Wisconsin Society of Addiction Medicine Articles

CDC Webinar: Clinical Implications of Medetomidine Mixed with Opioids

Mon, 11 Aug 2025 19:47:59 GMT

CDC’s Division of Overdose Prevention hosted a webinar on the clinical and public health implications of medetomidine-involved opioid overdose and withdrawal. A recording of the webinar is available. Continuing education is free at CDC TRAIN.

Learn lessons from the field about the diagnosis and treatment of overdoses and withdrawal involving medetomidine mixed with opioids. Medetomidine is an emerging public health problem, and clinicians and public health agencies need to be aware of how shifts in the drug supply over time, such as the addition of adulterants like medetomidine, might change patient signs, symptoms, and management during opioid overdose or withdrawal.

Click Here to watch the webinar and learn more on the CDC's website.

Wisconsin Underage Tobacco and Vape Sales Decreased in 2024

Mon, 21 Apr 2025 20:00:00 GMT

Decrease linked to successful public awareness campaign and actions by communities as public health leaders work to continue this downward trend

The Wisconsin Department of Health Services (DHS) reports a decrease in the rate at which tobacco and vape retailers sold to underage consumers last year, with annual data showing a decline from 13.6% in 2023 to 11.8% in 2024. These results come from the Synar Survey, an annual statewide assessment of the retailer violation rate. In 2019, the rate was 5.5% and reached its highest point in 2021 when the rate was 14.1%.

"We are glad to see a decline in overall sales of tobacco and vape products to underage kids, yet the rate remains too high," said State Health Officer and Division of Public Health Administrator Paula Tran. "We know that more than 80% of adult smokers started before the age of 18, and about 95% of them before turning 21. This is why it is so important to continue the work to prevent young people from starting to use commercial tobacco and nicotine products to protect their health today and long into the future."

View the entire news release.

Registration Open for the 2025 Opioids, Stimulants, and Trauma Summit

Fri, 14 Feb 2025 19:23:35 GMT

The 2025 Opioids, Stimulants, and Trauma Summit is May 6-8. The Wisconsin Department of Health Services invites professionals to join in person (Wisconsin Dells) or virtually to learn strategies to save lives and build healthy communities.

See more information about this event and information on how to register to attend.

Registration is open until 12 p.m. May 6. Register by March 7 and pay only $150 to attend virtually and $200 to attend in person.

Continuing education units or credits are available for people who attend the live event either in person or virtually.

This event is tailored for professionals spanning diverse fields, including corrections agents, counselors, doctors, educators, mental health services providers, nurses, pharmacists, peer specialists, recovery coaches, and social workers.

Other 2025 events organized by DHS

July 16-17: Harm Reduction Conference (Wisconsin Dells/virtual)
September 10-11: Substance Use Prevention Conference (Wisconsin Dells/virtual)

Integrated Opioid and Addiction Care ECHO - December 5, 2024

Mon, 02 Dec 2024 19:55:57 GMT

The Integrated Opioid and Addiction Care ECHO at Hennepin Healthcare is hosting a session titled “Compulsive Food Misuse: Is Food Addiction a Substance Use Disorder?” by Dr. Paul Earley on Thursday, December 5th, at 12:15 pm via Zoom.

This session is part of a larger series on Co-Occurring Eating Disorders and Substance Use. You can view the attached curriculum for a full list of topics covered in the series.

To join this and future sessions, please register on the iECHO program page.

If you have any questions, contact Rachel Langer at Rachel.Langer@hcmed.org.

DHS Launches New System to Help Communities Track and Respond to Overdose

Thu, 14 Nov 2024 17:29:51 GMT

Wisconsin Suspected Overdose Alerts for Rapid Response (WiSOARR) system will help the state's efforts to address overdose epidemic

The Wisconsin Department of Health Services (DHS) has launched an innovative new online tool for people working in overdose spike response, substance use prevention, harm reduction, treatment, and recovery. The Wisconsin Suspected Overdose Alerts for Rapid Response (WiSOARR) system will provide near real-time data on when and where suspected overdoses may have occurred to inform immediate actions to address drug overdoses.

"WiSOARR gives our substance use partners a faster and clearer understanding of when and where suspected overdoses are occurring in their communities," said Michelle Haese, DHS director of substance use initiatives. "This system is a step forward in our ongoing work to better understand and respond to the ever-evolving drug overdose epidemic with the right strategies at the right time."

View the entire news release.

DHS Announces Return of Wisconsin Harm Reduction Conference for 2025

Wed, 23 Oct 2024 17:26:26 GMT

Wisconsin Harm Reduction Conference ReturnsSave the date for July 16–17, 2025!

The Wisconsin Department of Health Services will host the Wisconsin Harm Reduction Conference on July 16–17, 2025, at the Chula Vista in Wisconsin Dells; there is also a virtual attendance option.

Wisconsin’s second Harm Reduction Conference will be providing a time and space to learn and network. The goal of the conference is to bring together experts in the field of harm reduction along with others interested in learning about and expanding harm reduction services, resources, and policies.

Conference objectives

Provide safe spaces for the exchange of ideas and cutting-edge practices that reduce harms associated with drug use.
Create networking opportunities for people from diverse backgrounds committed to program and policy change and reform.
Promote the delivery of harm reduction services in Wisconsin and Tribal nations that engage people who use drugs to support connection, safety, and improved quality of life.
Provide the opportunity to discuss the benefits of harm reduction, best practices, resources, policies, and areas needing development and support.

Who should attend

Syringe service programs (SSPs) providers
Local and Tribal health and health or human services department staff (including, directors, nurses, harm reduction staff, health educators, and peer support specialists)
Health care professionals (including, substance use disorders counselors, community health care workers, mental health professionals, nurses, nurse practitioners, pharmacists, and physicians)
Public health and health care students or fellows
Overdose fatality review (OFR) members
First responders (including, law enforcement, EMS, fire department, mobile response teams)
AIDS, HIV, and viral hepatitis care workers
Local government and Tribal elected officials (including, county and judge executives, mayors, presidents, council Tribal members)

Additional information

As more information becomes available, it will be posted to the conference website.

If you have a question please contact the planning team at citee-events@uwm.edu.

Related events

The Wisconsin Substance Use Prevention Conference is scheduled to be held in 2025. The dates and location for this event have not yet been set.

The Opioids, Stimulants, and Trauma Summit is scheduled for May 6–8, 2025, in the Wisconsin Dells and virtually.

ThedaCare Implementing Program to Offer Education and Resources

Wed, 09 Oct 2024 21:25:34 GMT

A new program being implemented at seven ThedaCare Hospital Emergency Departments (EDs) provides help and hope for those experiencing an opioid use disorder.

The Overdose Response Protocol aims to help people safely recover from any level of inappropriate use of opioids such as fentanyl, heroin or oxycodone, explained Dr. Ezra Lyon, MD, Associate Medical Director for Integrative Addiction Treatment and Family Medicine Practitioner at ThedaCare Physicians-Waupaca.

“When a person comes to the Emergency Department, our teams take extra time to ask an additional question about that person’s opioid use during the intake screening,” he explained. “We hope that by asking the question, we can connect with people who may be experiencing an opioid use disorder and make it easier for them to seek help.”

If a person does respond to the question and it is determined they are experiencing an opioid use disorder, teams can encourage them to engage with the ThedaCare Overdose Response Protocol and get them started on a path to recovery Dr. Lyon explained. The Overdose Response Protocol works with people to get them into counseling immediately and prescribe medication if necessary.

Provisional data from CDC’s National Center for Health Statistics indicate there were an estimated 107,543 drug overdose deaths in the United States during 2023 – a decrease of 3% from the 111,029 deaths estimated in 2022. This is the first annual decrease in drug overdose deaths since 2018.

“While it is encouraging to see the decrease in opioid deaths, there is still work to do and help to offer,” Dr. Lyon noted. “These are premature deaths that could have been prevented. Since 2009, an increasing proportion of drug overdose deaths have been caused by opioids, especially since the introduction of fentanyl into the illegal drug supply.”

Fentanyl is similar to morphine but is 50 to 100 times more potent, according to the National Institute on Drug Abuse.

“Our hope is that people will see our Emergency Departments as safe places that can provide help when they are considering stopping the use of opioids,” Dr. Lyon explained. “The Overdose Response Protocol can help reduce the barriers for people to get help. There’s no judgment. Our goal is to try to keep people alive.”

Responding to Community Needs

Every three years, ThedaCare conducts a Community Health Needs Assessment in partnership with Public Health and many other stakeholders to help understand the health and well-being of communities, as well as what community members need to help achieve health goals.

“Improving mental health and reducing substance abuse are some of the highest concerns in all of the Community Health Needs Assessments we do in the communities our hospitals serve,” said Tracey Ratzburg, Community Health Coordinator for ThedaCare. “Addressing those concerns then becomes part of our commitment to improving the population health and well-being in our communities. The Overdose Response Protocol is an example of that commitment.”

The Overdose Response Protocol includes providing buprenorphine (Suboxone) under the care of an ED provider to help relieve any withdrawal symptoms. The protocol also connects the patient to a recovery coach through ThedaCare’s ED2Recovery program, and upon release from the hospital, sending the patient home with a HOPE Kit. That kit includes naloxone (Narcan) in case of an overdose, fentanyl test strips, a CPR mask, and information about local resources, including recovery groups and outpatient clinics that can continue medication. Many patients also receive a short-term prescription for Suboxone.

In addition, each patient is connected to a local medical provider for continuing consultation. Care team members follow up with patients to help them establish with a clinic in their area. The patients also receive ongoing support from their recovery coach.

Active in Appleton

ThedaCare Regional Medical Center–Appleton began expanded screenings in its ED in late January 2024.

“We have seen patients who have been identified as having a substance use disorder that we have then engaged in the Overdose Response Protocol,” said Dr. Sean McCloy, a ThedaCare Emergency Medicine physician. “Once a patient is identified as having an opioid use disorder, they are offered the opportunity to participate in the Overdose Response Protocol. We provide treatment, and then once they are stabilized for whatever condition they came to the ED with, we will release them with a HOPE Kit. The ED2Recovery Coach connection is a very important component of this program. It’s somebody who has been through what they’re going through and can provide guidance and encouragement.”

The Overdose Response Protocol is now being implemented at ThedaCare Regional Medical Center–Neenah and will be active at all of the ThedaCare Critical Access Hospitals in Berlin, New London, Shawano, Waupaca and Wild Rose by the end of 2024.

“I don’t want anyone else to die of this disease, which is what substance use disorder really is – a disease,” said Dr. Lyon. “We want our Emergency Departments to be safe places where people can get help and begin their recovery.”

The Overdose Response Protocol is a project of the Wisconsin Society of Addiction Medicine and is funded by the Wisconsin Department of Health Services. Dr. Ritu Bhatnagar from the Wisconsin Society of Addiction Medicine and Jill Lindwall, Quality Director with the Wisconsin Hospital Association have been instrumental in helping ThedaCare implement the Overdose Response Protocol.

New Hours of Operation for UpliftWI

Tue, 01 Oct 2024 14:48:49 GMT

Shared by the Wisconsin Department of Health Services

UpliftWI now is available daily, including holidays, from 10 a.m. to 10 p.m. by calling 534-202-5438.

UpliftWI is Wisconsin's peer-run warmline operated by Mental Health America of Wisconsin under a grant from the Division of Care and Treatment of Services. It is open to all state residents.

A warmline is a nonemergency source of support for people experiencing increased stress or symptoms from mental health and substance use concerns. The operators are certified peer specialists. Certified peers specialists are people who have navigated their own mental health and substance use concerns, completed a training course, and passed a state exam that tests their skills in how to support others. They listen to the caller's needs, help them problem solve based on their life experiences and training, and provide information on community resources if requested. The goal is to diffuse difficult situations before they become a crisis through conversations and connections between people with similar life experiences.

The support offered by UpliftWI is free of charge.

Operators have access to interpreters if the caller does not speak English.

UpliftWI is an anonymous and confidential service. Callers are not required to provide their name, address, or other identifying information. The conversation stays between the caller and operator unless the caller requests support from others.

UpliftWI previously operated daily, including holidays, from noon to midnight. The new hours are effective today, October 1. There are no current plans to be open 24/7.

The type of support provided by UpliftWI is also available through drop-in visits to a peer recovery center and scheduled overnight stays at a peer-run respite.

People experiencing a mental health and substance use crisis can call, text, or chat the 988 Suicide & Crisis Lifeline. Call 911 if the emergency is life-threatening.

DHS to Mark International Overdose Awareness Day with New Investments to Reduce Drug Overdose Deaths

Fri, 30 Aug 2024 16:14:57 GMT

Strategies will focus on harm reduction services and supports

Ahead of International Overdose Awareness Day, August 31, the Wisconsin Department of Health Services (DHS) is highlighting new state efforts to end overdose deaths and improve the health of people who use drugs. This annual observance, as proclaimed by Gov. Tony Evers, is a day to remember those lost to drug overdose, acknowledge the grief of family and friends left behind, and act to save lives.

"Too many of our family members, friends, and neighbors are dying due to an unsafe drug supply, with no community immune to the impacts of the overdose epidemic," said DHS Director of Substance Use Initiatives Michelle Haese. "Together we can make a difference by meeting people who use drugs where they're at in their life journey without judgement, just the support and tools they need to stay safe."

Drug overdoses decreased slightly nationally and in Wisconsin in 2023, the first decrease since 2018. Despite this, more than 1,700 fatal drug overdoses occurred in Wisconsin in 2023, an increase of 45% since 2018.

View the entire news release.

Five Crisis Stabilization Facilities Now Open Across Wisconsin

Wed, 05 Jun 2024 19:00:00 GMT

Regional centers will serve those with mental health and substance use needs

Wisconsin has taken another step forward to help people with mental health and substance use emergencies with the opening of five crisis stabilization centers for adults. Crisis stabilization facilities support people who can't stay in their community safely, but don't need to be hospitalized. Funded by the Department of Health Services (DHS), the centers provide a dedicated location for this level of care for most counties.

"Whether it's been declaring 2023 the Year of Mental Health, securing new investments for school-based mental health and other initiatives, or supporting the launch of the state's 988 Suicide & Crisis Lifeline, we've been working to find solutions to the burgeoning mental health crisis facing our state since 2019," said Gov. Tony Evers. "This includes bolstering our state's crisis care infrastructure so that folks can access the care and support they need when and where they need it—especially in an emergency. While the opening of these new facilities is a tremendous step forward, we know there's far more to do, and we're committed to building on these efforts to ensure every Wisconsinite has access to mental and behavioral health care regardless of their ZIP code."

View the entire news release here.

David Galbis-Reig, MD, DFASAM receives Wisconsin Medical Society Presidential Citation

Fri, 12 Apr 2024 20:17:17 GMT

The Wisconsin Medical Society (WisMed) presented David Galbis-Reig, MD, DFASAM with the Presidential Citation Award. WisMed’s President has the privilege of presenting a Presidential Citation to a physician or non-physician who has made a significant contribution to medicine or public health.

Dr. Galbis-Reig received his Doctor of Medicine degree from Virginia Commonwealth University in Richmond, Virginia in 1999 and completed a residency in Internal Medicine at Aurora Sinai Medical Center in Milwaukee, Wisconsin in 2004. He is board certified and involved in Maintenance of Certification in Internal Medicine by the American Board of Internal Medicine and in the sub-specialty of Addiction Medicine by the American Board of Preventive Medicine.

As the Medical Director of Addiction Services at Ascension All Saints Hospital, he has passionately advocated for appropriate medical treatment of patients with mental health and addictive diseases for the past 20 years. He is the Medical Director of Addiction Services at Racine County Behavioral Health Services and the Kenosha KARE Center. He is a Past President of the Wisconsin Society of Addiction Medicine (WISAM) and the Wisconsin Medical Society Foundation.

“Dr. Galbis-Reig’s compassionate care and unwavering commitment to his patients who struggle with addiction has transformed the lives of countless individuals in our community,” said Kristin McManmon, Ascension All Saints Hospital President. “This recognition is a testament to his dedication, expertise and tireless efforts in addressing one of the most pressing public health challenges of our time. We are grateful for his outstanding contributions to Ascension Wisconsin and the positive impact he’s had in the community.”

Dr. Galbis-Reig led WISAM to partner with DHS to expand the availability of providers who can treat opioid use disorder by providing twelve buprenorphine trainings throughout Wisconsin between 2019 and 2021. He is an active member of the American Society of Addiction Medicine (ASAM) where he serves as the Chair of the Distinguished Fellows Committee and is the Chair for the BEST Study Tool Subcommittee. He has contributed to policy decisions in the state as a former member of the Wisconsin Marijuana Prevention Ad-Hoc Committee of the State Council on Alcohol and Other Drug Abuse (SCAODA). He is a current Board Member of the HOPE Council in Kenosha, Wisconsin.

He is the current Medical Director for the Ascension All Saints Women of Worth Intensive Outpatient Program. Women of Worth is a donor funded, family-centered substance abuse treatment program in Racine and Kenosha counties designed specifically for women. Dr. Galbis-Reig’s commitment to the program and his relationship with its donors has inspired over $500,000 in donor contributions toward Addiction Service at Ascension All Saints.

View Full WMS Press Release Here

DHS Submits Plan to Legislature’s Joint Committee on Finance on How to Use $36 Million in Opioid Settlement Funds

Wed, 03 Apr 2024 17:35:19 GMT

On April 1, the Wisconsin Department of Health Services (DHS) submitted its plan for the annual share of $7505 million of opioid settlement funds to the Legislature’s Joint Committee on Finance (JFC). As a result of settlements reached by the Wisconsin Department of Justice, Wisconsin will receive $36 million this year that will be used to prevent opioid misuse while continuing and strengthening successful efforts for harm reduction, treatment, and recovery.

“This is a thoughtful plan built from the advice we received through surveys, listening sessions, and roundtable discussions, as well as reviews of data and already existing programs, and by identifying the needs that still exist,” said Kirsten Johnson, DHS Secretary-designee. “We want to thank our partners, providers, and people with experience with opioid misuse and their family and friends, for sharing their ideas that helped us shape a plan that moves us toward the goal of ending the state’s opioid epidemic.”

Attorney General Josh Kaul added, “The efforts of the Wisconsin Department of Justice and others to get accountability in connection with the opioid epidemic have secured the recovery of approximately 3/4 of a billion dollars. It’s essential that these funds be used as effectively as possible to combat the epidemic and save lives.”

View the entire news release.

DHS Awards Grants from JUUL Settlement Funds to Prevent and Treat Vaping by Youth and Young Adults

Thu, 15 Feb 2024 17:24:38 GMT

Feedback from statewide listening sessions and surveys recommend how funds should be used

The Wisconsin Department of Health Services (DHS) has awarded 13 grants worth $830,000 over the next two years to community organizations throughout Wisconsin to help address the youth and young adult vaping epidemic. Funding for the Vaping Prevention and Treatment Initiatives (VPTI) grants comes from current payments to Wisconsin as part of a $14.7 million multiyear JUUL Settlement announced by the Wisconsin Department of Justice in September 2022.

The DHS Tobacco Prevention and Control Program hosted virtual statewide listening sessions and online surveys in summer 2023 to gather input from residents about vaping. The data collected helped drive the decision to support local organizations addressing the vaping epidemic, along with statewide efforts already in progress.

"The concerns and ideas shared by Wisconsinites show the impact vaping has in communities across the state," said DHS Secretary-designee Kirsten Johnson. "Through these grant awards, local organizations will protect teens and young adults in their communities from the dangers of nicotine addiction."

View the entire news release

WISAM Past-President Featured on WHN Panel

Mon, 15 Jan 2024 15:02:25 GMT

Discussing What’s Next for Medical Marijuana in Wisconsin

As states across the country loosen their laws on marijuana, momentum is gaining for a medical plan in Wisconsin. Assembly Republicans unveiled legislation this month that would allow residents with chronic diseases to access the drug from state-run dispensaries. But Senate Republicans have been less receptive to the concept and Democrats are pushing for full legalization. Meanwhile, the state’s doctors say there hasn’t been enough research on its efficacy.

A Wisconsin Health News virtual panel will examine what’s next for medical marijuana in the state and what impact it could have on patients.

Panelists:

Dr. David Galbis-Reig, Past President, Wisconsin Society of Addiction Medicine
Rep. Darrin Madison, D-Milwaukee
Rep. Patrick Snyder, R-Schofield

REGISTER HERE

DHS and DOJ Announce Dose of Reality Roundtable Discussions on Wisconsin’s Opioid Epidemic

Fri, 08 Dec 2023 16:00:00 GMT

Statewide tour will include local community leaders and partners to talk about what we can do to save lives

The Wisconsin Department of Health Services (DHS) and Department of Justice (DOJ) are announcing a series of roundtable discussions to hear directly from local communities who are working toward preventing overdose deaths in the state and helping Wisconsinites struggling with opioid use.

“We are calling these roundtable discussions a “Dose of Reality” because we want to hear the reality of Wisconsinites experiences in their own communities,” said DHS Secretary-designee Kirsten Johnson. “We want to understand our partners’ current situation, hear what is needed to address opioid use in their community, and celebrate their successes.”

Last year, 1,421 Wisconsinites died by opioid overdose. There were also 2,530 opioid-related trips to emergency departments, and 978 hospitalizations. Drugs mixed with fentanyl account for most of the overdose deaths.

View the entire news release.

Wisconsin Adds New Hub to Pilot Program

Thu, 02 Nov 2023 20:44:24 GMT

Northwest Milwaukee site to join effort to test model emphasizing care coordination in the treatment of substance use disorder

The Department of Health Services (DHS) will be adding a fourth site to a program initiated in 2020 that pilots a hub and spoke approach to treating Wisconsin Medicaid members affected by substance use disorder and physical and behavioral health issues that challenge their efforts in recovery. Vin Baker Recovery of Milwaukee was selected in a process earlier this year. The organization's startup costs as a pilot program participant will be funded through Wisconsin’s 2022 share of the National Prescription Opiate Litigation settlement. Nearly all of those funds have been distributed to agencies providing prevention, harm reduction, treatment, and recovery support.

Under the pilot, individual organizations take the lead as a “hub” on the care of people in their program, ensuring that substance use disorder treatment and other health care needs are addressed. Hub teams include peer providers who have lived experience with substance use to improve member engagement with their treatment. Each team develops individualized integrated care plans, implements those plans through connections and referrals, and facilitates members’ treatment across different settings. Each hub then works with a network of “spoke” organizations that provide a range of services customized to further address each member’s unique circumstances. 

“Adding a site to this promising pilot will increase our understanding of how this model works in another setting,” said DHS Secretary-designee Kirsten Johnson. “Better yet, it means more members can receive individualized services and improved access to the necessary physical health care providers, prescribers, and behavior health specialists, leading to better overall health outcomes.”

View the entire news release.

Wisconsin Addiction Recovery Helpline Marks Five Years of Service

Wed, 01 Nov 2023 15:35:52 GMT

More than 31,000 calls, texts, and chats for support answered since 2018

The Wisconsin Addiction Recovery Helpline reached a significant milestone this month – five years of connecting state residents experiencing substance use concerns with local services and support. This free and confidential service supported by a grant from the Department Health Services (DHS) and managed by 211 Wisconsin debuted in October 2018 as part of efforts by state officials to reduce drug overdoses. Since then, staff have answered 31,591 calls, texts, and chats from all 72 Wisconsin counties and nine of the 11 federally recognized Tribal nations with members in Wisconsin. These contacts resulted in 78,646 referrals to agencies providing substance use disorder assessment services, counseling, inpatient care, residential care, outpatient care, medication-assisted treatment, and supports from people in recovery from a substance use disorder trained to help others.

“For five years, the Wisconsin Addiction Recovery Helpline has offered people hope at a time when they may feel overwhelmed by what steps to take for health and healing,” said DHS Secretary-designee Kirsten Johnson. “Staffed by caring, trained specialists, it is a safe, trusted resource to turn to for information. We are grateful for the work of 211 Wisconsin and all the people who have made this service a success.”

View the entire news release.

WISAM President's Message | October 2023

Thu, 26 Oct 2023 19:32:57 GMT

Dear WISAM Members,

Happy October! It is with both gratitude and hope that I share my outgoing newsletter as President of the Wisconsin Society of Addiction Medicine. I wanted to take some time to reflect on the past two years.

As an organization, we have continued to be very active in educational, legislative, and treatment areas. We have published letters to the editor on salient topics, remain with representation on multiple state councils (SCAODA, MEB, WMS COL, CSB, Medicaid Advisory Committee), and have continued being part of the Good Samaritan Coalition to change how people are treated after an overdose.

We have had two annual conferences during my tenure, and the most recent in the Wisconsin Dells had many great first experiences for WISAM at this conference. This included poster presentations, art displays from people in recovery, and more regional representation than has ever occurred before! We are looking at being part of future regional conferences and it is a grand opportunity for us to find support from other states and discuss how to navigate the ever-changing landscape of the treatment of addiction. We were privileged to have national keynote speakers Yngvild Olsen, SAMHSA, and Dr. Brian Hurley, President of ASAM, interspersed among many intriguing discussions ranging from Harm Reduction (Dr. Elizabeth Salisbury-Afshar) to Cannabis Legislation Considerations (Dr. Doris Gundersen).

The COVID pandemic has officially been sunsetted, but the impact on telemedicine and our ability to provide access to services continues to be noted. For instance, addiction treatment providers and researchers proved that people can effectively access life-saving treatment without needing in-person visits. The DEA has just extended pandemic-era waivers for controlled prescription prescribing until December 2024.

Wisconsin DHS changed requirements for treating substance use disorders. On the heels of those changes, federal law changed so that prescribers no longer need a Buprenorphine waiver to treat people with this treatment from any office. This paved the way for WISAM to develop and implement an 8-hour SUD-focused training for primary care providers. We will just need to hang on for the ride and support each other through the next inevitable changes with an eye towards novel partnerships and shared solutions!

It has been an honor to lead this organization for the past two years and be a part of good ideas becoming reality. I remain inspired by our membership and hope that we can continue to support each other moving forward in treating addiction and saving lives.

Thanks for your interest and participation with WISAM - please stay involved with Open Exchanges in 2024!

In gratitude,

Dr. Ritu Bhatnagar, MD MPH FASAM DFAPA

National Addiction Treatment Week 2023

Sat, 14 Oct 2023 15:44:43 GMT

National Addiction Treatment Week is a pivotal, annual event that spotlights the addiction treatment gap and champions compassionate, evidence-based approaches to care. Supported by the Wisconsin Society of Addiction Medicine. This weeklong initiative amplifies three life-saving messages:

1. Addiction is a chronic, treatable medical disease.
2. Effective treatments are available.
3. Recovery is not only possible but achievable.

By sharing the stories and experiences of dedicated practitioners who provide care to patients with addiction, we aim to end the stigma surrounding addiction and encourage medical professionals to embrace individualized, compassionate addiction care.

Why Should You Get Involved?

This year, we are showcasing how the treatment of addiction has a profound positive impact on both a physician's career and a patient's life. By actively participating, you can:

1. Learn from Your Peers: Gain invaluable insights from firsthand accounts shared by addiction medicine specialists who have made transformative differences in their patients' lives through evidence-based care.

2. Be a Stigma Buster: Your active engagement plays a pivotal role in eradicating the stigma attached to addiction and fostering a more supportive environment for individuals seeking help.

3. Inspire Lasting Change: By sharing these compelling stories, you inspire fellow medical professionals to explore the world of compassionate and individualized addiction care.

How Can You Participate and Access the Toolkit?

To take an active role in this important initiative and access the comprehensive toolkit, click here.

Your involvement will elevate awareness, reduce stigma, and ignite transformative change in the landscape of addiction treatment. Explore the toolkit, share your own experiences, and actively engage on social media using #TreatmentWeek.

Unlock the potential of National Addiction Treatment Week 2023 and join us in shaping a future where compassionate, evidence-based addiction care is accessible to all who need it. Your commitment is invaluable, and we are excited to embark on this remarkable journey with you.

ThedaCare Foundation to Host Training October 28

Thu, 12 Oct 2023 14:13:13 GMT

ThedaCare (through generous support of the ThedaCare Family of Foundations and Wisconsin Society of Addiction Medicine) is pleased to offer a complimentary CME Event, Stemming the Tide of the Overdose Epidemic for a second time this year.

This CME event allows providers to meet the new requirement of 8 hours of addiction medicine training to renew and maintain DEA license. The day will consist of education and information on effective and evidence based treatment for substance use disorders, as well as interesting panel discussions and practical tips to help you implement substance use disorder treatment into your clinical practice.

We are very excited about the interest in this event. We wanted to answer some questions that have come up about the CME event and provide some context for the new DEA requirement. Attached are some answers to frequently asked questions as well as resources for additional training and support that is available.

Details and registration below:

Thank you and hope to see you on October 28^th!

Dr. Ezra Lyon

Associate Medical Director or Integrated Addiction Treatment

Heather Pagel

Manager, Integrated Behavioral Health

MKE County Announces Locations of 11 ‘Harm Reduction Vending Machines’ to Combat Death from Overdose

Fri, 22 Sep 2023 13:30:00 GMT

Milwaukee County Executive David Crowley, Chief Health Policy Advisor Dr. Ben Weston, Department of Health & Human Services (DHHS) Executive Director Shakita LaGrant-McClain, and Behavioral Health Services (BHS) are announcing the placement of 11 Harm Reduction Vending Machines to reduce injury and death from overdose, at locations across the county, informed by data and need. The machines provide free access to harm reduction and prevention supplies, including fentanyl test strips, nasal naloxone, medication deactivation pouches, medication lock bags, and gun locks. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), harm reduction is an evidence-based practice to prevent death for people who use drugs. In 2022, there were 667 drug overdose deaths in Milwaukee County.

“The opioid epidemic reaches communities in all parts of the county. It crosses all socio-economic, demographic and age ranges – there is no ‘type’ of person who succumbs to opioid addiction. Last year’s opioid settlement allow us to get to work right away funding projects that will help save lives and mitigate continued suffering for residents and their loved ones,” said County Executive Crowley. “Milwaukee County has been on the frontlines of this battle for years in the court system, and now we take the next step in bringing crucial resources to the doorstep of the communities that need them the most. By following the data and investing in the communities with the highest need, I am optimistic we will make our communities safer and healthier and help residents begin or continue their road to recovery.”

Click Here for Vending Machine Locations

Click Here to Read More

International Overdose Awareness Day a Time to Remember and Take Action

Thu, 31 Aug 2023 17:55:44 GMT

August 31 is International Overdoes Awareness Day, the world’s largest annual campaign to end overdose. Today we:

Remember loved ones who have died from drug overdose and acknowledge the grief of the family and friends left behind;
Take action to encourage support and recovery for everyone impacted by substance use and overdose; and
End overdose by spreading awareness of overdose prevention strategies.

The following article was posted on the American Society of Addition Medicine on August 30. It was written by Dr Nicholas Athanasiou (Editor-in-Chief) and summarizes the growing impact of overdoes in our world.

Drug use and overdose rates are a concern for the public’s health. A new report from the CDC looks at how overdose rates during the pandemic varied across different industries and work settings while highlighting significant health equity issues in the US (National Vital Statistics Report). It’s hard not to think about “deaths of despair” when reading this, but then an article from TIME reminds us that “deaths of despair” might be too narrow a view because there is more to "despair-ism" than originally conceptualized.

Data from Monitoring the Future found that young adults report using marijuana and hallucinogens at or near historically high levels while middle-aged adults report record levels of binge drinking (NIDA News). Maybe Generation X is responding to the difficulties of being sandwiched between two hippie generations.

Cannabis is now the most commonly used illegal (federal) drug in pregnancy, which means that perinatal research needs to close the knowledge gap quickly -- both for maternal and paternal use -- so we can better guide clinicians, develop policy, and inform the public (JAMA). A review on nitrous oxide toxicity reminds us that use of a cheap and easily accessible substance should be included on our differentials, especially when seeing youth and young adults with unusual gait (CMAJ).

More globally, Bashar al-Assad’s regime in Syria is looking to spread addiction and turmoil to global enemies by dealing a new amphetamine-type stimulant called captagon (The Messenger). Evidently, drug use and overdose rates are a concern for geopolitical foes too.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD

Philanthropic effort to fight opioid epidemic underway in Wisconsin

Tue, 22 Aug 2023 16:14:01 GMT

Wisconsin Health News

A national philanthropic effort to fight the opioid crisis on Monday released more details on its work in Wisconsin.

The Bloomberg Philanthropies Overdose Prevention Initiative launched in 2018 in two states and expanded its work to five more, including Wisconsin, in 2021. To date, Bloomberg Philanthropies has put $170 million toward the overall initiative.

The initiative supports Vital Strategies, which is working in Wisconsin to help provide the anti-overdose reversal drug naloxone, fentanyl test strips and information resources. It's also supporting the Department of Health Services in how to best use funding and programming for overdose deaths. The effort also backs harm reduction services and awareness efforts in Black and Indigenous communities.

“Working together, we can avoid the loss of life from drug overdoses and help those with substance use disorder on the path to recovery,” DHS Secretary-designee Kirsten Johnson said in a statement.

On Monday, Vital Strategies said it is:

Teaming up with Milwaukee radio stations on an educational campaign on how the overdose crisis is disproportionately impacting Black communities and how to access naloxone and other resources through the City of Milwaukee Office of African American Affairs.
Providing technical assistance and funding to the Bad River Tribe's harm reduction supply delivery program and an initiative by NEXT Distro to expand access to harm reduction supplies in rural and Indigenous communities.
Supporting a workgroup composed of leaders on Milwaukee’s north side in disseminating a report they wrote on the unmet harm reduction and treatment needs in the city’s Black communities.
Partnering with Samad’s House, a Black-led organization that provides healthcare and supportive services to women in substance use disorder recovery, to support women with lived experience in distributing harm reduction supplies and providing information on treatment and referrals.
Supporting Rebalanced-Life Wellness Association’s Black Barbershop Program to provide naloxone, fentanyl test strips, education and treatment referrals through its existing healthcare services in Black barbershops in Dane County.

State Med Board approves new opioid CME, chaperone rules

Mon, 21 Aug 2023 15:29:25 GMT

Wisconsin Medical Society | Medigram

The State of Wisconsin's Medical Examining Board (MEB) gave final approval to two administrative rules at its monthly meeting on August 16. One is the culmination of a multi-year exploration into establishing chaperone requirements; the other modifies current rules for physicians' continuing medical education (CME) responsibilities.

Opioid CME Requirements

The new rule alters the current requirement that a physician complete two credits of coursework each reporting period in a specific area of controlled substances prescribing; the specific subject area has varied over the previous cycles. Under the new rule, the two-credit requirement can be fulfilled with coursework pertaining to "prescribing opioids and other controlled substances." While previous cycles required those courses to be approved by the MEB, the new rule eliminates that requirement.

Since first establishing this subject-specific requirement, the MEB created each version of the rule with a sunset clause, meaning the requirement would expire if the MEB determined that specific prescribing education was no longer needed. As the state continues to experience overdose-related deaths – including an increase in synthetic opioid-related abuse – the MEB decided not to include a sunset clause for the new rule. Therefore, the requirement will remain until such time as the MEB decides to alter the rule.

The new rule is expected to take effect on October 1, 2023, which means it applies to the current CME cycle.

Public Hearing Announced: AB 304/SB332

Mon, 14 Aug 2023 19:36:42 GMT

WI 2023 SB332 proposes to significantly change the alcohol laws in Wisconsin. If enacted, the bill would change Wisconsin laws for the production, regulation, and distribution of alcohol beverages and change how alcohol is regulated and oversight is provided. The attached memo, created by Wisconsin Alcohol Advocacy Project, outlines ten significant changes this bill creates for alcohol regulation.

The public hearing on AB 304/SB332 has been scheduled for Thursday, August 17, 2023, at the State Capitol at 9:30 am, 411 South. There are several bills in this hearing. AB 304/SB332 is third on the docket.

CLICK HERE to view the video from the Wisconsin Alcohol Policy Project webinar last week entitled “Changes to Alcohol Regulation in Wisconsin: Proposed increases to availability, accessibility and production of alcohol.”

Racial Equity Training - Announcement

Mon, 14 Aug 2023 19:32:35 GMT

Racial Equity Training - Announcement from the Overdose Prevention Program

WISAM is sharing this racial equity training designed for organizations and providers working with people who use drugs. The training, "Taking Action on Racial Equity in Drug User Health Programs," was developed in collaboration with In the Works and Reframe Health. It consists of three modules:

• Racial Equity in Overdose & Drug User Health—This module will discuss race, racism and how overlapping systems of oppression can impact the lives of people who use substances, including its important to drug user health.

• Addressing Institutional Racism within Organizations—This module will focus on institutional racism within organizations, specifically which practices and policies create inequity for BIPOC staff, and further explore how interpersonal interactions can contribute to inequity.

• Racial Equity in Planning, Data, and Action—This module will discuss integration of racial equity into service provision and external facing work, what kind of information can inform our work and how to identify goals and targets and work with community partners

The modules are available as a free e-course and can be taken at your own pace. The total course, including supplemental sections, will take approximately six hours to complete. There are supplemental resources provided, including downloadable handouts, worksheets, and a glossary. In order to access the course, you must enroll for the course through this link.

We encourage you to also share this opportunity with other groups that you think will benefit from this resource. Please feel free to share any thoughts or suggestions you may have after accessing the modules. We hope this course will help meet the needs of your organization and improve programming.

988 Wisconsin Lifeline Marks First Anniversary

Fri, 14 Jul 2023 19:54:24 GMT

Wisconsin DHS News Release

Wisconsinites can call, text, and chat for free, 24/7 mental health and substance use support

The Wisconsin Department of Health Services (DHS) today is recognizing the positive impact the 988 Wisconsin Lifeline has had in the year since the service began taking calls, texts, and online chats. From July 2022 through June 2023, the 988 Wisconsin Lifeline received 91,834 contacts for mental health and substance use support.

“The 988 Wisconsin Lifeline is a critically important resource for Wisconsinites to be able to talk to someone when they need to,” said Gov. Tony Evers. “We are proud of the work the 988 Wisconsin Lifeline team has done over the last year to provide hope, help, and support for tens of thousands of Wisconsinites experiencing mental and behavioral health challenges.

View full press release.

July President Message

Mon, 10 Jul 2023 14:06:31 GMT

Dear WISAM Members,

Happy July- we can celebrate freedom in many ways, and recall Maya Angelou’s dictum that if we are free, we can work to free others.

The FDA has issued draft guidance on clinical trials with psychedelic drugs here. Please submit comments by August 25, 2023 at this website.

Please join us in July for the Open Exchange with Dr. Trost- see here. As we did last year, we will be offering a complimentary WISAM Annual Conference registration to one person, drawn from all attendees who join the monthly Open Exchange sessions. We are looking forward to convening on the 4th Monday of the month from 7-8 pm through September.

Sincerely,
Dr. Ritu Bhatnagar, MD MPH FASAM DFAPA

ATLAS is in Wisconsin!

Mon, 10 Jul 2023 14:05:23 GMT

ATLAS is in Wisconsin! This searchable database went live in June 2023. Please see their website Home | ATLAS (treatmentatlas.org) to share information about your program with people who are looking for treatment.

A press conference for the launch was held June 27, 2023 and Society President, Ritu Bhatnagar, MD MPH, is shown here with Attorney General Josh Kaul. It was great to see bipartisan support for this effort.

2023 Call for Nominations Now Open

Thu, 06 Jul 2023 14:23:28 GMT

The Wisconsin Society of Addiction Medicine’s Nominating Committee is now accepting nominations of any member in good standing interested in serving in WISAM leadership.

WISAM’s Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the organization. Board members are expected to participate in all Board meetings, the Open Exchange Series and Fall Conference, and to volunteer for other activities that will help advance the organization's strategic priorities.

Nominations are being accepted for Board of Director officers and director at-large to serve a two-year term beginning after the Fall Conference in October 2023.

Open positions include:

President-Elect
Treasurer
Secretary
Director-at-Large
Early Career Physician (ECP) Director

If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved.

Nominations are due by August 13, 2023.

Nominate Here Board Description

WISAM June 2023 President Message

Mon, 19 Jun 2023 15:46:46 GMT

Dear WISAM Members,

Happy June- hope you are enjoying some summer sun and fresh vegetables from the Farmers’ Markets!

The Public Health Emergency officially “ended” on May 11, 2023. As of this writing, we can continue to provide telemedicine for buprenorphine treatment as we have been through November 11, 2023, and if the provider-patient relationship was established by that date, the same allowances that existed during the pandemic can be continued through November 11, 2024.

DEA, SAMHSA Extend COVID-19 Telemedicine Flexibilities for Prescribing Controlled Medications for Six Months While Considering Comments from the Public

There continue to be overdose spikes in our areas, and if you can find a way to disseminate that within your networks, you can raise awareness and save a life!

We will take a summer break in June and reconvene in July for the Open Exchange. You can see the discussion with folks from the May discussion with United Way by visiting our website.

As we did last year, we will be offering complimentary WISAM Annual Conference registration to one person, drawn from all attendees who join the monthly Open Exchange sessions. We are looking forward to convening on the 4^th Monday through September from 7-8 pm.

Sincerely,
Dr. Ritu Bhatnagar, MD MPH FASAM DFAPA

Wisconsin Doctor Day 2023 Recap

Mon, 19 Jun 2023 14:06:30 GMT

Doctor Day 2023 was a success with over 300 registered attendees. AMA President, Dr. Jesse Ehrenfeld, joined us as the keynote presenter and physicians met with the legislators to discuss Doctor Day's priority issues which included; APRN Legislation and Extended Medicaid Coverage for New Moms. View WISAM's position paper here.

https://www.widoctorday.org/

ThedaCare-WISAM Joint CME Event: "Stemming the Tide of the Overdose Epidemic"

Tue, 23 May 2023 19:45:42 GMT

May 20, 2023

Appleton WI

Clinicians learn tools to treat substance use disorders

On May 20^th, clinicians from around the Fox Valley and surrounding areas gathered at Fox Valley Technical College to learn how to combat the opioid overdose epidemic. The event, Stemming the Tide of the Overdose Epidemic, was attended by over 70 physicians, nurse practioners and physician assistants. Clinicians came from as far away as Sturgeon Bay, Wautoma and Shawano to learn how to diagnose and treat opioid use disorder.

Attendees learned how to prescribe the life-saving medication buprenorphine, better known by its brand name Suboxone. Opioid overdose is now the leading cause of death in younger adults in Wisconsin and across the county. Treatment with buprenorphine reduces the risk of premature death by over 50% in people suffering from an opioid use problem. Many people struggle to access these medications and most PCPs do not treat addictions.

The event featured a panel of family physicians who are successfully treating opioid use in their busy primary care clinics. The panelists included Dr. Gretchen Wagner at Ascension in Greenville, Dr. Eric Smiltneek at Aurora in Oshkosh, Dr. Robert Sedlacek at ThedaCare in Waupaca and Dr. Karen Hulbert at ThedaCare in Princeton and Markesan.

The event closed with a panel discussion on stigma reduction in the treatment of people suffering from use disorders. Panelists shared how stigma keeps people from accessing life-saving treatment. The panel discussion was led by Joe Galey from Safe Communities of Madison and included Stephanie Good, a substance abuse counselor at Apricity/Mooring House in Neenah, Caitlin Reider, a substance abuse counselor at ThedaCare Behavioral Health and Jami Carlovsky, a collaborative care nurse manager at ThedaCare in Waupaca.

The event was led by Dr. Ritu Bhatnagar, an addiction psychiatrist at UW-Madison and the current president of the Wisconsin Society of Addiction Medicine (WISAM), and by Dr. Ezra Lyon, a family physician at ThedaCare in Waupaca and ThedaCare’s Associate Medical Director for Integrative Addiction Treatment. The event was free to participants due to generous grant support from the ThedaCare Family of Foundations and from WISAM through federal and state grants. Fox Valley Technical College provided generous in-kind support for the event. Another training is planned for fall of 2023.

Panel discussion on stigma reduction featuring (from left) Jami Carlovsky, Caitlin Reider, Stephanie Good and Joe Galey.

Statement from the DEA Administrator Anne Milgram on COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

Thu, 04 May 2023 13:48:01 GMT

From dea.gov,

The Drug Enforcement Administration received a record 38,000 comments on its proposed telemedicine rules. We take those comments seriously and are considering them carefully. We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards.

For this reason, last week, DEA, in concert with the Department of Health and Human Services, submitted a draft Temporary Rule to the Office of Management and Budget entitled “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” Further details about the rule will become public after its full publication in the Federal Register.

For additional context, please click here.

DEA Announces Changes in Buprenorphine Prescribing Rules

Wed, 12 Apr 2023 21:28:17 GMT

The Drug Enforcement Administration (DEA) announced changes in rules regulating prescribing of buprenorphine for opioid use disorder (OUD).

Section 1262 of the Consolidated Appropriations Act, 2023, removes the federal requirement for practitioners to have a DATA-Waiver to prescribe buprenorphine for treatment of OUD.

Effective June 21, 2023:

DATA-Waiver registration is no longer required to treat patients with buprenorphine for OUD.
All prescriptions for buprenorphine require only a standard DEA registration number.
There are no limits or patient caps on the number of patients a prescriber may treat for OUD with buprenorphine.
Existing state laws or regulations remain in effect.

Training Requirements

Beginning June 27, 2023, all DEA-registered practitioners will be required to check a box on their online DEA registration form affirming they have completed a one-time eight-hour training on treatment and management of patients with opioid or other substance use disorders.

These changes could improve access to medical treatment for OUD for pregnant persons in Wisconsin.

For more information on the 8-hour training requirement, click here.

For more information, visit the Substance Abuse and Mental Health Administration’s FAQ.

DHS Awards $10 Million to Construction Projects for Opioid Treatment and Recovery Support Services

Thu, 06 Apr 2023 16:31:32 GMT

The Wisconsin Department of Health Services (DHS) has awarded $10 million to three organizations for the construction of spaces designed to provide treatment and recovery support services for women.

“Women with opioid use disorder have unique care needs and require a broad range of services to meet these needs,” said DHS Secretary-designee Kirsten Johnson. “The facilities built through this grant program will remove barriers to long-term recovery by providing space to supports women with opioid use disorder to succeed in their journey to wellness.”

The funded projects include:

Arbor Place, $4,910,000

This project will establish the first residential treatment facility in western Wisconsin open to supporting pregnant women and mothers. It serve up to 20 women at one time once construction of a new building in Menomonie is completed in 2025.

Meta House, $4,910,000

This project will add space to an existing residential treatment program in southeastern Wisconsin open to all women that currently has a wait list for admission. The expanded program will be able to serve 60 more women when construction is completed in Glendale in 2024.

Lighthouse Recovery Community Center, $180,000

This project will create the first space in northeast Wisconsin focused on supporting pregnant women and mothers in need of safe and stable housing for their families while they participate in outpatient treatment. It will be able to house up to seven women at one time when renovations are completed on an existing building in Manitowoc in 2024.

These spaces will serve all state residents who qualify for the services to be provided.

These one-time grants are for construction costs only. They are funded from Wisconsin’s share of National Prescription Opiate Litigation settlement funds managed by DHS that were received last year. The funded organizations are responsible for costs related to staffing, program supplies, and materials for the delivery of services.

The National Prescription Opiate Litigation settlement funds were awarded in 2022 as part of agreements the Wisconsin Department of Justice entered into with pharmaceutical companies and distributors, settling the state’s legal claims that their actions fueled an epidemic of opioid use disorder, overdoses, and deaths. DHS is expected to receive $130 million over 18 years.

The first payments from the settlement funds were received in the last five months of 2022, totaling nearly $31 million. Based on feedback received through virtual listening sessions and a survey open to all state residents and service providers, and with approval of the legislature’s Joint Committee on Finance, the 2022 funds have been allocated to projects to prevent opioid use, reduce opioid overdoses and other harms from opioid use, expand access to treatment and recovery supports, and enhance data collection efforts to support decisions on the allocation of resources. Tribal nations and law enforcement agencies are receiving a portion of the 2022 funds to support projects unique to their communities and work.

All providers currently offering prevention, harm reduction, treatment, and recovery services for people with an opioid use disorder were invited to apply for a share of the $10 million in funding awarded today. The proposals submitted by the grantees most closely aligned with the approved goals of this grant program, which included the readiness of the agency to begin construction on the project and a focus on serving a population or region in need of services. Part of the funding was required to be allocated to projects that support the expansion of bed capacity for the treatment of pregnant women and mothers in a family-centered environment. At least $3 million was required to be allocated to projects in counties with fewer than 500,000 residents.

