an accomplishment. “We’ve made it possible to talk about addiction and recovery, to talk about what we’re doing well and what we’re not doing well. The Vermont Statehouse (Wikimedia Commons) To collectively raise our voices to talk about an issue that no one wants to talk about.” Health Commissioner Harry Chen laid out the statistics: Opioid users become addicted after mere days of drug use, and seek treatment after an average of eight years of use, compared to nearly 25 for alcoholism. More than 50 Vermonters died of opioid poisoning in 2013. Last year was the first year that more people sought treatment for opioid use than for alcohol. “I actually thought I’d never see that,” Chen said. “But it’s here.” Until three years and 131 days ago, that was Raina Lowell’s reality. She talked about what it was like to be an intravenous heroin user, a crack addict and an alcoholic. She described living without heat in the winter, stealing firewood from her neighbor to keep her children warm at night, losing everything she had down to her self-respect and hope. “The truth is, being an addict does define me,” Lowell said. “Addiction has affected every single aspect of my life. Being an addict in treatment tells you everything you need to know about me.” Lowell tells her story “to make it a little easier to find the human being stuck deep inside the shell of an addict. Only then we can create change,” she said. She left the podium to a standing ovation. One by one, forum participants talked about their own experiences with addiction and how they are trying to tackle the issue in their communities. Pat Martin started a weekly support group after the 1999 death of her 19-year-old daughter Sarah to heroin overdose. “Wit’s End” in Rutland helps families cope with the devastating impacts of addiction. Burlington High School offers in-school addiction counseling and Susie Walker provides a peer recovery counseling in Brattleboro. Burlington Labs hires ex-convicts or recovering drug addicts, and others provide housing for those in recovery, or use alternative treatments methods like yoga, meditation and arts. The Shumlin administration has committed $12 million to the crisis this year. The goal, Shumlin said, is to examine the issue from a variety of perspectives, “and turn it into the most innovative practices possible. We want to make sure that with the money we’re spending, no one who calls up asking for treatment has to wait in line.” On Tuesday, Shumlin will sign a bill that allows for a third-party assessment with drug convictions that will allow the defendant – if deemed eligible – to seek treatment and avoid judicial processes entirely. “You’ll never have a charge filed against you and you’ll never go through the court system. And that’s just common sense,” the governor said, to applause. Later this week, Shumlin also meets with Massachusetts Gov. Deval Patrick to address cross-border drug issues. On Thursday, Shumlin will travel to the White House for a national conference on drug policy. The Vermont Department of Health has organized meetings for 12 Vermont cities or “community” groups that will convene again in July, and come out with actions to take, and a list of desired outcomes. St. Johnsbury participants want to increase outreach to schools and business community and the Windham County group will conduct “asset mapping,” to identify resources and services and the gaps that remain. “We can’t solve this problem without owning it and embracing it,” Chen said. “Everyone here has a part to play the good news is Vermonters excel at community action.”

 

Hayden Mathieson to serve as Florida’s Assistant Secretary for Substance Abuse and Mental Health

Hayden Mathieson, Director of Substance Abuse and Mental Health and NASADAD member, will now serve as the Assistance Secretary for Substance Abuse and Mental Health. In addition to the promotion, Mr. Mathieson will continue to serve as the Florida State Director and NASADAD member. “Mathieson is an attorney with legislative experience, who prior to law school at Florida State, worked in behavioral healthcare with adolescents and families in inpatient and outpatient treatment settings” (Department of Children and Families press release).

From the Administration

White House releases report on the Medicaid expansion

The report, released by the White House Council of Economic Advisors, Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid, reviews the impact of the Medicaid expansion related to access to care, financial security, residents’ health and well-being, and State economies. The report also attempts to quantify these effects using economic analysis. According to the White House, an estimated 5.7 million people will be unable to access health insurance if the current number of States maintain current policies on expanding Medicaid.

Surgeon General releases resources to promote 2014 report on smoking and health

The new resources include a video interview with Rear Admiral Boris Lushniak, Acting Surgeon General on why Surgeon General reports matter. The Acting Surgeon General also gives an overview of the key findings of the previous 31 reports, providing valuable information on tobacco control, disparities, and the health effects of smoking. The Office of the Surgeon General will also be co-hosting a Twitter chat on July 16^th at 2 pm EST with the Centers for Disease Control and Prevention (CDC) on reproductive health and smoking. Finally, the Office is inviting people to sign up for their Tips from Former Smokers Thunderclap. A “Thuderclap” is an application that sends out identical messages via social media (Twitter, Facebook, Tumblr) form multiple accounts.

Use #SGR50chat to join the Twitter discussion on July 16^th at 2 pm EST

Around the Agencies

SAMHSA releases two resources for clinicians on managing chronic pain in adults in recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) released two KAP Keys based on Treatment Improvement Protocol (TIP) 54: Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders and a quick guide for clinicians. The resources provide concise information on “chronic non-cancer pain, pain management, treatment, and recovery for adults with substance use disorders” (SAMHSA press release). This includes information on comprehensive patient assessments, a summary of non-opioid pain relievers, and recommendations for clinicians when opioid therapy is indicated.