In partnership with tribal nations, other state agencies, county and municipal agencies, and community organizations, the DHS response to the impacts of opioids use has evolved as the impacts have become greater. The Dose of Reality public awareness campaign was revised last year in collaboration with the Wisconsin Department of Justice to provide information on how to build supportive communities where prevention works, treatment is effective, and recovery is possible. Naloxone and fentanyl test strips are more widely available to prevent overdoses and deaths. Treatment programs have been expanded and enhanced to focus on the most helpful approaches for care. Recovery supports delivered by people who have experienced the impacts of opioid use have become more accessible, with the peer-to-peer connection shown to be effective in promoting long-term health and wellness.

Learn about services and supports available for opioid use disorder by visiting the Wisconsin Addiction Recovery Helpline website or call 211. More information about Wisconsin’s response to the opioid epidemic can be found on the Dose of Reality webpages.

Substance Use Disorders Management Boot Camp

Wed, 05 Apr 2023 18:44:20 GMT

Join UW PROTEA & FAMMED for a Substance Use Disorders Management Boot Camp conference this spring, May 4-5, 2023! This training aims to enhance confidence and competencies related to the management of substance use disorders in general medical settings. Through case-based and interactive didactic content, the workshop will explore issues related to assessment, monitoring, prevention, and management in the setting of unhealthy substance use.

For more information, please visit https://www.fammed.wisc.edu/protea/

Or contact Kathleen Maher, Outreach Specialist, at Kathleen.Maher@fammed.wisc.edu

WI DHS Unwinding Implementation Briefing

Wed, 05 Apr 2023 18:40:48 GMT

On behalf of Jamie Kuhn, Wisconsin Medicaid Director, you are invited to attend a briefing on upcoming changes to BadgerCare Plus and other Wisconsin Medicaid programs that may affect one in four Wisconsinites. Staff from the Wisconsin Department of Health Services will provide updates on program eligibility, operational changes, agency readiness, partner outreach, and engagement opportunities. The agenda is attached. Mark your calendar and plan to attend.

When: Wednesday, April 12, 2023, at 1 p.m.

Where: Zoom meeting

One tap mobile: +16468287666,,1607480003# US (New York)

Meeting URL: https://dhswi.zoomgov.com/j/1607480003

Call In: (669) 254-5252 or (646) 828-7666

Meeting ID: 160 748 0003

During the COVID-19 emergency, the federal government allowed states to implement temporary changes in their Medicaid programs to protect member health and safety. The federal government has now given us a timeline to end those changes. “Unwinding” is the term they have coined to describe the period it will take for states to reinstate routine operations.

The biggest change will be that all of our members who have had continuous health care coverage since March 2020 will need to complete a renewal due in a month assigned to them between June 2023 and May 2024. This topic and more will be discussed during the briefing.

The target audience for this message is broad and includes health care associations, managed care organizations, providers, advocates, and partners. If you have questions or would like more information, email DHSForwardHealthPartners@dhs.wisconsin.gov.

WI DHS 2023 Opioids, Stimulants, and Trauma Summit

Fri, 31 Mar 2023 19:55:37 GMT

Presenting 2023 Opioids, Stimulants, and Trauma Summit

The 2023 Opioids, Stimulants, and Trauma Summit agenda is available now. It is loaded with exciting content and lots of speakers to present the most up-to-date information from some of the smartest people working in substance use and trauma prevention, harm reduction, treatment, and recovery services.

You are invited to join us May 16-18, 2023, in person (Wisconsin Dells) or virtually for five keynote presentations and more than 20 workshops. There is a pre-conference activity May 15.

See more information about this event and information on how to register to attend.

This event is designed to give you the facts and skills that will make a difference for you, your work, and your community in a positive and forward-thinking environment.

Continuing education credits are available for people who attend the live event either in person or virtually.

The registration deadline is 5 p.m. May 11, 2023. Register early. Registration fees increase April 16, 2023.

DHS Submits Plan to Legislature's Joint Committee on Finance on How to Use $8 Million in Opioid Settlement Funds

Wed, 29 Mar 2023 21:27:22 GMT

Today, the Wisconsin Department of Health Services (DHS) submitted its plan to use nearly $8 million in opioid settlement funds to the Legislature’s Joint Committee on Finance (JFC) to support prevention, harm reduction, and capital projects to address the state’s opioid crisis. The money is part of the $400 million the state receives in annual installments through an agreement with major pharmaceutical firms. $130 million of the total amount goes to the state, while the remainder is provided to counties and municipalities.

2021 Wis. Act 57 requires DHS to submit a plan for the anticipated settlement funds to the JFC every year. While the plan submitted in 2022 was created through information gathered at listening sessions across the state, this year DHS conducted a survey to gauge priorities for this plan and over 4,100 people responded.

“As with last year’s proposal, this plan prioritizes what people with lived experiences, their families and friends, and our partners told us is needed to address the state’s opioid crisis,” said Paul Krupski, DHS director of opioid initiatives. “People who responded to our survey ranked the programs and services they see as priorities, and we’re eager to have the committee’s approval of them.”

Priorities include:

Increasing the availability of Narcan® and fentanyl test strips statewide via existing DHS programs ($4 million).
- $1.5 million to maintain the availability of Narcan® statewide via the DHS Narcan® Direct Program through community provider agencies.
- $500,000 to maintain a statewide distribution of fentanyl test strips via the DHS fentanyl test strip direct program through community providers.
- $1 million to sustain the EMS Leave Behind Program providing EMS agencies with Narcan® and fentanyl test strips.
- $750,000 to sustain the DHS Law Enforcement Narcan® Direct Program
- $250,000 to sustain providing fentanyl test strips to law enforcement agencies participating in the DHS Law Enforcement Narcan® Direct program.
One-time capital projects ($3 million)
- Capital projects to expand prevention, harm reduction, treatment, and/or recovery services statewide.
Prevention ($1 million)
- Implementation of K-12 evidence-based substance use prevention programming.

In 2022, the Wisconsin Department of Justice (DOJ) announced final approval of an agreement with the nation’s three major pharmaceutical distributors (Cardinal, McKesson, and AmerisourceBergen) and Johnson & Johnson. Payments from the distributors will continue for 18 years. Payments from Johnson & Johnson will continue for nine years.

This year, Wisconsin will receive two payments from these settlements. The first payment of $617,290 from Johnson and Johnson is expected to arrive in mid-June. The second payment of $7,371,693 from the distributors is expected on July 30.

In fiscal year 2023, DHS received three settlement payments totaling just over $30 million, and under the plan approved by JFC in 2022, nearly $13 million has gone toward expanding the Narcan® Direct Program; capital projects to expand prevention, harm reduction, treatment, and recovery services; and room and board costs for residential treatment for Medicaid members. The remaining funds will go to programs and projects awaiting approval of applications, including funds to tribal nations, medication assisted treatment, and for after-school programming. Details about these projects will be released soon.

The opioid settlement funds supplement the ongoing efforts by the state to address the opioid epidemic in Wisconsin. Through the Dose of Reality campaign, a joint effort of DHS and DOJ, Wisconsinites can find resources for themselves and loved ones about preventing harm using overdose reversal medications, like Narcan® and fentanyl test strips, treatment and recovery options, and information about talking to family and friends about opioid use. Resources for health care providers is also available.

While data for 2022 has yet to be finalized, 2021 data show there were 1,427 opioid overdose deaths in Wisconsin, and 3,133 emergency room visits, as a result of opioid use. An increase in overdose deaths can be traced in large part to the addition of fentanyl, a powerful, synthetic drug, in substances like opioids.

DHS Issues Public Health Advisory to Warn of the Risks of Death from Drugs Laced with Fentanyl

Wed, 17 Aug 2022 19:14:13 GMT

DHS Issues Public Health Advisory to Warn of the Risks of Death from Drugs Laced with Fentanyl
Numbers show an increase in overdose deaths in Wisconsin are linked to the addition of synthetic substances and a mixture of drugs used

Fentanyl is up to 50 times stronger than heroin and up to 100 times stronger than morphine. Because it is so strong and cheap to produce, people who manufacture illegal drugs use fentanyl to make other drugs more powerful and less expensive to make. Fentanyl can be added to pills, heroin, cocaine, methamphetamines, and other drugs.
“As we continue our work to promote mental health, reduce harm, and increase support for those struggling with substance use disorders, we can't ignore the greater risks people face by not knowing what is included in the drugs they are taking,” said DHS Secretary-designee Karen Timberlake. "This is a public health crisis, and it's necessary to sound the alarm to prevent unnecessary deaths."

The Wisconsin Department of Health Services (DHS) has issued a public health advisory to inform Wisconsinites about the increased number of deaths caused by drugs laced with synthetic substances, especially fentanyl

DHS data shows that just last year, synthetic opioids, primarily fentanyl, were identified in 91 percent of opioid overdose deaths in Wisconsin, and in 73 percent of all overdose deaths. From 2019 to 2021, the number of fentanyl overdose deaths in the state grew by 97 percent.

State to get boost in fighting opioid epidemic through Teva settlement

Thu, 28 Jul 2022 15:06:41 GMT

Wisconsin Health News

The Wisconsin Department of Justice has reached an agreement in principle on the financial terms of a settlement with opioid-maker Teva that would provide up to $4.3 billion to participating state and local governments over 13 years.

Wisconsin is one of a dozen states leading negotiations with the Israel-based drugmaker over its alleged role in the opioid epidemic.

“Our efforts to pursue accountability from companies whose unlawful conduct contributed to the opioid crisis continue,” Attorney General Josh Kaul said in a statement. “This agreement, if finalized, will mark another significant step forward in bringing resources to Wisconsin for fighting this epidemic.”

The settlement is subject to ongoing negotiations. Details like the amount that will head to the state are still being worked out, per a Department of Justice spokeswoman.

Teva makes fentanyl products for cancer pain and generic opioids, including oxycodone.

The states alleged the company promoted fentanyl products for use by non-cancer patients, deceptively marketed opioids and failed to comply with suspicious order monitoring requirements.

As part of the agreement, Teva would provide up to $1.2 billion in generic naloxone over a 10-year period or $240 million in cash. The final settlement depends on complying with critical business practice changes and transparency requirements, according to the department’s statement.

The agreement would also provide $100 million for Native American tribes over 13 years, according to a Teva statement on its second quarter financial results.

The company expects the agreement to be finalized in the coming weeks, with a nationwide settlement sign-on process to follow.

“While the agreement will include no admission of wrongdoing, it remains in our best interest to put these cases behind us and continue to focus on the patients we serve every day,” the company said.

Gov. Evers, DHS Announce $2.5 Million in Telehealth Grants for Behavioral Health Providers

Wed, 27 Jul 2022 16:43:08 GMT

Gov. Evers, DHS Announce $2.5 Million in Telehealth Grants for Behavioral Health Providers
Neighborhood access stations to help remove barriers to care

Gov. Tony Evers and the Wisconsin Department of Health Services (DHS) today awarded more than $2.5 million to 27 providers for community behavioral health services that will provide access to mental health and substance use treatment and recovery supports through telehealth. Grantees will use this one-time funding from the American Rescue Plan Act to expand access to these important services by removing location and technology barriers to care. Private behavioral health telehealth stations with the tools needed for virtual appointments will be set up in central locations for people who may be struggling to access the services they need. This includes community centers, food pantries, homeless shelters, libraries, long-term care facilities, and schools.

"Every Wisconsinite should have access to quality, affordable health care they need when they need it, and that includes behavioral and mental health services,” said Gov. Evers. “These grants will help ensure more folks can meet with a provider no matter where they live, closing gaps in services and building a behavioral health system that works for everyone at a time when treatment and recovery supports for mental health and substance use are more important than ever.”

Allow medication in recovery housing -- Ritu Bhatnagar

Sun, 24 Jul 2022 14:48:17 GMT

It is accepted that medications for opioid use disorder save lives.

In the midst of the ongoing opioid epidemic, exacerbated by the pandemic and inflation, many people are feeling economically pinched. Some people with opioid and other substance use disorders are struggling to maintain housing.

When people find recovery-oriented housing, they are excited because they feel they will get the support they need.

But it is very challenging when they then sometimes find that they are not allowed to stay at the supportive living environment if they are taking medications for their medical illness.

The idea of taking medications for substance use disorders being equivalent to not being in recovery is flawed. If we define recovery as taking medications as prescribed, we can shift the discussion to providing an environment that will set a person up for success that is more inclusive and supportive of the idea that there is no one-size-fits-all for recovery. The Department of Health Services has recently taken steps to encourage recovery housing to allow medications for substance use disorders on site.

Is the recovery community ready to support people who are taking medications?

Dr. Ritu Bhatnagar, president, Wisconsin Society of Addiction Medicine

Read original post here.

Suicide and crisis lifeline now available

Thu, 21 Jul 2022 21:00:27 GMT

Wisconsin Medical Society

The 988 Suicide & Crisis Lifeline (Lifeline), a free, confidential behavioral health and support line is now available. Anyone can utilize the Lifeline at any time by calling 988 (multiple languages available), texting a message to 988 (English only), or using the chat feature at 988lifeline.org (English only). People can connect with a trained crisis counselor to get help for themselves or a loved one experiencing a crisis, such as is thoughts of suicide, a mental health concern, substance use issue or any kind of emotional distress.

Additional details about the Lifeline:

Wisconsin Lifeline counselors are trained to reduce stress, provide emotional support and connect people with local resources.
The 988 Suicide & Crisis Lifeline is available to use at no cost to Wisconsin residents. Additional care or intervention may come with a cost.
Wisconsin Lifeline is not able to send an in-person response directly. An in-person response requires a transfer to another service and could involve law enforcement.
Calls, texts and chats with Wisconsin Lifeline are confidential between the person and counselor, unless there is imminent danger for the person or others.

Jerry Halverson, MD, DFAPA, WisMed Board Chair and Rogers Behavioral Health Chief Medical Officer, told Fox6, "The purpose of 988 is to help you get over that crisis point, and get you someone that can help you more definitively. This is going to open up access to a lot of people who wouldn’t have taken advantage in the past. It can be a game-changer."

The 988 Suicide & Crisis Lifeline is a network of more than 200 support centers around the country. Contacts not answered by in-state partners roll over to a national backup system. The Wisconsin Lifeline has helped ensure that as many contacts as possible are answered by Wisconsin-based counselors who have the best understanding of local communities, cultures and resources.

Learn more about Lifeline here.

Fentanyl fueling record opioid deaths

Wed, 15 Jun 2022 15:11:18 GMT

Wisconsin Health News

Fueled by a continued surge in fentanyl use, opioid-related deaths set another record in Wisconsin last year, Paul Krupski, director of opioid initiatives for the Department of Health Services said Tuesday, previewing data the department plans to release this fall.

Nearly three-fourths of the deaths were linked to fentanyl and other synthetic opioids, according to Krupski.

“It’s clearly the driver of what we are seeing,” he said at a panel hosted by Wisconsin Health News.

Krupski’s announcement mirrors national trends.

A record-breaking 107,622 Americans died of drug overdoses in 2021, a nearly 15 percent increase from the prior year, according to provisional data from the Centers for Disease Control and Prevention. Of the reported deaths, two-thirds involved fentanyl and other synthetic opioids, up 23 percent from 2020.

“Fentanyl is so cheap, and it’s so easily accessible and readily available,” said Rep. Jesse James, R-Altoona, chair of the Assembly Committee on Substance Abuse and Prevention.

James, who spearheaded a new law decriminalizing fentanyl testing strips, called for strengthening Good Samaritan laws.

“Stop having our citizens that are using become criminals because they have to become criminals before they get the services offered to them,” he said. “There’s a problem there. We need to really look at that.”

With the first payment of a more than $400 million opioid settlement set to hit the state by this fall, counties, which are receiving 70 percent of the funds, have an eye toward education.

“Part of what will happen at the local level is we will partner with our educational facilities to try to increase awareness and education so that we don’t have the problem and play catch up when someone needs Narcan, or when we are arranging a funeral,” Wisconsin Counties Association CEO Mark O'Connell said. “We got to do it earlier.”

Dr. Ritu Bhatnagar, president of the Wisconsin Society of Addiction Medicine, said more needs to be done to address the systemic issues that are leading to a growing number of Wisconsinites abusing substances. She called for policies aimed at the social determinants of health to make recoveries more sustainable.

“The education part is important,” she said. “But when the children go home, they are going back sometimes to very dysfunctional areas.”

Drug test strips can save lives -- Op Ed By Ritu Bhatnagar

Wed, 08 Jun 2022 17:07:16 GMT

The recent passage of Senate Bill 600 to decriminalize fentanyl test strips is to be commended.

The only way people with substance use disorders can get to treatment is if they are alive. Fentanyl test strips work much like a home pregnancy test or rapid COVID tests. These low-cost strips provide a person deciding to use a substance immediate information about whether or not fentanyl is present. Providing fentanyl test strips to people who are at risk of overdose allows them to make informed choices about their use of any substance. With the prevalence of fentanyl in many substances (opioids, methamphetamine, “fake Adderall” and even cannabis), a single pill can kill.

To all the people who are thinking about trying something “just to feel better for a moment,” please remember that a single pill can kill.

Wisconsin is wise to pave the way to provide resources to help people be safe. Now we need a concerted effort to get fentanyl test strips to first responders and emergency departments.

Wisconsin Recovery Alignment Day

Thu, 26 May 2022 15:08:01 GMT

Pictured below is Dr. Ritu Bhatnagar, current WISAM President, attending and speaking at the Wisconsin Recovery Alignment Day on Tuesday, May 3 at the Wisconsin State Capitol. Recovery advocates and allies from across the state joined for the second annual day. The day included recovery and legislative speakers, meetings with the state representatives and senators, and opportunities to connect with recovery advocates. Special guest was Ryan Hampton.

Access WISAM Letter - MOUD in Jails

Mon, 23 May 2022 19:39:25 GMT

Back in January 2022, WISAM leaders created the attached letter which was sent to all Wisconsin Sheriffs. You can preview the letter below and access the full copy for use as needed to advocate in your own communities.

As advocates for the well-being, health and survival of our patients, the Wisconsin Society of Addiction Medicine urges County Jails, the DOC and DHS to take concrete and expedited steps to ensure that individuals incarcerated in our state’s jails and prisons have access to the standard of medical care for opioid use disorder (OUD). This means identifying both individuals currently receiving medications for opioid use disorder (MOUD) including buprenorphine, methadone, and extended release naltrexone, and individuals who would benefit from MOUD. Steps are needed to ensure that these individuals continue to receive MOUD while incarcerated. Buprenorphine and methadone, in particular, have been associated with reductions in mortality.

Access MOUD in Jails Letter Here

Wisconsin DOJ Grant Opportunities

Fri, 20 May 2022 17:04:53 GMT

As the State Administering Agency for federal justice grant funds, the Wisconsin Department of Justice develops statewide strategies, determines funding priorities, and advises the Governor and legislature on justice policy issues.

Board says Legislature will have to act on kratom

Tue, 17 May 2022 17:11:11 GMT

Wisconsin Health News

A state regulatory board on Friday said the Legislature will have to act to legalize kratom in Wisconsin, after lawmakers asked them to look into making the change.

Kratom, a herbal substance with stimulant and opioid-like effects, has been illegal in Wisconsin since a 2014 law replaced the definition of synthetic drugs with a description of their chemical structures.

A bipartisan group of 11 lawmakers wrote in a letter to the Controlled Substances Board last month that two of the chemical structures included in the law are found naturally in kratom.

“We believe this was done without adequate research and understanding of kratom in its natural form,” they wrote. “Therefore, we ask the board to review the research and provide guidance as to whether natural kratom merits scheduling.”

The lawmakers said kratom could be an alternative to prescription drugs.

Board Chair Doug Englebert said at Friday's meeting that they heard presentations on kratom in 2015 and 2018. They opted not to take action since the Legislature scheduled the drug and they didn’t know lawmakers’ intent.

“We didn’t feel it was appropriate for the board to undo that action without going through the legislative process,” he said.

The board unanimously voted to reiterate that position.

Mac Haddow, a senior fellow on public policy at the American Kratom Association, told board members that many of the concerns around kratom have to do with mixing the substance with more dangerous drugs.

“We understand that kratom is controversial," he said. "Part of that is because kratom has become a popular product for adulteration."

He noted that the substance is not illegal at the federal level and that recent research has shown that kratom is “not dangerously addictive and that it’s helping people, particularly those that are dealing with opioid addictions.”

Dr. Subhadeep Barman, a psychiatrist and board member, said the evidence that kratom is a viable product for the opioid use disorder is “just not there.”

“It’s a dangerous product,” he said. “In clinical practice, we come across kratom routinely as a problematic substance.”

Legislation that would have legalized kratom passed the Assembly Committee on State Affairs this spring 9-2. It didn't move beyond that and faced opposition from groups representing doctors and law enforcement.

Funding Awarded to Cover Room and Board Costs for Residential Opioid Use Disorder Treatment for Medicaid Members

Thu, 21 Apr 2022 16:08:55 GMT

Wisconsin Department of Health Services

Funding Awarded to Cover Room and Board Costs for Residential Opioid Use Disorder Treatment for Medicaid Members

$2.5 million in grants removes barrier to this level of care

An estimated 1,100 Wisconsin Medicaid members with an opioid use disorder will have access to residential treatment this year, thanks to $2.5 million in grants from the Department of Health Services (DHS) awarded to agencies serving 54 counties and four tribes. The funding from opioid settlement dollars will be used to cover room and board costs for this benefit. Federal law prohibits Medicaid from reimbursing residential substance use disorder treatment providers for a client’s room and board expenses. Lack of funds to cover room and board costs is the primary reason Medicaid members do not enroll in this level of treatment.

Funding for room and board expenses was included in Governor Evers’ 2021-23 biennial budget but was not approved by the legislature. These grants awarded today are funded by Wisconsin’s share of a multistate settlement with McKinsey & Company, a global consulting firm that for years fueled the opioid epidemic nationwide through its work with the manufacturers of opioid drugs. DHS is receiving $10.4 million over five years from this settlement. The funds must be invested in strategies to address Wisconsin’s opioid epidemic.

View full news release.

‘This is the right thing to do:’ Dane County Jail announces program to fight addiction-related crime

Fri, 15 Apr 2022 13:43:15 GMT

MADISON, Wis. — The Dane County Jail announced a new program Tuesday meant to help its residents fight opioid addiction.

The Medication Assistance Treatment program will allow the jail’s nurses to administer the prescription drug Subutex to those who were already being treated with the medication before they entered the jail.

“A large number of people entering our jail system are suffering from various forms of addiction,” Dane County Sheriff Kalvin Barrett said in a statement. “The ability to offer this medication program and help maintain someone’s sobriety is a huge step in reducing recidivism and improving public safety.”

Barrett said the program could expand beyond continuing care in the future. In the past, the jail has not been able to continue Subutex treatments inside the jail, leading to an interruption in recovery — and the possibility that those suffering from addiction commit more crimes in the future to support it.

“While addiction itself is not an actual crime, the criminal activity involved with supporting that addiction is where the crimes typically occur,” Barrett said during a press conference Tuesday.

If the county can help treat the addiction, it could lead to a reduction in crime by reducing the chances those people get arrested again.

“Our ultimate goal is to reduce recidivism,” Barrett said. “When we reduce recidivism, we reduce the jail population. By reducing the jail population, we decrease the crime rates. By reducing the crime rates, we increase public safety and we reduce criminal justice budgets.”

Dr. Elizabeth Salisbury-Afshar from UW-Madison says the drug has shown to be able to reduce illegal drug use and risk of death by as much as 50 percent.

“When someone with opioid addiction who is on medication is incarcerated, while they’re there, that medication is stopped,” Dr. Salisbury-Afshar said, referring to jails that do not use a Medication-Assisted Treatment program. “We know from research that this puts people at risk for multiple things: it reduces the chance that they re-enter treatment when they leave. It also increases their risk for resuming use and it increases risk for overdose death.”

Those who stop treatment while behind bars are 800 percent more likely to die from an overdose after they are released due to their tolerance being reduced, Dr. Salisbury-Afshar said.

“This is a really important first step and I commend Sheriff Barrett and the Dane County Jail for committing to continued efforts to continue to expand access to care beyond continuation of care, but eventually to be able to screen everyone coming in and even be able to initiate care and link people to treatment in the community,” Dr. Salisbury-Afshar said. “This is the right thing to do.”

Read article.

Opioid Settlement Funds

Thu, 07 Apr 2022 18:09:23 GMT

Wisconsin Department of Health Services

You spoke, we listened

In January 2022, we listened to Wisconsinites explain the profound impact of the opioid epidemic and potential strategies to save lives. Our goal was to gather input from a broad group of stakeholders to inform our use of future opioid settlement funds.

598 people attended one of our 12 listening sessions.

897 comments submitted through our input survey.

We heard from substance use services providers, family and friends of people with a substance use disorder, and people living with a substance use disorder.

Summary: Invest across the continuum from prevention to recovery

We heard that supporting policy and systems change is essential to success. The remainder of the feedback falls into one of the areas listed below.

Address root causes. Address the social determinants of health. Improve access to mental health services. Bolster family stability. Reduce people's exposure to trauma and the impact of trauma.
Prevent proactively. Provide evidence-based substance use prevention education, especially in K-12 schools, as well as in communities. Consider including voices of those with lived experience to reduce stigma in communities.
Enhance harm reduction. Maintain and expand harm reduction strategies, including needle exchange, safe use sites, increased access and use of naloxone/NARCAN®, and fentanyl test strips.
Expand treatment options. Increase the accessibility and availability of all forms of treatment that follow best practices. Ensure equity in the location and delivery of treatment options.
Support recovery. Support individuals in recovery with targeted wraparound services. Provide direct support to families with a loved one with substance use disorder.

The Drug Enforcement Agency (DEA) Announces Actions Expanding Access to Addiction Medicine

Mon, 28 Mar 2022 17:58:37 GMT

On March 23, 2022, the DEA announced a new option for DEA-registered practitioners working in hospitals, clinics, or emergency rooms, and for DEA-registered hospitals/clinics that allow practitioners to operate under their registration number. Per this new option, the DEA will grant requests for an exception to the one-day supply limitation in 21 CFR 1306.07(b) to allow for the dispensing of up to a three-day supply of narcotic drugs, including buprenorphine and methadone, “to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment.” Consistent with Pub. L. 116-215, the DEA will grant such exception requests while it works to amend 21 CFR 1306.07(b) as directed by said law.

As part of this effort to save lives in the opioid overdose crisis, the DEA also announced that it is working to make permanent its COVID-19 public health emergency temporary regulations allowing for the initiation of buprenorphine for opioid use disorder by telemedicine.

Finally, the DEA said it is, in partnership with HHS, “engaging in regular outreach with pharmacists and practitioners to express support for the use of medication-assisted treatment for those suffering from substance use disorder.”

Registration Open for 2022 DHS Opioids, Stimulants, and Trauma Summit

Mon, 28 Mar 2022 13:25:26 GMT

Wisconsin DHS | Division of Care and Treatment Services

This year's Opioids, Stimulants, and Trauma Summit is scheduled for May 10-12, 2022. You are invited to join us for this event in person or virtually.

View the agenda for each day and information on how to register to attend.

Continuing education units are available for people who attend the live event either in person or virtually.

Mobile Narcotic Treatment Program/Opioid Treatment Program Grant Opportunity

Fri, 25 Mar 2022 17:20:29 GMT

Wisconsin DHS | Division of Care and Treatment Services

We are accepting applications to award a contract for a mobile narcotic treatment program/opioid treatment program to provide opioid use disorder treatment services to underserved and high-need populations. Eligible applicants include for-profit agencies and nonprofit agencies currently certified under Wis. Admin. Code § DHS 75.13 and Wis. Admin. Code § DHS 75.15. Applications are due by 2 p.m. April 20, 2022. View more information on this grant funding opportunity.

DHS Releases Findings from Statewide Listening Sessions about Opioid Settlement Funds

Tue, 22 Mar 2022 20:35:05 GMT

DHS Releases Findings from Statewide Listening Sessions about Opioid Settlement Funds

Feedback from public and providers from listening sessions will inform agency's strategy to address state's opioid epidemic

Following a review of public feedback from listening sessions and an online survey in January on the best uses of funding received through national settlements with opioid distributors and manufacturers, the Department of Health Services (DHS) will begin finalizing its plan to invest the funds to save lives and address Wisconsin’s opioid epidemic. DHS held 12 regional listening sessions in early 2022. Nearly 600 people living with an opioid use disorder, their families and friends, and providers of opioid prevention, treatment, and recovery support services participated in these virtual events and nearly 900 comments were submitted through the online survey.

“We listened as hundreds of Wisconsinites explained the profound impact of the opioid epidemic on their families and communities, and we appreciate everyone who took time to share their feedback with us,” said DHS Secretary-designee Karen Timberlake. “The flexibilities offered by these settlement funds will give us an opportunity to be ever more innovative in our response to the opioid epidemic so we can help people who are currently struggling with an opioid use disorder, as well as work to prevent more individual and community heartbreak over the loss of lives to opioid overdoses.”

Read full press release here.

Gov. Evers Signs Three Bills in La Crosse to Help Address Substance Use and Overdose Deaths in Wisconsin

Wed, 16 Mar 2022 18:59:15 GMT

LA CROSSE — Gov. Tony Evers today signed three bills in La Crosse to help address substance use and overdose deaths in Wisconsin.

“Substance misuse has ravaged families and communities across our state, which has affected not only many Wisconsinites’ own health and safety but the well-being of their families and loved ones, too. Unfortunately, the pandemic has only further underscored challenges for folks working to overcome mental health crises and substance use disorders,” said Gov. Evers. “Tragically, fentanyl has played a serious role in overdose deaths across the country, and these bills are an important step toward reducing substance misuse and overdose deaths here in our state. We have to keep working to invest in getting folks and families the treatment and support they need to overcome these challenges.”

Preliminary data of 2020 from the Centers for Disease Control and Prevention (CDC) shows the highest number of overdose deaths ever recorded in a single year in U.S. history; more than 93,000 people died, representing a 30 percent increase from the previous 12-month period. CDC data also shows that 75 percent of these overdose deaths were opioid-related, and that synthetic opioids, such as fentanyl, are the main driver of drug overdose deaths. In Wisconsin, the CDC estimates that in 2020 alone, there were more than 1,200 opioid-related overdose deaths, underscoring the importance of the governor’s action today.

Senate Bill 352, now 2021 Wisconsin Act 179:

Creates a graduated penalty structure for manufacturing, distributing, or delivering fentanyl (or fentanyl analogs) or possessing it with intent to manufacture, distribute, or deliver it.

Senate Bill 600, now 2021 Wisconsin Act 180:

Specifies that materials used to test for the presence of fentanyl or a fentanyl analog in a substance are not drug paraphernalia.

Senate Bill 49, now 2021 Wisconsin Act 181:

Requires the Department of Administration, in collaboration with the Department of Health Services (DHS) and Department of Safety and Professional Services (DSPS), to issue a request for proposal, subject to approval by the Joint Committee on Finance under a 14-day passive review, to establish and maintain a data system to collect, format, analyze, and disseminate information on opioid and methamphetamines use.

These bills will build on the work the Evers Administration is doing to combat the opioid epidemic, such as the state’s new pilot “Hub and Spoke” model of care, as well as investing approximately $47 million of American Rescue Plan Act funding to increase community-level supports for people who have been grappling with mental health and substance use challenges. Last year, Gov. Evers also signed Assembly Bill 374, now 2021 Wisconsin Act 57, into law, paving the way for much-needed funds to flow to communities throughout Wisconsin to address the opioid epidemic through a settlement with opioid manufacturers and distributors. The final settlement agreement, approved by the Joint Finance Committee in November 2021, will provide more than $294 million over 18 years to the 87 local governments involved in the litigation and $126 million, as well as $9.6 million in additional restitution, to the DHS for programs aimed at fighting the opioid epidemic and saving lives.

Additionally, last year, Wisconsin joined the Bloomberg Opioids Overdose Prevention Initiative which provided $10 million to combat the opioid epidemic in Wisconsin over the next five years.

People looking for substance use treatment and recovery services are encouraged to use the Wisconsin Addiction Recovery Helpline, which is free and available 24/7.

An online version of this release is available here.

Wisconsin’s Unborn Child Protection Act

Mon, 14 Mar 2022 15:39:04 GMT

NASW | The Wisconsin Social Worker Journal | Winter 2021 | Pg. 15 | Ritu Bhatnagar, M.D., M.P.H.

What is Wisconsin’s Unborn Child Protection Act? Passed in 1997, Wisconsin’s “Unborn Child Protection Act” — also known as Act 292 and previously known as the “Cocaine Mom Law” — permits the jailing, forced medical treatment, or house arrest of a pregnant person on a suspicion that they have consumed or may consume alcohol or a controlled substance during their pregnancy. While the law is enforced differently across the state, according to statistics published by Wisconsin’s Department of Children & Families, each year for the past 5 years, between 400 and 500 Wisconsin women are subject state intervention under Act 292. The law was not supported by any medical organizations and has been challenged in court. In 2018, a judge found it to be unconstitutional because the language was so unclear, but the law still stands. Read more about the law and its history here.

What role do social workers play in the enforcement of Act 292? Social workers play a unique role in the enforcement of Act 292. Often, it is the hospital-based social worker making the report to the county or local law enforcement. Social workers may report a pregnant person out of fear of losing their license, presumed obligation, or misplaced assumptions about drug use. It is important to know that the way the law is written does NOT mandate reporting while the person is pregnant. Reporting is considered “permissive” in this situation, and it is important to ensure that your decision takes into account the situation of the woman and the potential for far reaching legal consequences of reporting (see story at right).

If you have further questions about this law, please contact Afsha Malik at afm@advocatesforpregnantwomen.org.

In 2014, Tammy Loertscher had a medical problem that caused depression if left untreated. After losing her job and consequently her health insurance, Tammy started to use methamphetamine regularly to manage her depression. Tammy made sure her drug use did not negatively affect other aspects of her life. As soon as Tammy realized she was pregnant, she stopped using methamphetamine. However, pursuant to Act 292, Tammy was ordered into drug treatment that she did not need and was incarcerated in Taylor County’s jail for 20 days for refusing that treatment, where she was held in solitary confinement, refused access to a lawyer, and denied access to her previously-scheduled prenatal care. To learn more about Tammy’s story visit us here.

Put safety above cannabis profits -- Ritu Bhatnagar

Mon, 14 Mar 2022 15:35:15 GMT

Madison.com | Ritu Bhatnagar | Op Ed

Some are interested in using legislation to modify cannabis laws to address certain health conditions and inequalities in drug law enforcement. They also want to increase tax revenue.

As an addiction psychiatrist, I’ve seen previously healthy young people with cannabis-induced psychosis that continued even after the cannabis use didn't. This led to significant life-long negative impacts. With more potent cannabis forms available, my colleagues are also reporting that they are also treating challenging outcomes related to cannabis use.

What we know about the impacts of cannabis on the developing adolescent brain is the drug can negatively affect attention and focus, anxiety and impulse control. Unfortunately, studies show a change in perception of safety of cannabis products: People think because the products are “natural,” they are “safe.”

Recent reports of severe lung infections have been linked to cannabis products.

My concern, after reading a recent bill allowing medical marijuana, is that it seems to be quite far reaching, and was written without much input from the medical community.

Lawmakers should meet with addiction health professionals with expertise in this area to craft legislation that prioritizes public safety over profits.

Dr. Ritu Bhatnagar, Madison, Wisconsin Society of Addiction Medicine

Read here.

The internet's meth underground, hidden in plain sight

Fri, 11 Mar 2022 16:33:40 GMT

NBC News | Ben Goggin

If you or someone you know is struggling with an alcohol, drug or other substance abuse problem, call any of these numbers for help: The Substance Abuse and Mental Health Services Administration's national helpline is 1-800-662-HELP (1-800-662-4357); the National Drug Helpline is 1-844-289-0879; and the American Addiction Centers' hotline is (866) 464-3073.

In December, Paul went home for the holidays. Like many people, he hadn’t seen his family for almost a year.

But instead of spending time with his loved ones, he said he stayed in his room and injected methamphetamine. While his family was downstairs, Paul said he pretended to be sick while he relapsed in a multiday meth binge.

Though he was alone in his room, he was using drugs with other people. As he was injecting methamphetamine, he connected with hundreds of other individuals doing the same thing over Zoom.

“There is no meth without Zoom, and there is no Zoom without meth,” Paul, whom NBC News is identifying only by his first name to protect him from professional harm, said in an interview. “That is where I found a forum, like a tribe, where I could be my authentic self with no fear of judgment.”

Paul, who said he’s been addicted to meth for about eight years, is part of a sprawling online community of meth users, hidden in plain sight on nearly every major social media platform and digital communication tool, from Facebook to Zoom to Reddit to Twitter.

As nearly all social media platforms and tech companies have trended toward increased platform moderation amid heightened scrutiny from watchdogs, meth users have attracted little attention as they build online communities of tens of thousands of people. With a mixed bag of policies pertaining to drug content that varies by platform, users have found numerous venues where they can post photos and videos of themselves using methamphetamine, sell drugs and encourage other people to use meth.

Wisconsin Doctor Day Review

Tue, 08 Feb 2022 20:04:25 GMT

WISAM was a 2022 sponsor for Wisconsin Doctor Day, which was held virtually on Tuesday, February 8. Click on the documents below to view.

Stop criminalizing opioid addiction

Wed, 02 Feb 2022 20:46:41 GMT

Featured in the Wisconsin State Journal | Stop criminalizing opioid addiction | Ritu Bhatnagar | Published January 21, 2022

Over 1,000 Wisconsinites died of opioid overdose in 2020. One of the most effective interventions to reduce these deaths is treatment with medication for opioid use disorder. Sadly, too few people with opioid use disorder have been able to access treatment.

Rather, these often-young people end up in the legal system because of punitive laws that direct people to jail rather than treatment. Their lives are negatively impacted for years to come because they now have a felony on their record and are unable to pass background checks or get a job.

As an addiction medicine professional, I frequently hear of patients who experience an overdose, and because of their overdose end up with criminal possession charges. This approach means that many people are now afraid to call 911 for help when someone is experiencing an overdose -- out of fear of legal involvement.

Currently, Wisconsin law (911 Good Samaritan Act) does not do enough to protect individuals who experience an overdose. At a time when opioid overdoses are at an all-time high, it is critical that the Wisconsin Legislature update and strengthen the existing Good Samaritan Law.

Preventing Opioid Harm in Wisconsin Starts with Real Talks

Wed, 02 Feb 2022 20:13:02 GMT

Wisconsin Department of Health Services

Preventing Opioid Harm in Wisconsin Starts with Real Talks
Updated Dose of Reality initiative now online

Governor Evers today joins the Wisconsin Department of Health Services (DHS) and the Wisconsin Department of Justice (DOJ) in announcing the launch of the updated Dose of Reality initiative today. The goal of this information and education campaign is to change the conversation around Wisconsin’s opioid epidemic. The Dose of Reality initiative provides the tools for all Wisconsinites to prevent or reduce the risks of opioid use through open and honest talks about the dangers of opioids and ways to save lives.

“We know that many Wisconsinites struggle with opioid use, and that’s a problem that tragically has only gotten worse over the last few years,” said Gov Evers. “Opioids have ravaged families and communities across our state, and this initiative is just one of the ways that my administration is working to tackle this issue head-on to help folks get on the road to recovery.”

The updated Dose of Reality initiative is a series of webpages found at doseofrealitywi.gov that:

Provide information on the risks of opioids.
Provide information about safe storage and disposal of medications to keep them out of the hands of people who may misuse them.
Offer strategies to support people at risk of or experiencing an opioid use disorder.
Provide information on naloxone, its availability, and how to use it to reverse an opioid overdose.
Help people find treatment and recovery services for an opioid use disorder.

Read full press release here.

Federal Report Finds Many Health Insurers Failing When It Comes To Mental Health Parity

Wed, 26 Jan 2022 16:35:26 GMT

APA Headlines

Bloomberg Law (1/25, Hansard, Subscription Publication) reports, “Health plans and insurers are failing to deliver parity in mental health coverage as required by law,” according to the 2022 Report to Congress on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (PDF) issued on Jan. 25 by the Departments of Labor, Health and Human Services, and the Treasury.

According to Fierce Healthcare (1/25, Minemyer), the report also “highlights one of the feds’ largest enforcement activities to date on mental health parity: a $15.6 million settlement with UnitedHealthcare.” That insurer “would routinely lower reimbursement rates for out-of-network behavioral health services and would flag members with behavioral health needs for utilization reviews.” Included in the August 2021 settlement were “$13.6 million in wrongfully denied claims and $2 million in lawyer fees and penalties.”

#HopeActLiveWI: Responding to Wisconsin's Opioid Epidemic

Wed, 26 Jan 2022 16:28:22 GMT

Department of Health Services | January 2022 Newsletter

A Message from Paul Krupski, DHS Director of Opioid Initiatives

Our work to address Wisconsin's opioid epidemic is more important than ever. Provisional data for 2021 show that the number of opioid-related deaths last year is on pace to meet or exceed the record number we experienced in 2020.

Our work to save lives this year will be bolstered by new funding that will allow us to create new programs and services to address gaps in our continuum of care.

One new funding source will be settlements with opioid manufacturers and distributors. We anticipate several settlements to be finalized in the coming months. Unlike many of our current funding sources, these settlements are not focused on specific parts of the continuum of care. We look forward to maximizing the flexibilities afforded by these funds to support programs and services we have not been able to support in the past due to funding restrictions.

Another new funding source is a partnership with Bloomberg Philanthropies. Wisconsin was one of five states selected to be part of this program. We will receive $10 million over the next five years. The Bloomberg Philanthropies partnership includes the Centers for Disease Control and Prevention Foundation, Johns Hopkins University, The Pew Charitable Trusts, and Vital Strategies. We will be working with these organizations to enhance our existing programs and services and implement new strategies. This work also includes advocating for federal policies to expand treatment access and harm reduction services. We are in the planning stage for this funding. We'll share more on our specific plan for this funding later this year.

We know that the COVID-19 pandemic has made our collective work to address the opioid epidemic more challenging. Thanks in large part to your work and support, we were making progress in reducing opioid harm prior to the COVID-19 pandemic. We were building healthy communities by advancing prevention strategies, increasing the availability of and access to the opioid overdose reversal drug naloxone and other harm reduction services, and improving access to and retention in treatment and recovery services. Staying the course and working with all of you, our statewide partners, we can again begin to see a reduction in opioid-related deaths.

Visit the DHS website for more information on opioids.

Call for Presentations: Now Open!

Thu, 13 Jan 2022 16:47:28 GMT

The WISAM 2022 Annual Conference is scheduled to be held on October 13-14, 2022 at the Pyle Center in Madison, WI. WISAM is looking for experts in their fields to submit proposals for posters or presentations based on the conference theme "Resilience" to educate and inspire our attendees.

Presentations will be accepted until May 1. We estimate that all applicants will be notified of the status of their applications by June 1.

Addiction medicine professionals, physicians, social workers, nurses, counselors, and more from Wisconsin will gather virtually to learn innovative strategies, cutting-edge ideas, new concepts and best-practice approaches to their work. If you can offer this type of expertise, we want you to share your poster presentation. Share your experience and insights with your peers, while increasing your visibility and enhancing your professional growth.

For more information and to submit your proposals, please visit our website.

Department of Health Services Hosting Virtual Listening Sessions on Future Opioid Settlement Funds

Fri, 07 Jan 2022 21:46:30 GMT

DHS | Opioid Prevention

The Wisconsin Department of Health Services is hosting a series of virtual listening sessions with stakeholders in January to hear ideas about how the State of Wisconsin could use future opioid settlement funds.

Currently, four opioid settlements are in process, each with varying and undetermined timelines. While we don’t yet know how much money the State of Wisconsin will receive from these opioid settlements, these listening sessions offer an opportunity for stakeholders to think big about what could be possible with settlement dollars.

Come with your ideas about what you would like to see happen with settlement dollars. The comments gathered in these sessions will help inform planning once the settlements are finalized.

We want to hear from all stakeholders, including opioid treatment providers and those with lived experience or who support individuals with opioid use disorders.

Share your ideas and comments at the listening sessions listed below or by filling out this survey by January 31, 2022.

Please join us by registering below for one of the 12 public listening sessions in January. (Please note that each session date has a unique link.) Participants can join the Zoom meeting online or call in using a toll-free phone number. After registering, you will receive a confirmation email containing information about joining the meeting.

If you need a translator or other accommodations, contact dhsopioidinitiatives@dhs.wisconsin.gov at least five business days prior to the session. Interpretation for the listening sessions is available by request in Spanish, Hmong, and American Sign Language.

Register in advance for all sessions by following the link.

Partners and stakeholders sessions are scheduled for:

Western region: Wednesday, January 12, 10:00 a.m. - 11:00 a.m.

Northern region: Friday, January 14, 10:00 a.m. - 11:30 a.m.

Northeastern region: Friday, January 21, 10:00 a.m. - 11:30 a.m.

Southeastern region: Wednesday, January 26, 10:00 a.m. - 11:30 a.m.

Southern region: Friday, January 28, 10:00 a.m. - 11:30 a.m.

Public and consumers sessions are scheduled for:

Western region: Wednesday, January 12, 1:00 p.m. - 2:30 p.m.

Northern region: Friday, January 14, 1:00 p.m. - 2:30 p.m.

Northeastern region: Friday, January 21, 1:00 p.m. - 2:30 p.m.

Southeastern region: Wednesday, January 26, 1:00 p.m. - 2:30 p.m.

Southern region: Friday, January 28, 1:00 p.m. - 2:30 p.m.

Evening sessions scheduled for anyone:

DSPS plans to improve prescription drug monitoring program’s interoperability

Mon, 20 Dec 2021 16:18:09 GMT

Wisconsin Health News

The Department of Safety and Professional Services will use a recent federal grant to facilitate connections between the state’s program for tracking controlled substances and electronic health records, per a Friday statement.

The agency is receiving more than $1.6 million from the Department of Justice for changes to the Enhanced Prescription Drug Monitoring Program.

The money will go toward expanding adoption of direct workflow integrations and making data more accessible to existing electronic health record systems, with a goal of benefiting providers in rural and underserved parts of Wisconsin.

Department of Safety and Professional Services Secretary Dawn Crim said the program has “been an invaluable tool in the state’s multi-faceted effort to address the opioid epidemic.”

“It has already transformed prescribing culture, and it continues to generate important data about prescribing trends in Wisconsin,” Crim said in a statement. “This additional funding will make it more functional for and more accessible to more providers throughout the state.”

The department is already pursuing a multi-year project to overhaul the program’s data capabilities, with a goal of finishing that work in 2023.

La Crosse Lighthouse Peer-Run Respite Opens

Mon, 13 Dec 2021 17:32:13 GMT

Wisconsin Department of Health Services

For Immediate Release | December 13, 2021
Contact: Elizabeth Goodsitt/Jennifer Miller 608-266-1683

La Crosse Lighthouse Peer-Run Respite Opens
A space for healing mental health and substance use concerns

Wisconsin’s sixth peer-run respite funded by the Department of Health Services (DHS)—the La Crosse Lighthouse—is now open. It offers a place where people with mental health and substance use challenges can stay in times of increased stress or symptoms and receive support from people who have themselves been mental health and substance use service users.

“Making sure folks have the mental health and treatment services they need is an essential part of addressing substance use in our state,” said Governor Tony Evers. “Growing the state’s network of peer-run respites is a critically important part of that effort as peer-to-peer connection can help folks address trauma, receive the support they need, and ensure they get on the road to recovery.”

Established in Wisconsin in 2015, peer-run respites prevent people from experiencing traumatic mental health and substance use crisis situations and costly hospitalizations. During a free stay, guests benefit from one-on-one and group peer support and activities focused on the eight dimensions of wellness guidance from the federal Substance Abuse and Mental Health Services Administration: emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental. There are no required activities for guests. They are free to come and go during their stay for doctor and therapy appointments, school, work, family, and other responsibilities. In many cases, guests also get connected to community resources designed to support their wellness after their stay.

View the entire news release.

Society, WISAM team up to warn Capitol about kratom legislation

Thu, 09 Dec 2021 16:34:35 GMT

WMS | Medigram

The Wisconsin Medical Society (Society) and the Wisconsin Society of Addiction Medicine (WISAM) joined forces on December 8 to warn state policymakers about the potential harmful effects of kratom – a tree native to southeast Asia whose leaves can contain compounds causing psychotropic effects. The two organizations provided testimony to the State Assembly Committee on State Affairs, asking legislators not to support Assembly Bill 599 – legislation that would legalize two of the substances found in kratom products and create a regulatory scheme that would allow for kratom sales.

The testimony included a literature review published in the April 2021 edition of the Wisconsin Medical Journal (WMJ) about ongoing experiences with patients suffering from Kratom Use Disorder (KUD), and a case report from a 2016 WMJ on kratom addiction and withdrawal. The testimony also highlighted various U.S. Food and Drug Administration warnings about the drug and how U.S. Marshals have seized numerous shipments of dietary supplements containing kratom over the past several years due to false claims about the product’s safety and efficacy.

The bill is now eligible for a committee vote. The Society and WISAM will continue to monitor AB 599 and offer to meet with any policymaker who has additional questions. Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information; he will also discuss the bill as one of the topics during the WisMed Friday Report tomorrow, December 10, at 12:15 p.m. Register here for this members-only event.

Drug overdose deaths increase

Tue, 23 Nov 2021 15:46:01 GMT

Wisconsin Health News

Deaths from drug overdoses in Wisconsin increased by 21.8 percent over the past year, according to provisional data released last week by the Centers for Disease Control and Prevention.

There were 1,599 predicted overdose deaths in Wisconsin during the 12-month period ending April 2021, compared to 1,313 the prior year.

The CDC noted the numbers are "underreported due to incomplete data."

Nationally, drug overdoses increased by over 28 percent over the past year. More than 100,000 people reportedly died over the 12-month period, the highest it has ever been.

Synthetic opioids caused roughly 64 percent of all drug overdose deaths during that time.

Assembly Committee unanimously approves WisMed-supported fentanyl strips bill

Thu, 11 Nov 2021 22:31:28 GMT

Medigram | Wisconsin Medical Society

As Wisconsin faces a resurgence in opioid overdose deaths, the State Assembly Committee on Criminal Justice and Public Safety unanimously approved WisMed-supported legislation that can help save Wisconsin lives. The unanimous 11-0 vote for Assembly Bill 619, which removes fentanyl test strips from the definition of “drug paraphernalia” in the criminal code, occurred November 10 in the State Capitol.

WisMed member and Wisconsin Society of Addiction Medicine (WISAM) President Ritu Bhatnagar, MD, testified in favor of the bill during the committee’s October 20 public hearing, emphasizing how these testing strips can prevent someone from unwittingly taking a drug laced with fentanyl. The bipartisan bill is authored by State Assembly Reps. Jesse James (R-Altoona) and Sylvia Ortiz-Velez (D-Milwaukee) and State Sens. Van Wanggaard (R-Racine) and Lena Taylor (D-Milwaukee).

As a recent story in the Wisconsin Examiner about the legislation cites, Wisconsin Department of Health Services data show that more than 6,200 people in Wisconsin died of a drug overdose from 2014-2019, with nearly 4,800 of those deaths involving opioids. Another 1,900 of those deaths were heroin-related. The article also points out that last year in Milwaukee County alone 544 people died a drug-related death – an unfortunate annual record for the county – and more than 400 of those deaths involved fentanyl.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Wisconsin to get $10 million over five years to fight opioid epidemic

Thu, 11 Nov 2021 16:06:47 GMT

Wisconsin Health News

Wisconsin will receive $10 million over the next five years to fight the opioid epidemic, thanks to an initiative that’s expanding into the state.

The Bloomberg Opioids Overdose Prevention Initiative launched in Michigan and Pennsylvania in 2018. It’s now moving into Wisconsin, Kentucky, New Jersey, New Mexico and North Carolina.

“The coronavirus pandemic has only underscored the crisis we are facing in our state and country with the opioid epidemic, as opioid-related deaths last year exceeded 1,000 in a single year in Wisconsin for the first time,” Gov Tony Evers said in a statement. “It’s more critical than ever that we get folks support."

The initiative aims to scale existing efforts, implement new programs and advocate for federal policies to expand treatment access and harm reduction policies. It’ll support technical assistance, direct services and staff at government agencies.

The program's expansion is funded by a $120 million investment from Bloomberg Philanthropies.

The Centers for Disease Control and Prevention Foundation, Global Health Advocacy Incubator, Johns Hopkins University, the Pew Charitable Trusts and Vital Strategies are partners.

Bill targets ‘regulatory barrier’ for social workers to provide substance use disorder treatment

Thu, 04 Nov 2021 15:06:47 GMT

Wisconsin Health News

The Senate Committee on Insurance, Licensing and Forestry unanimously approved legislation Tuesday that lawmakers billed as a technical correction so that more social workers can provide substance use disorder treatment without needing additional credentials.

Licensed clinical social workers are able to provide substance use treatment services within their scope of practice.

A 2018 law eliminated a requirement that other master’s level licensed mental health professionals, like marriage and family therapists and professional counselors, obtain an additional credential to provide the services.

However, lawmakers “unintentionally omitted” certified advanced practice social workers and certified independent social workers, since their credential is titled “certified” instead of “licensed,” Sen. Dale Kooyenga, R-Brookfield, said in testimony to the committee last week.

“This bill corrects this error and enables these master's level social workers to provide substance use treatment within their scope of practice, thus removing an unnecessary regulatory barrier that impacts access to treatment,” he said in written testimony.

The National Association of Social Workers Wisconsin Chapter and the Wisconsin Association of Family & Children's Agencies support the bill.

Two people registered against the plan. Michael Kemp, a certified substance abuse counselor, said he was “deeply disturbed by this effort to extend the scope of practice to professionals who have mostly received minimal education on the treatment of this unique brain disorder.”

Legislation would legalize fentanyl testing strips

Tue, 26 Oct 2021 15:07:27 GMT

Wisconsin Health News

Lawmakers are considering legalizing fentanyl testing strips, which can determine whether a substance contains the highly powerful synthetic opioid.

Current law considers fentanyl testing strips drug paraphernalia, making it a felony for any person to use or possess with intent to use.

Bill author Rep. Jesse James, R-Altoona, said last week the strips are “valuable, life-saving and very inexpensive.”

“We have a chance in Wisconsin to take a step forward in ending the increase of overdose deaths happening statewide,” James told the Assembly Committee on Criminal Justice and Public Safety. “Saving lives should never be a partisan issue or up for debate.”

“Let’s prevent the next fentanyl death,” said Rep. Sylvia Ortiz-Velez, D-Milwaukee. “Let’s pass this bill.”

Kristen Grimes, director of prevention services at Vivent Health, said they distributed more than 54,000 fentanyl test strips last year. They received around 3,700 reports back about their use from clients.

The reports show that once clients identified a drug with fentanyl, they used safer behaviors to reduce their risk of overdose, she said. That could include taking less of the drug to see how it feels, using it with friends to keep an eye on each other and telling others about what they’re finding in their drugs.

“I can tell you from personal experience, our clients do not want to die,” Grimes said. “They’re tired of watching their friends die. And they can utilize fentanyl test strips to save their lives.”

Society testifies on fentanyl testing strips bill

Thu, 21 Oct 2021 21:34:26 GMT

Wisconsin Medical Society | Medigram

The Wisconsin Medical Society joined with the Wisconsin Society of Addiction Medicine (WISAM) in supporting state legislation that can protect lives by preventing inadvertent fentanyl overdoses. The legislation, Assembly Bill 619, would decriminalize the possession and use of fentanyl test strips (FTS), which can be easily used to test substances for the presence of the powerful drug. The bipartisan bill is authored by Reps. Jesse James (R-Altoona) Sylvia Ortiz-Velez (D-Milwaukee) and Sen. Van Wanggaard (R-Racine) and Lena Taylor (D-Milwaukee).

“Saving lives should never be a partisan issue or be up for debate,” Rep. James said in his testimony as the main author of the legislation.

Ritu Bhatnagar, MD, testifies in the State Capitol

WISAM President and Society member Ritu Bhatnagar, MD appeared before the Assembly Committee on Criminal Justice and Public Safety and gave excellent written and verbal testimony describing what she sees in her practice as Medical Director for NewStart, Unity Point Health-Meriter Hospital’s addiction treatment service branch.

“I have taken care of people whose lives have been turned upside-down by having a legal charge related to the possession of these fentanyl test strips,” Dr. Bhatnagar testified. “They have had a very difficult time, then, once they’re in treatment with me, trying to get their lives back together, look for work, try to find anything else with this on their record.

“Everything you’ve heard today about needing to have these (FTS) decriminalized so that people don’t enter the criminal legal system is absolutely essential because of the differential enforcement that’s happening around the state,” Dr. Bhatnagar said.

The bill is now eligible for a committee vote. Similar legislation has been introduced in the Wisconsin State Senate as Senate Bill 600. Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

It's Almost National Addiction Treatment Week!

Mon, 04 Oct 2021 15:49:05 GMT

Save the Date for National Addiction Treatment Week!

Join National Addiction Treatment Week from October 18-24, 2021 and inspire the next generation of medical professionals to treat addiction and save lives! Each year, National Addiction Treatment Week raises awareness about the gap between the number of patients who need addiction treatment and qualified medical professionals available to treat patients using evidence-based approaches. The week highlights the critical need for more clinicians to enter the field of addiction medicine. Check out this year’s engaging schedule of events and ways to be involved! Mark your calendar today, join our partners and collaborators and spread the word to “treat addiction and save lives!”

Follow @TreatmentWeek on Twitter-Share the week’s messages using the week’s toolkit
Use hashtag #TreatmentWeek to share your perspectives on why it is important to treat addiction
Inspire medical students and residents to consider getting certified in addiction care and treatment

By putting our combined resources to work, we all contribute to the health and wellbeing of patients!

UW School of Medicine and Public Health Release New Videos on Tobacco Use

Mon, 27 Sep 2021 14:32:58 GMT

UW School of Medicine and Public Health have 6 free new videos on why and how to address tobacco use among patients with severe and persistent mental illness:

2 videos with administrators on why & how they support this.
2 videos featuring therapists on why & how they treat tobacco use.
2 videos with clients and peer specialists on why & how they succeeded.

Click to view: https://ctri.wisc.edu/smoking/

Lawmakers bring back tobacco 21 legislation

Mon, 13 Sep 2021 17:01:01 GMT

Wisconsin Health News

Lawmakers have brought back legislation that would align state law with federal law by raising the tobacco purchase age to 21, but health groups would like to see the bill amended to have a wider definition of vapor products.

The bill would align state law with the federal tobacco purchase age, enacted in 2019.

The legislation would allow state law enforcement to carry out the requirement since Wisconsin law otherwise doesn’t allow them to enforce non-criminal violations of federal law, bill author Sen. Howard Marklein, R-Spring Green, said at a Thursday public hearing.

If the state doesn’t comply with the federal law, it could also lose its federal substance abuse and treatment block grant funds, which amounts to $2.7 million annually, Marklein added.

He noted the bill has the support of business groups, convenience stores and the tobacco industry.

“We support this bill because raising the minimum age to 21 is one of the most effective ways to reduce underage use of tobacco products, a goal that we strongly support,” David Fernandez, vice president of public policy for Altria, told members of the Senate Committee on Judiciary and Public Safety.

Health groups would like to see an expansion of the bill’s definition for vapor products.

Nicole Hudzinski, government relations director for the American Heart Association, said current state tax law defines e-cigarettes as devices and not liquids unless they’re sold together as one packaged item.

While the bill would apply to liquids with nicotine, it wouldn't for other liquids that also contain harmful ingredients, Hudzinski said. Accessories aren’t covered under the definition either.

And she added that some products are advertising themselves as gels and would not be included if the bill only specified liquids.

“We are really, really encouraging the committee to consider having a more comprehensive definition as we move forward,” Hudzinski said.

Committee Chair Van Wanggaard, R-Racine, said he is working on the issue.

Sen. Eric Wimberger, R-Green Bay, has a “philosophical problem” with the bill.

“And I certainly don’t like the federal government dictating us,” Wimberger said. “The arguments, I think, are kind of obvious, but I won’t have to reiterate them, all about what it means to be 18 and whatnot.”

Wanggaard said he supports the plan in part because of concerns with the health effects of vaping.

The Assembly approved the legislation in early 2020, but the Senate didn’t take up the bill after it canceled one of its final floor periods due to COVID-19.

#HopeActLiveWI: Responding to Wisconsin's Opioid Epidemic

Fri, 10 Sep 2021 14:58:11 GMT

Wisconsin Department of Health Services

A Message from Paul Krupski, DHS Director of Opioid Initiatives

Living through the COVID-19 pandemic this past year and a half has been difficult for everyone. All of us have been affected in different ways.

It has been a trying time for people struggling with substance use. In 2020, 1,227 Wisconsin residents died from an opioid overdose, driven largely by fentanyl and fentanyl mixed with other drugs.

We are more committed than ever to our vision of zero opioid-related deaths. This may seem like an unattainable goal, but it is not. Prior to the onset of the COVID-19 pandemic, for the first time in over a decade, we experienced a decrease in opioid-related deaths. With your support and partnership, we can prevent the consequences of opioid use.

We are working on several projects funded in part by new federal and state funding, as well as Wisconsin's share of settlements with the manufacturers and distributors of opioids. We'll provide updates on this work in future newsletters. For now, take a moment to review this newsletter to learn more about some of our current efforts to respond to Wisconsin's opioid epidemic.

More Information.

DHS Renews Commitment to Reducing Drug Overdoses in Wisconsin

Tue, 31 Aug 2021 15:57:51 GMT

DHS Renews Commitment to Reducing Drug Overdoses in Wisconsin
August 31 is Overdose Awareness Day in Wisconsin
View the entire news release.

Governor Tony Evers has proclaimed August 31 as Overdose Awareness Day in Wisconsin, and the Department of Health Services (DHS) is urging residents to reflect on the impact overdoses have had on families and friends of people who use drugs in every corner of the state, and to renew our commitment to end overdoses in Wisconsin.

“There isn’t a community in our state that hasn’t been impacted by the opioid epidemic, and Wisconsinites who are struggling with substance use disorders deserve our kindness, compassion, and respect as they work toward recovery,” said Gov. Evers. “I’m glad to be declaring today Overdose Awareness Day in Wisconsin to remind us all of the work we have left to do to increase prevention and provide folks with the resources and support they need.”

UW launches psychoactive substances research center

Tue, 24 Aug 2021 15:15:03 GMT

Wisconsin Health News

The University of Wisconsin-Madison is launching a center to coordinate ongoing research and education in psychedelic compounds, including their use in treating substance abuse and psychiatric disorders.

The Transdisciplinary Center for Research in Psychoactive Substances, housed at the UW-Madison School of Pharmacy, will study the science, history and cultural impact of psychedelic agents, including their therapeutic potential.

“Psychoactive agents are the new frontier for potential new therapies and medications,” Paul Hutson, founding center director and a UW pharmacy professor, said in a statement.

Four clinical trials are currently underway on campus, including studying the effects of MDMA, or ecstasy, in treating post-traumatic stress disorder and psilocybin, also known as “magic mushrooms,” in treating depression and opioid addiction. Hutson anticipates federal approval for both substances within the next five years.

The center also seeks to increase participation in research by underrepresented groups.

And it will partner on the pharmacy school’s master’s of science program in psychoactive pharmaceutical investigation, the first accredited U.S. degree focused on the study and therapeutic development of psychedelic compounds and related drugs.

“We plan to continue being on the forefront of this field with innovation and development of novel therapies through our research and educational programs on psychoactive agents,” Hutson said.

The Usona Institute, a nonprofit medical research organization that supports work on consciousness-expanding medicine, also aims to be a center for psychedelic science and education. It broke ground earlier this month on a new campus in Fitchburg.

Three Sites to Pilot New Hub and Spoke Model to Improve Substance Use Disorder Treatment Services in Wisconsin

Wed, 18 Aug 2021 14:59:51 GMT

Wisconsin Department of Health Services

The Wisconsin Department of Health Services (DHS) is collaborating with three health care providers in different areas of the state to pilot a new approach to treating eligible BadgerCare Plus and Medicaid members who have substance use disorders and at least one other health condition. These providers will use an innovative “hub and spoke” program design to expand beyond traditional substance use disorder treatment services. Wisconsinites served by this new program will include people enrolled in BadgerCare Plus and Medicaid who are struggling with substance use disorders and also have other health conditions that create barriers to their recovery from addiction. The pilot sites will use a “hub and spoke” model to provide integrated services that give eligible members rapid access to comprehensive addiction and mental health treatment, primary care, and other needed supports to assist their recovery.

“It is past time to get folks the help they need in the way they need it, and we are excited to bring this proven strategy to Wisconsin,” said Governor Tony Evers. “By connecting the dots between substance use disorder treatment and other services, this new model will help us move the needle on ensuring access and effective care for our Wisconsin neighbors who are currently struggling.”

Four Wisconsin groups receive $4 million to improve rural access to substance use disorder care

Tue, 17 Aug 2021 16:31:42 GMT

Wisconsin Health News

Four Wisconsin organizations will receive $1 million each in federal funds to strengthen and expand substance use disorder prevention, treatment and recovery in rural areas.

The recently announced allocations come from the U.S. Department of Health and Human Services’ Health Resources and Services Administration.

Recipients include Duluth Clinic in Ashland, MetaStar in Madison, the Sokaogon Chippewa Community and Hospital Sisters Health System St. Joseph Hospital in Chippewa Falls.

Marinette County Group Home Association will also receive $500,000 under a separate grant program to help patients who misuse psychostimulants.

Biden Administration Approves Funding to Combat OUD in Rural Areas

Fri, 06 Aug 2021 18:34:39 GMT

Biden-Harris Administration Provides $90 Million to Improve Health Care in Rural Communities

The Biden-Harris Administration announced today that it is providing nearly $90 million to help rural communities combat opioid use disorders (OUD) and other forms of substance use disorders (SUD), and to improve access to maternal and obstetrics care. This funding is being distributed by the U.S. Department of Health and Human Services (HHS) through the Health Resources and Services Administration (HRSA).

"These investments address a wide range of critical issues the Biden-Harris Administration is focused on to improve health care in rural communities across the country," said HHS Secretary Xavier Becerra. "Expanding access to substance use prevention, harm reduction, treatment, and recovery services, and improving the daily lives of mothers and children across America are priorities for the Department."

HRSA has invested nearly $384 million, including today's announcements, in community-based grants and technical assistance over the last three years through the Rural Community Opioid Response Program initiative to promote the establishment and expansion of SUD/OUD prevention, treatment, and recovery services in rural communities in 47 states and 2 territories. This includes supporting 30 existing grants focused on neonatal abstinence syndrome.

"At a time when overdose deaths are rising across America and improvements to maternal health are urgently needed, HRSA is working on multiple fronts to address the health care needs of rural Americans," said HRSA Acting Administrator Diana Espinosa. "Today's announcement furthers HRSA's commitment to improve the wellbeing of people in rural communities."

HRSA's Federal Office of Rural Health Policy is making these awards through four key programs:

Rural Communities Opioid Response Program-Implementation: $78 million is being provided to 78 organizations across 35 states. These awards aim to reduce the morbidity and mortality of SUD/OUD in high-risk rural communities by strengthening and expanding SUD/OUD prevention, treatment, and recovery services.
Rural Communities Opioid Response Program-Psychostimulant Support Program: $7.5 million was awarded to 15 rural consortia across 13 states. These awards aim to strengthen and expand prevention, treatment, and recovery services for individuals misusing psychostimulants so they can access treatment and move towards recovery.
Rural Maternity and Obstetrics Management Strategies Program: $2.9 million was awarded to three recipients to test models to address unmet maternal and obstetric needs for their rural target populations. This effort will improve access to services for rural mothers and their children through better care coordination, use of telehealth and increased access to prenatal and other related services.
Rural Northern Border Region Planning Program: $760,000 was awarded to four community-based organizations to plan and identify key rural health issues in the rural Northern Border Regional Commission service areas.

Buprenorphine Mini-Course: Building on Federal Prescribing Guidance

Mon, 02 Aug 2021 14:43:02 GMT

The American Society of Addiction Medicine (ASAM) has announced the launch of a new, free, one-hour, online training module designed to educate medical professionals and students about prescribing buprenorphine to patients with opioid use disorder (OUD). The Buprenorphine Mini-Course: Building on Federal Prescribing Guidance module is presented by ASAM in collaboration with the American Medical Association (AMA) and Shatterproof.

Utilizing the chronic care framework of addiction treatment, the fully online module offers practical considerations for buprenorphine initiation, dosing, and ongoing patient management to prescribers seeking to initiate buprenorphine for the treatment of OUD. In addition, through interactive and application-focused learning, participants will explore the core principles of OUD treatment and the importance of language when treating patients with this chronic disease.

The brief training module is designed to expand on the Buprenorphine Quick Start Guide developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). The quick start guide was released in conjunction with Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder issued by the US Department of Health and Human Services (HHS). Under the practice guidelines, which remove some of the often-cited barriers associated with the “x-waiver” to prescribe buprenorphine in-office for the treatment of OUD, eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives are exempt from federal certification requirements related to training, counseling and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine.

We encourage medical professionals and students to sign up for the module today. By taking this course, learners will help strengthen America’s medical response to OUD and increase access to life-saving medications. Plus, CME credit is available upon completion of the training module.

To sign up for the free, one-hour, online training module, please click here.

The training module will be available for free in the ASAM e-Learning Center and the AMA Ed Hub for the duration of the CME approval period (3 years). In addition, ASAM is offering its eight-hour, fully online Treatment of Opioid Use Disorder Course in the ASAM e-Learning Center for free through December 31, 2021. ASAM’s Treatment of Opioid Use Disorder Course provides eight hours of required education to qualify for a waiver to prescribe buprenorphine for OUD to more than 30 patients in an office-based setting. We encourage medical professionals and students to take advantage of these fantastic resources!

Wisconsin sees significant spike in drug overdose deaths in 2020

Fri, 16 Jul 2021 13:40:16 GMT

Wisconsin Health News

Wisconsin saw a 27.4 percent increase in drug overdose deaths last year, according to provisional federal data released this week.

There were 1,539 predicted drug overdose deaths in Wisconsin last year, compared to 1,208 the prior year, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. The total number is likely underreported due to incomplete data, per the center.

Nationally, drug overdose deaths rose over 29 percent, the largest single-year increase recorded. A total of 93,331 predicted deaths were reported in 2020, compared to 72,151 the prior year.

Overdose deaths rose in all but two states last year, with only South Dakota and New Hampshire seeing a decrease.

Society warns legislature about kratom legalization proposal

Thu, 15 Jul 2021 14:16:24 GMT

WMS Medigram

The Wisconsin Medical Society (Society) warned state legislators this week about a proposal that would remove two compounds from the state’s list of controlled substances that are found in leaves of the kratom tree and can have psychotropic effects. The proposal from State Assembly Representative David Murphy (R-Greenville) would also create a state regulatory system that would enable companies to sell kratom as a therapeutic product, including the ostensible ability to help people “alleviate their opioid dependency.”

Working with physician members of the Wisconsin Society of Addiction Medicine (WISAM), the Society sent a message to all 132 State Assembly Representatives and State Senators asking that they not co-author the proposal. The message from the Society included:

a warning from the U.S. Food and Drug Administration that kratom “appears to have properties that expose users to the risks of addiction, abuse and dependence,”

information from the Mayo Clinic discussing how “evidence suggests that rather than treating addiction and withdrawal, the use of kratom may lead to them,” and

a recent literature review published in WMJ on how to best treat what the authors term “Kratom Use Disorder (KUD),” pointing out how increased use of kratom is an emerging public health concern.

The proposal is spearheaded by the American Kratom Association, which has unsuccessfully lobbied the state’s Controlled Substances Board to remove the compounds from the state’s list of illegal substances. Once the proposal has circulated for legislative cosponsors, it will likely be officially introduced and assigned to a legislative committee.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Wisconsin set to see more than $65 million for opioid efforts

Tue, 13 Jul 2021 15:20:57 GMT

Wisconsin Health News

Wisconsin could see more than $65 million for opioid abatement efforts through a settlement with the Sackler family and their company Purdue Pharma that’s pending approval before a bankruptcy court.

Attorney General Josh Kaul said the plan maximizes the amount Wisconsin will be able to recover. Kaul filed suit against the company two years ago.

“We’ve fought to get every dollar we can from Purdue and the Sacklers to help with the fight against the opioid epidemic,” Kaul said in a statement. “We opposed Purdue’s original bankruptcy plan, and we joined other states in negotiating for more resources to address the epidemic. Because of that multistate effort, the bankruptcy plan has improved.”

Kaul said the process has also revealed a need to reform the bankruptcy system. “It’s shameful that the Sackler family is using that process to limit their liability and that billions more can’t be recovered from them,” he added.

The state’s share of funding is around 1.8 percent of the $4.3 billion that would be paid over the next nine years. Thousands of victims would also receive compensation.

The plan permanently bans the Sacklers from the opioid business, with Purdue being sold or wound down by the end of 2024.

The Sacklers would also have to relinquish control of family foundations holding $175 million in assets to trustees of a foundation dedicated to abating the opioid crisis.

They couldn’t request or permit any new naming rights in connection with charitable or similar donations or organizations for the next nine years.

Purdue and the Sacklers would have to make public more than 30 million documents, including attorney-client privileged communications about the federal approval of painkiller OxyContin and tactics used to promote opioids.

LOAN Forgiveness for Addiction Counselors

Tue, 06 Jul 2021 18:42:58 GMT

On June 8th the Health Resources and Services Administration released the Fiscal Year 2021 Application and Program Guidance for the Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program (LRP). The STAR-LRP will provide repayment of education loans for individuals working in a full-time substance-use disorder (SUD) treatment job that involves direct patient care at a STAR LRP-approved facility located in either a Health Professional Shortage Area (HPSA) designated for Mental Health, or a county/municipality where the average drug overdose death rate exceeds the national average.

Evers signs opioid settlement bill into law

Thu, 01 Jul 2021 15:45:44 GMT

Wisconsin Health News

Gov. Tony Evers on Wednesday signed into law a bill setting up a framework for distributing funds from a settlement in a lawsuit brought by Wisconsin counties and others against opioid manufacturers, distributors and retailers.

The Republican-backed bill passed the Legislature last week mostly along party-line votes. It would require the attorney general to work with counties on the settlement and splits Wisconsin’s share of settlement funds 30-70 between the state and counties that are party to the litigation.

“It will help bring much-needed funds to communities throughout Wisconsin to address the opioid pandemic,” Evers said in a statement. “These funds will be used on opioid abatement and mitigation efforts.”

Evers signed the bill over the objections of Attorney General Josh Kaul, who said the bill shouldn’t become law.

Kaul said in a statement last week that the bill would “unconstitutionally” give the Joint Finance Committee significant authority over opioid-related settlements and that the bill creates no process for legislative review of confidential materials. And he noted the bill doesn’t cap attorney's fees for opioid-related settlements.

Evers acknowledged Kaul’s concerns about the committee’s oversight.

“Despite these serious concerns, I am not willing to risk our ability to maximize the amount of settlement dollars available to Wisconsin by vetoing this bill in its entirety,” Evers said in a statement.

“I agree with the Governor that aspects of this legislation are unconstitutional,” Kaul said in a Wednesday statement. “It’s unfortunate that this new law misses the opportunity to help maximize the resources that will go toward fighting the opioid crisis in Wisconsin.”

The Wisconsin Counties Association applauded the signing.

“Without this legislation, the state and counties could have lost vital opioid abatement funds," Lance Pliml, chair of the board of the association, said in a statement. "We are grateful for Gov. Evers’ leadership in acting in the best interest of Wisconsin to get this money quickly to our local communities for mitigation and abatement efforts.

Final Rule Published on Mobile Methadone

Mon, 28 Jun 2021 14:22:26 GMT

Today, the final rule for Registration Requirements for Narcotic Treatment Programs (NTPs) with Mobile Components was published. These regulations will allow the operation of a mobile component associated with a DEA-registered NTP to be considered a coincident activity permitted under the NTP’s registration. Based on these revisions, NTP registrants that operate or wish to operate mobile components (in the State in which the registrant is registered) to dispense narcotic drugs in schedules II-V at remote location(s) for the purpose of maintenance or detoxification treatment do not need a separate registration for such mobile component. This final rule waives the requirement of a separate registration at each principal place of business or professional practice where controlled substances are dispensed for those NTPs with mobile components that fully comply with the requirements of this rule. These revisions to the regulations are intended to make maintenance or detoxification treatments more widely available, while ensuring that safeguards are in place to reduce the likelihood of diversion.

This final rule will be effective 30 days after publication and can be found at: https://www.federalregister.gov/public-inspection/2021-13519/registration-requirements-for-narcotic-treatment-programs-with-mobile-components. Back in April 2020, ASAM wrote this letter urging final rule publication.

Adolescent marijuana, alcohol use held steady during COVID-19 pandemic

Fri, 25 Jun 2021 13:56:45 GMT

National Institute on Drug Abuse

Adolescent marijuana use and binge drinking did not significantly change during the COVID-19 pandemic, despite record decreases in the substances’ perceived availability, according to a survey of 12th graders in the United States. The study’s findings, which appeared online on June 24, 2021, in Drug and Alcohol Dependence, challenge the idea that reducing adolescent use of drugs can be achieved solely by limiting their supply. The work was led by researchers at the University of Michigan, Ann Arbor, and funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

In contrast to consistent rates of marijuana and alcohol use, nicotine vaping in high school seniors declined during the pandemic, along with declines in perceived availability of vaping devices at this time. The legal purchase age is 21 for nicotine products and alcohol in all states, and for cannabis in states that have legalized nonmedical cannabis use.

"Last year brought dramatic changes to adolescents’ lives, as many teens remained home with parents and other family members full time,” said NIDA Director Nora D. Volkow, M.D. "It is striking that despite this monumental shift and teens’ perceived decreases in availability of marijuana and alcohol, usage rates held steady for these substances. This indicates that teens were able to obtain them despite barriers caused by the pandemic and despite not being of age to legally purchase them."

The data for the study came from the annual Monitoring the Future (MTF) survey of substance use behaviors and related attitudes among adolescents in the United States. In a typical year, MTF surveys thousands of middle and high school students at more than a hundred schools across the country in the spring. MTF has been watching substance use trends for 46 years.

Bill would create framework for opioid settlement funds

Mon, 21 Jun 2021 15:48:28 GMT

Wisconsin Health News

State lawmakers are moving quickly on a plan that would create a framework for distributing settlement proceeds from a challenge filed by state and local governments against opioid makers, distributors and retailers.

The full Assembly is set to consider the measure Tuesday, after the Assembly Committee on State Affairs approved the measure last week on a 7-4 vote. All Democrats were opposed to the plan.

The Senate Committee on Health signed off on the measure 3-2 in a similar party-line vote Thursday, after holding a public hearing on the plan last Tuesday.

The bill would require the attorney general to work with counties on the settlement, with 70 percent of the settlement funds going toward local governments that are party to the litigation and 30 percent to the state. The Joint Finance Committee would have to sign off on the proposed settlement agreement.

The state’s share would go to the Department of Health Services, which would annually report to the Joint Finance Committee a proposal for spending the money in the next year. The committee would sign off on the plan through its passive review process.

Seventy-one of Wisconsin’s 72 counties have signed on to the lawsuit, and counties have borne the cost of the epidemic, said Senate Committee on Health Chair Patrick Testin, R-Stevens Point.

“This is common-sense legislation,” Testin said at the Tuesday public hearing. He said the bill would require that all funds be used for abatement purposes, rather than other government functions or to fill budget holes.

The Wisconsin Counties Association supports the measure.

“We should not wait even one minute longer than we have to to utilize the funds,” Executive Director Mark O’Connell said.

“This bill is the right bill for counties to be able to serve our citizens who have been affected by this crisis,” Racine County Executive Jonathan Delagrave said. “We are on the front lines.”

Attorney General Josh Kaul opposes the measure. In testimony submitted to the committee, he said it would be beneficial to set up a structure for distributing funds, but the bill is “fundamentally flawed.”

Kaul questioned the measure’s constitutionality, saying it would grant a legislative committee oversight for something that is the responsibility of the executive branch. He said legislative review of potential resolutions of opioid matters is not practical.

“Reducing the complexity of these matters to an abbreviated legislative review, without an agreed-upon process for the review of confidential information that protects the interests of the state, is not consistent with meaningful consideration of the issues,” Kaul wrote.

Instead, the bill should provide that opioid matters be resolved at the sole discretion of the attorney general, he said.

Kaul also raised a concern that a provision would allow local governments to compensate private attorneys using money otherwise designated for abatement, without a cap on such payments. The provision would allow payments even if a national settlement provides a pool of funding specifically for attorneys’ fees. Kaul said the provision could diminish funding for opioid abatement measures throughout the state.

Women's SUD Treatment Coordinator

Thu, 10 Jun 2021 15:15:08 GMT

The Department of Health Services strives to protect and promote the health and safety of all people of Wisconsin through the efforts of a dedicated and diverse workforce. DHS works to ensure access to individuals, families, and communities to achieve positive health outcomes in the areas of abuse prevention, mental health, public health, family care, long-term care, and much more.

The Division of Care and Treatment Services (DCTS) is recruiting for a Human Services Program Coordinator-Senior position, also known as the Women's Substance Use Treatment Coordinator, within the Bureau of Prevention, Treatment, and Recovery (BPTR) in Madison, WI.

Click here for more information.

Bill would create database to boost fight against opioid, meth epidemic

Tue, 01 Jun 2021 19:00:27 GMT

Wisconsin Health News

Lawmakers are considering establishing a centralized database for opioid and methamphetamine statistics that could help boost the fight against the state’s drug epidemic.

The Assembly Committee on Substance Abuse and Prevention approved the bill unanimously last week, and the Senate Committee on Health signed off on the measure in February. The bill would provide $1.5 million in the second year of the 2021-23 biennium to implement the data system.

The bill would direct the Department of Administration to work with a vendor to collect and analyze data on overdoses, drug trafficking and other measures. The state agency would also be charged with submitting reports to the Joint Finance Committee on data trends.

Committee on Substance Abuse and Prevention Chair Rep. Jon Plumer, R-Lodi, said different state agencies already collect the information that would be put into the database, but it’s not easily accessible.

“We need to be able to access that information more easily than we are now,” Plumer said. “This goes from a paper map to a GPS system. That’s how dramatic this change would be.”

Plumer said the measure would help not only with treatment, but law enforcement. He said law enforcement officials are more “reactionary” now to when substances appear in their area. The database would give them a “heads up” of what’s happening in other areas of the state, allowing them to target resources.

In testimony on the bill, Senate Committee on Health Chair Patrick Testin, R-Stevens Point, noted the state has recently seen an increase in overdoses and drug-related deaths. He said the bill would help assess the effectiveness of state initiatives.

The Assembly approved the bill last session, but it didn’t make it into law after the Senate canceled its final session.

The Joint Finance Committee removed a provision in Gov. Tony Evers’ budget that was similar to the bill when it removed a series of policies in early May. Evers included funding for a similar program in a bill that would expand Medicaid, which Republicans declined to take up last week.

Public Policy Committee Invites New Faces

Fri, 21 May 2021 18:01:30 GMT

WISAM is looking for individuals who are interested in becoming more involved in the Public Policy Committee. Our current Chair, Dr. Elizabeth Salisbury-Afshar, is ready to help lead a team with a keen interest in public policy matters around issues that affect addiction medicine, the practice of addiction medicine, and public policies that may impact the social determinant of health for our patients. Please contact us via the link below in order to get connected and learn more about the opportunities we have available to get involved.

Meet the Committee Chair

Elizabeth Salisbury-Afshar, MD, MPH is an Associate Professor in the Department of Family Medicine and Community Health and is core faculty for the Addiction Medicine Fellowship at the University of Wisconsin School of Medicine and Public Health in Madison Wisconsin. Dr. Salisbury-Afshar is board certified in family medicine, preventive medicine/public health and addiction medicine and her expertise lies at the intersection of these fields. Much of her work has focused on expanding access to evidence-based responses to the opioid overdose crisis. Past roles include serving as the Medical Director of Behavioral Health Systems Baltimore (a quasi-public entity that oversees all publicly funded addiction and mental health treatment), as the Medical Director of Behavioral Health at the Chicago Department of Public Health, the Director of the Center for Addiction Research and Effective Solutions at the American Institutes for Research, and Medical Director of Heartland Alliance Health (Chicago-based healthcare for the homeless provider). She has over ten years of experience working clinically in federally qualified health centers- providing direct patient care in both primary care and addiction medicine treatment. She currently serves as the Vice Chair of the ASAM Public Policy Committee and as the ASAM representative on the AMA Opioid Task Force.

Southeast Wisconsin cities, villages sue opioid manufacturers, distributors

Fri, 21 May 2021 15:36:34 GMT

Wisconsin Health News

Eleven communities in Milwaukee and Racine counties filed lawsuits this week against drug manufacturers and distributors for their alleged role in the opioid epidemic.

The cities of Cudahy, Franklin, Greenfield, Oak Creek, South Milwaukee, Wauwatosa and West Allis filed suit in Milwaukee County court. The villages of Mount Pleasant, Sturtevant, Union Grove and Yorkville filed suit in Racine County court.

South Milwaukee Mayor Erik Brooks said his city and other municipalities have spent an “enormous amount of resources to combat” opioid addiction.

“Opioids have taken an intensely personal toll on our community,” Brooks said in a statement. “Too many people have become addicted. Too many families have been broken. Too many have died. It is time for these defendants to answer these charges locally.”

Read the lawsuit.

WISAM Opens Board Nominations for 2021

Mon, 17 May 2021 18:51:53 GMT

The Wisconsin Society of Addiction Medicine has opened up the Call for Nominations for the following open positions:

President-Elect
Secretary
Treasurer
Member at Large (director-at-large)
Early Career Physician

These volunteer-positions within the leadership of WIASM are very important! We have a support system in place to give new individuals a chance to succeed in these roles and help grow the mission of the organization. Click here for more information on deadlines and to access the nomination form.

Statement from the American Society of Addiction Medicine on HHS Practice Guidelines Exemption from Enumerated X-Waiver Certifications For Eligible DEA-Registered Practitioners

Thu, 29 Apr 2021 15:45:06 GMT

ASAM | Addiction Policy News

The new policy exempts eligible, DEA-registered practitioners from federal certification requirements related to training, counseling, and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine – a step toward helping Americans with opioid use disorder access evidence-based addiction care

Rockville, MD - The American Society of Addiction Medicine (ASAM) applauds steps to reduce barriers to patients accessing medications for opioid use disorder (OUD), including today’s announcement from the U.S. Department of Health and Human Services (HHS) on Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, which were posted for public inspection in the Federal Register today.

“The guidelines released by HHS create exemptions from enumerated X-waiver certifications with respect to certain practitioners prescribing buprenorphine for opioid use disorder, an important step toward improving our patients’ access to this medication,” said Dr. William Haning, president of ASAM. “We now look to Congress to take critical and necessary next steps, including securing a permanent elimination of buprenorphine-specific training requirements, patient limits, and DEA audits, as well as the separate X-waiver application, for DEA-registered prescribers, while ensuring these clinicians receive baseline training on treating patients with substance use disorder.”

From 1999 to 2017, nearly 400,000 people in the United States died from overdoses related to opioids – due in part to a critical misunderstanding of the substantial evidence for the safety and effectiveness of medications that treat OUD, as well as the historical separation of addiction treatment from mainstream medical care.

Specifically, the new HHS practice guidelines exempt eligible, DEA-registered practitioners from the certification requirements under 21 U.S.C. §823(g)(2)(B)(i)-(ii). The exemption, however, is subject to the limitations of the guidelines. For example, a practitioner utilizing this exemption will still be required to obtain a waiver by submitting a Notice of Intent to the Substance Abuse and Mental Health Services Administration before treating patients with buprenorphine for OUD. Such a practitioner also will be limited to treating no more than 30 patients with buprenorphine for OUD at any one time, and time spent practicing under the exemption will not qualify the practitioner for a higher patient limit. Finally, while these guidelines change certain federal requirements, they do not govern possible state requirements that may be applicable.

ASAM notes that an elimination of the X-waiver should be combined with needed education about the identification and treatment of substance use disorder in patients seen in daily practice. Proper education increases clinicians’ willingness to administering life-saving, addiction care. ASAM commends HHS for recognizing that substance use disorder education is not yet uniformly integrated into medical education and that colleges of medicine and training programs are strongly encouraged to develop or to continue implementing comprehensive training in substance use disorder diagnosis and management as a component of their core, required curriculum.

“While the ongoing COVID-19 pandemic has wrought havoc on all, it has particularly jeopardized the health of vulnerable populations, including the more than 20 million Americans living with substance use disorder,” said Dr. Haning. “An elimination of the X-waiver coupled with increased addiction training has the potential to save thousands of lives and free DEA-registered prescribers of unnecessary barriers that have too long impeded them from helping their patients.”

Click here to access full article on ASAM site.

Miller and Westergaard Honored at April Board of Directors Meeting

Thu, 22 Apr 2021 18:38:34 GMT

WMS | Medigram

The Wisconsin Medical Society (Society) honored the accomplishments and contributions of two outstanding physicians during the Board of Directors meeting held virtually on April 17. The 2021 Director’s Award and Presidential Citation were presented to honor physicians who have made a difference to the Society and the profession of medicine.

Director's Award

The Director's Award was presented to Michael Miller, MD, Madison. Established in 1928, this award is the Society’s highest honor, given to recognize outstanding physicians who have served the medical profession with integrity and honor and who have made numerous and substantial contributions to the profession and the community.

Throughout his career, Dr. Miller has been involved with the Society in many ways, most notably as Speaker. Dr. Miller has also had longstanding commitment as an AMA Delegate/Alternate along with involvement in the AMA Council on Science and Public Health. He has also served as President and Board Chair of his national specialty society (ASAM), President and Board Chair of his county medical Society (Dane County) and as a Director of his specialty board (ABAM).

Presidential Citation

The Presidential Citation was presented to Ryan Westergaard, MD, PhD, MPH, Madison. The award was established in 1959 to recognize an individual who has made a significant contribution to medicine and to the public’s health.

Dr. Westergaard is the current Chief Medical Officer and State Epidemiologist for the Bureau of Communicable Diseases, Division of Public Health, at the Wisconsin Department of Health Services. Dr. Westergaard has been honored for his leadership in addressing the pandemic of the SARS-CoV-2 virus, exhibited by his communication with both Public Health Agencies and physicians, keeping them abreast of the most current scientific evidence, guidance and resources.

Premium holiday for state’s medical malpractice fund to last until June 2022

Thu, 08 Apr 2021 14:30:20 GMT

April 6, Wisconsin Health News

The premium holiday for Wisconsin’s medical malpractice fund will continue until mid-2022 to help offset impacts on providers from COVID-19.

Insurance Commissioner Mark Afable notified the Joint Finance Committee last week that he’s requesting that fiscal year 2022 rates for healthcare providers participating in the Injured Patients and Families Compensation Fund remain the same as the current fiscal year, which ends June 30.

The committee has until April 15 to approve the request. Currently, the fund is waiving fees for participating healthcare professionals and providers, per a request from the Wisconsin Medical Society. The premium holiday is set to last until June 30, 2022.

OCI spokeswoman Sarah Smith said that the rates will remain the same because the fund won’t be charging due to the COVID-19 pandemic.

Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said independent clinics are still fighting COVID-19 related costs and lost revenue and keeping the status quo for now makes sense.

“We’re doing all we can to advocate for those independent clinics who provide such important care to their communities while being on the front lines of the pandemic,” he said in an email. “We’re very fortunate to have a fund that’s run prudently and is in a stable financial condition so that it can provide a little fiscal relief for physicians.”

The Injured Patients and Families Compensation Fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate annually.

MEB approves prescribing CME requirement extension; begins work on potential chaperone rule

Thu, 25 Mar 2021 18:37:19 GMT

Medigram

The State of Wisconsin’s Medical Examining Board (MEB) at its most recent monthly meeting advanced a proposed administrative rule that will extend for another biennium the requirement that most physicians obtain two credits of continuing education related to opioid prescribing. The requirement applies to physicians who hold a Drug Enforcement Administration registration number, with the two credits being part of the 30 credits required each biennium. Courses must be approved by the MEB in order to satisfy the subject matter requirement.

The Wisconsin Medical Society (Society) spoke in favor of the rule at the MEB public hearing March 17, noting how the COVID-19 pandemic has exacerbated opioid abuse across the county. The Society also expressed appreciation that the rule widens the scope of qualifying coursework beyond opioid prescribing to include “other controlled substances.” This will allow physicians who hold a DEA number but may not prescribe opioids to access coursework more relevant to their practice.

The MEB also began to discuss whether to add a provision to the “unprofessional conduct” section of the MEB’s administrative code (MED 10) that could require physicians to offer patients a chaperone for certain sensitive physical exams. The idea comes from a January 2020 ACOG Community Opinion paper recommending that a chaperone be present for all breast, genital and rectal examinations. While the MEB discussed the issue only generally during its meeting March 17, it will review potential language at its April meeting.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Wisconsin Doctor Day Confirms Keynote Speaker

Thu, 25 Feb 2021 16:52:29 GMT

Wisconsin Doctor Day - May 5, 2021

Opening Keynote Address Featuring AMA President, Susan R. Bailey MD
Dr. Susan R. Bailey, a distinguished allergist/immunologist from Fort Worth, Texas, is the 175th president of the American Medical Association. Doctor Bailey's presentation, What Will Healthcare Look Like Post COVID-19?, will touch on delivery of care, rebounding from physician stress, and the impact of the pandemic on the physician workforce.

Click here for more information!

WISAM Hosting Buprenorphine X-Waiver Trainings Series in 2021

Wed, 17 Feb 2021 20:07:46 GMT

The Wisconsin Society of Addiction Medicine will begin the third year of hosting the X-Waiver Training Series with the first training available on March 5, 2021. WISAM partners with the Wisconsin Department of Health Services in order to offer these trainings for FREE to all Wisconsin providers who are eligible to prescribe buprenorphine. The partnership continues with the American Society of Addiction Medicine in order to provide the ASAM Treatment of Opioid Use Disorder Course (TOUD).

This series is designed to increase treatment capacity for opioid use disorders by training more prescribers to be able to treat opioid use disorders with buprenorphine. This live course has been approved by the Wisconsin Medical Examining Board as meeting the requirements for the two-hour continuing education course on responsible opioid prescribing per Med 13.03(3) of the Wisconsin Administrative Code.

The course involves 4 hours of online training paired with 4 hours of in-person training. The self-paced online course will be available through ASAM’s website upon registration.

This course is open to MDs, DOs, NPs, and PAs. MDs and DOs must complete the full 8-hour course to be eligible for their DATA Waiver. NPs and PAs must complete the full 8 hour course, plus 16 additional hours provided free by ASAM (contact education@asam.org about registering for the additional 16 hours.) Medical students and NP and PA students are eligible to take the course, but will not be eligible to apply for their waiver. Eligible providers who do not yet hold DATA Waivers are particularly encouraged to attend, but Waiver-holding providers can also attend for CME credit. You must attend the entire course to qualify for CME credit.

Click here to view the full schedule

Wisconsin gets grant to implement new suicide prevention hotline number

Mon, 15 Feb 2021 16:12:48 GMT

Wisconsin Health News

Wisconsin has received a grant to help develop an implementation plan for 988, a new calling code that will launch next year for the National Suicide Prevention Lifeline.

The $171,701 grant from Vibrant Emotional Health, the administrator for the national lifeline, will fund a coalition organized by the Department of Health Services to establish a system to ensure everyone in the state has direct access through the number to trained counselors.

“A three-digit calling code will open the door for more people to seek the help they need, while sending the message that healing, hope and help are happening every day,” said DHS Interim Secretary Karen Timberlake.

The new calling code is expected to launch July 2022. The coalition will start meeting in April, with a goal of having a draft of the plan completed by August and the final plan by the end of the year.

The coalition will ensure statewide coverage for 988 calls, sustainable funding and that call centers will be able to handle the current and projected volume of calls. They’ll also look at how to market the helpline.

BALDWIN, BRAUN, WHITEHOUSE AND BROWN LEAD SENATE INTRODUCTION OF BIPARTISAN MEDICAID REENTRY ACT

Wed, 10 Feb 2021 16:36:46 GMT

Grants states power to restart Medicaid services for incarcerated individuals 30 days before their release

WASHINGTON, D.C. – U.S. Senators Tammy Baldwin (D-WI), Mike Braun (R-IN), Sheldon Whitehouse (D-RI) and Sherrod Brown (D-OH) are leading the Senate introduction of the bipartisan Medicaid Reentry Act, legislation expanding access to addiction treatment and other health services for Medicaid-eligible individuals 30 days before their release from jail or prison. The bipartisan legislation is also being re-introduced in the House of Representatives by Congressmen Paul Tonko (D-NY-20) and Michael Turner (R-OH-10).

Currently, federal statute prohibits any form of federal health coverage for incarcerated individuals except under very limited circumstances. In most states, Medicaid coverage is immediately terminated when someone is sent to a correctional setting. This creates a serious coverage gap when individuals are released, as they often have no access to health care or addiction treatment during a stressful and dangerous time. This bill is a bipartisan response to this issue, following alarming evidence published in the New England Journal of Medicine that individuals reentering society are 129 times likelier than the general population to die of a drug overdose during the first two weeks after release.