CDC releases report on opioid prescribing by State

The resources from the Centers for Disease Control and Prevention (CDC) provide State-specific information on opioid prescribing patterns, as well as information on prescription opioid overdoses. Variation across States varies widely with providers in the highest-prescribing State writing almost 3 times as many prescriptions for opioid pain relievers per person than the lowest-prescribing State. The resources, including two studies, a Vital Signs issue, and a fact sheet, also make recommendations for States to encourage more responsible prescribing practices. Firstly, CDC recommends that States increase use of prescription drug monitoring programs (PDMPs) and consider policies to better regulate pain clinics to ensure patient safety. One of the resources is a review of overdose death rates in Florida following State policy changes related to opioid prescribing patterns.

DEA publishes final rule to reschedule tramadol to Schedule IV

The U.S. Drug Enforcement Administration (DEA) published the final rule in the Federal Register rescheduling tramadol to Schedule IV, effective on August 18^th. Tramadol, an opioid pain reliever, was originally approved by the Food and Drug Administration (FDA) in 1995. In 2010, the U.S. Department of Health and Human Services (HHS) conducted a review and analysis of tramadol for the DEA. Given the drug’s abuse potential, the analysis recommended that the DEA schedule tramadol as a Schedule IV substance. Some States, including Arkansas, Mississippi, and New York have already listed tramadol as a controlled substance (National Association of State Controlled Substances Authorities (NASCSA) press release).

Capitol Hill News

NH Senators introduce bills to fight prescription drug abuse

New Hampshire Senators Kelly Ayotte and Jeanne Shaheen introduced their legislation in June and July of 2014, respectively. Sen. Ayotte’s bill, the “Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2014,” creates an inter-agency task force with representatives from the U.S. Department of Health and Human Services (HHS), National Institutes of Health (NIH), Institute of Medicine (IOM), Department of Veterans Affairs (VA), Department of Defense (DOD), the Drug Enforcement Administration (DEA), and other professional addiction and physician experts to develop a set of best prescribing practices for pain management. The bill also authorizes appropriations for the Harold Rogers Prescription Drug Monitoring Program, reauthorizes the Byrne Justice Assistance Grant Program, directs the Office of National Drug Control Policy (ONDCP) to update the Prescription Drug Abuse Prevention Plan to account for the increase in heroin use, and directs the creation of a drug-free media campaign on prescription drug and heroin abuse.

Sen. Shaheen’s bill, the “National All Schedules Prescription Electronic Reporting Reauthorization Act of 2014,” reauthorizes the National All Schedules Prescription Electronic Reporting (NASPER) grant program for prescription drug monitoring programs (PDMPs) that is housed within HHS. The bill amends the 2005 NASPER reauthorization to emphasize data-sharing between States and integration between the PDMP and electronic health records, health information exchanges, and e-prescribing systems. The bill also provides that de-identified information from the PDMP may be released to other State agencies for the purposes of research. No later than 3 years from the date that funds are appropriated, the Secretary of HHS will complete a report that includes an analysis of the extent to which PDMPs have strengthened initiatives to link patients to substance use disorder services.

Events

Addiction Technology Transfer Center (ATTC) hosts webinar on telehealth

The webinar, Telehealth: Improving Access to Services, was hosted by the South Southwest Addiction Technology Transfer Center (ATTC) on July 9^th. As efforts to expand access to treatment continue to grow, some communities have a difficult time with access to care. This can result from a shortage in the health care workforce, as well as long-distances between treatment centers and those seeking help. Telehealth technology is one innovative way to increase access to treatment for those struggling, often rural, communities. The webinar featured presenations by Doug Denton, Executive Director of Homeward Bound, Inc. and Mary S. Cook, Research Associate at UT Austin Center for Social Work Research.

In the News

AATOD releases paper on increasing access to medication-assisted treatment

The American Association for the Treatment of Opioid Dependence (AATOD) released a paper, “Increasing Access to Medication to Treat Opioid Addiction versus Increasing Access for the Treatment of Opioid Addiction with Medications” on July 2^nd. The paper outlines the history surrounding access to and regulation of medication-assisted treatment (MAT). The paper touches on the full spectrum of FDA-approved medications to treat opioid addiction: methadone, buprenorphine, and naltrexone. AATOD calls on policymakers to fully investigate these issues and offers a series of questions to help facilitate the discussion. In particular, AATOD discusses the original intent of the patient limit for buprenorphine prescribers and offers some items to consider in efforts to raise or eliminate the limit. The paper provides a comprehensive overview of MAT for opioid addiction, as well as some important takeaways for policymakers.

Urban Institute releases report on Medicaid expansion

The Urban Institute report from the Health Reform Monitoring Survey, Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates, shows that States that expanded Medicaid had a 4% drop in the rate of uninsurance, compared to 1.4% in States that did not expand. This analysis shows that individuals gaining insurance through Medicaid under the Affordable Care Act (ACA) were previously uninsured, rather than switching from private insurance to Medicaid. According to the report, “Strong gains in any Medicaid/State coverage accompanied falling uninsurance rates among low-income adults, younger and older adults, white non-Hispanic adults, and women” (Urban Institute report).