“The opioid and substance use disorder epidemic remains rampant in Wisconsin and across the country, and the ongoing COVID-19 pandemic is dramatically impacting the addiction prevention, treatment, and recovery landscape in this country. This problem is harshly affecting incarcerated individuals who are working to reenter society, but currently lack the health care coverage they need to continue their recovery,” said Senator Baldwin. “We need to make sure these rehabilitated folks have Medicaid or other health care coverage needed to seamlessly transition back to community care, and reduce the risk of overdose deaths post-release. I’m proud to work with my Senate and House colleagues on this bipartisan reform to address our nation’s addiction crisis and support our continued fight against this deadly epidemic.”

Biden moving to nix Trump plan on opioid-treatment prescriptions

Mon, 25 Jan 2021 15:51:59 GMT

Washington Post | By Dan Diamond and Lenny Bernstein

The Biden administration is preparing to halt a last-minute plan by the Trump administration to let more physicians prescribe an opioid-treatment drug, said three officials with knowledge of the pending announcement, who spoke on the condition of anonymity because they were not authorized to discuss the plan.

The Trump plan had been hailed by physicians as loosening requirements they said had slowed their response to the nation’s worsening opioid crisis. Then-presidential candidate Joe Biden also criticized the prescribing rules and vowed to lift them if elected president. But some legal experts warned that the Department of Health and Human Services lacked the authority to issue guidelines that allowed physicians to avoid requirements mandated by Congress.

“Unfortunately, the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder announced by the Trump administration in its last days had significant legal and clinical concerns,” according to a draft announcement obtained by The Washington Post. “The Biden Administration will not issue the Guidelines previously announced.

Important Message from WISAM President

Fri, 15 Jan 2021 20:29:04 GMT

Updated 1/22/2021

The previously announced, Trump Administration, HHS practice guidelines regarding a new exemption from certain X-waiver certification requirements for certain physicians never posted to the Federal Register-- which means the exemption never went into effect. The Biden Administration has put a temporary freeze on matters not yet posted to the Register, pending further review. As soon as ASAM receives further information from federal agencies about all of this, we will inform our members.

In the meantime, on Capitol Hill, ASAM continues to advocate for a complete elimination of the X-waiver while ensuring controlled medication prescribers have baseline education on addiction – that will require a legislative “fix.”

Posted 1/15/2021

We have some important news to share regarding buprenorphine prescribing from HHS. For physicians, the requirement for a separate X-Waiver to prescribe Buprenorphine/naloxone will no longer be required. The patient limit for physicians without the X-Waiver will be 30 patients but it is unclear at this time what it will mean for X-waived providers. This does not apply to PA's or NP's. ASAM plans to put out a statement in the next few days when more details are available.

Sincerely,

David Galbis-Reig, M.D., DFASAM
President, Wisconsin Society of Addiction Medicine

HHS Expands Access to Treatment for Opioid Use Disorder

Gov. Evers, DHS Announce Nearly $9 Million Awarded for Drug Treatment Services

Thu, 14 Jan 2021 17:17:55 GMT

MADISON — Gov. Tony Evers announced today that the the Wisconsin Department of Health Services (DHS) has awarded nearly $9 million to 23 county agencies and five tribal nations to provide treatment services for the harmful use of opioids—such as prescription pain relievers, heroin, and fentanyl—or stimulants—such as cocaine and methamphetamine.

“Too many Wisconsinites, and their friends, family, and neighbors, have experienced the tragedies of harmful use of stimulants and opioids first hand,” said Gov. Evers. “It tears apart families, impacts our kids, and has affected every Wisconsin community in one way or another. I am glad we are able to get these critical funds out the door to provide treatment and hope for so many.”
“The problem use of opioids and stimulants is an epidemic in Wisconsin,” said DHS Secretary-designee Andrea Palm. “These grant awards enable our county and tribal partners to expand access to help those who need it most, giving them hope and healing, as we continue our collective work to build healthy communities.”
The grant awards listed below are based on the level of need for treatment services in the county or tribe and the types of treatment services to be provided by each county or tribe.

January Updates from the Wisconsin Medical Society

Thu, 07 Jan 2021 20:42:38 GMT

Wisconsin Medical Society | Medigram

Society weighs in on Assembly GOP COVID Response Bill

Signaling the importance of battling the COVID-19 pandemic, Wisconsin State Assembly Republicans and Democrats each unveiled their own COVID-19 response bills on Inauguration Day, January 4. With Republicans in control of that legislative house, Assembly Speaker Robin Vos (R-Rochester) introduced Assembly Bill 1 Monday afternoon, with a committee hearing and vote taking place the next day.

The 63-page omnibus bill hits a wide variety of areas, from schools to unemployment programs to health care workforce and funding. The Wisconsin Medical Society (Society) highlighted both the positive and concerning portions of the bill in this testimony, which was delivered electronically to the Assembly Committee on Health. Protection from COVID-19 exposure civil litigation, ensuring the state’s SeniorCare program covers COVID-19 vaccinations and preventing patients from facing copays or coinsurance for vaccinations garnered the Society’s support. Provisions limiting local public health and state health department powers during communicable disease outbreaks and interfering with employers’ ability to protect employees and customers from SARS-CoV-2 were not supported.

The Assembly Health Committee approved the bill Tuesday afternoon on an 11-5 party-line vote. The full State Assembly convened this afternoon, amending the bill to place stricter limits on public health and school board powers, then passing the bill on a similarly partisan 56-34 vote. The bill now heads to the State Senate, where the bill’s fate in that house is unclear. Any bill passing both houses must then survive Governor Tony Evers’ veto scrutiny.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Society opposes VA rule allowing care without physician supervision

The Wisconsin Medical Society joined with dozens of other state- and specialty-based health care organizations on a letter opposing a U.S. Department of Veterans Affairs proposed rule that would allow virtually all non-physician providers (NPP) to practice without the clinical supervision of a physician. The proposal would trump state scope of practice laws and regulations.

“NPPs are an integral part of physician-led health care teams,” the letter reads. “However, NPPs cannot substitute for physicians especially when it comes to diagnosing complex medical conditions, developing comprehensive treatment plans, ensuring that procedures are properly performed, and managing highly involved and complicated patient cases. Nowhere is this more important than at the Department of Veterans Affairs (VA), which delivers multifaceted medical care to veterans, including those with traumatic brain injuries and other serious medical and mental health issues. As such, our nation’s veterans deserve high quality health care that is overseen by physicians.”

The letter was signed by more than 100 organizations and delivered to the Secretary of the Department of Veteran Affairs today. Contact Mark Grapentine, JD for more information.

You’re a member! Now what? Exploring WisMed Assure

Explore the benefits of Wisconsin Medical Society membership by joining the WisMed team for an overview of WisMed Assure, the only Wisconsin-based insurance firm exclusively serving the health care community. Tune in on Wednesday, January 13 at 12 p.m. and learn how they can help you! Register today!

Designed for the busy schedules of physicians, these 15-minute webinars will occur on the second Wednesday of the month, 12 - 12:15 p.m. Whether you're a brand-new member or have been involved for years, you can learn more about the latest member benefits designed specifically for you!

You’re a member! Now what?
January 13 – Exploring benefits available through WisMed Assure
February 10 – Become an active advocate
March 10 – Take hold of your financial future
April 14 – Member benefits 101

Help shape Medical Society policies in 2021

With the Wisconsin Medical Society (Society) evolving its policymaking process to a year-round schedule, the Society is seeking a special group of members to help review policy proposals that are submitted for discussion and eventual action by the Board of Directors. This group will include Society members from across the state to ensure widespread representation. The function is similar to the role Reference Committees had in the former House of Delegates structure: listening to testimony on policy proposals and making recommendations for final action to the ultimate deciding body.

The committee will include members from all eight Society districts and the young physician, resident physician and medical student sections. They will meet as needed leading up to each Society Board of Directors meeting. If you are interested in serving on this policy-reviewing committee, please fill out this form.

For more information, contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD.

Physician Wellness Advisory Committee moving forward

The Physician Wellness Advisory Committee held its first meeting in December. The purpose of this committee is to design and establish the framework and operability of a Physician Wellness Program to offer help and respite when needed for the physicians of Wisconsin. The intent is to initiate the program in a short period of time and provide the framework for it to grow and be more robust in the future. Special thanks to Mary Jo Capodice, DO, MPH, Jacqueline Landess, MD, Erica Larson, DO, and Michael Miller, MD, for giving their time and providing recommendations as the Wisconsin Medical Society begins this crucial journey towards providing this valuable service to the physicians of Wisconsin.

The committee is currently reviewing options that can be provided in the immediate future. A model that has been adopted in multiple states is being strongly considered. This proposed model is similar to an Employee Assistance Program, where a limited number of confidential counseling/coaching services are provided without the need to go through one’s employer or health insurance. The option to pilot the program in specific counties is also under consideration.

Updates on the Committee’s progress will continue to be shared. Please reach out to Jim Lorence with any questions or comments.

Minnesota Medical Association physician well-being conference Jan. 28

The Minnesota Medical Association’s (MMA) 5th annual physician well-being conference will be held virtually on January 28, 2021. As a promotional sponsor for this event, Wisconsin Medical Society members can access this conference at the discounted MMA member price of $195 with the code JOYMEDPARTNER.

Bryan Sexton, PhD, an associate professor at Duke University and director of the Duke Center for Healthcare Safety & Quality will kick off the conference with his keynote presentation Bite Size Coping During Times of Uncertainty.

For additional information including a full agenda and registration, click here.

Part 2 of COVID Relief Bill

As expected, the COVID Relief Bill was signed into law just before the end of 2020. The $900 billion bill was embedded in the much larger Consolidated Appropriations Act of 2021.

Click here for some key provisions applicable to Wisconsin families and health care.

Please contact Mark Ziety, CFP®, AIF® at 608.442.3750 with any questions.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society

ACMT to Offer Virtual Total Tox Course for Healthcare Providers

Wed, 06 Jan 2021 20:40:18 GMT

PHOENIX (PRWEB) JANUARY 06, 2021

The American College of Medical Toxicology (ACMT) will present the 2021 Virtual ‘Total Tox Course’ on three Fridays in February – the 5th, 12th, and 19th. Attendees may choose to register for one, two, or for the complete course, all three days. Register here.

The Total Tox Course is a comprehensive review of the scope of emergency toxicology and will include up-to-date interventions and management options for poisoned patients. Prominent experts in medical toxicology and emergency medicine will lead the course. The 3-day course will focus on medical toxicology topics of interest to Physicians, Pharmacists, Advanced Practice Nurses, Nurses, Physician Assistants, Medics, EMTs, Specialists in Poison Information (SPI), Laboratorians, Poison Center Educators, First Responders, Operational or Tactical Specialists, Residents and Students. Attendees will be presented with the most up-to-date information to evaluate and manage cases of poisoning and exposure to medications, drugs of abuse, chemical terrorism, and environmental toxins.

Topics will include:

Dangers and Management of Opioid Abuse
Over-the-Counter Poisons
Carbon Monoxide Poisoning
Envenomations
Disaster Preparedness - Radiation, Nerve Agents, & Biologic Terrorism
Dangers in Your House
Tricyclic Antidepressants, Antipsychotics, SSRIs and Lithium
Ethanol Intoxication & Withdrawal
Plants, Mushrooms & Nutritional Supplements
Toxic Alcohols
Antimicrobials & Antivirals
Drug Screen Pitfalls
Asphyxiants
Anticonvulsants
Malignant Hyperthermia
Local Anesthetic Toxicity
Dysrhythmias
Beta and Calcium Channel Blockers
Toxicity of Endocrine Agents

Course organizer Christina Hantsch, MD, FACEP, FAACT, FACMT explains, “The possibility of a hazmat event is a daily reality; drug overdose has surpassed trauma to become a leading cause of death from injury in the US and is increasing with the COVID-19 pandemic-related stress; exposure to disinfectants, sanitizers and both prescribed and homeopathic COVID-19 treatments are also increasing. With facts such as these in mind, it’s clear that healthcare providers need to stay up-to-date in toxicology.”

This activity is eligible for CME (Continue Medical Education) and CPE (Continuing Pharmacy Education). Registration for the course is open now! Register here.

This course has been recommended by the American Academy of Emergency Medicine (AAEM), American Academy of Emergency Nurse Practitioners (AAENP), American Association of Poison Control Centers (AAPCC), Central State Occupational and Environmental Medicine Association (CSOEMA), Society of Forensic Toxicology (SOFT), and the Wisconsin Society of Addiction Medicine (WISAM).

About ACMT
The American College of Medical Toxicology (ACMT) is a professional, nonprofit association of physicians with recognized expertise and board certification in medical toxicology. Our members specialize in the prevention, evaluation, treatment, and monitoring of injury and illness from exposures to drugs and chemicals, as well as biological and radiological agents. We care for people in clinical, academic, governmental, and public health settings, and provide poison control center leadership.

New DoD Opioid Prescriber Safety Training

Mon, 28 Dec 2020 14:58:29 GMT

The CEPO and DoD Opioid Prescriber Safety Training Work Group has been working diligently to provide an update to the current DoD Opioid Prescriber Safety Training Program on the CE Management System (CMS).

The DoD Opioid Prescriber Safety Training Program stems from the presidential memo, "Addressing Prescription Drug Abuse and Heroin Use," from October 2015 that mandated training for all providers, residents, and clinical trainees in federal health care facilities who prescribe controlled substances. The memo is accessible at http://go.wh.gov/QyMgQT. It was created by tri-service experts and equips providers to improve patient outcomes for substance use disorders and pain management. This program will replace the previous version that closes on 31 December 2020.

The new DoD Opioid Prescriber Safety Training Program will go live in the CMS on 1 January 2021 and will offer participants 2.0 Continuing Education/Continuing Medical Education credits (CEs/CMEs). The training features a video developed by the DoD/VA Joint Pain Education Project (JPEP) to summarize the DoD and VHA approach to pain management, as well as, a video developed by the JPEP that provides clinicians and patients with an explanation and understanding of the New Pain Paradigm driven by emerging evidence regarding the risks of opioid therapy.

Target Audience:
This activity is designed to meet the educational needs of Physicians, Nurses, Pharmacists, Physician Assistants, Dentists, and other health care professionals.

To access the DoD Opioid Prescriber Safety Training Program event flyer, please click here.

2021 Clinical Communities Speaker Series

The Defense Health Agency's Continuing Education Program Office has scheduled the dates for the FY21 Clinical Communities Speaker Series (CCSS). The CE/CME educational activities enhance quality of care, patient outcomes and population health by improving the practice skills and clinical knowledge of health care providers across the military health care system. Participants will have the opportunity to earn up to 7.0 CE/CME credits per series!

Save the Date for the FY21 DHA CCSS Activities:

25 February 2021: Emerging Priorities in Women’s Health
22 April 2021: Youth in Transition
24 June 2021: Exploring Evidence-Based Practices in Modern Medicine Primary Care
26 August 2021: Exploration of Innovations in Health Care
28 October 2021: Promising Practices in Military Health Care

*Please note, event details are subject to change*

Target Audience:
CEs/CMEs are available for the following health care professionals: Physicians, Nurses, Pharmacists, Pharmacy Technicians, Physician Assistants, Optometrists, Dentists, Dental Hygienists, Dental Lab Technicians, Social Workers, Psychologists, Occupational Therapists, Certified Counselors, Case Managers, Kinesiotherapists, Speech-Language Pathologists, Audiologists, Healthcare Executives, Registered Dieticians, Dietetic Technicians, and other health care professionals.

To access the 2021 CCSS Save the Date Flyer, please click here.

Continuing Education:
The DHA, J-7, CEPO awards the credits, which are limited in scope to health care providers who actively provide care to U.S. active-duty service members, reservists, National Guardsmen, military veterans and their families.

Participation:
Please visit the CE Management System to participate in the 2020 DHA CCSS Home Study activities and additional CE/CME offerings: https://www.dhaj7-cepo.com/

https://public.govdelivery.com/accounts/USMHS/subscriber/one_click_unsubscribe?verification=5.f0d309d9b2624539baaa028dff891a51&destination=sally%40badgerbay.co

First COVID-19 vaccinations expected soon

Tue, 08 Dec 2020 16:38:01 GMT

Wisconsin Health News

The first COVID-19 vaccinations are expected in Wisconsin soon.

Wisconsin is set to receive 49,725 first doses of the Pfizer and BioNTech vaccine after it receives emergency use authorization from the Food and Drug Administration, Stephanie Schauer, Department of Health Services Division of Public Health Immunization Program manager, told reporters Monday.

And DHS also expects Wisconsin to receive a first allocation of 16,000 doses of the Moderna vaccine this month once it's approved, a spokeswoman said. Further allocations of vaccines doses would arrive in the following weeks, she said.

DHS Deputy Secretary Julie Willems Van Dijk said the vaccine has not arrived in Wisconsin yet, but they’ll start giving doses sometime this month.

“Distributing COVID-19 vaccine is the most significant public health undertaking of our lifetimes,” Willems Van Dijk told reporters. “It will require both preparedness and adaptability and patience.”

Wisconsin will use a “hub-and-spoke” model to disseminate the Pfizer vaccines, which will arrive in batches to hubs like health systems in each of the state’s healthcare emergency response coalition regions, Willems Van Dijk said.

Those hubs will be equipped with the ultra-cold storage needed to store the vaccine. Once at the hubs, vaccines will head to smaller clinics around the area.

The Moderna vaccine, when approved and available, will be sent directly to vaccinators since it doesn’t require ultra-cold storage, Willems Van Dijk said.

DHS plans to prioritize front-line healthcare workers and long-term care facility residents, followed by high-risk groups. Then the general public will be eligible.

Willems Van Dijk said it’ll take months to vaccinate everyone in Wisconsin, meaning people will have to continue using preventive measures for some time.

She predicted summer or fall would be a “really realistic goal” for moving beyond COVID-19 precautions, like mask wearing and social distancing.

“I know everybody’s excited and we’d love to take our masks off by Valentine’s Day, but that’s not just going to happen,” she said.

She also said they’re working on a contract for additional vaccinators, given that healthcare providers and public health workers are “deeply embroiled” in responding to the pandemic.

Willems Van Dijk said they’re assessing who has capacity and where additional workforce might be needed.

The UW System recently offered tuition credit to nursing students who help vaccinate. Willems Van Dijk said that Wisconsin Emergency Management and the Wisconsin National Guard could help bolster efforts.

Walgreens and CVS will provide vaccinators in long-term care facilities, she added.

Introduction to AMNet: Addiction Medicine Practice-based Research Network (AMNet)

Tue, 08 Dec 2020 15:44:13 GMT

The American Society for Addiction Medicine (ASAM), American Psychiatric Association (APA), National Institute on Drug Abuse (NIDA) and Friends Research Institute (FRI) are developing the Addiction Medicine Practice-based Research Network (AMNet) to address the nation's opioid epidemic.

Though addiction medicine/psychiatry practices play an essential role in responding to the opioid epidemic, little is known about the type of patients treated in these practices, the type and quality of services their patients receive, and their patient outcomes. These practices often have limited opportunities to organize their data for quality improvement (QI) efforts and are rarely invited to participate in clinical research. AMNet aims to change this disparity.

On December 18, a special information and session on AMNet will be held virtually to introduce participants to the background and aims of AMNet, discuss eligibility criteria and advantages of participating in AMNet, and demonstrate how to access AMNet standardized tools and quality measures in the PsychPRO.

AMNet Informational Session
Friday, December 18, 2020
2:00 pm CST / 3:00 pm EST
Please register in advance

Questions may be directed to AMNet@psych.org

UPCOMING: Total Tox Course - Virtual Event - February 2021

Mon, 07 Dec 2020 15:20:43 GMT

The ACMT Total Tox Course is a comprehensive review of the scope of emergency toxicology and will include cutting-edge interventions and management options for poisoned patients. Prominent experts in medical toxicology and emergency medicine lead the course.

The online course will focus on medical toxicology topics of interest to emergency providers, including toxicological issues of current clinical and public health importance. Attendees will be presented with state-of-the-art updates on the evaluation and initial management of poisoning and exposure to medications, drugs of abuse, chemical terrorism, and environmental toxins.

Target Audience: Physicians, Pharmacists, Advanced Practice Providers, Nurses, Medics, EMTs, SPIs, Laboratorians, Poison Center Educators, First Responders, Operational or Tactical Specialists, Residents and Students.

Click here for more information!

Registration open for Doctor Day!

Thu, 03 Dec 2020 22:31:42 GMT

Wisconsin Medical Society | Medigram

Doctor Day, the state’s premier event for physician advocacy, is set for May 5, 2021. Preparations are underway to ensure the event can be held that day either virtually or in-person – so be sure to save the date! As the state looks forward to finding a way through the COVID-19 pandemic, the 8th annual Doctor Day could be the most important ever. Elected officials and policymakers always benefit from physicians sharing their expertise; that knowledge will be needed even more in spring 2021.

One of the most popular aspects of Doctor Day is meeting with Capitol legislators and staff, and those important interactions will be on the agenda as well – either virtually or in-person depending on the COVID-19 situation at the time. Of those attending last year’s Doctor Day, 99 percent said they would “highly recommend” the event to their colleagues.

Please save the date and register today at widoctorday.org. Contact Heidi Green for more information.

December Updates from the Wisconsin Medical Society

Wed, 25 Nov 2020 12:30:00 GMT

COVID-19 Risk Chart to share with your patients

The current rise in COVID-19 cases has shown that a significant portion of the general public remains unsure about activities that put them more at risk for catching the underlying virus despite widespread information about COVID-19. To help inform your patients, the Wisconsin Medical Society’s (Society) COVID-19 Task Force has created this downloadable display that you can use when talking with your patients, have on display in your examining rooms, lobby or other areas where patients may see it or give to your patients at discharge.

The Society’s COVID-19 Task Force meets every other week to discuss the latest issues related to the pandemic and strategize on ways to support physicians and better educate the public. Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD with any questions or suggestions.

Nominees sought for Society offices; deadline Jan. 4

Nominations are now being accepted for several Wisconsin Medical Society (Society) offices, and all nomination materials are due to the Society’s Nominating Committee by Monday, January 4, 2021.

Candidates are sought for the following offices:

President-Elect for 2021-2022
AMA Delegate for 2022 and 2023 (two positions) – George Lange, MD, of River Hills (incumbent and eligible for reelection); Charles Rainey, MD, JD of River Hills (ineligible for reelection)
AMA Alternate Delegate for 2022 and 2023 – Don Lee, MD, of Milwaukee; Nameeta Dookeran, MD, of Waukesha (both incumbents and eligible for reelection)

All candidates must submit a curriculum vitae not to exceed three pages, a cover letter no longer than one page, a completed candidate questionnaire for the office the candidate is seeking and a completed Disclosure of Significant Affiliations (conflict of interest) form. The candidate questionnaire forms are available here.*

The Nominating Committee will meet Friday, Jan. 22, 2021, at 4 p.m. via Zoom. The Committee will interview and evaluate the candidates for Society offices and prepare a slate of nominees for presentation to the membership.

Those serving on 2020-2021 Nominating Committee are:

District 1—Arthur Angove, DO, of New Berlin; Joshua Gershtenson, MD, of Kenosha; David Galbis-Reig, MD, of Racine; Michelle Graham, MD, of Milwaukee; Cynthia Jones-Nosacek, MD, of Milwaukee; Aurora Lybeck, MD, of Hartford; Anthony Rieder, MD, of Wauwatosa.
District 2—Lynn Broderick, MD, of Madison; Michele Brogunier, MD, of Madison; Natalie Wheeler, MD, of Madison; Alan Schwartzstein, MD, of Oregon.
District 3—Hilary Bingol, MD, of La Crosse; Michael White, MD, of Onalaska.
District 4—Larry Gordon, DO, of Weston; Michele Montgomery, MD, of Wausau; William Raduege, MD, of Woodruff.
District 5—Bret Pasiuk, MD, of Fond du Lac.
District 6—Bradley Burmeister, MD, of Green Bay.
District 7—Cecil Berlie, MD, of Eau Claire; Lee Hofer, MD, of Eau Claire.
District 8—Charles Bertel, MD, of Ashland.
Specialty Sections—Vacant.
Resident/Fellow—Evan Henricks, MD, of Milwaukee.
Medical Students—Kyle Bevers, Medical College of Wisconsin; Noah Borchardt, University of Wisconsin School of Medicine and Public Health.

Communications to the Nominating Committee should be addressed to Clyde “Bud” Chumbley, MD, MBA, CEO, Wisconsin Medical Society, PO Box 1109, Madison, WI 53701. Communications also can be emailed to Noreen Krueger. Click here to learn more about the nominating process and to download the candidate questionnaires and the conflict of interest form.*

Note: The Society will post the completed candidate questionnaire and cover letter on WisMed Community upon submission. The Society will post the conflict of interest form of all candidates selected by the Nominating Committee as nominees on WisMed Community after nomination by the Committee.

For questions or more information, email Noreen Krueger.

*WisMed Community is a members-only resource and will require you to log in. For questions or assistance please contact Anne Hauer.

Financial lunch and learn sessions

Put the major financial pieces in place for your future by joining one or all of the lunch and learn classes hosted by WisMed Financial. The Retirement Readiness series is focused on decisions for those near or in retirement. Financial Planning 101 provides a good knowledge base for anyone. All of the sessions start at noon. To register please visit wismedfinancial.org/lunch-learn.

Retirement Readiness
11/19 Have you saved enough and Social Security
12/3 Wills, estate documents and charitable giving
12/10 Replacing the paycheck with investments and smart tax planning
12/17 Health insurance, Medicare and long-term care

Financial Planning 101
11/17 Cash flow and eliminating debt including student loans
11/24 Charitable giving, wills and other estate documents
12/1 Saving for retirement and kids’ college
12/8 Building an investment portfolio
12/15 Smart tax strategies, life and disability insurance

To learn more or for questions, please contact Mark Ziety, CFP®, AIF® of WisMed Financial, Inc.

Mark Ziety, CFP®, AIF®
WisMed Financial, Inc. part of the Wisconsin Medical Society

Society continues statewide push for smart COVID-19 behaviors

Building off of Governor Tony Evers’s November 18 announcement that he will declare another public health emergency and extend the face coverings order through mid-January 2021, the Wisconsin Medical Society (Society) called on the state to help protect physicians and other health care staff in the face of a growing COVID-19 pandemic.

“Every day, more Wisconsin physicians... are personally affected by the pandemic, and that means hospital capacities are even more strained,” Society President Erik Gundersen, MD, said in a press statement provided to the state’s media outlets. “Everyone in Wisconsin needs to rally around what can attack this pandemic.

“If we all do this, we can save lives,” Gundersen said.

As various gubernatorial orders have been challenged in the state’s courts as an overreach of executive branch power, Wisconsin’s COVID-19 case numbers continue to rise – dragging hospitalizations and ICU bed usage numbers along with them. Combined with more health care staff succumbing to the virus itself or quarantining due to exposure, dramatic action is needed to help stave off even worse overall outcomes.

“The Society is continuing to call for all private and public entities to help fight the pandemic and protect our heroic health care workforce,” Society CEO Bud Chumbley, MD, MBA, said. “Physicians can lead the way in urging our communities to put politics aside and do the things that we know make a difference: wash hands, wear masks and stay home.

“The Society will continue to use all of its means to help physicians during the pandemic,” Dr. Chumbley said. “And that includes urging the public to step up for their physicians and the communities they serve.”

As the holiday season approaches – and as COVID-19 cases continue to rise at alarming rates – the Society’s COVID-19 Task Force created this downloadable display that can be used when talking with patients, as a display in examining rooms, lobbies or other areas where patients may see it or give to patients at discharge. Additionally, Wisconsin Department of Health Services (DHS) produced an informational piece about how to celebrate the holidays safely.

Physicians can access the Society’s COVID-19 Resources page for additional tools that can help them educate the public about smart COVID-19 behaviors and other information.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

ASAM 2020 National election is NOW open through December 7, 2020

Mon, 23 Nov 2020 18:00:00 GMT

The ASAM 2020 National election is NOW open through December 7, 2020.

ASAM’s Officers and Board of Directors define the strategy and direction of ASAM and ensure our policies, programs, and services align with ASAM’s mission. This year we are selecting who will represent our chapter on the ASAM Board as regional director. This is an important election and I encourage everyone to participate.

The individuals elected represent YOU and speak as the voice of addiction medicine for ASAM. Make your voice heard by casting your electronic vote TODAY for ASAM’s 2021 Officers and Regional Directors.

Physician members should have received a special email from ASAM’s election vendor Survey & Ballot Systems with your unique, encrypted, ballot link. Check your email and vote today! Click here to preview this year’s nominees.

**If you do not have your election login information, please click on the link below, enter your email address that is on file with ASAM, and your election login information will be emailed to you. https://www.directvote.net/asam/sendID.aspx

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

Wed, 11 Nov 2020 19:51:17 GMT

Early lessons from maternal mortality review committees on drug-related deaths - time for obstetrical providers to take the lead in addressing addiction
Marcela C. Smid, MD, MA, MS; Charles W. Schauberger, MD; Mishka Terplan, MD; Tricia E. Wright, MD

The problem: In the United States, maternal mortality review committees are providing compelling data that drug-related deaths are emerging as a leading cause of pregnancy-associated death (death during pregnancy or up to a year postpartum). Recommendations from the maternal mortality review committees consistently highlight screening all pregnant and postpartum women for drug use and improving access to evidence-based substance use disorder and mental health treatment. Unfortunately, many providers lack the confidence, skills, and necessary resources to screen for substance use, provide basic behavioral health services, or facilitate referral to high-quality services in their clinical settings. Our profession’s collective lack of response to a leading cause of maternal death represents a missed opportunity for potentially life-saving interventions.

A solution: We call on our fellow obstetrician-gynecologists to incorporate the lessons learned from maternal mortality review committees and integrate addiction assessment and treatment into prenatal and postpartum care. However, provider-level integration of behavioral health services is insufficient to fully address the magnitude of drug-related maternal deaths in the United States. Therefore, we ask our colleagues to address the structural and systemic barriers to care identified by the maternal mortality review committees. By doing so, we can prevent drug-related maternal deaths.

Read the full article here.

Pfizer, BioNTech say Covid vaccine is more than 90% effective — ‘great day for science and humanity’

Tue, 10 Nov 2020 19:06:18 GMT

CNBC | Sam Meredith

Pfizer and BioNTech announced Monday their coronavirus vaccine was more than 90% effective in preventing Covid-19 among those without evidence of prior infection, hailing the development as “a great day for science and humanity.”

I think we can see light at the end of the tunnel,” Pfizer Chairman and CEO Dr. Albert Bourla told CNBC’s Meg Tirrell on “Squawk Box.” “I believe this is likely the most significant medical advance in the last 100 years, if you count the impact this will have in public health, global economy.”

The announcement comes as drugmakers and research centers scrambled to deliver a safe and effective vaccine to help bring an end to the coronavirus pandemic that has claimed over 1.2 million lives worldwide.

Scientists are hoping for a coronavirus vaccine that is at least 75% effective, while White House coronavirus advisor Dr. Anthony Fauci has said one that is 50% or 60% effective would be acceptable.

Wisconsin has largest drug take back collection in country

Tue, 10 Nov 2020 19:00:05 GMT

Wisconsin Health News

Wisconsin had the largest drug take back collection in the country this year during a national daylong event in late October, Attorney General Josh Kaul said Monday.

The state collected 89,982 pounds of unused and unwanted medications on Oct. 24.

Kaul said in a statement that the “efforts help with the fight against substance-use disorder by ensuring that those unused medications won’t be diverted.”

Across the state, 230 law enforcement agencies hosted events and collected drugs from 485 permanent drug disposal boxes.

The drugs will head to Indianapolis where they’ll be incinerated.

November Updates from the Wisconsin Medical Society

Sun, 01 Nov 2020 15:08:24 GMT

Financial planning now available to WisMed members

In order to help Wisconsin Medical Society members be secure, the Society has launched WisMed Financial, Inc. “Helping members with their finances can change the direction of a family and is a tremendous responsibility. WisMed Financial will have a meaningful and positive influence for our members,” said Mark Ziety, CERTIFIED FINANCIAL PLANNER™. And the data supports it. Fifty percent of physicians under age 40 who use a professional financial advisor are ahead in savings, emergency funds and retirement tools according to a report.

To ensure the client’s interest always comes first, the company follows a no commission, fee-only model and is held to the fiduciary legal standard. According to The White Coat Investor®, it is estimated that 80% of doctors need, want and should use a financial planner and/or an investment manager. So it was important to put these high standards in place at the company’s creation.

Providing top-notch service and products is critical, too. The firm is partnering with TD Ameritrade, RightCapital and other industry leaders. In addition, Mark Ziety brings more than 15 years of experience, he is a CERTIFIED FINANCIAL PLANNER™ and Accredited Investment Fiduciary®.

The company helps members invest and plan for retirement, eliminate student loans, reduce taxes, plan for their family (wills and trust), charitable strategies, college funding and other personal financial matters. Mark can be reached at mark.ziety@wismedfinancial.org or 608.442.3750.

Packers, other state pro teams join WisMed in COVID coalition

The Green Bay Packers, Milwaukee Brewers and Milwaukee Bucks have joined the ever-growing coalition of health care, business and government advocacy organizations urging the public to help control the spread of COVID-19. The Stop the COVID Spread! coalition also released another public service announcement statewide on October 26 featuring the Packers’ Adrian Amos, Kenny Clark and Marquez Valdes-Scantling. This new message follows on the heels of another PSA featuring former Wisconsin Governor and current UW System President Tommy Thompson.

The Wisconsin Medical Society (Society) is a founding member of the coalition, helping to launch the campaign earlier this month.

“The Packers playing in an empty Lambeau Field really drives home the point of what can happen when a pandemic hits our state,” Society CEO Bud Chumbley, MD, MBA, said. “I know we all miss getting together with our family and friends to do things like watch the Packers play, so we hope the message of masking, hand washing and social distancing coming from some of Green Bay’s finest themselves will grab people’s attention.”

The Society is also using its social media accounts to help share these safe behavior messages; Society members are encouraged to share, retweet and post those messages on their own personal accounts.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

SARS-CoV-2 CME series begins next week with Virus Biology and Vaccine Development

Scott S. Terhune, PhD, Professor of Microbiology & Immunology and Biomedical Engineering at the Medical College of Wisconsin (MCW), kicks off the first of five sessions in the Wisconsin Medical Society’s SARS-CoV-2 CME Town Hall Series* with the presentation Virus Biology and Vaccine Development.

Terhune received his PhD from Northwestern University and his postdoctoral training at Princeton University. He participates in both graduate student and medical student education at MCW focusing on virus replication and infection. Research in the Terhune laboratory focuses on defining how human cytomegalovirus manipulates human cells and alters networks of interactions to support infection.

This webinar is free for Wisconsin Medical Society members, but registration is required to attend.

Session topics and schedule for the entire series are listed below. All live presentations will be held from 12:15 – 12:45 p.m. To view the sessions and to register click here.

November 4, 2020: SARS-CoV-2 Virus Biology and Vaccine Development
November 11, 2020: The Current State of Therapeutics
November 18, 2020: Communicability and Public Health Response
November 25, 2020: The Convergence of Seasonal Flu and SARS-CoV-2
December 2, 2020: Combating COVID-19 Challenges in Disadvantaged Populations – a Case Study

Please email education@wismed.org with any questions.

*This activity has been approved for AMA PRA Category 1 credit™.

Governor’s prescription costs task force releases final recommendations

Governor Tony Evers’s Task Force on Reducing Prescription Drug Prices released its final recommendations October 21 on potential future state law and policies that could improve prescription drug accessibility and affordability. The task force membership included 21 people from diverse backgrounds, including members from the state executive and legislative branches and private citizens with health care, insurance and consumer experience. Wisconsin Medical Society member Michael Goldrosen, MD, was a task force member.

The task force divided their recommendations into separate tiers: those with support from a majority of the task force, issues for further consideration and issues that came up but weren’t discussed thoroughly. Among the top-tier items:

Passing legislation related to pharmacy benefit managers (PBM) similar to a bill proposed and amended this legislative session (Assembly Bill 114 as amended by Assembly Substitute Amendment 1) that passed the state assembly unanimously but did not receive a state senate vote.
Limiting what insurers can charge for a month’s insulin supply.
Requiring companies in the prescription drug supply chain to provide information to aid transparency in understanding the cost drivers of high-costs prescription drugs.
Increasing the number of state Department of Justice consumer protection and antitrust attorneys focused on improper drug company practices.
Developing a statewide medication repository with a centralized prescription drug inventory or collaborating with an existing system in another state.

The entire 156-page report is available here, along with information about the task force’s activities and membership. An executive summary is here. It is likely that some items in the report could be included in Governor Evers’s next biennial budget proposal, which will be unveiled in the winter of 2021.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

ASAM Partners with ACOG to Provide X-Waiver Courses

Fri, 23 Oct 2020 15:35:13 GMT

In partnership with American College of Obstetricians and Gynecologists (ACOG), the American Society of Addiction Medicine (ASAM) is providing courses to help providers, who care for pregnant women, obtain their X-Waiver and feel more comfortable with management of substance use disorders during pregnancy.

They are also offering a question + answer session to focus on more specific, provider-driven concerns and to offer mentorship.

Please share on your networks!

Here is the link: https://www.asam.org/education/live-online-cme/waiver-qualifying-training/ob-gyn-focus

CDC COCA Call: Leveraging Existing Resources to Meet the Challenges Faced by People Who Use Drugs or Who Have Substance Use Disorders During the COVID-19 Pandemic

Thu, 22 Oct 2020 18:20:27 GMT

Wisconsin DHS

The COVID-19 pandemic has presented challenges in healthcare for those who may be at greater risk for adverse health outcomes such as people who use drugs or people who have a substance use disorder. To better facilitate provision of care, the Centers for Disease Control and Prevention (CDC) organized a COCA Call on Thursday, October 22 to help improve understanding among clinicians of the concerns of people who use drugs and people who have a substance use disorder. The COCA Call featured speakers from CDC, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the American Society for Addiction Medicine (ASAM).

During the COCA Call, subject matter experts highlighted existing resources and exceptions for clinicians who prescribe medications for opioid use disorder, increased awareness of existing community-based linkage to care resources, and discussed the outpatient telemedicine experience from a front-line provider perspective.

If you were unable to attend the live COCA call, the recording and slide set will be available for viewing on the COCA Call webpage a few hours after the live event.

Free Continuing Education (CE) will be offered for the COCA Call.

Vote Safe Wisconsin 2020

Wed, 07 Oct 2020 19:57:02 GMT

WISAM has joined the Vote Safe Wisconsin 2020 Coalition! We are committed to sharing with our community partners about encouraging safe voting. We encourage you to vote absentee, early, or with a mask and social distance at the polls! Join us and learn more: https://www.wpha.org/mpage/VoteSafeWisconsin2020

October Updates from the Wisconsin Medical Society

Tue, 06 Oct 2020 14:50:54 GMT

WISAM is pleased to share these updates from our partners at the WI Medical Society

As Governor extends statewide mask order, the Society urges proactive public behaviors

As Governor Tony Evers declared a new public health emergency and issued a new face covering mandate on September 22 due to increases in the state’s COVID-19 case rate, the Wisconsin Medical Society (Society) took the opportunity to remind the public how they can take proactive measures to help reduce the spread of the virus, regardless of any government action related to the pandemic.

In a media statement sent statewide the afternoon of the Governor’s announcement, Society CEO Bud Chumbley, MD, MBA, emphasized how mask wearing, physical distancing and regular hand washing are proven effective strategies to reduce the spread of COVID-19. “If we all agree to take simple steps, we can reduce the spread of the pandemic and protect our state’s physical and economic health,” Dr. Chumbley said in the statement. “We strongly urge everyone to wear masks, maintain social distancing and continue to wash hands often and thoroughly,” Dr. Chumbley said. The statement also emphasized that with seasonal influenza season looming, getting a flu vaccination is another action individuals can take that helps protect themselves and the public.

The statement is the latest in a series of actions the Society has taken to help remind the public of their important role in helping stem community spread, including three public service announcements that have been aired on statewide television and on the Society’s various social media channels.

Contact Mark Grapentine, JD for more information.

Medical Examining Board concerned over possible proposal to change nursing collaboration requirement

Many physician members of the state’s Medical Examining Board (MEB) raised concerns at its monthly meeting on September 16 over a potential Board of Nursing (BON) proposal that would repeal a requirement that Advanced Practice Nurse Prescribers (APNP) work in collaboration with at least one physician or dentist. While the MEB does not have jurisdiction over how nurses are regulated, numerous MEB members were concerned that such a proposal would have negative impacts on Wisconsin’s high-quality health care system.

The MEB’s concerns rose from a BON meeting on Sept. 10, which included initialization of the process used to change the administrative code: preparing a proposed “Scope Statement” laying out the desired change. The specific scope statement proposal, which requires approval from the Governor before it can be developed further, was included in yesterday’s MEB agenda for discussion.

State MEB administrative staff indicated that the BON may be withdrawing or further modify the scope statement and said a BON subcommittee will be discussing the issue Sept. 18. The Society will attend that subcommittee meeting and has already been in contact with other physician-centric advocacy organizations to ensure all are aware of the possible attempt to alter the collaboration requirement.

In other action, the MEB unanimously approved its own scope statement for a regulatory update that would extend the current requirement for physicians holding a U.S. Drug Enforcement Administration number to complete controlled substance education as part of the 30 hour biennial license requirement.

That statement will now be sent to the Governor for review; the Board will further develop the rule following the Governor’s likely approval.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Society's COVID-19 Task Force asks physicians to review DHS alert on antigen testing

The Wisconsin Medical Society’s (Society) COVID-19 Task Force recommends that Wisconsin physicians review a COVID-19 Health Alert on antigen testing issued today, September 24, by the state’s Department of Health Services’ (DHS) Bureau of Communicable Diseases.

Calling this testing an “important and evolving topic,” DHS Chief Medical Officer and State Epidemiologist for Communicable Diseases Ryan Westergaard, MD, PhD, MPH, provides important information regarding various aspects of this type of testing, including considerations for using antigen tests in symptomatic vs. asymptomatic patients, the characteristics of the antigen tests for SARS-CoV-2 currently available and a list of antigen tests currently authorized for use in the U.S.

The Society’s COVID-19 Task Force continues to meet biweekly as Wisconsin battles the pandemic, and regularly updates relevant information on the Society’s COVID-19 Resources webpage.

Contact Society CEO Bud Chumbley, MD, MBA with any questions for the COVID-19 Task Force.

Virtual Trivia – October 8

Join your fellow Wisconsin Medical Society members for a virtual WisMed Meet Up! Trivia nights provide an opportunity to connect with your peers across the state from the comfort of your home.

The Society will create trivia teams, or you are welcome to invite colleagues to create a team of your own by emailing Jess. (Maximum of 4 people per team).

Date: Thursday, October 8, 2020
Time: 6:00-7:00 p.m.
Register here!

Gift cards will be awarded to the winning team! Please contact our Membership Specialist at jessica.schreiter@wismed.org with any questions.

Thanks to Exact Sciences for sponsoring this member exclusive event!

Calling Addiction Medicine Physicians to Become Poll Workers: How You Can Help Wisconsin Elections

Mon, 05 Oct 2020 14:48:57 GMT

The Wisconsin Elections Commission encourages every eligible citizen to vote and to become involved in the election process. One way to get involved is to become an Election Day poll worker, also known as an election inspector).

Citizen involvement is essential to conduct open, accurate and fair elections in Wisconsin. And, Addiction Medicine Physicians as well as other healthcare providers are uniquely positioned given the comfort level with PPE.

There are several different jobs at polling places in Wisconsin, all of which are appointed by municipal clerks. Learn more at elections.wi.gov.

Governor Evers Announces New Emergency Order

Fri, 02 Oct 2020 15:58:14 GMT

In response to the increasing COVID-19 cases, Governor Evers announced a new Emergency Order—EO-2. Included in this new order are new provisions applicable to health care providers including interstate reciprocity, credentialing, and Telemedicine.

In addition, the provisions from previously released EO-16 related to physician assistants and nurses are included by reference. The new order is effective immediately and unless suspended by the legislature or the courts, will remain in effect for the duration of the federal declared public health emergency.

View the Governor's press release.

Trump Administration Announces $20 Billion in New Phase 3 Provider Relief Funding

Thu, 01 Oct 2020 20:02:24 GMT

U.S. Department of Health & Human Services | HHS.gov

Today, under the leadership of President Trump, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing $20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Under this Phase 3 General Distribution allocation, providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.

Providers can begin applying for funds on Monday, October 5, 2020.

“HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus,” said HHS Secretary Alex Azar. “We’ve worked with all of the resources we have across HHS to ensure that America’s heroic healthcare providers know they can apply for support.”

HHS has already issued over $100 billion in relief funding to providers through prior distributions. Still, HHS recognizes that many providers continue to struggle financially from COVID-19’s impact. For eligible providers, the new Phase 3 General Distribution is designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.

Further, HHS recognizes constraints such as the stay-at-home orders and social isolation have been particularly difficult for many Americans. A recent Centers for Disease Control and Prevention (CDC) report found the prevalence of symptoms of anxiety disorder in the second quarter of 2020 was approximately three times those that reported in the second quarter of 2019 (25.5% versus 8.1%); and the prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%). Our behavioral health providers have shouldered the burden of responding and confronting this expanded challenge triggered by the pandemic. When traditional face-to-face counseling was restricted and new telehealth flexibilities were put in place in response to the pandemic, many behavioral health providers invested in and adopted - PDF telehealth technologies to continue providing patient care. While some Medicare or Medicaid behavioral health providers have already received prior General Distribution payments, others have not. Working with the Substance Abuse and Mental Health Services Administration (SAMHSA), HRSA developed a list of the nation’s behavioral health providers now eligible for funding, which includes, for example, addiction counseling centers, mental health counselors, and psychiatrists.

National Addiction Treatment Week: SAVE THE DATE

Wed, 16 Sep 2020 18:54:10 GMT

National Addiction Treatment Week is an initiative which promotes that addiction is a disease, evidence-based treatments are available, and recovery is possible. The week also highlights the need for clinicians to enter the field of addiction medicine. Join us October 19 - 25, 2020!

The American Society of Addiction Medicine (ASAM) launched National Addiction Treatment Week in 2017 along with partner organizations in order to generate awareness of the disease of addiction and push for more medical professionals to enter the field of addiction medicine.

Find more information on the website and stay tuned as WISAM shares information, resources and more leading up to and during this designated week!

Final Rule: 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records

Wed, 19 Aug 2020 20:17:41 GMT

On July 15, 2020, a final rule revising the federal regulations governing the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2 (Part 2), was released by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. The rule will go into effect on August 14, 2020. A SAMHSA fact sheet outlining the changes is here and the final rule here.

Between the time the Part 2 proposed rule was released and the final rule was promulgated, Congress included legislation to align 42 CFR Part 2 with HIPAA for the purpose of treatment, payment and operations in section 3221 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The legislation was originally introduced in the Senate by Senators Joe Manchin (D-WV) Shelley Moore Capito (R-WV) in the Protecting Jessica Grubb’s Legacy Act, and in the House by Representatives Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK) in the Overdose Prevention and Patient Safety Act.

The CARES Act became law on March 27, 2020. SAMHSA will need to release new regulations to implement the law, which are required no earlier than March 27, 2021. The SAMHSA regulations going into effect on August 14, 2020 do not include provisions from the CARES Act.

How your health care has evolved in the era of COVID-19

Fri, 14 Aug 2020 17:14:31 GMT

Open Record: Telehealth Trends | By Amanda St. Hilaire | Fox 6 Milwaukee

"We all know the coronavirus has changed so much in our day-to-day lives and that includes our health care. Many people have shifted to seeing doctors and various specialists virtually. Telemedicine numbers have never been higher and experts say how we're treated by medical professionals could potentially be changed forever. In this episode of Open Record, FOX6 Investigator Amanda St. Hilaire shares a recent conversation she had with the medical director of Addiction Services at Ascension Wisconsin All Saints.

David Galbis-Reig is also the president of the Wisconsin Society of Addiction Medicine. Amanda and David dive into an issue affecting everyone: How your health care has evolved in the era of COVID-19. One of the main topics of their conversation revolves around addiction -- from opioids to methadone."

Listen to the full story here.

Telehealth All-Inclusive Webinar Recordings Now Available

Fri, 07 Aug 2020 18:32:22 GMT

The Wisconsin Department of Health Services (DHS) hosted all-inclusive webinars last week to engage providers, provider associations, members, and member advocates in telehealth expansion. These webinars provided an overview of the telehealth expansion project and gathered input on permanent telehealth policy.

Recordings of the webinars are now available on the telehealth webpage. You can also view and download the presentation slides on that page.

DHS gets $2 million to support behavioral health during COVID-19

Thu, 06 Aug 2020 18:20:22 GMT

Wisconsin Health News

A $2 million federal grant will help support the state’s behavioral health response to the COVID-19 pandemic, the Department of Health Services said Wednesday.

DHS is partnering with seven counties identified as having the greatest need for behavioral health services relative to the COVID-19 pandemic. The counties are:

Brown County - $140,930
Dane County - $292,498
Kenosha County - $270,000
Milwaukee County - $320,000
Racine County - $122,512
Rock County - $212,702
Waukesha County - $168,833

They’ll use it to develop programs to help those facing the greatest challenges during the pandemic. That could include addressing barriers to care, expanding services for those experiencing or at risk of homelessness and enhancing supports for foster care families.

Other efforts include providing telehealth, substance-free housing, safe spaces for residential use treatment and peer specialists.

Mental Health America of Wisconsin is getting $48,016 to provide treatment services to healthcare workers through telehealth. And Behavioral Consulting Services is getting $58,203 to provide treatment and recovery support to staff at long-term care facilities.

The remainder of the money is going to data collection and monitoring of the outcomes and efficacy of the projects. Grant funding is available through August 2021.

EVERS DECLARES NEW PUBLIC HEALTH EMERGENCY, ISSUES MASK MANDATE

Thu, 30 Jul 2020 19:38:22 GMT

Wisconsin Health News

Gov. Tony Evers issued an emergency order on Thursday mandating that Wisconsinites wear masks when indoors starting Saturday.

Evers issued the order by declaring a public health emergency. It’s the second public health emergency he’s declared during the pandemic.

Under the order, which expires Sept. 28, Wisconsinites over the age of 5 will have to wear a face covering when indoors or in an enclosed space if they’re around people who aren’t members of their household or living unit. The order doesn’t apply to private residences.

Face coverings will be recommended when outdoors.

Evers said that local health departments “have been doing a heck of a job” responding to the pandemic, but there needs to be a statewide approach to fighting the virus.

“While I know emotions are high when it comes to wearing face coverings in public, my job as governor is to put people first and to do what’s best for the people of our state, so that’s what I am going to do,” Evers said.

View the full article here.

COVID Workplace Policy Generator

Tue, 28 Jul 2020 18:57:07 GMT

As states reopen, many small and medium-sized healthcare and other businesses are struggling to sift through all the evolving guidance to create comprehensive, user-friendly return-to-work plans. Yet, having a thoughtful plan in place is critical to controlling the spread of COVID-19 as you increase activity in your workplace and mitigating liability should employee complaints arise.

Badger Bay is pleased to announce that we have partnered with premier law firm Husch Blackwell LLP to offer members a special discount on an easy, quick, and affordable tool that your members can use to create customized Return-to-Work policies. Husch Blackwell’s new Return-to-Work Policy Generator enables businesses of all sizes to quickly create return-to-work plans, customized to their operations, without starting from scratch. Built-in are Husch Blackwell’s knowledge of health, safety and employment issues, and extensive experience helping clients navigate the COVID-19 crisis.

The tool involves a 15-minute secure online questionnaire to learn about each company’s operations and policy needs. It generates a customized policy, which an attorney works to finalize directly with the company through an included consultation. Most policies are ready within a few business days.

Through the tool, Husch Blackwell offers each policy for a flat-fee price quoted up-front based on the complexity of each company’s operations and needs. Members of your associations can enter a referral code (“BadgerBay”) while completing the questionnaire to obtain an additional 10% discount.

To learn more, see a demo, and try the tool, visit the Return-to-Work Policy Generator here.

What does it involve?

Your member fills out a quick online questionnaire (approx. 15 minutes)
After determining the scope of the policy, the company will receive a low, flat price (starting at $1,500)
An attorney works with the company to finalize a customized draft

This is great for lots of companies…

Especially small, mid-sized, and regional firms (DIY is overwhelming!)
Even those with essential workers (non-essential workers may be returning to work)
Especially those in multiple states (the policy pulls in relevant state requirements)
Even those that already returned to work (many reopened quickly but still need a policy)

What’s special here?

Quick and easy guided online questionnaire
State-specific and federal guidance
Industry-specific provisions where applicable
Customized to each company’s operations/workplaces
Optional forms and links to CDC/OSHA posters
Upfront pricing with low, flat fee
Included one-on-one attorney review and client consult
Saves hours of time and lots of money

DHS: Suspected opioid overdoses up 117 percent

Thu, 23 Jul 2020 18:09:40 GMT

Wisconsin Health News

The Department of Health Services said Wednesday that suspected opioid overdoses are up 117 percent since the start of the COVID-19 pandemic compared to the same time in 2019.

Preliminary data show 325 suspected opioid overdoses from March to July 13, compared to 150 suspected overdoses during the same time in 2019.

Paul Krupski, DHS director of opioid initiatives, said the pandemic has increased stress and anxiety.

“For individuals who have struggled with substance abuse and may currently be in treatment for that, this adds an extra layer to the challenges,” Krupski told reporters. “What we’re really trying to stress is to make sure that they know that there are healthy ways to cope with it. There are ways to make sure they continue down their path of recovery.”

According to a DHS statement, calls to 211 Wisconsin that include request for information on behavioral health have also increased. Under additional funding from DHS, specialists with the Addiction Recovery Helpline are now able to follow up with people asking for help.

The department has launched its Resilient Wisconsin campaign during the pandemic, which promotes healthy ways of dealing with stress and trauma. Program Manager Robin Matthies, said the pandemic has increased anxiety.

“It’s just really important that folks are paying attention to how they feel and to how people they care about might be doing,” Matthies said.

"An open letter to the people of Wisconsin..."

Wed, 22 Jul 2020 15:29:10 GMT

Wearing a face mask, maintaining physical distancing and regular handwashing are the most effective ways to protect yourself, your family, your friends and your fellow Wisconsinites from becoming infected with COVID-19.1,2 It could still be more than a year before an effective vaccine is developed and new therapies are still being studied for their safety and effectiveness.3 The spread of COVID-19 and the duration of the pandemic did not end with the lockdowns. The reopening of our economy should not be confused as a return to normalcy—the pandemic is not behind us.

Read the full letter here.

MESSAGE FROM THE WISAM PRESIDENT

Mon, 20 Jul 2020 16:12:01 GMT

Good Morning,

As some of you may already be aware, both the US House of Representatives and the US Senate have introduced complimentary Bipartisan Legislation that would create a new and permanent audio-visual telehealth exception to the Ryan Haight Act's in-person exam requirement and clarify Medicare'a continued ability, beyond the COVID-19 emergency, to reimburse for audio-only SUD services after an in-person or Telehealth evaluation. The proposed legislation is know as the TREATS Act.

In response, the American Society of Addiction Medicine has built out the action alert (linked below) which I encourage you to use if you want to voice support for this legislation on the Hill.

Feel free to share with others.

David Galbis-Reig, M.D., DFASAM

https://www.votervoice.net/mobile/ASAM/Campaigns/75935/Respond

ASAM Historical Research - We Need Your Help!

Mon, 20 Jul 2020 15:36:49 GMT

ASAM has hired Historical Research Associates to write a history of our organization. HRA’s team is building on the many wonderful materials gathered and historical narratives drafted by a number of our past and present members. We’re asking our members to look into their personal collections to see if they possess pre-1990: photographs (with dates and captions) , personal papers (notes, minutes, communiques, awards, letters, etc.), and any other materials related to the society and its chapters. If you have items you’d like to share, please email it to lhausealvarado@asam.org.

Please share these details with anyone you know who may be able to assist in the collection of these historical items. Thank you!

ASAM Urges Congress, Administration to Expand Access to Evidence-Based Addiction Treatment for Americans Who are Incarcerated

Thu, 16 Jul 2020 18:03:39 GMT

Rockville, MD – In a new public policy statement on treatment of opioid use disorder (OUD) in correctional settings, the American Society of Addiction Medicine (ASAM) calls on policymakers to support measures that would expand access to evidence-based addiction treatment for Americans who are incarcerated. Individuals who are incarcerated are a vulnerable population and withholding evidence-based OUD treatment increases risk for death during detainment and upon release. The new policy statement describes the standard of care that ASAM believes all individuals with OUD who are detained and incarcerated should receive and outlines systemic changes to ensure universal access to such care within correctional institutions.

OUD and COVID-19 Survey

Wed, 15 Jul 2020 14:08:59 GMT

Please read this important letter from AAAP and complete the anonymous survey for providers treating OUD during the COVID-19 pandemic. The information received will help formulate future policy and educational resources. Thank you!

DHS seeks applicants for hub-and-spoke model

Tue, 07 Jul 2020 15:36:28 GMT

Wisconsin Health News

The Department of Health Services is asking organizations to apply to pilot a new addiction treatment model of care for Medicaid members, according to a Monday statement.

The organizations will pilot a hub-and-spoke model of care.

Under the model, the organization will serve as a “hub,” offering more intensive substance use disorder treatment. They’ll then work with a network of “spokes,” which will provide less intensive care and other services.

“Piloting the hub-and-spoke model is the next step in integrating quality healthcare for individuals with a substance use disorder,” said DHS Secretary-designee Andrea Palm.

The state’s current budget directs the agency to pursue the model, which was recommended by former Gov. Scott Walker’s Task Force on Opioid Abuse.

The task force was co-chaired by Joint Finance Committee Co-Chair Rep. John Nygren, R-Marinette, and former Lt. Gov. Rebecca Kleefisch.

The deadline to apply is Aug. 24. DHS will fund up to three pilots. The agency will announce the successful sites in October.

50% Off ASAM Membership

Mon, 06 Jul 2020 15:50:14 GMT

50% OFF MEMBERSHIP

2020 is half over, but you are still able to take advantage of an ASAM membership today! Membership is half price of the normal dues rate of each category. All members that join will still receive full member benefits.

Current ASAM members are not eligible for the 50% offer, only new or re-instated members.

As you are talking to your colleagues, let them know of the great benefits WISAM is able to offer, and the stellar work we are doing in treating addiction during this COVID-19 pandemic. Please visit the ASAM Resources page at www.asam.org/Quality-Science/covid-19-coronavirus.

Join by going to www.asam.org/join and using code 2020MIDYR at check-out or contact us with any questions WISAM@Badgerbay.co.

ASAM Nominations & Awards Council is seeking nominations

Fri, 03 Jul 2020 15:54:38 GMT

It is time to recognize your colleagues for their notable contributions in the addiction medicine field!

The Nominations & Awards Council is seeking nominations for the following 2021 awards: John P. McGovern Award on Addiction & Society, ASAM Annual, Public Policy, Media and the ASAM Training Directors Award.

Award recipients will be honored at the 52^nd Annual Conference to be held in Dallas Texas, April 22^nd – April 25, 2021. For more information on how to nominate an individual, or yourself, please click here.

The Nominations & Awards Council is dedicated to ASAM’s goal of increasing diversity and inclusion within our Society. As part of this effort, we highly encourage nominations for individuals from historically underrepresented groups in the addiction medicine field.

Submission Deadline: August 7, 2020

If you would like additional information, please contact Valerie Evans at vevans@asam.org

State Strategies to Support Access to Substance Use Disorder Treatment Services through the COVID-19 Pandemic

Thu, 02 Jul 2020 15:50:47 GMT

National Governors Association

"Prior to the COVID-19 pandemic, many governors were looking for ways to strengthen substance use disorder (SuD) provider capacity as part of their comprehensive response to the opioid epidemic. However, the imperative is now greater than ever as providers and states face unprecedented fiscal challenges and there are increasing reports that the country is seeing an increase in need for SuD treatment as a result of the stress, social isolation, and job loss associated with the pandemic (Box 1). While comprehensive national data are not yet available, initial reports suggest that many states are experiencing a resurgence of overdose deaths, potentially erasing some of the progress made in recent years in combatting the opioid epidemic.1 At the same time, SuD providers, many of whom are Medicaid providers, are facing financial hardship as they lose revenue due to lower utilization, face new costs for personal protective equipment (ppe), and are required to reconfigure their work spaces and approach to providing care to reduce the risk of spreading coviD-19 (Box 2 below).2"

Read the full document here.

Injured Patients and Families Compensation Fund announces premium holiday

Thu, 18 Jun 2020 22:02:46 GMT

Wisconsin Medical Society | Medigram

Yesterday, the Injured Patients and Families Compensation Fund (Fund) approved waiving the upcoming fiscal year’s premiums for physicians, CRNAs and hospitals enrolled in the fund.

The Society has been working hard to find ways to assist its membership during these unprecedented times and approached the Fund with the idea of a premium holiday to provide some financial relief. "COVID-19 has posed unprecedented health and economic challenges to our state, and the health care industry is no exception," said Bud Chumbley, MD, MBA, a Fund Board member and the CEO of the Wisconsin Medical Society. "The premium holiday approved yesterday by the board will provide some financial relief to many of the Wisconsin medical professionals and providers who have been affected by the pandemic and who face ongoing challenges."

Full-time physicians will save between $382 and $2,521, depending on their specialty, with Residents saving $229 and part-time or retired physicians saving $95. The premium holiday will be in effect from July 1, 2020 through June 30, 2021. Additional details can be found in the Society's update or the Fund’s press release.

Fall in percentage of those testing positive for COVID-19 and hospitalized 'good news,' says MCW CEO

Wed, 10 Jun 2020 16:46:53 GMT

Wisconsin Health News

The percentage of people testing positive for COVID-19 who are hospitalized continues to fall, a positive sign for the state’s fight against the pandemic, according to Medical College of Wisconsin CEO Dr. John Raymond.

As of Tuesday, the number of total hospitalizations for COVID-19 in the state was 2,904, an increase of 44 from Tuesday. The number of total positive tests was 21,308, an increase of 270 from Tuesday.

That put the total percentage of patients testing positive for the disease that were or are hospitalized at 13.6 percent, unchanged from Monday.

That’s an improvement from the beginning of the pandemic when the percentage was around 30 percent, Raymond said during a Metropolitan Milwaukee Association of Commerce webinar.

“I think that’s good news, probably emblematic that as our testing has grown, we’ve been able to diagnose people earlier in their illnesses and maybe even some asymptomatic individuals,” Raymond said. “I also believe that we know a whole lot more about how to give high quality supportive care to patients with COVID-19 and to triage them appropriately into the hospital, to home or into intensive care settings.”

Raymond said there’s adequate capacity at Wisconsin hospitals, and the number of those in inpatient settings or intensive care units is stable. He said most hospitals have been able to resume “some semblance of normal activity” with stable personal protective equipment supplies.

The most critical needs are goggles and gowns. N95 masks may also become a problem in southeast Wisconsin, he said.

There were 347,210 total negative test results reported on Tuesday, an increase of 13,957 from Monday. Total deaths were 661, an increase of 15 from Monday, according to the Department of Health Services.

ALCOHOL WITHDRAWAL MANAGEMENT GUIDELINE

Mon, 08 Jun 2020 16:49:39 GMT

ASAM offers a Clinical Practice Guideline on Alcohol Withdrawal Management

Intended to aid clinicians in their clinical decision making and management of patients experiencing alcohol withdrawal syndrome.

Visit the ASAM website for more information here!

Racism is a Public Health Crisis

Fri, 05 Jun 2020 20:35:00 GMT

Wisconsin Medical Society | Medigram

"I can’t breathe.” These were the harrowing last words of an American, George Floyd, spoken as a system deprived him of life. The systemic racist structure failed the promise of life to this American. Racism is a constant threat to health, medical care and longevity in America. The Wisconsin Medical Society, driven by our mission of health to Wisconsinites, declares racism to be a Public Health Crisis and calls for equity in health.

Racism threatens health. Racism worsens the social determinants of health, including housing, employment, education, community and neighborhood, food and medical care. Poor housing, including homelessness, results in illnesses such as diabetes and asthma. Unemployment increases heart disease risks and overall mortality; poor education increases death from diabetes; physical space loss for exercise increases childhood obesity; and food deserts significantly increase African-American obesity. The greatest health threat faced today in COVID 19 has further revealed these profound disparities demonstrated by the disproportionate mortality in communities of color.

The human toll is destructive and untenable. To move forward, we must take a stand against racism. In doing so, we stand in solidarity with organizations across the state and our country condemning racism, injustice, and health disparities.

With the AMA, we know racism is detrimental to health in all its forms.

With ACOG, we acknowledge that people of color face threats to their health and well-being daily across Wisconsin and the United States.

With AAMC, we have seen that over the past three months, “the coronavirus pandemic has laid bare the racial health inequities harming our black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy.”

With APA, we stand “with the Black community and all those opposed to racism to protect and improve the lives of those who have experienced discrimination and the associated trauma.”

With the ANA, the AAFP, and other health care organizations, we consider racism a Public Health Crisis.

Black lives matter. To remain silent is to be complicit.

The Wisconsin Medical Society refuses to be complicit or indifferent on this issue. Daily, physicians see the tragedy of lost health from systemic racism in our community. We proclaim the “thoughts and prayers” approach to racism to be complicit with systemic racism. The Rabbi Abraham Joshua Hershel clarified the act of complicity well when he said, “The opposite of good is not evil, the opposite of good is indifference.”

Change requires action. As such, we are in solidarity with AAMC, and join them in the key actions outlined below:

We must acknowledge and speak out against all forms of racism, discrimination, and bias in our environments in our institutions, communities, and society.
We must stand in solidarity with the black community and speak out against unjust and inhumane incidents of violence.
We must demonstrate empathy and compassion and acknowledge the pain and grief that the families and the communities of these victims are experiencing.
We must take the lead in educating ourselves and others to address these issues head on.
We must be deliberate and partner with local communities, public health agencies, and municipal governments to dismantle structural racism and end police brutality.
We must employ anti-racist and unconscious bias training and engage in interracial dialogues that will dispel the misrepresentations that dehumanize our black community members and other marginalized groups.
We must move from rhetoric to action to eliminate the inequities in our care, research, and education of tomorrow’s doctors.

As the voice of physicians in the state of Wisconsin, we resolve to make health equity a priority. The Wisconsin Medical Society stands with all Wisconsinites for healing and for the elimination of racism in all its forms.

For a full PDF of this statement, click here.

Northern Wisconsin drug treatment programs serve more than 900

Wed, 03 Jun 2020 19:16:14 GMT

Wisconsin Health News

Northern Wisconsin opioid and methamphetamine treatment programs funded by the state served 939 people last year, according to an annual report recently submitted to the Legislature.

Last year was the fifth year of operation for programs located at HSHS St. Vincent’s Hospital and Libertas Treatment Center, Family Health Center of Marshfield and NorthLakes Community Clinic. They were in their second year for methamphetamine treatment.

Family Health Center of Marshfield also runs a program in Ladysmith and NorthLakes Community Clinic has partnered on a program with Lake Superior Community Health Center. Both of those programs were in their second year of operation.

The total grant funding was $2.3 million for the initiative.

The report includes additional data on the number of people served by the programs, their improvement in quality of life and demographics.

WACEP and WHA Promote Safe Care in Hospitals and ERs

Sat, 16 May 2020 20:03:48 GMT

The Wisconsin Chapter of the American College of Emergency Physicians and the Wisconsin Hospital Association have partnered to spread the message that hospital emergency rooms and urgent care clinics remain safe, clean and ready to help give patients the care they need. We believe it is important to remind the public that hospitals are hard-wired to provide a safe environment and prevent infection spread. Along with a press release, two versions of an audio Public Service Announcement have been distributed:

30 second PSA: https://youtu.be/vdMQgW9VEzw
15 second PSA: https://youtu.be/pJA-4-TEhIU

Visit their website here: https://www.wisconsinacep.org/

"Opioid Treatment Programs Submitting Claims for Phone Calls Under the Five-Minute Threshold,"

Fri, 15 May 2020 14:06:41 GMT

ForwardHealth has published Alert 019, titled "Opioid Treatment Programs Submitting Claims for Phone Calls Under the Five-Minute Threshold," to the COVID-19: ForwardHealth Provider News and Resources Portal page.

ForwardHealth Alerts are short, targeted publications designed to disseminate the latest COVID-19 information to providers quickly. They may contain news, policy, or resources deemed critical or helpful for providers. Providers will receive messaging letting them know when Alerts have been published that may impact them, and all Alerts relating to COVID-19 will be linked from this page. Register today on their website to receive the alerts.

Wisconsin’s Latest Emergency Order #35

Tue, 05 May 2020 19:30:37 GMT

Wisconsin’s latest Emergency Order #35 includes updated information pertaining to Community Support Programs (Section IX) and Community Substance Abuse Services (Section X), both of which are relevant to the field of addiction medicine.

Among the changes outlined in this Emergency Order include the extension of time-frames for compliance, relaxed “face-to-face” and in-person requirements, and loosened staffing and documentation requirements. These changes are temporary and scheduled to stay in place through the state’s “safer at home” order.

Read Emergency Order #35 here!

Governor Announces Badger Bounce Back Plan

Mon, 20 Apr 2020 15:59:35 GMT

Governor Evers today announced Wisconsin's "Badger Bounce Back" plan which outlines important criteria for Wisconsin to be able to reopen its economy in phases and includes steps to make sure workers and businesses are prepared to reopen as soon as it is safe to do so. In coordination with this announcement, at the direction of the governor, Wisconsin Department of Health Services Secretary-designee Andrea Palm issued Emergency Order #31 establishing the process and outlining the phases of the plan. The emergency order is available here.

The Badger Bounce Back plan is informed in part by the President's Guidelines for Opening Up America Again that was issued by the White House on April 16, 2020. Currently, Wisconsin does not meet the criteria the White House established to start reopening our state. The Badger Bounce Back plan takes important steps to get the state of Wisconsin there.

The goal of the Badger Bounce Back plan is to decrease cases and deaths to a low level, and increase capacity in our healthcare system so the phased reopening of businesses is possible. As part of that plan the state will be working to increase access to more testing and expand lab capacity. Under the Badger Bounce Back plan, everyone who needs a test should get a test. The state is setting a goal of 85,000 tests per week, averaging about 12,000 tests per day. More information on the state's testing efforts was released earlier today, and is available for review here.

Next, the state will be expanding contact tracing and more aggressively tracking the spread with the goal of every Wisconsinite who tests positive being interviewed within 24 hours of receiving their test results and their contacts being interviewed within 48 hours of test results.

Additionally, the state will continue to pursue every avenue to grow Wisconsin’s supply of personal protective equipment (PPE) for healthcare and public safety entities to conduct COVID-19 testing, patient care, and public safety work. Finally, the plan works to bolster healthcare system capacity where patients can be treated without crisis care and there are more robust testing programs in place for at-risk healthcare workers.

The state will be looking for a downward trajectory of influenza-like illnesses and COVID-19 symptoms reported within a 14-day period, and a downward trajectory of positive tests as a percent of total tests within a 14-day period. When the state has seen these efforts be successful, Wisconsin can begin to turn the dial, re-open the state, and get businesses and workers back on their feet.

The Badger Bounce Back plan is available here. The Wisconsin Economic Development Corporation’s portion of the Badger Bounce Back plan aimed at helping to ensure workers and businesses are prepared and ready to bounce back is available here. The Badger Bounce Back plan in brief is also available here.

Governor Extends Wisconsin's Safer at Home Order

Thu, 16 Apr 2020 13:57:03 GMT

Governor Evers today directed Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to extend the Safer at Home order from April 24, 2020 to 8 a.m. Tuesday, May 26, 2020, or until a superseding order is issued. The order implements some new measures to ensure safety and support the progress we've made in containing COVID-19, but also allows certain activities to start up again.

The extension of the Safer at Home order includes a few changes. Some changes allow more businesses and activities to open back up, while other changes help make businesses safer for employees and customers.

The changes in this order go into effect on April 24, 2020. The order will remain in effect until 8 a.m. on May 26, 2020.

The order is available online (link). The Governor’s full press release is also available online (link).

Call for Cases - Perinatal Substance Use Disorders

Wed, 15 Apr 2020 18:11:54 GMT

Call for Cases - Perinatal Substance Use Disorders
The Periscope Project

We are excited to partner with the Addiction and Co-morbid Conditions: Enhancing Prevention and Therapeutics (ACCEPT) program through the UW School of Medicine and Public Health to offer an educational session on substance use disorders in the perinatal population. The session will be streamed live through ACCEPT’s Project ECHO series. We are looking for a few clinical cases to present during the session. Cases should be focused on pregnant or postpartum patients with substance use disorders including, but not limited to, opioid, alcohol, benzodiazepine, marijuana, or stimulant use. During the session, experts will review and discuss the case in an interactive session followed by a brief didactic. If you’d like your clinical case presented, please email Shelby Kuehn (shkuehn@mcw.edu).

Learn more about ACCEPT and the UW Addiction Consultation Provider Hotline.

Wisconsin Legislature Passes COVID-19 Response Legislation

Wed, 15 Apr 2020 13:54:55 GMT

The State Legislature passed, and the Governor has signed, the state's COVID-19 response package, which includes liability immunity provisions. A late amendment broadens the measure and ensures there is no ambiguity about protections applying to COVID and non-COVID patients alike.

The legislation also includes provisions that will help the state draw down additional federal dollars for Medicaid as well as a provision related to out of network billing.

Below is the liability immunity language as adopted.

SECTION 98. 895.4801 of the statutes is created to read:

895.4801 Immunity for health care providers during COVID-19 emergency.

(1) DEFINITIONS. In this section:

(a) “Health care professional” means an individual licensed, registered, or certified by the medical examining board under subch. II of ch. 448 or the board of nursing under ch. 441.

(b) “Health care provider” has the meaning given in s. 146.38 (1) (b) and includes an adult family home, as defined in s. 50.01 (1).

(2) IMMUNITY. Subject to sub. (3), any health care professional, health care provider, or employee, agent, or contractor of a health care professional or health care provider is immune from civil liability for the death of or injury to any individual or any damages caused by actions or omissions that satisfy all of the following:

(a) The action or omission is committed while the professional, provider, employee, agent, or contractor is providing services during the state of emergency declared under s. 323.10 on March 12, 2020, by executive order 72, or the 60 days following the date that the state of emergency terminates.

(b) The actions or omissions relate to health services provided or not provided in good faith or are substantially consistent with any of the following:

Any direction, guidance, recommendation, or other statement made by a federal, state, or local official to address or in response to the emergency or disaster declared as described under par. (a).
Any guidance published by the department of health services, the federal department of health and human services, or any divisions or agencies of the federal department of health and human services relied upon in good faith.

(3) APPLICABILITY. This section does not apply if s. 257.03, 257.04, 323.41, or 323.44 applies.

COVID-19 Volunteer Program Announced

Fri, 10 Apr 2020 13:56:55 GMT

Governor Evers announced that the state is seeking volunteers to support Wisconsin's healthcare system during the COVID-19 pandemic. Active and retired healthcare professionals and those who wish to help in non-clinical support positions are encouraged to sign up to volunteer through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR).

The number of patients in Wisconsin who need to be treated for COVID-19 is expected to surge in the coming weeks. Building a network of available volunteers now will greatly reduce the hardships on hospitals and clinics that would not normally have the capacity to care for the increase in patients.

Both active and retired healthcare professionals can volunteer for critical clinical roles by entering their information into the WEAVR, a secure, password-protected, web-based volunteer registration system for healthcare and behavioral health professionals. Individuals who are not licensed professionals are also encouraged to sign up to volunteer for non-clinical support positions.

Volunteers will be assigned to locations across Wisconsin to support ongoing efforts related to the COVID-19 national emergency. Those who are willing to travel should note that when they sign up. All volunteers should also be aware that they will be required to complete a background check.

The full copy of the Governor’s press release is available online (link).

Wisconsin Granted Federal Disaster Declaration Due to COVID-19 Pandemic

Sat, 04 Apr 2020 13:39:22 GMT

Governor Evers announced that Wisconsin has been granted a major disaster declaration for the entire state of Wisconsin, as a result of the COVID-19 pandemic. The declaration provides access to Public Assistance programs for all 72 Wisconsin counties and the state’s federally recognized tribes.

Gov. Evers earlier this week requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

The Federal Emergency Management Agency (FEMA) notified the state today that it is granting the request for Public Assistance to help provide reimbursement for emergency protective measures taken by state and local governments in their response to the COVID-19 outbreak. The declaration also authorizes direct Federal Assistance which means when the State and local governments lack the capability to perform or to contract for eligible emergency work and/or debris removal, the State may request that the work be accomplished by a federal agency. The governor’s additional requests for assistance remain under review.

The major disaster declaration covers assistance to public entities, and will cover eligible projects submitted by counties, cities, townships, tribes, and certain private, not-for-profit organizations. Local governments in the declared counties are now eligible for federal assistance and should contact county emergency management directors for further information. Under the program, FEMA provides 75 percent of eligible costs, while the remaining 25 percent is the responsibility of state and local agencies.

The Governor’s full press release is available online (link).

Wisconsin DHS Announces Resilient Wisconsin Initiative

Fri, 03 Apr 2020 13:33:08 GMT

The Department of Health Services announced the creation of the Resilient Wisconsin Initiative (website) on Friday, which provides Wisconsinites with resources to cope with stress and mental health challenges from COVID-19.

DHS recommends that Wisconsinites do the following:

Get the three goods. That’s good-for-you foods, a good night’s sleep, and a good amount of exercise every day.
Stay connected to your support system. Reach out to family and friends, colleagues, and community groups in whatever way you can—calls, texts, video chats, and more.
Spend time away from focusing on COVID-19. Don’t let the pandemic take over what you read, watch, or talk about. And don’t be afraid to ask friends and family to talk about something else.
Reduce anxiety by reducing your risk. Stay safer at home. Wash your hands for at least 20 seconds. Cover your nose and mouth when you cough or sneeze. Stay at least 6 feet apart while running essential errands at the store, pharmacy, or gas station. Knowing you’re doing everything you can to stay healthy can help you worry less.
Check in with yourself. Everyone’s reaction to stress is different. Difficulty concentrating or sleeping, irritability, fatigue, and even stomachaches can be normal. But if you find you are overwhelmed or having thoughts of self-harm or suicide, reach out for help right away. Text HOPELINE to 741741 or call the National Suicide Prevention Lifeline at 1-800-273-8255.

Executive Order Suspends Rules Related to Narcotic Treatment Services for Opiate Addiction

Fri, 03 Apr 2020 12:59:03 GMT

Governor Evers signed Executive Order 21 on April 3. The Order suspends a number of rules related to Opiate Addiction Services. The order specifically makes changes to:

Suspends in part DHS 75.15(4)(a) that requires Medical Director accessibility and responsiveness as defined by striking the 45 minute requirement;
Partially suspends DHS 75.15(4)(b) to allow an RN to be onsite or remote to supervise dosing and other functions delegated by a physician;
Suspends in part the ratio of patients in service defined in DHS 75.15(4)(d);
Suspends requirement in DHS 75.15(5)(h) for treatment programs to notify the State authority prior to treating non-residents, self-pay patients;
Suspends in part DHS 75.13(13)(b) related to drawing blood for testing; and
Partially suspends DHS 75.15(17)(a) and DHS 75.15.17)(c) related to screens for TB, viral hepatitis and STDs by asking treatment providers to use a risk assessment tool to determine if patients need to be referred for a test and follow-up.

The full executive order is available online (link).

New Marquette Law School Poll Finds Strong Support for Coronavirus Closings

Thu, 02 Apr 2020 18:15:58 GMT

A new Marquette Law School poll of Wisconsin registered voters finds strong support for government actions to control the coronavirus pandemic, even as the poll also shows these actions to be having a substantial financial impact on voters.

The survey found:

Eighty-six percent say that it was appropriate to close schools and businesses, and restrict public gatherings, while 10 percent say that this was an overreaction to the pandemic;
A large majority of voters approve of Gov. Tony Evers’ handling of the coronavirus issue, with 76 percent saying they approve and 17 percent saying they disapprove;
A majority, 51 percent, approve of President Donald Trump’s handling of the pandemic, while 46 percent disapprove;
Opinion is divided on holding the April 7 spring election as scheduled, with 51 percent saying the date should be moved and 44 percent saying it should be held as scheduled.

A full copy of the survey is available online (link).

Governor Evers Announces Second Package of Comprehensive Legislative Proposals Providing COVID-19 Relief and Support

Wed, 01 Apr 2020 18:10:29 GMT

Governor Evers today announced a second package of comprehensive legislative proposals that would provide critical investments in health services, support for essential workers, and assistance for Wisconsin families and businesses in response to the COVID-19 pandemic. The governor’s announcement today comes just days after Gov. Evers announced a first piece of legislation, which included additional funding and flexibility for public health professionals and healthcare professionals, a repeal of the one-week waiting period for unemployment insurance, expanding and improving access to telehealth services, among many other proposals.

As additional needs and issues arise from agencies and stakeholders, the governor is committed to working with legislators to find bipartisan solutions. The governor’s office welcomes the opportunity to hear and consider any proposals that legislators have to address the impacts of COVID-19 on the health and well-being of Wisconsin residents, businesses and communities.

This package, among many other proposals, includes:

Increasing funding for Medicaid providers via supplemental payments and rate increases to support the healthcare system’s response to the public health emergency;
Establishing a fund to reduce providers’ uncompensated care costs targeting reimbursement for treatment-related costs for uninsured individuals;
Establishing a COVID-19 reinsurance program to reduce health insurance premiums;
Providing grant funding to provide food assistance and meal delivery;
Prohibiting utility cooperatives from disconnecting customers and prohibiting land-lord directed disconnections from rental units during a public health emergency;
Ensuring workers receive back payment for any lost unemployment insurance benefits as a result of the delay in suspending the one-week waiting period;
Providing supplemental payments to child care providers, if that provider needed to shut down during the public health emergency;
Allowing households to apply for heating assistance under the low-income energy assistance program anytime during the 2020 calendar year;
Increasing the Earned Income Tax Credit for low-income families;
Providing municipalities the flexibility to implement multiple installments of three or more payments for 2020 property taxes;
Waiving interest and penalties on delinquent property taxes included in the 2019 payable 2020 tax roll, on and after April 1, 2020;
Creating a fund through the Wisconsin Housing and Economic Development Association to provide 6 months of support for prevention of single-family foreclosures and providing refinancing opportunities to current borrowers; and
Providing grant funding for small businesses and workers through the Wisconsin Economic Development Corporation.

The Governor’s first COVID-19-related legislation was introduced last week as LRB-5920 and is available here for review. A brief explanation of LRB-5920 is available here. A brief explanation of the governor’s second round of proposed legislation announced today is available online (link).

ForwardHealth Expands List of Drugs Available Through Expedited Emergency Supply

Wed, 01 Apr 2020 18:08:23 GMT

Effective for dates of service on and after April 1, 2020, ForwardHealth, which has an expedited emergency supply policy dispensing option available for certain drugs, has expanded the list of drugs available through expedited emergency supply and will allow most drugs to be dispensed in up to a 100-day expedited emergency supply.

A table with the expanded list of drugs available by expedited supply is included below and is also available on the Pharmacy Resources page of the ForwardHealth Portal. Pharmacy providers should continue to follow the current processes for requesting an expedited emergency supply of drugs detailed in the Emergency Medication Dispensing topic (#1399) of the ForwardHealth Online Handbook.

This Action Alert 10 and others are available on the ForwardHealth website (link).

Governor Evers Statement on April 7 Election

Wed, 01 Apr 2020 18:07:26 GMT

Governor Evers issued the following statement regarding the upcoming April 7 election:

“We have three branches of government to ensure a system of checks and balances, and questions about our elections typically rely on all three playing a role. If I could have changed the election on my own I would have but I can’t without violating state law. I’ve asked the legislature to do its part to ensure a fair and safe election and I hope we can get some clarity as soon as possible. The bottom line is that we have to keep folks safe and we have to make sure everyone who wants to vote has the opportunity to make their voice heard.”

Previously, the governor proposed legislation that had several provisions aimed at making voting easier and more accessible during the public health emergency. A brief summary of that legislation is available here for review. Additionally, he called for the Legislature to act on this issue in a video, available here.

The amicus brief submitted on behalf of the governor is available here.

Wisconsin LFB Published Report on State Funding in CARES Act

Wed, 01 Apr 2020 18:02:50 GMT

Wisconsin nonpartisan Legislative Fiscal Bureau (LFB) published an analysis of the approximately $2.2 billion Wisconsin is expected to receive from the from the Coronavirus Relief Fund created by the CARES Act. About $1.8 billion would go to the state government while the remaining funds would go to the City of Milwaukee, Milwaukee County and Dane County. The LFB has also provided Wisconsin-specific estimates for some of the programmatic increases provided by the stimulus package. That report is available online (link).

The report includes a summary on all programs funded in the Act, including:

Public Health Emergency Preparedness funding from CDC;
Administration for Community Living
Public Health and Social Services Emergency Fund
Direct Payments to State and Local Governments
Transportation, Housing and Unemployment Programs

Details on the full $2 trillion COVID-19 stimulus package are also available in the full bill available online (link). The following is a summary of some of the healthcare related provisions in the bill.

Health and Long-term Care

Grants to Hospitals and Health Care Providers: Provides $100 billion to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus. Medicaid and Medicare providers are included in the definition of health care provider. To apply, providers must submit an application to the Secretary of Health and Human Services that includes a statement justifying their need.

Delay of Disproportionate Share Hospital Reductions. Delays scheduled reductions in Medicaid disproportionate share hospital payments through November 30, 2020.

Increasing Provider Funding through Immediate Medicare Sequester Relief. Temporarily lifts the Medicare sequester from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care by 2%. The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.

Medicare Add-on for Inpatient Hospital COVID-19 Patients. Increases the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20%. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This add-on payment would be available through the duration of the COVID-19 emergency period.

Grants to the V.A.: Provides $14.4 billion to the Veteran’s Administration for medical services.

CDC: Provides $4.3 billion to the CDC. Of these funds, $1.5 billion is set aside for grants to states, territories and tribes to help carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.

Strategic National Stockpile: Provides $16 billion in funding for the Strategic National Stockpile to procure personal protective equipment, ventilators and other supplies.

Hospital Preparedness: Provides $250 million for grants to improve the capacity of healthcare facilities to respond to medical events.

Rural Health: Provides $180 million to expand services and capacity for rural hospitals, telehealth, poison control centers.

Health Savings Accounts for Telehealth Services. Allows a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible.

Providing Hospitals Medicare Advance Payments. Expands, for the duration of the COVID-19 emergency period, an existing Medicare accelerated payment program. Specifically, qualified facilities would be able to request up to a six month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100% of the prior period payments, with Critical Access Hospitals able to receive up to 125%. Finally, a qualifying hospital would not be required to start paying down the loan for four months, and would also have at least 12 months to complete repayment without a requirement to pay interest.

Extension of Physician Work Geographic Index Floor. Extends payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020.

National Academies Report on America’s Medical Product Supply Chain Security: Requires the Department of Health and Human Services to enter into an agreement with the National Academies to examine and report on the security of the United States medical product supply chain. Part of the report requires the examination of the United States’ dependence on critical drugs and devices that are sourced or manufactured outside of the U.S.

Requiring the Strategic National Stockpile to Include Certain Supplies: Requires the strategic national stockpile to include personal protective equipment, ancillary medical supplies, and other applicable supplies required for the administration of drugs, vaccines and other biological products, medical devices, and diagnostic tests.

Preventing Medical Device Shortages: Requires manufacturers of medical devices that are critical during public health emergencies to notify the federal government of any discontinuance or interruption to manufacturing of the device that could disrupt the supply of the device in the U.S. The information will be used to compile a list of devices that are determined to be in short supply.

Rapid Coverage of Preventive Services and Vaccines for Coronavirus: Requires insurers to cover without cost-sharing any qualifying coronavirus preventive service. Qualifying preventive services include any evidence-based item, service, or immunization that is intended to prevent or mitigate coronavirus disease.

Increased Funding for Health Centers: Provides $1.3 billion in additional funding to community health centers in fiscal year 2020.

Telehealth Network and Resource Center Grants: Provides $29 million per year through 2025 and reauthorizes Health Resources and Services Administration (HRSA) grant programs that promote the use of telehealth technologies for health care delivery, education, and health information services.

Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs. Provides $79.5 million per year through 2025 and reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services.

Limitation on liability for volunteer health care professionals during COVID-19 emergency response. Makes clear that doctors who provide volunteer medical services during the public health emergency related to COVID-19 have liability protections. In order to have the liability protections provided by the bill, a volunteer provider must be acting within the scope of their license, registration or certification as defined by the state.

Health Care Workforce

Reauthorization of health professions workforce programs.

Provides $51.4 million per year between 2021 and 2025 for scholarships to health care students. The funding is given to eligible entities, which includes schools of medicine, nursing, dentistry, optometry, public health, etc.

Provides $48.9 million per year for the primary care training and enhancement program. Adds language prioritizing grant awards to programs that train physicians in rural areas.

Provides $41.2 million for eligible entities to establish health care workforce educational programs.

Provides $1.1 million per year for a loan repayment program for medical, dental and nursing students who agree to serve as faculty following graduation.

Provides $15 million per year to provide educational assistance to individuals from disadvantaged backgrounds to pursue health care education.

Extension of Demonstration Projects to Address Health Professions Workforce Needs: Extends the Health Professions Opportunity Grants (HPOG) program through November 30, 2020 at current funding levels. This program provides funding to help low-income individuals obtain education and training in high-demand, well-paid, health care jobs.

Education and training relating to geriatrics. Provides $40.7 million per year and reauthorizes and updates Title VII of the Public Health Service Act (PHSA), which pertains to programs to support clinician training and faculty development, including the training of practitioners in family medicine, general internal medicine, geriatrics, pediatrics, and other medical specialties. It emphasizes integration of geriatric care into existing service delivery locations and care across settings, including home- and community-based services. The Secretary may provide awardees with additional support for activities in areas of demonstrated need, which may include education and training for home health workers, family caregivers, and direct care workers on care for older adults. Eligible entities could receive awards of at least $75,000.

Economic Relief

Recovery Rebates for Americans: Provides a one-time payment of $1,200 to individuals with incomes below $75,000 or a one-time payment of $2,400 for joint filers with incomes below $150,000. Payments are increased by $500 per child. The bill requires the one-time payments to be made as soon as possible.

Relief Payments to States, Tribal Governments and Local Units of Government: Provides $150 billion in direct payments to states, tribal governments and local units of government with. To qualify, local governments must have populations of more than 500,000 people. Payments are required to be used to cover expenditures related to COVID-19 that occur between March 1, 2020 and December 30, 2020. Expenditures must not have been accounted for in the state or local government’s most recent budget. The bill requires the Treasury Secretary to make these payments within 30 days of enactment.

Loans for Small Businesses, Non-profits, Contractors and Self-Employed Individuals. Allows nonprofits and other businesses with less than 500 employees to get loans from the Small Business Administration if they were adversely impacted by COVID-19. Loans can be used to cover payroll costs, health care benefits, mortgage or rent payments, utilities or interest on debt. Borrowers will be eligible for loan forgiveness if they maintain employees and their salaries. The eligibility period runs from February 15, 2020 to June 30, 2020. Maximum loan amounts will be determined using the organization's average monthly payroll amounts over a one year period. The bill appropriates $349 billion for this loan program.

Employee retention credit for employers subject to closure due to COVID-19. Provides a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The credit is available to employers whose (1) operations were fully or partially suspended, due to a COVID-19-related shutdown order, or (2) gross receipts declined by more than 50 percent when compared to the same quarter in the prior year.

Small Business Administration Disaster Loans: Provides $562 million to the Disaster Loan Program.

Broadband and Telehealth

Rural Utilities Service--Distance Learning, Telemedicine and Broadband Program: Provides $25 million for telemedicine and distance learning services in rural areas.

Reconnect Pilot: Provides $100 million for grants for the costs of construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas.

Federal Communications Commission Telehealth: Provides $200 million to the FCC to respond to COVID-19. This includes supporting health care providers by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

Higher Education and Student Loans

Temporary Relief for Federal Student Loan Borrowers: Requires the Secretary to defer student loan payments, principal, and interest for 6 months, through September 30, 2020, without penalty to the borrower for all federally owned loans.

Adjustments of Subsidized Loan Limits. For students who dropped out of school as a result of COVID -19 excludes the term from counting toward lifetime subsidized loan eligibility.

Exclusion from Federal Pell Grant Duration Limit. For students who dropped out of school as a result of COVID -19 excludes the term from counting toward lifetime Pell eligibility.

Institutional Refund and Federal Student Loan Flexibility. For students who dropped out of school as a result of COVID -19, the student is not required to return Pell grants or federal student loans to the Secretary. Waives the requirement that institutions calculate the amount of grant or loan assistance that the institution must return to the Secretary in the case of students who dropped out of school as a result of COVID-19

Exclusion for certain employer payments of student loans: Allows employers to provide a student loan repayment benefit to employees on a tax-free basis. Under the provision, an employer may contribute up to $5,250 annually toward an employee’s student loans, and such payment would be excluded from the employee’s income. The $5,250 cap applies to both the new student loan repayment benefit as well as other educational assistance (e.g., tuition, fees, books) provided by the employer under current law. The provision applies to any student loan payments made by an employer on behalf of an employee after date of enactment and before January 1, 2021.

Emergency Order 16 FAQ and Telehealth Guidance

Wed, 01 Apr 2020 13:21:04 GMT

Emergency Order 16 FAQ and Telehealth Guidance
Wisconsin Department of Safety and Professional Services

The Department of Safety and Professional Services (Department) has received numerous inquiries regarding Emergency Order 16 and also the status of telemedicine/telehealth practice as a result of the COVID-19 public health emergency.

The emergency covers a wide range of issues across many health care professions. The order took action that will make it easier to quickly expand the health care workforce by readmitted those with expired licenses and by welcoming providers from other states. It will also enhance flexibility so providers can more effectively respond to areas of greatest need. Please read the order, linked above, and also reference this Frequently Asked Questions document for clarifications. Both address individuals who have expired licenses and wish to return to practice.

Also, the order addresses telemedicine specifically, but we have also received questions about telehealth practice for other providers. The practice of telehealth is generally allowed under existing Wisconsin law unless there is some profession-specific requirement or restriction. Credential holders must use their professional judgment to determine if telehealth is appropriate for the patient or client being treated, to abide by all other applicable rules of practice and professional conduct, and to be properly credentialed or authorized to practice in the state of Wisconsin. If someone can practice in Wisconsin via an Emergency Order, a compact, or a temporary or permanent license, that individual can practice telehealth in Wisconsin and provide services to Wisconsin residents to the same extent as similarly licensed Wisconsin practitioners.

The Wisconsin Medical Examining Board has the only telemedicine rule currently in effect in Wisconsin. This rule may be found at Wis. Admin. Code Med chapter 24. While this rule applies only to the Medical Examining Board, many of the concepts in this rule may be informative to credential holders in other professions. Here is a link to this rule. Note that portions of this rule were suspended when Governor Evers issued Emergency Order 16. Please review both Med chapter 24 as well as the statutory and rule provisions governing your profession when evaluating telemedicine/telehealth practice options during the COVID-10 public health emergency.

The Department is not able to answer legal questions regarding what the standard of care requires for any specific profession or any specific situation a credential holder may encounter. If practice-related questions arise, the Department encourages credential holders to consult with a supervisor, with their own private or institutional legal counsel, with their colleagues within the profession, or other sources familiar with their profession’s standards of practice. Profession-related statutes and rules can be found by clicking on a profession under the Rule/Statutes column here.

Also, there have been recent changes to Medicaid reimbursement of telehealth services. The Wisconsin Department of Health Services issued guidance on telehealth reimbursement changes and status during the COVID-19 public health emergency. The guidance is available here. The Office of the Commissioner of Insurance has also sent this letter regarding related insurance (malpractice) issues to insurers.

This information will be posted to our website. Please visit often, as we are updating it daily as decisions are made and new information is available.

Sincerely,

Dawn B. Crim

Secretary-designee

Attachments:

Doc 1
Doc 2
Doc 3

Wisconsin Partnership Program Releases RFP for $1.5 Million in COVID-19 Grant Funding

Tue, 31 Mar 2020 17:00:18 GMT

The Wisconsin Partnership Program released an RFP Tuesday for a new $1.5 million grant program to support projects that “aim to improve the health of the people of Wisconsin by lessening the impact of the COVID-19 pandemic.”

About $750,000 will be available for programs led by Wisconsin-based nonprofits, tax exempt, 501(c)(3) organizations or tribal/government entities. Special emphasis will be given to projects that target vulnerable populations.

Grant applications are due April 15, 2020.

Governor Evers Sets Up State COVID-19 Voluntary Isolation Facilities

Tue, 31 Mar 2020 16:57:59 GMT

Governor Evers today announced the State of Wisconsin Emergency Operations Center (SEOC) is opening two state-run voluntary isolation facilities in Madison and Milwaukee and is providing guidance to local communities throughout Wisconsin. The two sites are set to open April 1, 2020 are at Lowell Center in Madison and a Super 8 hotel in Milwaukee.

These facilities are for symptomatic individuals suspected to be infected with COVID-19 or who have a confirmed case of COVID-19. Individuals will not be permitted to register at the facility unless referred by a medical provider or public health official. Individuals register and stay at the isolation facility on a voluntary basis. The expected length of stay will be about 14 days, or 72 hours after symptoms dissipate. At any time, either the individual or the facility may terminate the individual’s presence at the site. Those staying at the facility will have wellness checks by phone every four hours during the day and if needed at night.

Additionally, the SEOC also issued guidance for communities seeking to open their own voluntary self-isolation centers. This guidance will aid local communities with the following:

How do we select, set up, and staff an isolation site?
How does a person get referred to and checked into the isolation site?
What happens while occupants are at the isolation site? Including details about medical monitoring/wellness check calls and other on-site services.
When do occupants leave the site? Including details about discharge and involuntary check out from the isolation site.

The full press release is available online (link).

Governor Evers Asks for Presidential Disaster Declaration

Tue, 31 Mar 2020 16:55:15 GMT

Governor Evers today sent a letter to the Federal Emergency Management Agency (FEMA) requesting that the president issue a major disaster declaration for the entire state of Wisconsin, as a result the COVID-19 pandemic. The request covers all 72 counties and the state’s federally recognized tribes.

Having determined that Wisconsin met all of the criteria required to receive a major disaster declaration, Gov. Evers in his letter requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

Gov. Evers declared a public health emergency on March 12 in response to the outbreak, which directed the Department of Health Services to take all necessary and appropriate actions to help combat the spread of the virus. On March 14, the governor directed Wisconsin Emergency Management to activate the State Emergency Operations Center (SEOC) to provide additional coordination in support of the state’s response.

A copy of the governor’s letter (link) and the full press release are available online (link).

Governor Evers Announces Additional Shipment of Personal Protective Equipment from the Strategic National Stockpile

Tue, 31 Mar 2020 15:30:36 GMT

Governor Evers today announced that Wisconsin has received its second phase of Personal Protective Equipment (PPE) from the Strategic National Stockpile (SNS) and is in the process of distribution. The second phase of supplies from the SNS are being delivered to healthcare workers, emergency medical services, and medical facilities including hospitals, nursing homes, assisted living facilities and clinics across Wisconsin.

The State Emergency Operations Center and Department of Health Services continue working to supply medical facilities with supplies requested from the Strategic National Stockpile. The second phase includes approximately 51,880 N95 respirators, 130,840 face/surgical masks, 23,400 face shields, 20,226 surgical gowns, 96 coveralls, and 79,000 pairs of gloves. Today’s shipment comes as Governor Evers announced Wisconsin’s first delivery of SNS supplies which included approximately 52,800N95 respirators, 130,000 face/surgical masks, 24,768 face shields, 20,286 surgical gowns, 96 coveralls, and 61,750 pairs of gloves. In total Wisconsin has received approximately 104,680 N95 respirators, 260,840 face/surgical masks, 48,186 face shields, 40,512 surgical gowns, 192 coveralls, and 140,750 pairs of gloves from the SNS.

The SNS supply shipments do not include supplies the governor has requested from FEMA for non-medical personnel or supplies being aggressively pursued through procurement, donations, or the governor’s buyback program.

Governor Announces New Public-Private Partnership to Increase COVID-19 Laboratory Testing Capacity

Mon, 30 Mar 2020 16:42:55 GMT

Governor Evers announced a new public-private partnership among Wisconsin industry leaders to increase Wisconsin's laboratory testing capacity for COVID-19. Prior to today's announcement, the Wisconsin State Lab of Hygiene and the Milwaukee Public Health Lab were leading the Wisconsin Clinical Lab Network labs to bring additional COVID-19 testing online.

The new partnership now includes laboratory support from Exact Sciences, Marshfield Clinic Health System, Promega, and UW Health. These organizations, along with the Wisconsin Clinical Lab Network, will now share knowledge, resources, and technology to bolster Wisconsin’s testing capacity.

The Wisconsin Clinical Lab Network labs have been averaging completion of 1,500-2,000 COVID-19 tests per day. The expanded capacity from the state’s new public-private partnership is expected to double that capacity initially and continue to expand as additional platforms and supplies become available.

Residents who are seeking a COVID-19 test are still required to receive an order from a doctor. These labs are not testing sites.

The full press release is available online (link).

ForwardHealth Announces New Policies for Telehealth Reimbursement

Mon, 30 Mar 2020 16:42:17 GMT

ForwardHealth will allow telehealth services utilizing interactive synchronous (real-time) technology, including audio-only phone communication, for currently covered services that can be delivered with functional equivalency to the face-to-face service. This applies to all service areas and all enrolled professional and paraprofessional providers allowable within current ForwardHealth coverage policy.

Please refer to the Forward Health Update 2020-15 (link) for a comprehensive explanation of the update.

Forward Health Publishes Changes to DME and Disposal Medical Supply Face-to-Face Requirements

Mon, 30 Mar 2020 15:27:11 GMT

ForwardHealth has published Alert 009, titled "Temporary Changes for Durable Medical Equipment and Disposable Medical Supplies Face-to-Face Requirements," to the ForwardHealth COVID-19 Portal Page (link). Beginning March 12, 2020, ForwardHealth will not require a face-to-face visit with a physician or authorized non-physician practitioner for an initial prescription of any durable medical equipment or disposable medical supplies. A prescription will continue to be required for durable medical equipment and disposable medical supplies.

Governor Releases COVID-19 Legislation

Sat, 28 Mar 2020 16:39:29 GMT

Governor Evers released a 65-page draft piece of legislation and a draft joint resolution on Saturday night aimed at addressing COVID-19. The Governor also released a chart outlining the proposal. The Legislative Fiscal Bureau also provided a Summary of provisions of Governor Evers’ proposed legislation and Joint Resolution indefinitely extending public health emergency to state legislators.

The bill includes several healthcare provisions, including language related to out-of-network bills that occur during the public health emergency. The language caps physician payment rates at 250% of the Medicare rate.

Insurance

Prohibits health plans from charging patients more for out-of-network services related to the diagnosis and treatment of the condition for which a public health emergency has been declared than they do for in-network services (if an in-network physician is not available).
The bill requires the plan to reimburse the out-of-network provider at 250% of the Medicare rate. Providers and facilities are prohibited from charging patients more than what they are reimburse by the plan.
Creates a process for out-of-state physicians to have liability coverage in Wisconsin during a public health emergency. They would need to provide OCI with a certificate of insurance for a policy of health care liability insurance issued by an insurer that is authorized in a jurisdiction accredited by the National Association of Insurance Commissioners.
Requires health plans to cover without cost-sharing any testing, treatment or vaccines related to COVID-19.
Requires health plans to cover any services provided via telehealth if they cover that service when it is provided in-person.
Prohibits health plans from canceling policies due to non-payment during the COVID-19 emergency
Prohibits health plans and pharmacy benefit managers from requiring prior authorization for any early refills of prescriptions or restricting the period of time in which a drug may be refilled.
Creates a process for pharmacists to extend prescription orders by up to 30 days during public health emergencies.

Emergency Preparedness

Provides $300 million to the Department of Military Affairs to respond to the public health emergency.
Provides $200 million to the Department of Administration to respond to the public health emergency.

Health

Creates a public health emergency fund for the Department of Health Services.
Provides $100 million for a new health care provider grant program specific to planning, preparing for and responding to COVID-19.
Provides $17.4 million to local health departments.
Creates 64 positions within the Department of Health Services’ Division of Public Health.
Allows DHS to suspend any premium or cost-sharing requirements for childless adults on BadgerCare in order to qualify for enhanced federal Medicaid matching funds related to COVID-19.
Exempts the Department of Health Services, during a public health emergency, from the current law legislative review requirements for submitting waiver requests to the federal government, amending the state Medicaid plan or raising Medicaid reimbursement rates.
Expands the definition of public health emergency to include toxins or other threats to health.

Health Care Workforce

Allows former health care providers to receive a temporary license to provide services during a public health emergency. This would apply to physicians, nurses, PAs, dentists, pharmacists, phycologists, social workers and other health providers who have practiced within the last 5 years but do not currently have a license. The temporary license would be valid until 90 days following the conclusion of the health emergency.
Allows out-of-state health care providers to receive a temporary license to practice in Wisconsin. The temporary license would be valid until 90 days following the conclusion of the health emergency.
Allows the state to waive licensure fees for physicians, physician assistants, nurses, dentists, pharmacists, psychologists, and certain behavioral health providers.
Exempts certain health care provider credentials issued by credentialing boards in DSPS from having to be renewed during the public health emergency.

Unemployment Insurance

Eliminates the one-week waiting period for Unemployment Insurance

Voting

The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would:

Require elections held during public health emergencies to be held by mail.
Waive the state’s Photo ID requirement.
Waive the requirement that mail-in absentee ballots need a witness signature.
Allow mail-in ballots to be counted as long as they are postmarked by Election Day.
Allow voters to register electronically until 5 days before the election.

Governor Issues Order to Expedite Expansion, Enhance Efficiency of Healthcare Workforce

Sat, 28 Mar 2020 13:29:22 GMT

Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

The order includes the following policy changes:

Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04.
Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency.
Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents.
Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty).
Nurse Training and Practice: The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years.
Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.
Recently Expired Credentials: Requires the state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education.
Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing.

The order is effective immediately and will remain in effect through the duration of the public health emergency.

The full version of the Governor’s press release is available online (link).

ForwardHealth Update on Urgent Prior Authorization Requests

Fri, 27 Mar 2020 15:13:22 GMT

For urgent prior authorization requests for fee‐for‐service members, contact ForwardHealth Provider Services at 800‐947‐9627 for assistance with expediting the prior authorization process. An urgent, medically necessary situation is one where a delay in authorization would result in undue hardship for the member or unnecessary costs for Wisconsin Medicaid as determined by the Division of Medicaid Services. In general, urgent requests will receive a response within five business days. Additional information regarding urgent services is available (link).

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

This Action Alert 08 and others are available on the ForwardHealth website (link).

Temporary Change for Urgent Prior Authorization Requests

Fri, 27 Mar 2020 15:02:58 GMT

In response to the COVID‐19 pandemic, ForwardHealth is temporarily altering certain procedures in order to prevent further spread of the disease and effectively treat existing cases. These altered procedures will only be in effect during the public health emergency declared by Governor Tony Evers for the State of Wisconsin under Executive Order 72.

Temporary Phone Number Change for Urgent Prior Authorization Requests

Note: Prior authorization is not required for emergency services, defined as services that are necessary to prevent the death or serious impairment of the health of the individual. Reimbursement is not guaranteed for services that normally require prior authorization that are provided in emergency situations; those services still must meet all ForwardHealth coverage requirements, including medical necessity.

Governor Suspends Evictions and Foreclosures During Public Health Emergency

Fri, 27 Mar 2020 14:01:49 GMT

Governor Evers directed the Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to temporarily order the suspension of evictions and foreclosures amid the COVID-19 public health emergency. The full order is available online (link).

The order prohibits landlords from evicting tenants for any reason unless failure to proceed with the eviction will result in an imminent threat of serious physical harm to another person and mortgagees from commencing civil action to foreclose on real estate for 60 days. Wisconsinites who are able to continue to meet their financial obligations are urged to do so. This order does not in any way relieve a person's obligation to pay their rent or mortgages.

The full press release is available on the Governor’s website (link).

Wisconsin Safer at Home Order

Mon, 23 Mar 2020 16:42:30 GMT

Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24. Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work. This includes healthcare professionals, grocers and family caregivers. The full details of the order to be announced by the Governor’s office. Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.

This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic. These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases. We must do everything we can to keep our healthcare systems from becoming overwhelmed, and protect both the public and essential healthcare workers who are taking care of the critically ill.

SAMHSA Opioid Treatment Program (OTP) Guidance

Mon, 16 Mar 2020 12:46:48 GMT

Opioid Treatment Program (OTP) Guidance

SAMHSA recognizes the evolving issues surrounding COVID-19 and the emerging needs OTPs continue to face. SAMHSA affirms its commitment to supporting OTPs in any way possible during this time. As such, we are expanding our previous guidance to provide increased flexibility.

Getting opioids can be easier than getting treatment, but Wisconsin doctors are pushing for change

Sun, 15 Mar 2020 13:01:27 GMT

Fox 6 Now / Amanda St. Hilaire

View the full article and watch the news report here.

MILWAUKEE -- When Dr. TJ Harrington's patients struggle to quit smoking, he can instantly connect them with options like the nicotene patch.

But the Aurora Health Care Senior Chief Resident of Family Medicine says getting patients help for opioid addiction has been much more complicated.

"He actually ended up overdosing and passing away," Harrington said, describing a patient who struggled with addiction. "It was upsetting, it was heartbreaking, and I think frustrating knowing that maybe we could have had a different outcome."

Now, that different outcome is within reach. Aurora, along with health systems like Ascension and ProHealth, is part of a statewide effort to make it easier for patients to access buprenorphine, a medication used for addiction treatment.

"Thank goodness," Harrington said with a sigh. "I’ve got something that can maybe help."

Clearing the hurdles

Buprenorphine is a medication used to assist in addiction treatment. Many patients know it by the brand name Suboxone, which is a combination of buprenorphine and naloxone.

Buprenorphine works by partially acting like an opioid and binding to the same receptors in the brain, without getting patients high. Doctors say the medication protects their patients from cravings and withdrawals, allowing them to focus on counseling and therapy.

"I didn't have the cravings all the time," Tina Kasten, a woman who says buprenorphine helped her fight heroin addiction, told FOX6. "It wasn't constantly on my mind like, 'OK, am I going to use? Am I not? Am I going to use? Don't do it. Oh, but you should.' It's like the devil and the angel and [buprenorphine] tells them to be quiet and go home."

Methadone and naltrexone, often known by the brand name Vivitrol, are also medications used to help treat addiction. But there are strict regulations surrounding the administration of methadone, and naltrexone requires the patient to first abstain from opioid use for several days.

Buprenorphine is seen as the most accessible option, because patients can start taking it right away. It also tends to be more affordable for the uninsured or under-insured.

Because burprenorphine acts like an opioid, doctors need a waiver to prescribe it for addiction treatment. That waiver requires training that family doctors, OB-GYNs, and other primary care providers traditionally have not had.

That means instead of being able to get a buprenorphine prescription at their regular doctors appointments, patients have had to deal with barriers like transportation, additional cost, and wait times in order to see an addiction specialist.

"Addiction is a terminal illness," Ascension All Saints Medical Director of Addiction Services Dr. David Galbis-Reig. "Without treatment, you end up dying."

Galbis-Reig is also president of Wisconsin Society of Addiction Medicine.

"If we're talking a four week gap in treatment, in four weeks if someone continues to use, every day is a risk of overdose and death," Galbis-Reig said.

Not all addiction treatment facilities offer buprenorphine.

Federal data from the Substance Abuse and Mental Health Services Administration shows 104 published addiction treatment facilities within 50 miles of Milwaukee. Only 40 percent are listed as prescribing buprenorphine.

"I'm old enough to have delivered some of my patients who are now adults," Dr. Jake Bidwell, Advocate Aurora Health Wisconsin VP for Medical Education said. "It's very frustrating to not be able to help them through a chronic problem in their life."

The solutions

There is a statewide push in Wisconsin to expand training so that more primary care doctors can prescribe buprenorphine directly to their patients, eliminating barriers to treatment.

"When you ask personal questions to someone that you know really well, that trust and that rapport that's there actually provides the foundation to open up and say, 'Yeah, you know what? Something isn't right, Doc,'" Harrington said.

Aurora is now making buprenorphine training a resident requirement for Wisconsin OB-GYNs, family doctors, and internal medicine physicians. The health system will roll out its program, in which those doctors can directly prescribe buprenorphine to patients, over the summer.

Ascension has a full-service addiction unit, along with a program to get patients burprenorphine prescriptions immediately in the emergency room.

ProHealth started its push to expand buprenorphine access when doctors noticed a trend of babies born dependent on opioids.

"It was often unexpected," ProHealth Medical Director of Opioid Use Disorder Program Dr. Susanne Krasovich said. "Often mom's use was unknown or undisclosed. And we really wanted to figure out how to get a handle on that."

ProHealth now requires family medicine residents to train to prescribe buprenorphine.

"Without that type of collaboration and partnership between health systems, we're not going to make that large of an impact," Wisconsin Department of Health Services Director of Opioid Initiatives Paul Krupski said.

DHS helps coordinate buprenorphine training, with the goal of allowing more patients to get their medications at regular doctors appointments. Since that effort started at the end of 2018, there's been a 43 percent jump in doctors who are able to prescribe the medication in Wisconsin.

DHS is also in the process of getting input to eventually update state rules about addiction treatment.

"The changes that you can make are literally saving lives, saving families, making communities safer," Krupski said.

COVID-19 and Opioid Treatment Programs (OTPs) - Frequently Asked Questions (FAQ)

Fri, 13 Mar 2020 18:56:10 GMT

*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:

Email: elizabeth.Collier@dhs.wisconsin.gov
Cell phone: 608-215-8601

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.

Affirming ThedaCare’s Commitment to Combating the Opioid Crisis

Tue, 10 Mar 2020 14:36:02 GMT

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 Heindel, ThedaCare’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.

Milwaukee County gets federal grant for opioid use disorder treatment

Fri, 06 Mar 2020 13:03:19 GMT

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.

Evers signs HOPE bills into law

Wed, 04 Mar 2020 17:16:59 GMT

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.

Tentative settlement would provide more resources to fight opioid epidemic

Thu, 27 Feb 2020 16:36:32 GMT

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 agreement, subject 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.

Assembly signs off on Tobacco 21 plan

Fri, 21 Feb 2020 16:44:05 GMT

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.

Wisconsin tribal leader calls for more action to fight the opioid epidemic

Wed, 19 Feb 2020 16:40:47 GMT

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.

Milwaukee data science institute's first projects include opioid overdose study

Tue, 18 Feb 2020 19:30:13 GMT

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.

Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder

Fri, 07 Feb 2020 13:57:20 GMT

JAMA - American Medical Association
Sarah E. Wakeman, MD1,2; Marc R. Larochelle, MD, MPH3,4; Omid Ameli, MD, MPH5; et 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.

Personalizing the Treatment of Substance Use Disorders

Mon, 03 Feb 2020 20:29:07 GMT

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.

Rogers plans Sheboygan location

Mon, 03 Feb 2020 16:16:26 GMT

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.

UW offering free smoking cessation CME

Fri, 31 Jan 2020 15:56:17 GMT

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).

DHS seeks input on Medicaid coverage of residential treatment for substance use disorder

Thu, 30 Jan 2020 16:37:46 GMT

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.

Smoking Cessation: A Report of the Surgeon General

Mon, 27 Jan 2020 16:11:43 GMT

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.

WISAM President Speaks in Support of Expanding Addiction Treatment

Wed, 22 Jan 2020 12:27:49 GMT

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.

DHS weighs in on HOPE bills

Thu, 09 Jan 2020 19:06:14 GMT

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.

Participation in a Hospital Incentive Program for Follow-up Treatment for Opioid Use Disorder

Fri, 03 Jan 2020 15:42:23 GMT

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!

TREATING TOBACCO USE DISORDERS IN BEHAVIORAL HEALTH

Fri, 06 Dec 2019 19:29:09 GMT

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:

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.
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

Society excited to launch WisMed Community – members-only online community

Thu, 05 Dec 2019 20:24:15 GMT

December 5 - Wisconsin Medical Society Medigram

The Wisconsin Medical Society is excited to announce that WisMed Community – the new online community just for WisMed Members – will be live on Monday, December 9! This new member benefit will allow physicians to connect, collaborate and celebrate their successes.

Initially, there will be two community groups: WisMed Members (for general discussions about things like tips and recommendations) and Share a Success (for you to share the great work you or a colleague is doing to advance health care). More community groups will go live in the coming months including Advocacy in Action, so be sure to check back often.

Members will receive an email on Monday with information about how to get logged in and start connecting with colleagues. Please add connectedcommunity.org to your safe sender list so you stay connected.

Contact Anne Hauer with questions.

Wisconsin collects more than 30 tons of drugs during drug take back day

Tue, 12 Nov 2019 16:16:43 GMT

November 12, Wisconsin Health News

Wisconsin collected more than 30 tons of prescription drugs during a drug take back day last month, according to final numbers released by the Department of Justice last week.

Wisconsin collected a total of 60,472 pounds of drugs on Oct. 26. Across the state, 280 law enforcement agencies held drug take back events and collected medications from 476 drug disposal boxes.

The collected medications were transported to Indianapolis where they were incinerated.

Wisconsin had the second largest collection of any state in the nation, according to a report of preliminary numbers from the Drug Enforcement Agency.

Seven more HOPE bills surface

Tue, 12 Nov 2019 16:12:17 GMT

November 12, Wisconsin Health News

Legislators are asking their colleagues to sponsor seven more bills that are part of a years-long effort to fight the opioid epidemic.

The bills began circulating for co-sponsorship last week.

They’re part of the Heroin, Opioid Prevention and Education Agenda, a series of 30 bipartisan bills that have passed the Legislature.

Rep. John Nygren, R-Marinette, noted that recent data show overdose deaths declining in Wisconsin. He said that they've worked with healthcare professionals, the recovery community and law enforcement on addressing the issue.

“The HOPE Agenda is not a silver bullet solution to our statewide drug epidemic, but I am proud that we are continuing to take steps in the right direction,” Nygren said in a statement.

The bills would:

Increase a supplemental appropriation for the Joint Finance Committee by $1 million over the biennium to up Medicaid rates for physical health services, like chiropractic care and physical therapy. The Department of Health Services would have to request the release of the funds from the Joint Finance Committee. The bill also directs DHS to submit a plan to the federal government to create a Medicaid benefit for acupuncture.
Repeal a sunset for current 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 to those calling for help for another person suffering an overdose. It also ends a sunset for a law granting immunity from prosecution or having probation, parole or extended supervision revoked for a controlled substance to overdose victims, if they complete a drug treatment program.
Extend a sunset for a law requiring prescribers to check a patient's records in the state’s prescription drug monitoring program before issuing a prescription order. Under the bill, the requirement would end on April 1, 2025, rather than April 1, 2020. The bill would also require the Controlled Substances Board to conduct a quarterly review of the program through Oct. 30, 2025, rather than through Oct. 30, 2020.
Require the Medical Examining Board to issue guidelines on the best practices for treating neonatal abstinence syndrome.
Require DHS to create a Medicaid benefit for peer recovery coach services. Also mandate that the department establish and maintain a program to coordinate and continue care following a substance use overdose.
Require DHS to create a registry of approved recovery residences. DHS couldn’t include any recovery residency that excludes those participating in medication-assisted treatment programs. The legislation also bars disciplining state employees who are using controlled substances as a recommended part of their medication-assisted treatment.
Require DHS to study the availability of medication-assisted treatment for opioid use disorder in prisons and jails. The agency will then have to propose a pilot project to the Joint Finance Committee to make all approved mediations for substance use disorder treatment available in at least one prison or county jail. The plan allows county jails to enter into an agreement with an ambulance service provider or doctor to obtain a supply of the anti-overdose drug naloxone and allows jailers to receive the training to administer the medication. The bill also grants legal immunity for administering naloxone.

DHS finalizes plan for Medicaid coverage of residential substance use disorder treatment

Wed, 06 Nov 2019 16:41:24 GMT

November 6, Wisconsin Health News

A new Medicaid benefit for residential substance use disorder treatment could go into effect Feb. 1, pending approval of a final plan submitted to the Joint Finance Committee.

The Centers for Medicare and Medicaid Services signed off on the plan last month. The committee will take a passive review process to the plan, meaning it'll go into effect unless members decide to meet.

DHS has begun pre-implementation outreach and communication activities about the program.

The benefit would cover short-term residential services in facilities that have been excluded from federal reimbursement because they're institutions for mental disease.

Thousands contact addiction helpline

Mon, 28 Oct 2019 15:44:16 GMT

October 28, Wisconsin Health News

More than 5,000 people contacted a state helpline connecting those seeking help with addiction to community resources during its first year.

The Addiction Recovery Helpline, a 24/7 hotline managed by 211 Wisconsin under a contract with the Department of Health Services, offers help to individuals with challenges related to drug use.

“Too often people delay seeking treatment for a substance use challenge simply because they don’t know where to begin,” DHS Secretary-designee Andrea Palm said in a Friday statement. “The Wisconsin Addiction Recovery Helpline is a good first step."

The helpline began taking calls on Oct. 22. In its first year, 5,594 contacted it.

Operators facilitated 11,940 referrals as people can call the line more than once and can be referred to more than one service.

Assessment, detoxification and residential treatment services were the most referred services.

Michael Miller, MD, DFASAM Receives McGovern Award at the ASAM 51st Annual Conference

Tue, 22 Oct 2019 20:21:39 GMT

2019, WISAM Announcement

Michael Miller, MD, DFASAM, founding member of the Wisconsin Society of Addiction Medicine and past president of ASAM, receives the McGovern Award at the ASAM 51st Annual Conference. View video here.

This video is being shared from the ASAM 50th Annual Conference. You're invited to view more of The ASAM 50th Annual Conference on ASAM’s e-Learning Center here: https://elearning.asam.org/products/asam-50th-annual-conference-innovations-in-addiction-medicine-and-science-2019-85-cme.

Wisconsin Doctor Day Keynote Announced

Tue, 08 Oct 2019 17:53:31 GMT

Charles Franklin, PhD, nationally recognized government scholar and pollster, will headline Doctor Day 2020.

Doctor Franklin has served as director of the Marquette Law School Poll since its inception in 2012. During that year’s highly scrutinized election cycle, he established Marquette as the definitive source for information concerning public opinion in Wisconsin.

Under Doctor Franklin’s direction as a visiting professor at Marquette, the poll became the largest independent polling project in state history. It accurately captured voter attitudes before every major election in 2012, including the gubernatorial recall, U.S. Senate and presidential races.

Since joining Marquette as a professor of law and public policy in August 2013, Doctor Franklin has used the poll to continue tracking political races of interest to voters and explore additional public policy issues.

At Doctor Day on January 29, 2020, Franklin will share his insight and polling data relevant healthcare policy and the 2020 elections.

Click here for more information!

More than $5 million headed to state to support fight against opioid epidemic

Wed, 04 Sep 2019 15:20:25 GMT

September 4, Wisconsin Health News

Around $5.2 million in new federal funding is heading to Wisconsin to help fight the opioid epidemic, Democratic U.S. Sen. Tammy Baldwin said Tuesday.

The money, from the Centers for Disease Control and Prevention, will help the Department of Health Services' opioid surveillance and prevention efforts.

Baldwin pushed for the money.

"Washington needs to do more to address the opioid epidemic," she said in a statement. "A strong partnership with state and local officials is essential to an effective response."

Lutheran Social Services plans to open addiction treatment facility

Wed, 28 Aug 2019 15:55:24 GMT

August 28, Wisconsin Health News

Lutheran Social Services of Wisconsin and Upper Michigan plans to open a facility in Waukesha offering addiction treatment next year, according to a Wednesday statement.

The 22-bed LSS Aspen Center will serve about 125 individuals from southeastern Wisconsin annually. It will fill a need in Waukesha county by offering affordable, medically monitored treatment for women seeking care.

“Being able to serve women inside of Waukesha County rather than sending them to surrounding areas for treatment is a win,” Paul Farrow, Waukesha County executive, said in a statement.

Lutheran Social Services of Wisconsin and Upper Michigan hopes to raise $1.7 million by the end of the year for the facility.

It's already secured a $300,000 grant from Waukesha County. It needs about $500,000 to open treatment services at the start of next year.

DHS reports lowest number of opioid deaths since 2015

Thu, 15 Aug 2019 19:10:00 GMT

August 15, Wisconsin Health News

The number of opioid deaths in the state is at its lowest level since 2015, the Department of Health Services reported Wednesday.

There were 838 deaths in 2018, a 10 percent reduction from the previous year.

“The most recent data on Wisconsin’s opioid epidemic is encouraging,” said DHS Deputy Secretary Julie Willems Van Dijk. “It shows that our collective ongoing efforts to support individuals and communities affected by this public health crisis are working to save lives, but we still have a lot of work to do to end this epidemic.”

The department on Wednesday released a federally funded online tool containing up-to-date information on opioid usage, hospitalizations and deaths.

Wisconsin health centers, academic institutions get federal boost for opioid efforts

Mon, 12 Aug 2019 15:56:44 GMT

August 12, Wisconsin Health News

Around $2.5 million is heading to 15 Wisconsin community health centers and two La Crosse academic institutions to help combat the opioid epidemic.

The funding is part of $400 million awarded nationally by the Department of Health and Human Services. The community health centers are set to get $2.4 million.

“While progress has been made increasing access to these services, community health centers are still working to ensure that the recovery programs are sustainable and they can hire qualified staff members to best meet significant community needs," said Stephanie Harrison, CEO of the Wisconsin Primary Health Care Association.

Viterbo University in La Crosse is getting about $741,000 to enhance training for students preparing to become behavioral health professionals.

Western Technical College in La Crosse is getting around $103,000 to enhance training for students preparing to become behavioral health paraprofessionals.

Milwaukee Common Council supports exploring legal options to fight opioid epidemic

Wed, 31 Jul 2019 15:43:47 GMT

July 31, Wisconsin Health News

Milwaukee’s Common Council unanimously approved a resolution Tuesday allowing Milwaukee’s city attorney to file suit against drugmakers and distributors that could be held responsible for damages from the opioid epidemic.

The resolution allows the city to retain outside counsel for the litigation. It notes that thousands of governmental entities – including Milwaukee County last year and Wisconsin this May – have filed lawsuits over the epidemic.

The resolution now heads to Mayor Tom Barrett's office.

The action comes as Milwaukee County Medical Examiner's Office reported a total of 14 probable overdose deaths between Friday and Monday morning.

On Monday, the Milwaukee Community Opioid Prevention Effort released a report showing a 10 percent decline in the number of opioid-related overdose deaths from 2017 to 2018.

There were 302 opioid-related overdose deaths last year, down from 337 in the prior year.

Around 62 percent of all overdose deaths last year involved fentanyl, either alone or in combination with other drugs, an increase from the prior year.

The group estimated in its report that for every death, there were five more people who experienced an overdose that survived.

In 2016, the rate of opioid overdose death in the county was double the rate of Wisconsin, showing the crisis is “disproportionately impacting Milwaukee County and its citizens,” the report noted.

Last week, the City-County Heroin, Opioid and Cocaine Task Force met to review efforts to fight the epidemic.

Those efforts included:

· A June awareness event, modeled after a similar initiative in Dayton, Ohio, that aimed to connect those suffering from substance use disorder with treatment. Task force members said the event should happen regularly.

· A $20,000 awareness campaign by the Milwaukee Health Department, funded by a grant from the Department of Health Services, that city officials hope to launch in August.

· The Milwaukee County Office of Emergency Management has applied for a $600,000 grant that would help emergency medical services, law enforcement and hospital systems track overdoses in real time.

The Milwaukee Overdose Response Initiative, an effort by the Milwaukee Fire Department, has been working to follow up with overdose victims and connect them to treatment.

Career Long Mentoring in Addiction Medicine

Mon, 22 Jul 2019 15:09:51 GMT

WISAM Members In the News

All Ways Forward; University of Wisconsin - Madison

When Eric Smiltneek ’01, MD’06 was in medical school, he dreamed of being able to help both individuals and an entire community. Today his dual roles in Oshkosh as a family medicine doctor at ThedaCare Physicians and a medical director at Nova, an addiction-treatment center, have allowed him to do just that. “I’ve enjoyed both being a family and a community doctor,” he says.

After earning his UW undergraduate degree, Smiltneek spent a year with AmeriCorps in Chicago, where he learned about substance abuse and its devastating impact. When he returned to UW–Madison for medical school, he says, “I had fantastic mentors.” Dr. Michael Miller in particular encouraged him to continue his work with addiction, and Miller still serves as a mentor for Smiltneek today. “Even 10 to 15 years out, I’m still learning from the people I was learning from at the UW,” Smiltneek says.

After arriving in Oshkosh, he first focused on treating prescription-drug addiction and then helped to address the expanding heroin epidemic. Smiltneek is also involved with a Wisconsin Department of Corrections pilot program to help recently released nonviolent drug offenders. The program, he says, has doubled or even tripled the number of clients able to avoid relapse after one year.

Smiltneek also approaches addiction from a prevention angle. A former member of the Wisconsin Hoofers with a lifelong passion for the outdoors, he leads a youth sailing club and he also founded Dr. Eric’s Skate Club in Oshkosh to lay the foundation for appreciating physical activities at a young age.

“I realized what an awesome release this was for stress and feeling sad and needing something exciting to happen,” he says. “If people can have something that gets them outside and find something that really grounds them, then I hope the need for drugs and alcohol is less, and we can get more healthy addictions.”

Input Requested: Behavioral Health Gaps Survey

Wed, 17 Jul 2019 20:40:50 GMT

The Wisconsin Department of Health Services has identified the Wisconsin Society of Addiction Medicine as a key stakeholder to participate in a needs assessment of the behavioral health service system in our state.

WISAM members are invited and encouraged to participate in a Behavioral Health Gaps Survey, comprised of approximately 10 topics ranging from service availability, accessibility, and service gaps for subpopulations.

Participation in the survey is both anonymous and voluntary, and is estimated to take approximately 30 minutes or less to complete. Please:

Complete survey prior to the deadline of August 9, 2019.
Complete the survey only once even if you receive multiple invitations.
Use the same computer if you need to complete the survey in more than one sitting. The survey link will take you to the point you stopped as long as you use the same computer.
Direct all questions or problems with the survey to Abra Vigna, lead staff a UW-PHI, avigna@wisc.edu.

BEGIN SURVEY

Thank you for your participation.

AMA Advocacy Update Aligns with ASAM

Mon, 01 Jul 2019 21:25:47 GMT

A message from Mike Miller, MD, DFASAM, WISAM's Public Policy Chair

The advocacy positions of the AMA are very aligned with those of ASAM. With its rich history and broad membership, AMA's presence and clout opens doors in the legislative arena and Congress pays attention. Below is an excerpt of a recent AMA Advocacy Update. I encourage you to stay abreast of these updates.

AMA Advocacy Update, June 27, 2019

ISSUE SPOTLIGHT: Funding boost needed to close treatment gap for patients with opioid use disorder

The nation's opioid epidemic is worsening as policy, regulatory and especially insurance barriers continue to block access to treatment, AMA President-elect Susan R. Bailey, MD, told Congress.

"The good news is that we know that there are policy and clinical interventions that work and have a direct impact on saving lives and improving care," Dr. Bailey testified last week at a House Oversight and Reform Committee hearing. "The bad news is there is a huge gap in access to treatment. It is estimated that less than 35% of adults with opioid-use disorder had received treatment for it in 2018."

Progress continues on multiple fronts. As shown in the AMA Opioid Task Force's 2019 progress report, physicians have significantly lowered the number of opioid prescriptions they write and there are rising numbers of doctors registering with and using their state prescription drug monitoring program, getting certified to provide in-office buprenorphine and prescribing naloxone for at-risk patients.

Medical societies in several states have used the AMA's model legislation to remove commercial and Medicaid prior authorization barriers to medication-assisted treatment (MAT).

Looking to Advance to ASAM Fellow Status?

Mon, 24 Jun 2019 21:10:00 GMT

Fellow designation gives recognition to and raises awareness of ASAM members who are board certified addiction specialists. ASAM Fellows are able to use the FASAM designation after their name.

To qualify for the FASAM designation, physicians must be members of ASAM for two consecutive years and be currently certified in Addiction Medicine.

Learn more to see if you qualify!

July 9 WHN Luncheon: The vaping epidemic and what it means for healthcare

Thu, 20 Jun 2019 13:08:26 GMT

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:

Jeanne Ayers, Public Health Division Administrator, Department of Health Services
Sen. Andre Jacque, R-De Pere
Dr. James Meyer, Pediatrician, Marshfield Clinic Health System
Dona Wininsky, Director of Advocacy, Grassroots and Patient Engagement, American Lung Association of Wisconsin

Federal grants support consortiums to address substance abuse treatment

Thu, 06 Jun 2019 16:23:08 GMT

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."

Report: Dispensing of medication-assisted treatment on the rise

Thu, 30 May 2019 16:18:58 GMT

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.

President's Message, May 2019

Tue, 14 May 2019 17:31:42 GMT

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

News Conference Addresses MAT Coverage under BadgerCare

Wed, 08 May 2019 19:54:39 GMT

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.

WISAM at the Forefront of Collaboration with DOJ

Thu, 02 May 2019 18:04:51 GMT

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 1^st, 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.

New Workforce Programs Will Help Address Deadly Opioid Overdose Epidemic

Tue, 30 Apr 2019 15:26:08 GMT

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.

ASAM Review Course, July 25-27

Tue, 30 Apr 2019 15:13:28 GMT

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.

Marquette Researchers Receive $1.9M to Study Addiction

Thu, 18 Apr 2019 21:43:13 GMT

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.”

Ritu Bhatnagar, MD, MPH, named ‘Superhero of Medicine’

Thu, 11 Apr 2019 21:32:13 GMT

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.”

Report: Expanding Medicaid Improves Access to Opioid Addiction Treatment

Thu, 11 Apr 2019 12:45:26 GMT

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 – Idaho, Nebraska 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 Florida, Missouri, North Carolina, South Carolina, Tennessee, 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."

Strong Wisconsin Showing at ASAM in Orlando

Wed, 10 Apr 2019 12:56:41 GMT

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.

Doctor Michael Miller Honored by ASAM

Fri, 05 Apr 2019 13:24:40 GMT

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.

More counties, tribes get grants to provide medication-assisted treatment

Thu, 21 Mar 2019 16:09:07 GMT

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)

Palm touts hub-and-spoke model

Thu, 21 Mar 2019 16:06:09 GMT

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.

Experts break down health and legal aspects of marijuana

Wed, 20 Mar 2019 20:40:38 GMT

March 20, Wisconsin Health News

National experts broke down the health and legal aspects of marijuana at a Tuesday panel in Madison.

There's some evidence that marijuana can reduce nausea in patients undergoing chemotherapy as well as reduce pain in adults with chronic pain, according to Dr. Ron Wallace, a professor of epidemiology and internal medicine at the University of Iowa College of Public Health and Medicine. Wallace worked on a national report summarizing marijuana’s health effects.

Those with multiple sclerosis who use marijuana also report fewer muscle spasms. But Wallace said that the effects of cannabinoids were “modest."

“Cannabis can help a little bit,” he said at an Evidence-based Health Policy Project briefing. “But it’s not clear whether it’s better than the other options that are out there.”

There’s some evidence that long-term cannabis smoking can worsen respiratory problems and exacerbate some mental conditions, he said. Cannabis can also impair learning, memory and attention.

But it’s unclear how cannabis relates to heart attack, stroke and diabetes. And it’s not known how using marijuana during pregnancy affects pregnancy and childhood outcomes.

Determining marijuana's health effects can be difficult due to a host of issues, including a lack of standardization among the drug, federal restrictions and little funding for research, Wallace said.

Karmen Hanson, program director of behavioral health at the National Conference of State Legislatures, said 34 states have legalized medical marijuana.

Most states require or allow dispensaries and patient registries. They also have a list of specific conditions that patients can use medical marijuana.

But each state’s program is unique and legislators have to design programs that work best for their state, Hanson said.

“No two programs are going to be alike,” she said. “You can’t take what has worked in Colorado and drop it into Wisconsin.”

Gov. Tony Evers’ budgetwould legalize medical marijuana, but parts of it face opposition from Republican leaders.

Kaul: Increasing treatment access, prevention could curb opioid epidemic

Wed, 20 Mar 2019 20:38:19 GMT

March 20, Wisconsin Health News

Attorney General Josh Kaul called Tuesday for increasing access to treatment, taking action to prevent people from becoming addicted to opioids and holding drug traffickers and others accountable for their role in the opioid epidemic.

Speaking at an opioid forum in Green Bay, Kaul said the state should ensure more Wisconsinites have access to treatment and expand local programs that are working well.

He also called for taking federal money to expand Medicaid to get more people access to healthcare.

Wisconsin has done well on raising awareness, but it needs to take more action to prevent people from being addicted, Kaul said. That includes continuing work on reducing overprescription of opioids and its drug take back days.

He also suggested looking at the legalization of marijuana in other states and seeing whether it was effective as an alternative to opioids.

“My view is that I would have a doctor prescribing that patient medical marijuana than an opioid in almost every case,” he said.

Kaul also said large-scale drug traffickers need to be held accountable as well as those who created the epidemic.

Those who “reaped massive profits off the creation of the epidemic owe money back,” he said.

“It’s critical that we learn what caused this epidemic so that we don’t repeat the mistakes that were made as this epidemic was created,” he said

Wisconsin Medical Society, medical schools partner to host conference April 5-6

Tue, 05 Mar 2019 14:29:11 GMT

Summer is only a few months away, and the Wisconsin Medical Society has teamed up with the Medical College of Wisconsin (MCW) and the University of Wisconsin School of Medicine and Public Health (UWSMPH) to make sure your health care team is prepared.

From Asthma to Zika: A Physician's Guide to Summer is being held April 5-6 in Madison. Focusing on emerging health trends in infectious disease, environmental health and trauma, the new two-day education conference features a full lineup of speakers from MCW and UWSMPH, plus the opportunity to fulfill opioid education required by the Medical Examining Board and plenty of time to network with colleagues from across the state. s teamed up with the Medical College of Wisconsin (MCW) and the University of Wisconsin School of Medicine and Public Health (UWSMPH) to make sure your health care team is prepared.

Click here for details including session descriptions, speaker bios and registration information. The conference has been approved for AMA PRA Category 1 Credit™. Application for CME credit with the American Academy of Family Physicians is pending.

Quarterly Complex Pain Case Conference

Fri, 22 Feb 2019 20:24:23 GMT

This quarterly recurring conference, taking place on May 22, 2019; September 11, 2019 and November 20, 2019, creates an educational forum in which primary care providers present cases of patients with complex pain to a multidisciplinary medical team.

The team consists of specialists in:

Addiction Medicine
Pain Medicine
Pharmacy
Physical Therapy  Physical and Rehabilitation Medicine
Primary Care
Psychiatry

The team will offer patient-specific recommendations for

Opioid and non-opioid medication management
Psychiatric and/or behavioral-health factors and treatment pathways, including addiction treatment
Physical therapy and other movement therapies
The use of interventional and non-interventional pain-blocking therapies

Patient identifiers will be removed so that other providers can attend the case presentations and learn the team’s recommendations for controlling pain and improving function.

This conference is designed to support providers’ efforts to develop multi-modal, pain management plans for their complex, chronic pain patients.

Providers on the May 22nd team include:

Alaa Abd-Elsayed, MD, MPH, Medical Director, UW Health Pain Services; Medical Director, UW Pain Clinic
Ellen Braatz, DPT – Physical Therapy, UnityPoint Health-Meriter
John Ewing, MD – Addiction Medicine, NewStart – UnityPoint Health-Meriter
Jennifer George, PharmD – Pharmacy, UnityPoint Health-Meriter
Jared Greenberg, MD - Interventional Spine and Rehabilitation, UnityPoint Health-Meriter
Jim Shropshire, MD, Primary Care – Conference Moderator, UnityPoint Health-Meriter, Chair of the Ambulatory Chronic Pain Committee
Ketty Thertus, MD – Psychiatry, Assistant Professor, Department of Psychiatry, UW School of Medicine and Public Health,

The conference will recur quarterly and team members may vary. If you would like to present a case at a future conference, please email james.shropshire@unitypoint.org.

This conference is generously funded by the UnityPoint Health-Meriter Foundation.

STATEMENT OF ACCREDITATION UnityPoint Health - Meriter is accredited by the Wisconsin Medical Society to provide continuing medical education for physicians.

AMA CREDIT DESIGNATION STATEMENT UnityPoint Health - Meriter designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity

WISAM and WMS Voice Concerns Over DOJ Letter to Prescribers

Fri, 15 Feb 2019 14:22:28 GMT

The Wisconsin Medical Society and the Wisconsin Society of Addiction Medicine (WISAM) have raised concerns that a recent letter sent by the U.S. Department of Justice (DOJ) could have negative unintended consequences for patients trying to receive medically necessary treatment.

The letters were sent February 4 to more than 180 Wisconsin physicians, physician assistants and nurse practitioners who are “prescribing opioids at relatively high levels compared to other prescribers,” but did not specify if those comparisons reflected different types of patient populations that exist—a critical variable considering that some clinicians spend the bulk of their practices treating patients who experience pain or who are being weaned off addictive drugs, including opioids.

“We’re very concerned that these letters will alarm prescribers to the point that they may get out of the pain treatment arena altogether,” said Society President Molli Rolli, MD, in a press release distributed statewide today. “For years, Wisconsin’s physicians, elected officials and law enforcement leaders have collaborated to find the best ways to combat the opioids crisis; these letters seem to pivot into an area where physicians are threatened with criminal sanctions even if the treatment provided is medically appropriate.”

The DOJ letter admits that those receiving the letter haven’t been accused of any criminal wrongdoing: “Your prescriptions may be medically appropriate, and we have made no determination that you are violating the law.”

However, WISAM President Matthew Felgus, MD, said, “You have to get pretty deep into the letter to see that disclaimer. So essentially the letter is saying ‘you’re not doing anything illegal, but we’re watching you’—that’s a very new law enforcement attitude compared to what we’ve seen over the last several years, so it’s quite troubling.”

A recent report from the state’s Prescription Drug Monitoring Program (PDMP) shows that the total number of opioids and other monitored prescription drugs dispensed in Wisconsin has decreased 29 percent between 2015 and 2018—a drop of almost 1.5 million prescriptions.

“We’re making progress in reducing the amount of opioids being prescribed; at the same time, it’s important to remember that it’s already very difficult for some patients in Wisconsin to get quick access to legitimately needed care,” said Dr. Felgus. “Prescribers receiving this letter may think twice about continuing to see patients who have pain treatment needs—and those patients risk turning to street drugs when they can’t see a physician who is trying to wean them off opioids altogether.”

Both Dr. Felgus and Dr. Rolli emphasized that physicians are grateful for law enforcement efforts to help combat the opioid epidemic and suggested that the state’s Medical Examining Board—made up of 10 physicians and three public members—is best-suited to determine if a physician should face sanctions for providing inappropriate care.

“We hope to continue to collaborate with law enforcement on efforts like Wisconsin’s Dose of Reality initiative and drug take-back days, which have resulted in literally tons of unused prescription drugs being turned in to law enforcement offices for destruction, and that what appears to be a more punitive stance in the DOJ letter is an anomaly rather than a new standard,” said Dr. Rolli.

Wisconsin Chapter Meeting at ASAM Conference, April 6

Fri, 01 Feb 2019 14:28:17 GMT

Heading to The ASAM 50th Annual Conference April 4-7? While in Orlando, make plans to participate in a Wisconsin Chapter meeting on Saturday, April 6th, 5:30-6:30 pm EST. We look forward to seeing you there!

Report: Fatal opioid overdoses appear to be leveling in Milwaukee County

Wed, 30 Jan 2019 18:16:08 GMT

January 30, Wisconsin Health News

Opioid-related overdose deaths appear to be leveling off in Milwaukee County, according to a recent report.

If trends continue, the projected likely number of fatal opioid-related overdoses last year will be 9 percent lower than in 2017, according to the Milwaukee Community Opioid Prevention Effort.

The report estimated that for every overdose death, five additional people received an anti-overdose drug and survived.

The report also called for efforts focused on reducing drug use, working with providers to prevent those taking pain medications from developing opioid use disorder and connecting people with treatment.

"While much effort has been put into addressing the opioid crisis, and projected fatal and non-fatal overdoses appear to be decreasing, more is needed," the report noted.

The Milwaukee Community Opioid Prevention Effort is sponsored by the city of Milwaukee, The Medical College of Wisconsin's Department of Emergency Medicine and the Zilber Family Foundation.

Society urges flexibility in future CME/opioids requirements

Fri, 21 Dec 2018 16:06:53 GMT

December 20, WMS Medigram

The Wisconsin Medical Society has urged the state’s Medical Examining Board (MEB) to be flexible when approving courses related to opioid prescribing so that more physicians can receive useful education befitting their particular specialties. The input was given at a public hearing before the MEB on a new administrative rule related to an extension of the opioid prescribing continuing medical education (CME) course requirement until November 2021.

Current rules require physicians holding a U.S. Drug Enforcement Administration number to complete two of the 30 required hours of CME per biennium in an MEB-approved course related to the state’s opioid prescribing guidelines. The current requirement expires in November 2019. The MEB is extending the requirement for another CME reporting biennium while broadening the subject matter scope to “an educational course or program related to opioid prescribing.”

The Society was the only organization to testify before the MEB on the rule proposal.

Flexibility in the types of courses that can gain MEB approval would make the requirement more relevant to certain physicians who, while not being active opioid prescribers, often take care of patients dealing with the aftermath of opioid addiction or abuse. The Society also suggested that the Board could incentivize physicians taking coursework in Medication Assisted Treatment (MAT) by making those courses eligible to satisfy the requirement should they be submitted for CME approval. The MEB welcomed the comments and indicated that such flexibility would be useful as Wisconsin continues to grapple with this issue.

The MEB unanimously approved the rule proposal, which now moves on to standard Governor’s office and legislative review.

Each of the webinars available in the Society’s opioid prescribing series has been approved by the MEB for fulfilling the 2018-2019 CME requirement, including two 2-hour webinars presented by Michael McNett, MD. The other programs vary in length and may be combined to satisfy the mandate. Click here to learn more.

Governor’s opioid task force releases final report

Thu, 20 Dec 2018 17:22:16 GMT

December 19, Wisconsin Health News

A state commission has designed a care delivery model to increase access to treatment for substance use disorder. But critical parts of the model, like how it'll be paid for, still need work.

The report from the Commission on Substance Abuse Treatment Delivery was released at the final meeting of the Governor’s Task Force on Opioid Abuse in Friendship last week.

The commission, created by Gov. Scott Walker in January, met with Medicaid officials, provider associations and others as it developed the model.

The report describes a system of regional “hubs,” with staff specialized in addiction providing high-intensity, medication-assisted treatment, and “spokes” that offer less intensive treatment in the community.

Vermont first developed the hub-and-spoke model, and other states have adopted similar models.

“The model can be viewed as a draft, and a goal to move towards, as it will benefit from further input from additional stakeholders and from individuals with lived experience of addiction,” the report notes.

The report recommends that the treatment initiation process begin within 24 hours of a person seeking care to minimize withdrawal. That capacity isn’t available in the current system, the report notes, describing it as a “long-term goal.”

But a starting point could be emergency departments, where doctors could provide patients with a one- to three-day prescription for buprenorphine, a drug used to treat opioid addiction.

Care teams that provide support throughout treatment and recovery and address the social determinants of health are another critical part of the model. The makeup of the teams could vary, and the report doesn’t specify how they’d be paid for and what requirements they'd need to meet.

Hubs will have to be able to quickly accept transfer patients that spoke clinics can't support. Spokes will also need access to specialized resources to support patients, which could be provided by either the team or the hub. “All services should be available locally across the state,” the report notes.

The report's roadmap toward implementation includes coordinating funding and a call on healthcare payers to change how they pay for care to ensure providers participate in the model. That could include increases in reimbursement rates and incentives for care coordination and delivery.

It’ll also require a “comprehensive monitoring and program evaluation plan" to track performance.

Health information technology and telehealth will play a large role as will regulatory changes aimed at breaking down barriers to accessing medication-assisted treatment, according to the report.

“How services are integrated and provided can look very different in different regions and counties, and it indeed should look different,” the report notes. “The current expectation is not a finished model, but to align the direction and goals that all partners are moving towards.”

WISAM President's Message, December 2018

Tue, 18 Dec 2018 17:10:08 GMT

Matt Felgus, MD
WISAM President

The impact of substance use disorders is in the news every day -- there is no escaping the effects this has on patient care whether you are a physician, nurse, pharmacist or therapist. However, not all of our colleagues are comfortable with this unavoidable reality, which is why it is so important for all of us to stay informed and to serve as points of contact along the way.

I've heard some of you, especially newer WISAM members, say that you don't feel you know enough about addiction to be able to serve as a point of contact for your colleagues. But the fact that you've joined WISAM and are reading this now makes a huge difference in moving our respective fields forward in this critical subject. Keep connected and keep learning!

As one who started in the field as a drug counselor and finished addiction psychiatry training in the late 90s at the crest of the 'patients can't get addicted to opioids if they are using them only for pain' era, I can say from experience that your involvement matters more than you think. And for this I thank you and honor your willingness to join with us.

And for those of you who have been on the front lines of addiction treatment for years, deep gratitude to you as well. WISAM is an amazing organization with tireless, committed officers, committee chairs, administrative staff and members. It's been an honor to represent and work alongside of you all. Let's keep moving things forward!

Have a wonderful holiday season. And Best Wishes for 2019!

Matt Felgus, President

Jan. 8 Program - What's the future of marijuana and CBD in Wisconsin?

Tue, 18 Dec 2018 17:08:01 GMT

Marijuana was among the big winners at the polls in November, with voters in counties across the state signaling their support for legalization. Backers also have a friend in Gov.-elect Tony Evers, who has said doctors should be able to use cannabis to treat patients.

Meanwhile, CBD, which is extracted from hemp plants, has been heralded as a cure-all for everything from seizures to chronic pain to better sleep. State lawmakers recently approved its use, but questions over its health benefits - and legality - remain.

A Jan. 8 Wisconsin Health News panel in Madison will take a closer look at the legal and health issues around marijuana and CBD oil – and their future in the state. Confirmed panelists include:

Rep. Chris Taylor, D-Madison
Sen. Pat Testin, R-Stevens Point
Dr. Mike Miller, American Board of Addiction Medicine

Learn more and register to attend.

DHS grants to support opioid use disorder treatment in jails

Tue, 18 Dec 2018 17:04:39 GMT

December 18, Wisconsin Health News

More than $1.3 million in state grants will support medication-assisted treatment programs for inmates living with opioid use disorder at 16 county jails, according to a recent Department of Health Services statement.

Grant recipients are working with jails in Bayfield, Brown, Columbia, Dane, Dodge, Grant, Kenosha, Iowa, Manitowoc, Racine, Rock, Shawano, Sheboygan, Walworth, Waushara and Vilas counties.

The money, provided under a law enacted earlier this year, is available through June 30. Up to $750,000 is available in future state fiscal years.

Fighting Addiction in Rural Northern Wisconsin

Fri, 14 Dec 2018 14:59:31 GMT

Editor's note: the following excerpt is taken from "For One Rural Community, Fighting Addiction Started With Recruiting The Right Doctor" heard on NPR's Weekend Edition Sunday, Sunday, December 9, 2018.

The story features Mark Lim, MD, an active member of WISAM/ASAM who has presented at WISAM annual conferences and recently led a session in WISAM's 2018 Webinar Series. He is board certified in both Addiction Medicine and Family Medicine, and serves as the Medical Director of NorthLakes Community Clinic in Ashland, Wisconsin.

Dr. Mark Lim says he is surprised he's here in this 8,000 person port-town on Lake Superior. He'd dreamed of living in a big city since he moved to the U.S. from the Philippines. When he got the call about the job, he was hesitant at first. "I didn't know where that was on a map," he recalls.

But he saw this part of Wisconsin, where the death rate from drug and alcohol abuse is nearly twice as high as the state average, as a place where he could make a difference.

Lim's been board certified in addiction medicine since it was officially recognized as a subspecialty in 2016, but he's been working in the field since about 10 years ago when he started working in an addiction practice in Maine.

He took the Wisconsin job, with one stipulation: He would start a program to address addiction as a whole. His expertise would be just one part of the treatment approach.

"If I'm just going to be the Suboxone doctor I'm not doing the full practice of addiction," Lim says. Read full story.

Milwaukee Opioid, Cocaine Task Force Releases Recommendations

Mon, 03 Dec 2018 16:23:16 GMT

December 3, Wisconsin Health News

A Milwaukee task force finalized recommendations Friday on how to reduce drug misuse and overdoses.

The recommendations from the City-County Heroin, Opioid and Cocaine Task Force aim to guide efforts in Milwaukee County. The task force hopes to implement the changes through grants and collaboration.

Alderman Michael Murphy, who co-chairs the task force, noted that more than 400 people died last year from overdoses. He recently received new data from the Milwaukee County Medical Examiner’s Office showing a decline.

“Right now, god willing, if things hold, we’ll see a 25 percent reduction compared to last year,” he said. “So that’s a great story.”

Murphy wants to determine what’s working and support those programs. The task force plans to continue to meet and follow up on the recommendations.

“Sometimes, being in government, you look at reports and you wonder if they just gather dust after they’re done,” he said. “We don’t intend to have that happen.”

Among the changes the report recommends are:

A widespread public health education campaign on substance abuse as well as efforts targeting children and teenagers.
Collaborating with local medical groups to increase use of the Enhanced Prescription Drug Monitoring Program.
Supporting harm reduction strategies beyond anti-overdose drugs like Naloxone, including rapid testing kits for drugs users to test substances for fentanyl and safe needle exchanges.
Developing a system for rapidly detecting spikes in overdoses in the county to ensure that resources target high-need areas.
Pursuing policies that incentivize property owners to rent to those in recovery.
Integrating medication-assisted treatment into federally qualified health centers, opioid treatment programs, prisons and other places.
Expanding drug courts that offer treatment to those serving time in prison.

DHS Grants Aim to Expand Opioid Use Disorder Treatment

Tue, 27 Nov 2018 21:56:04 GMT

The Department of Health Services awarded grants to expand medication-assisted treatment for opioid use disorder in Madison and Milwaukee, according to a Monday statement.

ARC Community Services in Madison and United Community Center in Milwaukee each received $250,000 grants that last through September.

The money comes from an $11.9 million federal grant DHS received last month. It's expected to be an annual award, according to the statement.

ASAM Applauds Signing of Historic Bipartisan Opioid Package

Tue, 30 Oct 2018 15:00:52 GMT

On October 24, ASAM issued a press release applauding the President for signing the SUPPORT for Patients and Communities Act (H.R. 6) into law. The legislation follows weeks of discussion between the House of Representatives and Senate legislative conference. The final bill signed today includes key provisions to bolster the country’s addiction treatment workforce, provide standardized, evidence-based treatment for SUD, and ensure that coverage and payment models facilitate continuity of care for patients with SUD. Read more.

Drug Take-Back Day is October 27!

Fri, 26 Oct 2018 14:26:27 GMT

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.

National Prescription Drug Take-Back Day is Saturday, October 27, 2018 from 10:00 a.m. - 2:00 p.m. National Take-Back Day is a safe, convenient, and responsible way to dispose of unused or expired prescription drugs.

Learn more about Drug Take-Back Day in Wisconsin, and find a location near you to safely drop off your unwanted or unneeded prescription painkillers and other drugs.

Milwaukee Summit on Opioid and Meth Abuse Kicks Off Drug Take Back Day Events

Fri, 26 Oct 2018 14:11:29 GMT

Oct. 25, WMS Medigram

A statewide summit on fighting opioid and meth abuse drew more than 500 attendees from across Wisconsin earlier this week in Milwaukee. Hosted by Wisconsin Attorney General Brad Schimel and U.S. Attorneys for Wisconsin Scott Blader and Matthew Krueger, the summit coincides with Drug Take Back Day, which is this Saturday, Oct. 27.

The summit, “Making Progress through Collaborations,” brought together
local public health agencies, law enforcement, first responders, hospital personnel and other health care professionals, social services, prevention and intervention workers, victim advocates, teachers, community groups, faith-based leaders, government officials and others—all focused on fighting opioid and meth abuse.

Attendees kicked off national Drug Take Back Day by bringing unused and unwanted medications to temporary drug disposal units at the summit.

This Saturday, in partnership with the Wisconsin Department of Justice and the Drug Enforcement Administration (DEA), 300 local law enforcement agencies throughout Wisconsin will participate in Drug Take Back Day. Held every October and November, this event provides a safe, convenient and responsible means of disposal of both prescription and over-the-counter medications, while also educating the community about the potential abuse and consequences of improper storage and disposal of these medications.

Since 2015, Wisconsinites have disposed of over 400,000 pounds of unused and unwanted medications, and the state has been a national leader in the DEA’s drug disposal program. To find a Drug Take Back location, click here.

FDA: Immediate-Release Opioids Now Under REMS

Tue, 18 Sep 2018 20:36:55 GMT

Sept. 18, MedPage Today

The FDA said Tuesday that it is broadening its Risk Evaluation and Mitigation Strategy (REMS) for opioids to include immediate-release agents prescribed for outpatients, and will cover all "providers who are involved in the management of patients with pain" -- not just those writing prescriptions.

But although the agency is requiring opioid manufacturers to create new training modules for nonprescribers, and that cover immediate-release products, the training will remain voluntary for professionals.

The broadened REMS will also apply to extended-release and long-acting (ER/LA) opioids for outpatient use, for which the FDA first imposed a REMS in 2012. The agency noted that Tuesday's action raises the number of individual products subject to the opioid REMS from 62 to 347.

"Our aim is to make sure the medical community can take advantage of the available education on pain management and safe use of opioid analgesic products," said FDA Commissioner Scott Gottlieb, MD, in announcing the changes.

"At the same time, we're also taking new steps to advance the development of evidence-based, indication-specific guidelines to help further guide appropriate prescribing of opioids. The goal is that these guidelines will provide evidence-based information on the proper number of opioid doses that should be dispensed for different medical conditions for which these drugs may be indicated. The aim is to reduce overall dispensing as a way to further reduce exposure to these drugs," Gottlieb added. He did not give a timeline for when these more specific guidelines would be released.

The FDA noted that the new training -- components of which were outlined in a "blueprint" document -- must be made available to nurses and pharmacists, for example, in addition to those authorized to prescribe opioids. "The new REMS also requires that the education cover broader information about appropriate pain management, including alternatives to opioids for the treatment of pain. The agency is also approving new product labeling containing information about the health care provider education available through the new REMS," the agency said.

That labeling about education will now appear as part of the boxed warnings and other sections on "warnings and precautions."

Previously, the opioid REMS ordered manufacturers of ER/LA opioids to develop training materials for prescribers, with the aim of minimizing risks of overuse and abuse. However, the FDA stopped short of requiring prescribers to undergo special training. REMS requirements for many other types of medications do include mandatory training, and the agency said opioids could eventually be added to that list.

"The FDA's Opioid Policy Steering Committee continues to consider whether there are circumstances when the FDA should require some form of mandatory education for health care providers and how the agency would pursue such a goal," according to the Tuesday announcement.

2019 Call for ASAM Annual Conference Awards

Thu, 13 Sep 2018 22:05:17 GMT

The American Society of Addiction Medicine is seeking nominations for:

The 2019 John P. McGovern, ASAM Annual Award, and
The ASAM Media Award

Awards will be presented at the ASAM 50th Annual Conference in Orlando, FL in April 2019. Members are encouraged to nominate deserving individuals for these awards.

Nomination submissions are being accepted through the ASAM Online Portal on or before October 31st . To be eligible for consideration, all nominations must be submitted electronically. A separate nomination form for each nominee and/or award is required.

Drug Overdoses Up in Wisconsin

Mon, 27 Aug 2018 15:26:39 GMT

August 27, Wisconsin Health News

Drug overdoses increased about 7 percent in Wisconsin from 2016 to 2017, according to new data from the Centers for Disease Control and Prevention. About 1,200 died in the state last year from overdoses.

Nationally, nearly 72,000 died of drug overdoses in 2017, a more than 6 percent increase from the year before.

DHS awards nearly $600,000 to fight opioid crisis

Mon, 27 Aug 2018 15:24:54 GMT

August 27, Wisconsin Health News

The Department of Health Services has awarded almost $600,000 to 70 community coalitions fighting the opioid epidemic.

The grants range from $500 to $22,300 and will support organizations that promote awareness about opioid misuse, hold community drug take-back events and provide an anti-overdose drug and training on its use, according to a statement from last week.

All of the recipients are members of the Alliance for Wisconsin Youth, which is made up of organizations focused on substance abuse prevention. They're expected to complete their projects by April.

The money comes from $7.6 million in federal grant money received by Wisconsin, the second round of funding provided by the federal government.

Healthcare and the 2018 Elections: What's at Stake?

Mon, 20 Aug 2018 22:36:38 GMT

Healthcare is poised to play a central role in the 2018 state and federal elections, and the results could reverberate across Wisconsin.

Democrats are hoping a blue wave will put the brakes on President Trump’s attack on the Affordable Care Act, but if Republicans retain control of Congress, it may seal the law’s fate. Meanwhile, the races for Governor and the Legislature are certain to shape the future of healthcare for years to come.

A panel of the state’s top healthcare lobbyists will analyze what’s at stake for the Badger State and preview their priorities for the coming year. Panelists:

Eric Borgerding, CEO, Wisconsin Hospital Association
Dr. Bud Chumbley, CEO, Wisconsin Medical Society
Stephanie Harrison, CEO, Wisconsin Primary Health Care Association
John Sauer, CEO, LeadingAge Wisconsin
Nancy Wenzel, CEO, Wisconsin Association of Health Plans

The event is Tuesday, September 11 at the Madison Club (11:30am – 1pm). Register here.

UW to host Suicide Bereavement Clinician Training, Sept. 19

Wed, 15 Aug 2018 13:50:18 GMT

UW Madison will host a day-long workshop on Suicide Bereavement Clinician Training, presented by national experts Drs. Jack Jordan and Nina Gutin, on Wednesday, September 19, 2018 at the Pyle Center in Madison.

This unique opportunity in the arena of suicide post-vention and prevention coincides closely with the conclusion of National Suicide Prevention Week. Few clinicians have been properly trained to understand and respond to the complicated features of grief associated with suicide loss. The workshop is designed to prepare clinicians for working with individuals who are grieving the loss of someone to suicide.

More Graduate from DOC Opioid Treatment Program

Wed, 08 Aug 2018 15:13:48 GMT

August 8, Wisconsin Health News

Fourteen offenders have completed a Department of Corrections’ opioid addiction treatment program, bringing the total number of graduates from the program to 58, according to a Tuesday statement.

The program got its start with $1.6 million from Gov. Scott Walker’s 2015-17 biennial budget. It received an additional $1.6 million this biennium.

The program provides medication-assisted treatment over a yearlong period, providing naltrexone to treat inmates with opioid dependency.

It targets inmates with a history of opioid dependency being released into Brown, Calumet, Door, Kewaunee, Manitowoc, Outagamie, Waupaca and Winnebago counties.

“The treatment offered through this program and drug courts across Wisconsin can transform lives and loosen the opioid epidemic’s hold on Wisconsin,” Attorney General Brad Schimel said in a statement.

After finishing the program, participants receive additional AODA treatment through the Department of Corrections or a medical provider.

New Addiction Hotline Launches

Thu, 02 Aug 2018 15:23:04 GMT

August 2, Wisconsin Health News

The University of Wisconsin and UW Health are offering a new hotline allowing primary care doctors and other providers in the state to consult with addiction experts to treat patients.

The Department of Health Services awarded a $500,000 grant for the hotline, which can be renewed for an additional year. The service, which UW believes is the first of its kind in the nation, will provide counsel about a range of addictions during weekdays.

Seventy percent of Wisconsin’s rural counties lack a provider who is certified to provide medication-assisted treatment for opioid use disorders, according to Dr. Randall Brown, who oversees the program team for the services.

“The goal of this project is to offer real-time support and expertise from specialists in addiction medicine, addiction psychiatry, psychology and AODA counseling,” he said in a statement last week. “I am confident that we can reduce the enormous suffering substance abuse produces in this state.”

Pew Releases More Recommendations to Tackle State's Opioid Epidemic

Wed, 18 Jul 2018 16:09:17 GMT

July 17, Wisconsin Health News

A nonprofit policy and research organization released more recommendations last week for improving Wisconsin's substance use disorder treatment services.

Pew Charitable Trusts has spent the last year studying the state’s treatment system. The Governor’s Task Force on Opioid Abuse adopted a series of recommendations from the organization in January, with lawmakers enacting some through executive order and others through new laws.

Andrew Whitacre, senior associate for the Substance Use Prevention and Treatment Initiative at the Pew Charitable Trusts, presented more recommendations at a task force meeting in Madison Friday. He said lawmakers could accomplish them by April.

Whitacre said the recommendations aim to ensure the state is getting its “biggest bang for the buck” and building a treatment infrastructure that can address future drug epidemics. Pew tried to strike a balance between innovation and evidence-based approaches.

“There’s a lot of opportunity for states to be innovative and push the envelope,” he said. “The bottom line is an effective treatment system gets people into treatment sooner, so that people can get back to work and lead productive lives.”

Pew’s recommendations were:

Expand opioid treatment programs. Whitacre said that Wisconsin does not have enough providers offering methadone, a medication used to treat opioid use disorder. Pew suggested allowing sites that deliver medical services to operate as methadone treatment programs. That could improve access to physical and mental health services for people with opioid use disorder.
Develop a legal definition for recovery housing that would bar discrimination against those using medication-assisted treatment. Whitacre said that Pew’s interviews and focus groups in the state have confirmed that substance use disorder patients on medication-assisted treatment have been barred from some recovery housing in Wisconsin.
Ensure patients receiving medication-assisted treatment are placed in the right setting through a standardized patient placement tool. Patients seeking treatment aren’t often referred to the right care setting, leading to administrative waste and burdens on those who want help and providers, according to Whitacre. The tool could reduce costs and standardize care.
Fund an expansion of buprenorphine training for providers during training programs for doctors, nurse practitioners and physician assistants, as many patients have difficulty accessing medication for opioid dependence.
Use the Behavioral Health Review Committee established under recent state law to ensure that Wisconsin’s substance abuse counselor certification and licensure process align with best practices and that the number of counselors meets the state’s needs. Whitacre suggested the committee could find ways to evaluate and meet the need for counselors across the state. That could include a look at training requirements, scope of practicing, continuing education requirements and regulatory barriers.
Direct the Department of Health Services to develop a plan with the Department of Corrections to pilot the availability of medication-assisted treatment in at least one prison or one jail. Part of the plan should include a review of prisons and jails to document the current availability of treatment. Whitacre suggested Rhode Island as a model, which has a correctional medication-assisted treatment program that led to a 61 percent decrease in overdose deaths among recently incarcerated people and a 12 percent decrease in overdose deaths statewide.
Direct DHS to promote best practices of care for pregnant women with substance use disorder by requiring programs receiving Medicaid reimbursement and other public funding to follow guidelines that call for screening of patients and medication-assisted treatment. About 12.5 percent of treatment facilities in the state offer programs tailored to pregnant women, compared to 20.7 percent nationally.
Direct DHS to incentivize healthcare providers to either offer or partner on postpartum care programs for women with substance use disorder.
Direct the Medical Examining Board to establish guidelines on neonatal abstinence syndrome, a group of problems that newborns face if they're exposed to drugs in the womb. The rate of babies diagnosed with neonatal abstinence syndrome in Wisconsin more than doubled between 2009 and 2014, and treatment isn’t uniform across the state, according to Pew.

Whitacre said Pew is planning to wind down its work in Wisconsin, but it will help support recommendations if the state moves forward.

They’re also planning to release a final report soon, with other recommendations that could take longer than nine months. They'll include proposals targeting medication-assisted treatment in emergency rooms

Help Patients Quick Smoking - Free CME for Online Learning

Mon, 16 Jul 2018 19:25:20 GMT

The Wisconsin Department of Health Services is sponsoring an online training program on how to help behavioral health patients quit smoking. The program offers 6 hours of complimentary CE credits, and is being held in partnership with the University of Wisconsin Center for Tobacco Research and Intervention, and the Wisconsin Nicotine Treatment Integration Project. Learn more.

WHN Hospital CEO Roundtable

Mon, 16 Jul 2018 15:35:37 GMT

The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry. Panelists include:

Dr. Sue Turney, CEO, Marshfield Clinic Health System
Robert Van Meeteren, CEO, Reedsburg Area Medical Center
Dr. Alan Kaplan, CEO, UW Health

Workers’ Comp. Premiums Decline for Third Year

Mon, 16 Jul 2018 15:34:47 GMT

July 12, Wisconsin Health News

Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.

That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016.

“A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline."

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program.

“We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.”

Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.”

Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise.

“Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email.

Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.”

Proposals to establish a fee schedule haven't gained traction with lawmakers.

Supreme Court Upholds Cap on Noneconomic Damages

Wed, 27 Jun 2018 17:11:49 GMT

The Wisconsin Supreme Court issued its ruling today in the Ascaris Mayo v. Wisconsin Injured Patients and Families Compensation Fund case to uphold the $750,000 cap on noneconomic damages, thus restoring medical malpractice caps in Wisconsin.

In January, a coalition of medical specialty organizations jointly filed an amicus brief with the Supreme Court in support of the cap. The collaborative efforts of Wisconsin’s medical community resulted in a major victory for physicians and helped preserve access to healthcare across Wisconsin.

The case centers around Ascaris Mayo, who lost her limbs after a Milwaukee emergency room failed to identify an untreated infection. A court awarded her economic damages as well as $15 million intended to compensate for pain and suffering.

The state’s Injured Patients and Families Compensation Fund, which covers large medical malpractice claims in the state, moved to reduce the $15 million to $750,000. An appeals court backed the award and ruled the law unconstitutional.

Chief Justice Patience Roggensack wrote the majority opinion upholding the law, in part because she said the Legislature acted rationally when creating the law.

“We conclude that the Legislature's comprehensive plan that guarantees payment while controlling liability for medical malpractice through the use of insurance, contributions to the fund and a cap on noneconomic damages has a rational basis,” she wrote. “Therefore, it is not facially unconstitutional.”

President's Message, June 2018

Mon, 25 Jun 2018 20:42:15 GMT

Dear WISAM Members,

Our next teleconference is this Thursday June 28 at 7:00 pm. This will be our one and only teleconference of the summer so join us! Along with the always-lively dialogue among colleagues, some issues we will be discussing include updates on ongoing projects such as the conference and webinars (see below) as well as the State expansion of prescribing of buprenorphine by NPs and PAs and the requirement for MD supervisors for these prescribers. If you have a topic idea to submit for this or future teleconference calls, please send your ideas to WISAM@badgerbay.co.

Our Annual Conference is September 27-29, 2018 at the UW Pyle Center. CME wil be provided as well as credit for the MEB Opioid Prescribing educational requirement. Register here for the main conference (Thursday/Friday). On Saturday, September 29, we will be offering clinical training workshops for those who are prescribing (or considering prescribing) ORT. Primary Care providers will find these workshops very useful. For information and to register for the Saturday workshops, click this link.

Our 2018 Webinar Series is underway! The first of the four part series began on June 20th and was led by Drs. Bhatnagar and John Ewing. There are nearly 50 providers currentlyi registered to take part in some or all of the sessions. The next session will be presented live on Wednesday, July 18 at Meriter Hospital in Madison. It's not too late to register to access the recordings for any of the sessions, or attend the live presentations of the upcoming sessions. Learn more.

Happy summer to all!

Matthew Felgus, MD FASAM
President

Michael Miller Elected to AMA Council Leadership

Mon, 18 Jun 2018 21:37:30 GMT

In competitive elections for council seats, seven delegates were selected by their peers at the AMA House of Delegates to serve. Included was longtime WISAM member and leader, Michael M. Miller, MD, an addiction psychiatrist with Rogers Behavioral Health, who was elected to serve on the AMA Council on Science and Public Health.

Doctor Miller is a nationally recognized addiction psychiatrist and addiction medicine physician. He has effectively integrated addiction care into the various psychiatric subspecialty services at Rogers Behavioral Health.

His work with the Division of Mental Health and Substance Abuse Services of the Wisconsin Department of Health Services, and his work on prevention with respect to opioid overdose and accidental deaths, is well known and ongoing in the state of Wisconsin, and nationally.

Dr. Miller has served as Vice Speaker of the Wisconsin Medical Society House of Delegates and has been a member of the WMS delegation to the AMA HOD since 2000. Prior, he served as a specialty society delegate to the AMA HOD from ASAM. He has been a member of three AMA HOD Reference Committees, including serving as chair of the Reference Committee on Advocacy Related to Medical Education and Science and Public Health. A Past President of the Dane County Medical Society, Dr. Miller has chaired or served on numerous committees and task forces of the WMS, the WPA, AAAP, ASAM, ABAM, and the ABAM Foundation. Notably, he chaired the WMS Council on Addictive Diseases and served a dozen years on the Managing Committee of Wisconsin’s Statewide Physician Health Program.

President's Message, May 2018

Thu, 10 May 2018 17:44:04 GMT

Dear WISAM Members,

It's been an interesting month. For those of you who were not able to make it to the Annual ASAM conference in San Diego, we hope you'll consider attending the 2019 conference. Mark your calendars now for April 4-7, 2019 in Orlando, Florida.

While in San Diego, several WISAM officers and members were interviewed by Ashley Luthern, a reporter for the Milwaukee Journal Sentinel, who showed a real interest for, and an understanding of, the issues we face in treating the disease of addiction. View article.

Also at the conference, we connected with our counterparts from Illinois (ISAM). Dr Raymond Bertino, ISAM President, plans to distribute our Wisconsin Chapter Annual Conference information to Illinois Chapter members, so we are hoping for a good turnout from colleagues to the south.

The WISAM 2018 Annual Conference, Road to Recovery: The Science of Addiction and Practical Applications, is September 27-29 at the Pyle Center in Madison. Our conference committee has put together an exciting program, and registration is now open! The detailed registration brochure will be available soon.

In other news, I’d like to express my thanks to WISAM member Britni Bolduc, who has volunteered to get our WISAM Facebook page up and running. Stay tuned for details on connecting with us on Facebook.

WISAM is launching its four-part webinar series, Treatment of Substance Use Disorders in Primary Care, funded through a WMS Foundation educational grant. The topics and speakers are confirmed, and sessions are scheduled to begin June 20th. Each session in the series will be presented as a live educational activity at Meriter Hospital in Madison, and will be recorded for members to view on-demand for up to one year following the recorded presentation.

And finally, after an April break, our monthly teleconference series will resume on Thursday May 24th from 7:00 to 8:00 pm. Dr. David Galbis-Reig, WISAM President-Elect, will lead the discussion. Stay tuned for more information.

Enjoy your spring!

Matt Felgus, MD, FASAM
President

ASAM 2018 Conference Recap

Thu, 19 Apr 2018 17:45:33 GMT

Aleksandra Zgierska, MD

Approximately 65 people from Wisconsin attended the American Society of Addiction Medicine's Annual Conference in San Diego. Many of them were WISAM members but quite a few were not, and we welcome them to consider membership.Approximately 30 people attended the Wisconsin Chapter annual business meeting, which took place during the ASAM conference.

ASAM has developed a toolkit that offers suggestions on how you can make most out of Addiction Treatment Week. Please spread the word through social media, as well as engagement with the community and the media. See below for more information!

WISAM President Matt Felgus, MD and Immediate Past President Aleksandra Zgierska, MD holding the certificate signed by Governor Walker proclaiming the week of Apr 23-29 as Addiction Treatment Week.

Statewide Prescription Drug Take Back Day is April 28

Fri, 13 Apr 2018 14:12:59 GMT

In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), Wisconsin law enforcement agencies will again hold Prescription Drug Take Back Day on Saturday, April 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the event.

The goal of Prescription Drug Take Back Day is to provide a safe, convenient and responsible method of disposal for unused or expired prescription drugs. The events also educate the community about potential abuse and consequences of improper storage and disposal of these medications.

Drug take back days are held each spring across the country. The October 2017 Drug Take Back events in Wisconsin collected 63,941 pounds of unused medications, the largest fall drug take back collection to date. Wisconsin also had more law enforcement agencies participate than any other state in the country with 266 police and sheriffs’ departments hosting 130 events. Since October 2015, the Drug Take Back Day program has successfully collected and disposed of nearly 360,000 pounds of unused medications in Wisconsin alone.

In addition to the semiannual Take Back Day, there are 349 permanent drug disposal drop boxes throughout Wisconsin, providing citizens a convenient, environmentally friendly and anonymous way to dispose of unused medications all year.

For more information, including a list of accepted medications, visit the “Dose of Reality” website, which also features an interactive map to find a drug take-back location.

Governor Walker Announces April 23-29 as Addiction Treatment Awareness Week

Tue, 20 Mar 2018 15:41:12 GMT

March 19, 2018

Governor Walker recently signed a proclamation declaring April 23-29th as the 2018 Addiction Treatment Awareness Week throughout the state of Wisconsin. This was at the request and in partnership with the American Society of Addiction Medicine and the Wisconsin Society of Addiction Medicine.

National Addiction Treatment Week is an ASAM initiative that generates awareness that addiction is a disease, not a moral failing, promotes quality and evidence-based treatments for addiction, and focuses on the need for all medical professionals to treat addiction and save lives. A series of online events are scheduled for the week, including a webinar with ABPM and SAMHSA discussing the importance (and pathways) for physicians to enter the field of addiction medicine and Treat Addiction to Save Lives.

A copy of the Governor’s proclamation is attached (link). For more information on addiction treatment, please visit the ASAM website (link).

FDA declares kratom an opioid

Thu, 08 Feb 2018 18:06:35 GMT

MD Magazine
The U.S. Food and Drug Administration has classified kratom, a botanical substance widely used as a painkiller despite agency approval, as an opioid. FDA Commissioner Scott Gottlieb released a statement referencing the FDA's concerns about the plant substance and its health consequences, which they said include death. Since they've been keeping tally, there have been 44 deaths reported that are considered associated with kratom, an increase from the 36 that had been reported in a November 2017 FDA advisory document.

JFC to Take Up Opioid bills

Thu, 08 Feb 2018 16:14:00 GMT

Wisconsin Health News

The Legislature’s budget-writing committee is set to consider two bills Thursday that would support efforts to fight the opioid epidemic.

The bills include recommendations proposed in a January report by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch, co-chairs of the Governor’s Task Force on Opioid Abuse.

“It’s important that we get treatment to those who need it and punish those who are facilitating the flow of illegal drugs into Wisconsin,” Nygren told members of the Joint Finance Committee during a public hearing Wednesday.

One of the proposals would create grant programs to combat drug trafficking, support substance abuse prevention and establish juvenile and family treatment courts. The proposal would also fund grants to provide medication-assisted treatment to inmates leaving jail and create two attorney positions in the Department of Justice to help with drug prosecutions.

It would allocate $2.75 million in general purpose revenue and $500,000 in federal funding during the biennium.

It also allows courts to order those guilty of drug violations to attend a victim impact panel or a similar program that shows how substance abuse affects an individual and their family.

An additional bill makes a series of changes to boost substance use disorder treatment and prevention. The task force has been working with Pew Charitable Trusts, which recommended parts of the proposal. Other parts of Pew’s recommendations were enacted through two executive orders Gov. Scott Walker signed in January.

“Wisconsin is a leader nationally on this issue, and these reforms will continue to push the state ahead,” Andrew Whitacre, senior associate for the Substance Use Prevention and Treatment Initiative at Pew, told lawmakers.

The bill would require prescribers to submit proof of completion of continuing education requirements on best practices in prescribing controlled substances when renewing their licenses.

It would also allow nurse practitioners and physician assistants who receive federal approval to dispense buprenorphine, a drug used to treat opioid addiction, even if their supervising doctor doesn’t have the same approval. The bill also prohibits the Department of Health Services from requiring prior authorization for buprenorphine combination products in Medicaid.

The bill would expand pathways for people to become substance abuse counselors and require school boards to incorporate drug abuse awareness and prevention into its health instructional programs.

It also aims to boost enrollment in the psychiatric mental health nursing program at the University of Wisconsin-Madison, expand the program’s capacity and provide fellowships for students to participate in clinical rotations in rural communities or areas with shortages of mental health professionals.

The bill would provide $50,000 to the Department of Children and Families to develop and maintain resources for social services workers who deal with cases related to substance abuse.

Dane County to pursue lawsuit against opioid manufacturers

Mon, 05 Feb 2018 16:12:32 GMT

WI Health News

The Dane County Board of Supervisors voted last week to give the OK for the county to pursue a lawsuit against opioid manufacturers.

More than 80 percent of Wisconsin counties have sued drugmakers alleging that their marketing contributed to the opioid epidemic. The companies involved have denied wrongdoing.

“This is a crisis that must be addressed," Supervisor Mary Kolar said at a meeting last Thursday.

Dane County’s resolution authorizes the county’s Office of Corporation Counsel to select outside counsel to pursue the lawsuit. The county would enter into a contingency fee arrangement, so the outside counsel wouldn’t receive compensation unless the county receives financial benefit.

Marcia MacKenzie, Dane County’s Corporation Counsel, said they’ll talk with the firms being used by the Wisconsin Counties Association. But she wants to “see if the county could get a better deal elsewhere” than the arrangement other counties have pursued.

“It may not be possible because they’ve already cornered the market,” she said. “But we owe it to the citizens and the taxpayers to look into it.”

Opioids Aren't America's Only Painkiller Problem

Thu, 01 Feb 2018 16:48:12 GMT

En Español

By Alan Mozes
HealthDay Reporter

TUESDAY, Jan. 30, 2018 (HealthDay News) -- There's a well-known crisis going on with opioid painkiller abuse, but new research reveals a sizeable chunk of Americans are popping far too many over-the-counter pain relievers, too.

Among those surveyed who take over-the-counter ibuprofen (Motrin, Advil), 15 percent admitted to exceeding daily maximum dosage when taking either ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs), the study found.

NSAIDs include popular medications such as aspirin, Advil, Motrin, Aleve (naproxen) and Celebrex, a prescription pain reliever.

The researchers tracked week-long NSAID "diaries" from about 1,300 adults, completed between 2015 and 2016. All had taken an ibuprofen medication at some point in the month before completing their diaries.

Many users said they'd either exceeded the prescribed daily limit of a single NSAID; taken two different NSAIDs together; or had popped a second dose earlier than indicated.

Study author David Kaufman, director of Boston University's Slone Epidemiology Center, noted that ibuprofen and other NSAIDs are among "the most-used medicines in the U.S.

"[But] most NSAID use is over-the-counter," he added, "with users deciding what to take without involvement by health care providers."

Kaufman believes NSAID misuse has the potential for serious side effects, including both gastrointestinal bleeding and/or a raised risk for heart attack.

His team's findings "can help guide programs that will lead to safer NSAID use," he said.

In the study, participants were 45, on average. Three-quarters were white, and about 60 percent were women.

About 87 percent said they took OTC ibuprofen during the week they recorded their usage habits. But about 37 percent also took other types of NSAIDs, with aspirin being the most popular, followed by naproxen.

That said, less than 40 percent actually understood that the NSAID medications they were taking were, in fact, NSAIDs.

What's more, 11 percent of ibuprofen users reported exceeded daily dosage instructions at least once during the week. That figure hit 23 percent among naproxen users.

Overall, 15 percent of participants were found to have exceeded dosing recommendations for at least one NSAID on one or more days throughout the week.

The team further observed that the risk for excessive NSAID use appeared to be higher among those respondents who were in poor physical condition while also struggling with chronic pain. Having a relatively poor knowledge about proper dosing also upped risk.

The findings were published online Jan.26 in the journal Pharmacoepidemiology and Drug Safety.

Kaufman downplayed the notion that users might be popping too many NSAIDs to avoid using addictive opioid painkillers.

"My guess," he said, "is that while avoidance of opioids may influence prescribing decisions by doctors, it may not affect consumer behavior very much."

Instead, Kaufman believes some consumers may simply decide to take an excessive number of pills -- regardless of label instructions. But that behavior is "potentially modifiable with better education of users," he added.

But another expert does think there could be a link between excessive OTC painkiller abuse and the current opioid epidemic.

Dr. David Katz directs the Yale University Prevention Research Center in New Haven, Conn. He said that "the nation's highly publicized opioid crisis is really just a window to a less-publicized crisis of chronic, inadequately managed pain" among an unhealthy portion of the American public.

"When narcotics are not being used to manage such pain, NSAIDs often are," said Katz, who wasn't involved in the study. "That a substantial subset of those relying on NSAIDs are using them ill-advisedly or excessively is rather to be expected under these circumstances."

One solution, according to Katz, is to boost "health literacy," so that patients know the risks of taking any medicine.

But a longer-term solution to all painkiller abuse requires refocusing attention on the benefits of a healthy lifestyle, Katz said, with the goal being "the prevention and management of chronic pain by means other than medication."

More information

There's more on NSAID safety concerns at U.S. Food and Drug Administration.

SOURCES: David Kaufman, Sc.D., director, Slone Epidemiology Center, Boston University, and professor, epidemiology, Boston University School of Public Health; David Katz, M.D., director, Yale University Prevention Research Center, New Haven, Conn.; Jan. 26, 2017, Pharmacoepidemiology and Drug Safety

Last Updated: Jan 30, 2018

The Pain Pill Problem: How the opioid epidemic is impacting the workplace and what employers can do about it

Wed, 24 Jan 2018 16:50:02 GMT

Jan 19, 2018, 5:00am

The opioid epidemic has become a serious problem in the United States, impacting every demographic segment of the population. Employers are on the front line of this problem, both because of the impact employees with opioid addiction can have on workplace safety and because these addictions can begin with prescriptions for work-related injuries. The Milwaukee Business Journal recently assembled a panel of experts to explore what companies – large and small – need to know about the opioid epidemic and the role they can play in mitigating its impact.

LAURIE GREENLEES (Moderator): How serious of a challenge for society is opioid addiction, and how does it compare to other addiction challenges the nation has faced or currently faces?

MICHAEL MILLER: Addiction has been affecting workers and workplaces for a very long time. Alcohol has been a perennial problem. There were methamphetamines in the 1970s and the cocaine epidemic of the late 1980s and 1990s. The opioid epidemic is grabbing everyone’s attention today because of the overdose deaths. Alcohol kills, too, but it’s not as sudden – it can take decades.

KEVIN HILDEBRANDT: That is a very good point. Opioids are definitely a concern, but alcohol and other types of addictions are very prevalent.

JIM MUELLER: Drug addiction is costing us $80 billion annually in medical care, addiction treatment and lost productivity. There were 63,632 drug overdose deaths in 2016, with two thirds of those deaths opioid-related. To put that in context, the Foxconn deal was $3 billion and that was considered a really big deal and the 9/11 terrorist attacks killed about 3,000 people. We’re losing 63,000 Americans to drug overdoses every year. If those were war casualties, it would be front-page news and on all of the networks daily. It’s a very serious problem.

GREENLEES: How is it impacting employers?

HILDEBRANDT: It directly affects employers in terms of safety issues, productivity and lost work time. It can also have an indirect impact if the addiction is in the employee’s family. They’re distracted because their mind is on their loved one. I don’t know how big an issue it is nationally, but I know what I see and it’s frightening. There’s a young guy at work whose sister is addicted and there’s an older person whose son is addicted. It is hard for me to believe, but it’s true.

MILLER: Another problem is presenteesim, which is when an employee shows up to work, but is not productive. They may be hung over, in withdrawal or under the influence. They may be distracted because of a family member’s addiction. That impacts productivity, and can lead to workplace errors and injuries.

HILDEBRANDT: It can be very difficult for an employer to help when it is an employee’s family member who is addicted. You can tell something is wrong because the employee is distracted, but it is very difficult to understand how you can help.

MILLER: That’s why employee assistance programs (EAPs) are so important. They let people get help confidentially.

MUELLER: Drug problems are an especially big problem for employees right now because there is such a supply and demand issue for workers. Employers’ priorities change over time. Ten years ago it was health care. Right now it is hiring and retention. I also think opioid addiction is a big workplace safety issue. Not only for the worker, but for the people around them. I think the impact of drug problems on workplace safety is going to be fertile ground for legal liability in the future, especially for employers who are not proactive in this space.

GREENLEES: From an employment perspective, is opioid addiction more or less of a problem than other addictions?

HILDEBRANDT: I would go back to some of the comments Dr. Miller made. The addiction problem is probably more pronounced when you look at alcohol or tobacco, but opioid addiction is more impactful from a perception standpoint.

MILLER: One of the challenges with opioid addiction is that there is such a significant overlap with the chronic pain population. It is very difficult to get those suffering from chronic pain back to work at a functional level after an injury. It really requires two different approaches. One is effective pain management and the other is addiction treatment, if necessary.

HILDEBRANDT: When someone who has an addiction problem is injured, the time it takes to get them back to work is extended. It’s even more challenging if it is an opioid addiction. It definitely extends the recovery time.

MUELLER: I would make two points here. The first point is that when it comes to addictions involving alcohol or tobacco, the solution is to eliminate the person’s need for those substances. When it comes to opioids, however, there is often an underlying issue related to pain. The cure needs to focus on returning the person to functionality, not eliminating the pain, and that requires a different type of treatment. The second point is that, unlike other addictions, opioid addiction often starts in the medicine cabinet. One study found that 54 percent of the time, the drug comes from a friend or relative. I have pain, you have medication. And, 82 percent of the time, that friend or relative obtained it from a physician.

MILLER: The pills may be given to them by a friend or relative or they may be stolen from the medicine cabinet. People with a 30-day supply of opioids for acute pain typically use three to five days’ worth, which means they have up to 27 days’ worth of supply sitting in the medicine cabinet. That’s why there’s been a major public health strategy to focus on safe medication storage and disposal. You shouldn’t keep extra prescription pills around. You need to take them to a designated medication drop location.

MUELLER: I agree. There are a lot of people who don’t realize that there are drug drops in Walgreens and most other pharmacies where you can dispose of your unused prescriptions.

GREENLEES: Many employers think they are inoculated from the opioid problem because they have drug screening programs in place. Is that an accurate assessment?

HILDEBRANDT: There are ways to beat drug tests so it is a question of what type of drug testing program you have, how effective it is and how representative it is of what is going on in your workplace. And the goal should not be to “catch” people, but to identify and help people so that you can have a safe and healthy workforce.

MILLER: There’s a tremendous misunderstanding when it comes to drug testing, which is that employment-based drug testing will detect people who are taking pain pills. Often, it won’t. The test looks for opiates – codeine, morphine, heroin and other substances that come from opium itself. Pain pills like OxyContin, hydrocodone and methadone are synthetic drugs. They are opioids, not opiates, and they are not detected by the common, commercially available drug-screening tests.

GREENLEES: What are the most effective treatment options for opioid addiction?

MILLER: The treatment for opioid addiction is unique in that medications play a key role. The medications are extremely important for improving outcomes because they block the opioid receptors, making it difficult for the drug to work. That creates a new issue, however, because the counselors who are on the front line of therapy cannot prescribe medications. You need to have licensed prescribers, which is why we are working to get primary care physicians more involved in treating opioid addiction.

MUELLER: An important issue is early identification, which can be a problem in our current, production-based health system where primary care physicians need to see 38 or so patients per day. You need to spend time with patients to identify this issue.

MILLER: Early identification is critical, and the best places are often in the workplace or schools. You want to get the problem identified – whether it is alcohol, cocaine, opioids or methamphetamines – before physical health and functionality are impaired.

GREENLEES: What role can employers play in reducing the opioid challenge? What programs and/or policies do you think we should have in place?

HILDEBRANDT: There are three or four different things. First, they have to be open to the concept that the addiction problem exists and that it is counterproductive to their organization. That starts the conversation. Reasonable suspicion training, which helps supervisors detect signs and symptoms of alcohol and drug abuse, can have a significant impact on early identification. The next component is having a robust drug testing program. Without that, you are not doing anything. The final component is being committed to helping employees by pointing them in the right direction and being accommodating to that EAP process. You do those things and you will have an impact. The worst thing an employer can do is nothing, because they will just be letting their problems compound.

MUELLER: The best practice I know of is QuadGraphics. They have an education program that involves all of their members – all of their employees, their families and their other dependents. You have to reach out to everyone.

GREENLEES: What would you say to employers who forego drug testing due to their concerns about finding a sufficient number of drug-free workers in a highly competitive job market?

MILLER: I can’t imagine a more misguided decision than to forego pre-employment drug testing. All you are doing is hiring people you don’t know anything about.

HILDEBRANDT: Drug testing can play a critical role in both weeding out job applicants and in helping employees. If you have a good employee who has an addiction problem, imagine how great they could be if they had a clear mind. Unions also play an important role. They can have just as much impact as employers on educating and influencing employees. Unfortunately, some people in union leadership do not want to address the issue.

MUELLER: A lot depends on the size of the employer. Small employers are at a significant disadvantage due to the time and financial commitment of a drug program. They do not have the ability to hire someone like Kevin with his expertise and focus. Drug testing alone can be a burden. For larger employers, it is a matter of priority and culture. When it comes to drug programs, about 20 percent of large employers are proactive, 20 percent are reactive and 60 percent are passive. Action is recommended, obviously. You have to know who you are hiring and you want to be able to identify and help your existing employees with robust EAP programs that provide counseling and treatment. Those programs that can really make a difference. Unfortunately, too many employers look at their EAP programs as a checkbox, something they have as part of their long-term disability coverage. It offers three consultations, period.

MILLER: I agree. EAPs can be a major part of solution, but they have to be high quality. They cannot be window dressing.

GREENLEES: What steps can employers take to increase awareness of EAP benefits?

HILDEBRANDT: You can treat it the same way you treat your retirement planning. Make them aware of it. You can also encourage employees to guide employees to an EAP instead of turning a blind eye.

GREENLEES: The Legislature is reportedly looking at the opioid challenge as part of a broader look at workers compensation issues in the state. What role can employers have in minimizing opioid prescriptions as a form of pain management for workers compensation claims?

HILDEBRANDT: One thing that I think can be done is for the employer to work with health care providers, workers and insurers. The communication has to be very effective and open. Employers can also do a better job of early detection using reasonable suspicion training programs and by working with insurers and providers to identify individuals who may be going from emergency room to emergency room in search of prescription drugs.

MUELLER: You have to look at the problem holistically and comprehensively. You need to have drug testing for opioids, which is beyond the regular five panel tests. You need to have education at the supervisor level, the employee level and the dependent level. You need to have good communication with your workers comp carrier. You also need to have access to treatment and to EAPs that have some depth to them.

MILLER: A lot of this work falls on the health care system. Educating and training doctors, nurse practitioners and physician assistants to prescribe differently is really key. Benefit structures are also important. Current benefit designs incentivize the use of injections, nerve blocks and other types of interventional pain management. Unfortunately many insurers won’t pay for comprehensive pain treatment that uses counselors, physical therapists, massage therapists and alternative medicine. The same is true for pharmacy benefits, which incentivize the 30-day supplies that can be problematic when it comes to opioids. What if you had a plan design that had no copay for a five-day supply and the usual copay for a 30-day supply? That change would incentivize a safer prescribing process for opioids.

MUELLER: I agree. Acupuncture and alternative pain treatments are becoming more popular, but are still not frequently prescribed. We need to be trying different methods of treatments beyond prescriptions.

HILDEBRANDT: You need an aggressive post-injury, return-to-work policy where the person is not allowed to fall out of the work cycle. You need to get them back to work as soon as you can. When people stay away from work, they go backward. The sooner they get back to work, the better they are for themselves and society.

TABLE OF EXPERTS

Moderator

Laurie Greenlees, MBA, PHR, SHRM-CP

Human Resource Business Advisor Manager and HR Hotline, MRA

Laurie is a certified Professional Human Resources manager with expertise in talent management, employee relations and engagement, compliance and best practices in FMLA and ADA administration and leadership development. As manager of MRA’s 24/7 HR Hotline, Laurie and her team of professional HR Advisors answer questions regarding the opioid crisis and its impact on area workplaces.

Kevin Hildebrandt

Director of Risk Management, Miron Construction Co., Inc.

Kevin provides support for Miron’s field operations, enhancing production while controlling risk for employees as well as customers, their facilities and equipment, and the public. He supervises the safe operation of all Miron equipment, and serves as the lead instructor for Miron’s professional crane operator development program.

Michael Miller, MD, DFASAM, DLFAPA

Medical Director, Herrington Recovery Center at Rogers Behavioral Health

Dr. Miller is a board-certified general psychiatrist and addiction psychiatrist. He has practiced for more than 30 years, and is a Distinguished Life Fellow of the APA and ASAM, as well as at-large director of the ABAM. He serves as a faculty member for the Addiction Psychiatry Fellowship and the Addiction Medicine Fellowship at the University of Wisconsin School of Medicine and Public Health.

Jim Mueller

Owner, Mueller QAAS

Jim has more than 30 years of employee benefit experience serving as president of Frank F. Haack & Associates and Zywave, one of the largest technology companies in the metro Milwaukee area. Jim helped Frank F. Haack & Associates grow into the largest benefit broker/consultant in Wisconsin and a top 70 brokerage firm nationally. He is now committed to providing employers objective advice on their employee benefit programs through Mueller QAAS.

Opioid task force releases more recommendations

Mon, 22 Jan 2018 16:41:30 GMT

WI Health News

Gov. Scott Walker signed two executive orders that are part of a series of new recommendations offered by his task force charged with tackling the opioid epidemic.

One of Walker’s orders creates the Governor’s Commission on Substance Abuse Treatment Delivery, which will study whether Wisconsin should adopt a “hub-and-spoke” delivery model for substance abuse disorder treatment.

The model involves regional “hubs” that serve as resource centers for addiction treatment and “spokes” in the community that provide recovery support for patients as well as referrals to more intensive services.

“Too many Wisconsin families feel the painful effects of this crisis every day,” Walker said in a Friday statement. “Through the guidance and recommendations of the task force, we've created reforms that will open the door to the best treatment outcomes for patients and their families.”

An additional order signed by Walker directs the Department of Health Services to convene a faith-based summit on opioids for pastors, priests and those involved in faith-based organizations.

Under the order, DHS will work with the Law Enforcement Standards Board to develop best practices around how law enforcement and first responder should treat situations involving opioids.

The order directs DHS to apply for a federal grant to develop software that tracks treatment capacity for substance abuse services, create uniform statewide standards on data submission for people seeking treatment, work with the Department of Corrections to facilitate continuity of care for offenders reentering the community and review Medicaid prior authorization rules to ease access to buprenorphine, an opioid-addiction treatment drug.

The Department of Children and Families will also have to revise some of its programs and standards to better document and track substance abuse problems in child welfare cases. And the state patrol and Capitol Police will have to use software aiming to ensure accuracy and timely reporting for overdoses.

The order calls on the Governor’s Task Force on Opioid Abuse to continue its work. Both executive orders come from recommendations in a Friday report by task force co-chairs Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette. The recommendations build on previous actions by the Legislature and Walker's administration.

“Wisconsin is leading the way,” the co-chairs wrote in their Friday report. “Our kids and communities deserve nothing less.”

The report recommends that the state:

· Expand Department of Children and Families programs that help at-risk youth.

· Clarify state law so that schools have to teach students about prescription drug abuse.

· Create a fund to provide grants to state and local agencies to expand efforts to fight against illegal drugs.

· Add two regional drug resource prosecutors to Department of Justice field offices in Wausau and Green Bay.

· Support the use of victim impact panels, a sentencing tool for judges in drunken driving cases, that involve people in recovery or family members of overdose victims.

· Encourage the adoption of software allowing police departments to participate in a nationwide database that tracks overdose data.

· Analyze the use of technology in Milwaukee County that aims to help law enforcement and medical examiners process overdose cases faster.

· Require all prescribing professionals to have continuing education requirements specific to controlled substances.

· Provide one-time funding to the Department of Children and Families to develop internet-based training resources on the opioid epidemic for county-based social services and veterans service staff.

· Look into reciprocity for mental health and substance abuse professionals with other states.

· Fund graduate nursing education to reduce wait lists and increase class sizes at the University of Wisconsin's mental health nursing program.

· Incorporate recommendations from the agreed-upon bill from the Worker’s Compensation Advisory Council that help expand coverage for addiction treatment.

· Clarify state law so that nurse practitioners and physician assistants can prescribe buprenorphine even if their supervising physician can't.

· Provide $1 million to launch a pilot project providing Vivitrol, which targets drug abuse, to individuals with substance use disorder whom are leaving jail.

· Revise Wisconsin law that targets pregnant mothers with substance abuse disorder.

· Pass a bill expanding drug courts to juvenile courts and create a fund to support such efforts.

· Pass a bill clarifying standards around people with drug convictions seeking occupational licensures.

Read the report.

Clinical tools, electronic monitoring are C-suite priorities to fight opioid crisis

Fri, 12 Jan 2018 14:52:22 GMT

Premier survey shows executives at U.S. health systems are prioritizing their response to the crisis because technology may be among the most important tools to manage it.

By Mike Miliard

January 11, 2018

01:02 PM

As the opioid crisis continues to ravage the United States, hospitals and health systems are on the front lines of the battle. Commanding majorities of C-suite leaders say their organizations see the epidemic as one of their top priorities – and are marshaling technology resources to help fight it.

A new survey from Premier shows that 90 percent of execs from member health systems are focusing on the opioid crisis as an imperative for 2018. Hospital leaders are focusing their efforts on assessing patients to evaluate their pain levels upon admission, educating their staff about resources for safe opioid use and exploring alternative methods for pain relief, the study shows.

Patient education is key too, of course, and health systems are focusing on engaging those patients on smart pain management treatment and safe use of opioids. They're also collaborating with state, local and community partners.

But in the opioid battle, technology may be among the most important tools: Health systems are increasingly relying on advanced clinical decision support, automated patient alerts, e-prescribing practices and continuous electronic monitoring of patient-controlled analgesia, according to Premier.

Premier CEO Susan DeVore said Premier’s members are striving to improve pain management issues to reduce misuse and addiction.

To that end, Premier offers its members medication surveillance tools that can give them real-time alerts on high-risk drugs and dangerous drug-drug interactions, monitoring patients who are prescribed high-dose or long-acting/extended-release opioids. The technology also offers advice and recommendations for co-prescribing naloxone and feature educational tools for patient and families who may need to administer naloxone in cases of overdose.

Those hospitals taking part in Premier’s Hospital Improvement Innovation Network, meanwhile – it's part of the Centers for Medicaid & Medicare Services Partnership for Patients program – are also participating in an initiative to measurably improve pain management among providers, clinicians and patients/families.

Premier also recently launched its Safer Post-operative Pain Management pilot program, with more than 30 hospitals working together to redesign care delivery processes to better manage pain and the potential for drug addiction.

The alliance has also published a Safer Pain Management Toolkit for its 3,750 hospitals and 130,000 provider members. If provides a repository of all Premier group purchasing contracts, suppliers, services and programs in the pain management space and allows members to search for alternative therapies, devices that monitor oxygen and carbon dioxide levels to avoid respiratory-related side effects and infection prevention treatments to improve the immune system’s response to opioids.

The toolkit also offers analytics on opioid visits, utilization and prescribing practices in the emergency department at nearly 650 Premier hospitals, allowing other providers to benchmark themselves against against national data.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Topics:

Decision Support, Electronic Health Records (EHR, EMR), Pharmacy, Population Health, Quality and Safety

More Wisconsin counties sue opioid manufacturers

Tue, 09 Jan 2018 16:01:59 GMT

More than 80 percent of Wisconsin counties are suing opioid manufacturers for alleged aggressive and fraudulent marketing of painkillers.

Twelve additional counties joined the lawsuit Friday, bringing the total number of Wisconsin counties suing drugmakers to 60. The lawsuit is being led by Milwaukee-based Crueger Dickinson and Simmons Hanly Conroy, a law firm with offices throughout the country.

The counties allege that drug companies pursued a deceptive marketing campaign that's led local governments to spend millions fighting the opioid epidemic. The drug companies, which include Purdue Pharma, deny wrongdoing.

Simmons Hanly Conroy has launched similar lawsuits in Connecticut, Illinois, Iowa, Louisiana, New York and Pennsylvania

Be a Part of the #WhyITreatAddiction Campaign. Share Your Story!

Thu, 04 Jan 2018 15:20:47 GMT

Share Your Story!

Be a Part of the #WhyITreatAddiction Campaign. Share Your Story!

ASAM would like to hear your story about why you treat addiction. Between now and January 31st, share your story and enter the chance to be featured in a possible ASAM national campaign.

Share now!

Guidelines:
• While we would love to hear all stories, selected winners must be current 2018 members of ASAM.
• Stories are limited to 200 words or less.
• Every story must start with “I treat addiction because...” (This does not count towards the word count.)
• Selected winners will be notified by email.

Disclaimer: If your story is selected, we may require a high-quality photograph of you to accompany your story. Winning stories will go through a editing and vetting process and are subject to minor changes which will be sent for your approval before any publication. The winning stories will be shared publicly, and further participant background information may be required.

Thanks for sharing!

DHS Announces New Substance Use Treatment Options in High Need Areas

Thu, 04 Jan 2018 15:18:24 GMT

For Immediate Release

January 4, 2018

Contact: Jennifer Miller/Elizabeth Goodsitt (608) 266-1683

DHS Announces New Substance Use Treatment Options in High Need Areas

Four grants issued to expand services for treatment of opioid and methamphetamine addiction

The Wisconsin Department of Health Services (DHS) has awarded grants to four organizations to establish treatment services for opioid and methamphetamine addictions in areas of the state most in need of help.

“Accessible addiction services are a vital part of our plan to treat Wisconsin’s opioid and methamphetamine problems,” said DHS Secretary Linda Seemeyer. “People who are struggling with the chronic disease of addiction need supports close to home, to help them manage their recovery. This investment moves us closer to our vision of everyone living their best life.”

View the entire news release.

DHS Announces New Grants to Support Graduate Medical Education

Wed, 03 Jan 2018 21:32:14 GMT

For Immediate Release

January 3, 2018

Contact: Jennifer Miller/Elizabeth Goodsitt (608) 266-1683

DHS Announces New Grants to Support Graduate Medical Education

The Medical Residency Programs help increase access to health care in rural and underserved areas

Grants totaling more than $2.9 million to support development of three new residency programs and eight new resident positions in current programs were announced today by the Wisconsin Department of Health Services. Launched in July 2014, the DHS Graduate Medical Education (GME) Initiative builds on numerous partnerships among hospitals and clinics, health systems and academic institutions to expand graduate medical education (GME) and helps ensure access to quality health care in rural and other underserved areas of the state.

View the entire news release.

####

Bill allows free clinic doctors, dentists to apply for loan forgiveness program

Tue, 02 Jan 2018 14:53:11 GMT

December 20, Wisconsin Health News

An Assembly committee is planning to take up a bipartisan bill Wednesday that would allow providers in free and charitable clinics to apply for a loan forgiveness program that now targets those working in underserved areas.

The Wisconsin Office of Rural Health administers the program for those who practice in federally-designated shortage areas for healthcare providers or for federally qualified health centers. The bill would add workers at free and charitable clinics to that list.

Under the program, physicians and dentists working 32 hours a week for three years are eligible to have up to $50,000 of their loans repaid. Physician assistants, certified nurse midwives, dental hygienists and nurse practitioners who work the same amount of time may receive up to $25,000 in loan forgiveness.

Sara Nichols, executive director of Open Arms Free Clinic in Elkhorn, told lawmakers at a public hearing last week that they recently received a federal grant to hire a dentist and dental hygienist.

“We can’t hire a hygienist,” she said. “We can’t find them. We have no carrot to wave because we have no loan forgiveness program.”

Lake Area Free Clinic in Oconomowoc recently opened its own dental clinic and is planning to hire two full-time dentists, according to Medical Director Dr. Peter Geiss.

“We’re not really competitive right now, and it’s difficult for us to hire dentists as well as dental hygienists,” he said. The bill “would help us dramatically,” he said.

Katherine Gaulke, Wisconsin Association of Free and Charitable Clinics executive director, said they pursued the legislation in part because the Department of Health Services ended a waiver that allowed dentists to volunteer and serve BadgerCare patients in free clinics without having to be certified by the program.

“We just want to get on an even playing field with the other partners in the safety net,” she said.

The program now serves around 20 out of 50 applicants a year, said John Eich, director of the Wisconsin Office of Rural Health.

The proposal doesn’t add new money to the program, and Eich said that additional applicants would be judged “on equal footing” with existing applicants.

He doesn’t anticipate seeing many additional applicants under the bill as it’s “very unusual” for providers to volunteer that amount of time or be paid by a clinic.

Partnership Program awards $400,000 to eight projects

Mon, 18 Dec 2017 16:49:37 GMT

The Wisconsin Partnership Program has awarded almost $400,000 in two-year grants to eight projects in the state, according to a recent statement.

They’re the first set of projects awarded through the program’s Community Catalyst Grant Program.

The grants were:

· $50,000 to WisconsinEye to create and distribute curriculum for a documentary featuring young Wisconsinites sharing their stories of opioid and heroin addiction and recovery.

· $50,000 to Great Lakes Dryhootch to support development of an online space to provide peer-based mental healthcare to veterans.

· $38,500 to Nehemiah Community Development Corporation to create a University of Wisconsin class on providing healthcare to incarcerated individuals.

· $50,000 to the Milwaukee Inter-City Congregation Allies for Hope and Leaders Igniting Transformation to improve opportunities for Milwaukee youth at risk of expulsion and incarceration.

· $50,000 to complete development of HealthConnect.Link, a website that aims to help residents of Dane, Rock and Sauk counties access healthcare and social services.

· $50,000 to Centro Hispano of Dane County to create an educational program to train community health workers on how to reduce health disparities affecting Latina postpartum women.

· $50,000 to Supporting Families Together Association to address health inequities associated with childhood abuse and neglect.

· $50,000 to expand Wood County’s River Riders Bike Share Program.

DOJ continues to investigate opioid drugmakers

Mon, 18 Dec 2017 16:45:04 GMT

The state Department of Justice continues to investigate the role pharmaceutical manufacturers played in creating the opioid epidemic.

Attorney General Brad Schimel announced in June that he was working with a bipartisan coalition of attorneys general in an ongoing investigation. He said Friday that they recently subpoenaed five drugmakers.

About two-thirds of Wisconsin counties have sued opioid manufacturers alleging that their marketing practices helped the epidemic. The companies have denied the allegations.

Two Democratic senators called on Schimel to hold drug companies accountable last month.

NIDA study compares OUD Tx medications

Thu, 14 Dec 2017 19:22:32 GMT

December 13, 2017

Dear Partners:

We are excited to share the findings of a new study conducted within the NIDA Clinical Trials Network, which suggests that a buprenorphine/naloxone combination and an extended release naltrexone formulation show similar patient outcomes in the treatment of opioid use disorder (OUD) once the medications are initiated. As hypothesized, it was more difficult for active opioid users to initiate treatment with naltrexone, since using this drug requires complete detoxification.

"The good news is we filled the evidentiary void, and also learned that, for those who were able to initiate treatment, the outcomes were essentially identical, as were adverse events," said John Rotrosen, M.D., the study lead investigator. "This gives patients the freedom to choose a treatment approach that best suits their lifestyle, goals, and wishes."

More on OUD Treatment
Visit the NIDAMED Treatment Information page for other OUD treatment study findings and for resources on opioid and drug addiction treatment for both clinicians and patients.

Share the News!
Please share this message with members, peers, and colleagues and visit NIDAMED for updates on on the rapidly evolving field of opioid treatment. If you would like sample promotional material (e.g., social media messages, graphics, or brief text) to share this information, please contact the NIDAMED coordinator, Michelle Corbin.

With kind regards,

Follow NIDA on Twitter and Facebook.

Drug may help surgical patients stop opioids sooner

Thu, 14 Dec 2017 14:28:15 GMT

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

When patients received a non-opioid medication called gabapentin before and after surgery, the need for continued opioid painkillers was reduced by 24 percent, said researchers at Stanford University School of Medicine.

The finding comes amid an opioid epidemic in the United States. Since 1999, overdose deaths have quadrupled, in large part due to abuse of prescription painkillers such as OxyContin (oxycodone) or heroin.

"Our country is facing an opioid crisis, and a lot of people are exposed to opioids after surgery," said researcher Dr. Sean Mackey, chief of the division of pain medicine.

More than 51 million Americans undergo surgery each year, according to background notes in the study. Most are given opioid painkillers afterward, and up to 13 percent become habitual users.

"There are some people who are vulnerable to the addictive proprieties of these drugs," Mackey said. "We would prefer to find ways of not having people get into problems with opioids."

Gabapentin (brand names: Neurontin, Gralise) is used to help prevent seizures and ease nerve pain from shingles. It's available as a generic, so it is inexpensive and covered by most drug plans.

Now, it appears to reduce the time patients feel they need opioid relief by a "modest" amount, the researchers said.

"This means that people are less likely to become addicted to opioids and less likely to have the side effects of an opioid," Mackey said.

Those side effects can include sedation, nausea and constipation.

Surprisingly, the drug had no effect on how long it took for post-operative pain to subside, Mackey said. But it did effect how long patients needed opioids.

For the study, Mackey and his colleagues randomly assigned 410 surgical patients to receive gabapentin or a placebo before surgery and for three days afterward. Patients were followed for up to two years.

Procedures included chest surgery, knee replacements, and hand and breast surgery, to name a few. The study found that gabapentin seemed to help regardless of the type of operation.

It's not clear how gabapentin might reduce the need for opioids, Mackey said. Perhaps it's changing brain chemistry after surgery, he said.

"It's probably having pain-relieving properties along with the opioid, and you don't need so many opioids because the effects of the gabapentin are long-lasting," he said.

Gabapentin is considered nonaddictive.

Mackey said more work needs to be done to determine which patients would benefit most from gabapentin, at what dose and for how long.

It's also possible that gabapentin might benefit patients with pain from trauma. Given in the emergency room, it might help reduce the need for opioids, and thus help to prevent addiction in that setting, he said.

The findings were published online Dec. 13 in the journal JAMA Surgery.

Dr. Michael Ashburn is director of pain medicine at the Penn Pain Medicine Center in Philadelphia. He said this study may have important implications.

"This and other studies have reported that the duration of opioid administration may impact whether or not patients transition to chronic opioids after surgery," said Ashburn, co-author of an accompanying journal editorial.

Although gabapentin doesn't seem to reduce the length of time it takes for pain to cease after surgery, it "may allow for opioids to be discontinued more quickly following surgery," Ashburn said.

Giving gabapentin after surgery is already part of clinical practice at Lenox Hill Hospital in New York City, said Dr. Kiran Patel.

"I am constantly looking for ways to reduce opioid requirements and to get patients off opioids so they don't transition to chronic opioid use," said Patel, an anesthesiologist and pain management specialist at the hospital.

There are ways to manage pain aside from opioids and anti-inflammatories after surgery, she noted. "Incorporating them with the right patients, we might be able to reduce their overall use of opioids," she said.

More information

For more about opioid use, visit the U.S. National Institute on Drug Abuse.

SOURCES: Sean Mackey, M.D., Ph.D., chief, pain medicine, and director, Stanford Systems Neuroscience and Pain Lab, Stanford University School of Medicine, Palo Alto, Calif.; Michael Ashburn, M.D., M.P.H., professor, anesthesiology and critical care, and director, pain medicine, Penn Pain Medicine Center, Philadelphia; Kiran Patel, M.D., anesthesiologist and pain management specialist, Lenox Hill Hospital, New York City; Dec. 13, 2017, JAMA Surgery, online

Last Updated: Dec 13, 2017

Medical College of Wisconsin-Led Project to Address Opioid Use Disorder Earns Funding from Robert Wood Johnson Foundation

Tue, 12 Dec 2017 19:38:54 GMT

A team of partners from MCW, Dryhootch and Mental Health America of Wisconsin contributed to the development of this project.

By Medical College of Wisconsin - Dec 6th, 2017 01:12 pm

Pills by Tom Varco (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons.

Milwaukee, Dec. 6, 2017 – Military veterans can experience high levels of chronic pain due to their military service, and are at risk of developing addiction from the opiates used to treat their pain. Nationwide, opioid addiction and misuse is becoming an epidemic. The Milwaukee VA Medical Center, Medical College of Wisconsin and other partners are working aggressively to help reduce opioid misuse. Thanks to support from the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Award, an interdisciplinary team of faculty at the Medical College of Wisconsin (MCW) is working with community partners in Milwaukee to prevent opioid use disorder (OUD) among U.S. military veterans.

Using a community-engaged research (CEnR) approach, Milwaukee Prevention of Opioid Misuse through Peer Training (PROMPT) integrates chronic pain treatment and trauma-informed care with input from local military veterans to develop innovative ways of addressing OUD. CEnR emphasizes community stakeholder involvement in all phases of the research including project/concept development, data collection and interpretation and dissemination of the results.

“Opioid misuse has been on the rise nationally and it has devastated many lives in the Milwaukee area,” said Syed Ahmed, MD, MPH, DrPH, senior associate dean for community engagement and professor of family and community medicine at MCW and the project’s principal investigator and clinical scholar. “One of the strengths of this project is the community-academic partnership structure that includes the voices and perspectives of community members and stakeholders affected by this issue. We are equal collaborators in the research process, and that is key to driving success.”

A team of partners from MCW, Dryhootch and Mental Health America of Wisconsin (MHA) contributed to the development of this project. Dryhootch is a nonprofit organization founded in 2008 by a Vietnam veteran with a mission of helping veterans and their families. MHA is an affiliate of the national non-profit dedicated to helping all Americans achieve wellness by living mentally healthier lives, and has extensive experience implementing programs for populations affected by opioid addiction.

“Veterans are trained to have the back of another brother or sister in combat. So peer mentoring is the most effective in reaching the veterans that we work with. Our goal is to provide wrap-around services and support to fellow veterans while building a sense of camaraderie,” said Bob Curry, Founder and President of Dryhootch. “It’s great that this research project involves us as equal voices at the table to hear our perspectives and understand our needs.”

Academic partners L. Kevin Hamberger, PhD, MCW professor of family and community medicine; Kajua Lor, PharmD, MCW chair of the department of clinical sciences and associate professor in the School of Pharmacy; and Robert Hurley, MD, PhD, professor and executive director of Pain Shared Services at Wake Forest Baptist Medical Center round out the team of RWJF Clinical Scholars. The project team also includes Zeno Franco, PhD, MCW associate professor of community engagement; Sarah O’Connor, MCW community engagement program manager, and Tiffiney Gray, MCW program coordinator; Bob Curry and Otis Winstead of Dryhootch; and Martin Gollin-Graves and Anne Ruiz of MHA.

This project is supported by the Robert Wood Johnson Foundation Clinical Scholars leadership development program, which funds teams of clinicians from different disciplines who collaborate to address a problem in their community.

Mentioned in This Press Release

People: Anne Ruiz, Bob Curry, Kajua Lor, L. Kevin Hamberger, Martin Gollin-Graves, Otis Winstead, Sarah O’Connor, Syed Ahmed, Tiffiney Gray, Zeno Franco

Organizations: Medical College of Wisconsin

Extended-release, abuse-deterrent opioid safe, effective for chronic low back pain

Thu, 07 Dec 2017 15:49:14 GMT

December 6, 2017

Egalet Corporation recently announced that Egalet-002, an extended-release, abuse-deterrent form of oxycodone, demonstrated safety and efficacy endpoints for the treatment of moderate-to-severe chronic low back pain in a phase 3 trial.

The multicenter, double-blind, enriched enrollment, randomized withdrawal study evaluated how safe and effective Egalet-002 was in opioid-experienced and opioid-naïve patients with moderate-to-severe chronic low back pain compared with placebo.

The results showed that average pain intensity from randomization to week 16 was statistically and significantly different among patients with receiving Egalet-002 vs. placebo.

In a previous safety study of Egalet-002, the drug was found to be generally well-tolerated for up to 56 weeks in opioid-experienced patients with moderate-to-severe chronic noncancer pain.

The current study did not identify any new safety concerns.

“These results demonstrate Egalet-002, an abuse-deterrent, extended-release oxycodone, provided effective pain relief for patients with moderate-to-severe chronic back pain,” Bob Radie, president and CEO of Egalet, said in a press release. “Given the prevalence of chronic back pain combined with the prescription abuse epidemic, we believe development of more abuse-deterrent products like Egalet-002 is important for our communities.”

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.

Naloxone Effectiveness Compared by Route of Administration

Thu, 30 Nov 2017 20:10:48 GMT

HealthDay News — For reversal of opioid overdose, higher-concentration intranasal naloxone has similar efficacy to that of intramuscular naloxone administered at the same dose, according to a review published online November 27 in the Annals of Internal Medicine.

Roger Chou, MD, from the Oregon Health & Science University in Portland, and colleagues conducted a systematic review to synthesize evidence on the effects of naloxone route of administration and dosing for suspected overdose in out-of-hospital settings, and the need for transport to a health care facility after reversal of overdose with naloxone. Data were included from 13 eligible studies.

The researchers found that 1 trial demonstrated similar efficacy between higher-concentration intranasal naloxone and intramuscular naloxone administered at the same dose (2mg/mL). One trial found that lower-concentration intranasal naloxone was less effective than intramuscular naloxone, but the risk for agitation was reduced (low strength of evidence). There was insufficient evidence to assess other comparisons for administration route. Low rates of death and serious adverse events were reported in 6 uncontrolled studies in non-transported patients after successful naloxone treatment.

"Higher-concentration intranasal naloxone (2mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events," the authors write. "Non-transport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport versus non-transport."

Abstract/Full Text
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20 more Wisconsin counties sue opioid drugmakers

Wed, 29 Nov 2017 16:04:57 GMT

More than half of Wisconsin counties have sued opioid manufacturers, as 20 more counties announced Tuesday that they are filing lawsuits.

The counties are led by the Milwaukee-based law firm Crueger Dickinson and Simmons Hanly Conroy, which has offices throughout the country and has filed similar suits in five other states.

The counties allege that the drug manufacturers' business strategies helped create the opioid epidemic.

There are now 48 Wisconsin counties that are seeking damages. Purdue Pharma, one of the companies named in the lawsuit, has denied the allegations.

Milwaukee County highlights $2.6 million to fight addiction

Tue, 28 Nov 2017 16:33:32 GMT

Milwaukee County officials highlighted $2.6 million in grants that will help them expand addiction treatment programs at a press conference Monday.

County Executive Chris Abele said that the funding is “a huge step forward” and will support local efforts to fight the opioid epidemic.

“As a country, we need to use every dime we’ve got,” he said. “We need to focus on an issue that is growing faster and killing more people than just about anything you can imagine.”

Milwaukee County Family Drug Treatment Court is receiving $2.1 million over the next five years from the Substance Abuse Mental Health Services Administration.

“We are transforming these families,” said Milwaukee County Court Judge Joe Donald.

Robyn Ellis, who participated in the county’s family drug treatment court, started using alcohol as a child and illegal drugs as a teenager.

In 2013, she lost custody of her daughter. Then family drug treatment court got involved.

“It’s hard for me to stand up here and share all of this because I’m in such a different place today,” she said.

The court helped her get and stay sober, and she regained custody of her daughter in 2014.

An additional $506,000 grant from the Wisconsin Department of Health Services will allow the county’s Behavioral Health Administration to expand its alcohol and other drug addiction treatment and recovery services to 75 more people.

Those services include medication-assisted treatment, residential treatment, recovery housing and counseling.

“We really want the community to know that addiction is a disease,” said Mike Lappen, division administrator. “It can be prevented. It can be treated.”

Workers Compensation Call to Action

Mon, 27 Nov 2017 21:49:52 GMT

The legislature is considering legislation based on proposals from the Workers Compensation Advisory Council. The proposals were developed Labor and Management representatives on the Council. But not all of the proposals share the support of the Council’s health care representatives, including a recommended fee schedule. Health care organizations will need to be even more active this session than last to again defeat the fee schedule proposal.

It is important to note that works compensation premiums have dropped – without a government mandated fee schedule. This year alone, employers received an 8.46 percent reduction in their worker’s compensation insurance premiums, saving employers an estimated $170 million. At the same time, Wisconsin’s health care system continues to lead the nation in outcomes with injured employees returning to work a full three weeks earlier than the national average. And health care costs per worker’s comp claim lower than the national average.

Your calls are needed to both the State Assembly and State Senate to explain why the proposed health care fee schedule could harm Wisconsin’s model worker’s compensation system. You can find your legislators contact information on the state legislature’s website.

Let your State Representative and State Senator know you are a physician in their district, serving patients who are also constituents and that you are opposed to an artificial fee schedule for a worker’s compensation system that provides the nation’s best care at a below-average worker’s compensation cost. Thank you for your time and action on this important issue.

Wisconsin Supreme Court to review case on medical malpractice caps

Mon, 27 Nov 2017 21:46:43 GMT

November 27, Wisconsin Health News

The state’s Supreme Court agreed last week to review a lower court’s decision striking down a cap on how much patients can receive for some malpractice claims.

An appeals court ruled in July that a state law capping awards for noneconomic damages at $750,000 was unconstitutional. Noneconomic damages seek to compensate patients for pain and suffering. The Wisconsin Hospital Association and the Wisconsin Medical Society have raised concerns about the court’s decision and its potential ramifications for providers and accessibility to healthcare. In her opinion striking down the decision, Judge Joan Kessler said the law placed an “unfair and illogical burden only on catastrophically injured patients, thus denying them the equal protection of the laws.”

The case involves Ascaris Mayo, who lost her limbs after providers at a Milwaukee-area emergency room failed to notify her she had an infection. A jury awarded Mayo and her husband $16.5 million for noneconomic damages, which the state sought to reduce.

OPIOID CRISIS HITTING BOOMERS, MILLENNIALS HARDEST

Wed, 22 Nov 2017 16:51:53 GMT

By Amy Norton

HealthDay Reporter

TUESDAY, Nov. 21, 2017 (HealthDay News) -- The U.S. opioid epidemic seems to be taking its biggest toll on the baby boomer and millennial generations, a new study suggests.

Researchers found that since 2010, boomers -- born between 1946 and 1964 -- have had heightened rates of death from prescription opioids and heroin. Meanwhile, millennials -- people in their 20s and 30s -- also have been hard hit by heroin overdoses.

"The opioid epidemic has affected everyone," said senior researcher Dr. Guohua Li. "But what we're seeing is that these two generations are at highest risk," said Li, a professor of epidemiology at Columbia University.

Li said he could only speculate on the reasons.

But the findings on boomers were not surprising, he noted. That generation is known to have a relatively high rate of drug abuse, versus other generations. Plus, Li said, they were middle-aged when prescriptions for opioids were taking off in the 1990s -- which means they were a "primary target" for the medications.

According to the U.S. National Institute on Drug Abuse, more than 2 million Americans were abusing opioids in 2015. That included heroin and prescription opioids, such as painkillers like Vicodin (hydrocodone), OxyContin (oxycodone) and codeine.

Recent research has found that Americans' prescription opioid abuse has leveled off. But overdose deaths are still climbing.

Earlier this year, a U.S government study highlighted the toll that heroin alone is taking. Between 2002 and 2016, deaths from the drug soared by 533 percent nationwide -- from just under 2,100 deaths to more than 13,200.

So while efforts to curtail opioid prescriptions have worked, opioid deaths overall have not yet declined, said Robert Heimer, a professor of epidemiology at Yale School of Public Health.

Unfortunately, some people addicted to prescription opioids switch to heroin or, more recently, illicitly made "synthetic" opioids such as fentanyl.

"Often, people on heroin started with prescription opioids," Heimer said. However, he added, these are typically illegally sold prescription drugs.

Heimer, who was not involved in the new study, said the findings are "useful."

"It really suggests it's the older and younger generations that are being most affected by this epidemic," he said.

The study analyzed national vital statistics for the years 1999 to 2014.

Li's team found that compared with people born in the late-1970s, boomers were up to 27 percent more likely to die of a prescription opioid overdose. And they were up to one-third more likely to die of a heroin overdose.

Meanwhile, the rate of heroin overdose death accelerated most among millennials -- people born in the 1980s to early '90s. For example, those born in 1989 and 1990 were 23 percent more likely to die of a heroin overdose compared with Americans born in the late 1970s.

According to Li, it's not clear why millennials face a higher risk than their "Generation X" predecessors. But he speculated that they have had relatively less economic security than Gen Xers.

On the prevention side, various medical groups have changed guidelines to rein in opioid prescriptions.

Also, U.S. states have launched drug monitoring programs, which electronically track prescriptions for controlled substances. Doctors can check them before prescribing opioids, to help catch "doctor shoppers" -- people who go from one provider to the next, seeking a new opioid prescription.

But those efforts only go so far, Heimer pointed out.

To cut down overdose rates, access to addiction treatment is vital, Heimer and Li agreed.

"Medication-assisted treatment" -- with the drugs methadone, buprenorphine or naltrexone -- is considered the most effective therapy for opioid dependence. The medications act on the same brain targets as opioids do, and help suppress withdrawal symptoms and cravings.

But there are big barriers to receiving that kind of treatment. Only a small number of U.S. doctors prescribe them, and lack of training is one reason, according to Heimer.

"Stigma" is a wider, underlying issue, he said. The drugs used to treat opioid addiction are sometimes seen as nothing more than a substitution, and there is still a belief that total abstinence should be the goal.

"The biggest problem is that medication-based therapy is stigmatized," Heimer said. "We don't do that with any other chronic disease, and addiction is a chronic disease."

The findings were published online Nov. 21 in the American Journal of Public Health.

More information

The U.S. National Institute on Drug Abuse has more on treating opioid addiction.

SOURCES: Guohua Li, M.D., Dr.PH., professor, epidemiology, Columbia University Mailman School of Public Health, New York City; Robert Heimer, Ph.D., professor, epidemiology, Yale School of Public Health, New Haven, Conn.; Nov. 21, 2017, American Journal of Public Health, online

Last Updated: Nov 21, 2017

THE TRUE COST OF OPIOID EPIDEMIC TOPS $500 BILLION, WHITE HOUSE SAYS

Mon, 20 Nov 2017 16:50:05 GMT

The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars.
In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate.
The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion.

Published 5 Hours AgoThe Associated Press Jim Watson | AFP | Getty Images

President Donald Trump delivers remarks on combatting drug demand and the opioid crisis on October 26, 2017 in the East Room of the White House in Washington, DC.

The White House says the true cost of the opioid drug epidemic in 2015 was $504 billion, or roughly half a trillion dollars.

In an analysis to be released Monday, the Council of Economic Advisers says the figure is more than six times larger than the most recent estimate. The council said a 2016 private study estimated that prescription opioid overdoes, abuse and dependence in the U.S. in 2013 cost $78.5 billion. Most of that was attributed to health care and criminal justice spending, along with lost productivity.

The council said its estimate is significantly larger because the epidemic has worsened, with overdose deaths doubling in the past decade, and that some previous studies didn't reflect the number of fatalities blamed on opioids, a powerful but addictive category of painkillers.

The council also said previous studies focused exclusively on prescription opioids, while its study also factors in illicit opioids, including heroin.

"Previous estimates of the economic cost of the opioid crisis greatly underestimate it by undervaluing the most important component of the loss — fatalities resulting from overdoses," said the report, which the White House released Sunday night.

Last month at the White House, President Donald Trump declared opioid abuse a national public health emergency. Trump announced an advertising campaign to combat what he said is the worst drug crisis in the nation's history, but he did not direct any new federal funding toward the effort.

Trump's declaration stopped short of the emergency declaration that had been sought by a federal commission the president created to study the problem. An interim report by the commission argued for an emergency declaration, saying it would free additional money and resources.

But in its final report earlier this month, the panel called only for more drug courts, more training for doctors and penalties for insurers that dodge covering addiction treatment. It did not call for new money to address the epidemic.

More than 64,000 Americans died from drug overdoses last year, most involving a prescription painkiller or an illicit opioid like heroin.

Society Selects New CEO

Mon, 20 Nov 2017 14:15:35 GMT

November 3, WMS Medigram

The Wisconsin Medical Society Board of Directors has named Clyde “Bud” Chumbley, MD, MBA, chief executive officer of the Wisconsin Medical Society.

“I’m excited to have the opportunity to serve as the next CEO of the Wisconsin Medical Society; I consider it a tremendous honor,” said Dr. Chumbley, who will begin on November 27. “Having been a Society member for 37 years, I’m a firm believer in its mission to advance the health of the people of Wisconsin by ensuring access to high-quality, cost-efficient care. And I look forward to drawing on my experience to further strengthen the Society so we can continue to make a difference for our patients and our profession.”

In addition to caring for patients as a board-certified obstetrician/gynecologist throughout his 36-year medical career, Dr. Chumbley has held numerous leadership and management positions, including serving nearly 20 years as president and CEO of a large, independent multi-specialty medical group practice. He currently serves as chief medical adviser for Wisconsin Medical Society Holdings and as chief medical officer for the Wisconsin Medical Society Holdings Association Health Plan.

Past leadership roles in Wisconsin include serving as chief medical officer/chief clinical integration officer for Aspirus Health and president of Aspirus Clinics, and as president and CEO of ProHealth Care Medical Associates. He also has served on the board of directors and as past chair and treasurer for the Wisconsin Collaborative for Healthcare Quality. In Texas, he served as chief medical officer for Scott & White Healthcare in the Austin region.

Doctor Chumbley is a graduate of the University of Missouri School of Medicine and the Kellogg School of Management at Northwestern University and holds medical licenses in Wisconsin and Texas.

“We were fortunate to have a number of highly qualified candidates interested in this position,” said Jerry Halverson, MD, chair of the Society’s Board of Directors and co-chair of the search committee. “Doctor Chumbley is an excellent advocate for physicians and the patients we serve, and with his extensive administrative experience and medical expertise, we believe he is an outstanding choice to lead the Society. We look forward to all we can accomplish under his leadership.”

Doctor Chumbley is the eighth Society CEO in its 176-year history. Susan L. Turney, MD, MS, FACMPE, FACP, was the first physician to hold the position from 2004 to 2011.

FDA Approves First Device to Treat Opioid Withdrawal —Electrical neurostimulator was previously cleared for use in acupuncture

Thu, 16 Nov 2017 14:29:20 GMT

by Alexandria Bachert MPH, Staff Writer, MedPage Today November 15, 2017

WASHINGTON -- A first-in-class neurostimulation device to relieve symptoms of opioid withdrawal is approved for marketing, the FDA announced Wednesday.

The NSS-2 Bridge device is a small, battery-powered electrical nerve stimulator that is placed behind a patient's ear and emits electrical pulses to stimulate branches of certain cranial nerves. Patients can use the device for up to 5 days during the acute physical withdrawal phase.

The device, made by Innovative Health Solutions, was previously cleared by the FDA in 2014 for use in acupuncture.

"Given the scope of the epidemic of opioid addiction, we need to find innovative new ways to help those currently addicted live lives of sobriety with the assistance of medically assisted treatment," said FDA Commissioner Scott Gottlieb, MD, in an agency press release. "While we continue to pursue better medicines for the treatment of opioid use disorder, we also need to look to devices that can assist in this therapy."

Device approval was based on a study that evaluated the clinical opiate withdrawal scale (COWS) score -- measuring symptoms on a scale of 0 to more than 36 (0 being the least severe) -- in 73 patients undergoing opioid physical withdrawal. Study results showed that all patients had a reduction in COWS of at least 31% within 30 minutes of using the device and that 88% of patients transitioned to medication-assisted therapy after 5 days.

The device is available only by prescription and is contraindicated for patients with hemophilia, cardiac pacemakers, and psoriasis vulgaris.

Learn more.

PRIMARY CARE-BASED MODELS EFFECTIVE FOR OPIOID ADDICTION

Mon, 06 Nov 2017 17:38:51 GMT

Lagisetty P, et al. PLOS One. 2017;doi:10.1371/journal.pone.0186315.

November 3, 2017

Multidisciplinary and coordinated care delivery models effectively provide opioid use disorder treatment and increase access to medication-assisted treatment in primary care, according to data published in PLOS One.

“It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience,” Pooja Lagisetty, MD, from the division of general internal medicine and the Institute for Health Policy and Innovation at the University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System, said in a press release. “But, if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible. There is a major need to do this.”

Distinguished Fellow, American Society of Addiction Medicine (DFASAM)

Thu, 02 Nov 2017 13:31:18 GMT

Please note that ASAM physician members may apply for the Distinguished Fellow, American Society of Addiction Medicine (DFASAM) title until November 15, 2017. ASAM and the Board of Directors recognize these elite professionals as "Distinguished Fellows" because of their significant contributions to the field of addiction medicine and their work as outstanding, prominent, and distinguished professionals in the medical community. Authorized members may employ the DFASAM designation after their names as a mark of distinction and to provide a description of their unique position.

We encourage you to apply (If you haven’t already) and remind physician members in your chapter that the DFASAM application period is open for only 2 more weeks. Click here to access the DFASAM page.

Department of Health Services Names Paul Krupski as Director of Opioid Initiatives

Mon, 30 Oct 2017 18:31:12 GMT

Department of Health Services Names Paul Krupski as Director of Opioid Initiatives

New position aimed at coordinating efforts to fight the state's opioid crisis

The Wisconsin Department of Health Services (DHS) announced today Paul Krupski has been selected to serve as the new Director of Opiate Initiatives to coordinate the department’s efforts to end the state’s opioid crisis, effective today.

“Opioid overdoses and the misuse of opioids affects every corner of the state, and Paul’s experience and skills support our efforts to ensure that our response is as aggressive and effective as possible,” said DHS Secretary Linda Seemeyer. “Opioid use disorder, including heroin and prescription drugs, is destroying families, and we must do whatever we can to end the heartbreak affecting so many.”

View the entire news release.

4 actions the Trump administration will take now that opioid crisis is a national public health emergency

Mon, 30 Oct 2017 13:26:36 GMT

by Ilene MacDonald |

Oct 27, 2017 9:17am

President Donald Trump on Thursday declared a war on drug addiction and opioid abuse, saying he would mobilize his entire administration to address the crisis now that he has officially determined it is a national public health emergency.

“We will defeat this opioid epidemic,” Trump said. “We will free our nation from the terrible affliction of drug abuse. And, yes, we will overcome addiction in America … We have fought and won many battles and many wars before, and we will win again.”

Although he didn’t offer specific actions the administration would take during his remarks or how they will be funded, Trump said federal agencies are working with doctors and medical professionals to implement best practices for safe opioid prescribing, and requiring that federally employed prescribers undergo special training.

The public health emergency directive allows the government to waive some restrictions, Trump said, such as a 1970s-era rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those who suffer from drug addiction. But it doesn’t come with a substantial amount of funding that would have been available had Trump declared a national emergency under the Stafford Act, which would have allowed access to funding under the Federal Emergency Management Agency.

Later in the day the administration released a statement that provided some of the actions the government would take as a result of the declaration:

Expand access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.

Allow the Department of Health and Human Services to quickly make temporary appointments of specialists who can help the agency respond to the crisis.

Allow the Department of Labor to issue dislocated worker grants to help those who have been displaced from the workforce because of the opioid crisis (subject to available funding).

Shift resources within HIV/AIDS programs to help people eligible for those programs to receive substance abuse treatment, an action that the administration noted is vital given the connection between HIV transmission and substance abuse.

Trump said during his remarks that he is awaiting a final report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis and the administration will act quickly to evaluate and implement its recommendations.

The administration later said in a statement that since Trump took office the government has allocated or spent more than $1 billion to address drug addiction and the opioid crisis. That funding includes $800 million for prevention, treatment, first responders, prescription drug monitoring programs, recovery and other care in communities, inpatient settings, and correctional systems. It also includes $254 million in funding for high-risk communities, law enforcement, and first responder coordination and work.

Opioid epidemic also hitting older adults

Wed, 25 Oct 2017 15:49:37 GMT

The Hill
BY RACHEL ROUBEIN - 10/24/17 12:44 PM EDT

As America grapples with an opioid epidemic, senior citizens are often overlooked.

Yet, older adults are highly susceptible to chronic pain and the prescription painkiller addiction is hitting this population.

“We really are looking at the opioid epidemic, we know how destructive it is, but we think of its younger victims,” Rep. Katherine Clark (D-Mass.) said at an event on aging and addiction, hosted by The Hill and sponsored by Surescripts. “This is more of a quiet, more silent, but equally deadly part of the opioid epidemic,” she said.

Roughly one in three beneficiaries in Medicare’s prescription drug program received a prescription for opioids in 2016. About half a million received high amounts of opioids. And nearly 90,000 are at “serious risk” of opioid misuse or overdose, according to a July report by the inspector general of the Department of Health and Human Services (HHS).

“What the data really revealed — the final takeaway — is that Medicare may be paying for opioids that are not medically necessary and in fact Medicare may be paying for opioids that are doing harm to seniors and perhaps even others as the drugs are diverted into the street for resale,” said Ann Maxwell, assistant inspector general for evaluations at the HHS Office of Inspector General.

At the event, Clark and Rep. Markwayne Mullin (R-Okla.) touted their bill requiring e-prescriptions for controlled substances under Medicare.

Of potential opposition to the measure, Clark said, “the burden is really going to come to doctors, to hospitals, to upgrade their technology to be able to do the e-prescribing.” She added the legislation includes built in ways to give them time to meet this criteria.

But, she said, “this is worth it,” calling it a “critical tool going forward.” Mullin added that the bill doesn’t go into effect until 2020.

A panel of experts discussed their views on how Congress and the administration can help combat the rates of opioid addiction among older adults. These recommendations included an infusion of federal funds, regulations from the Centers for Medicare and Medicaid Services on pharmacy and prescriber lock-in programs under Medicare, cautious prescribing of opioids and more.

Wisconsin Medicaid Announces Increased Rates for Professionals Providing Outpatient Mental Health and Substance Use Disorder Services

Tue, 24 Oct 2017 14:01:20 GMT

Under the leadership of Governor Walker, the Department of Health Services (DHS) Division of Medicaid Services (DMS) is pleased to announce that effective January 1, 2018, we will increase reimbursement for outpatient mental health (MH) and substance use disorder (SUD) treatment.

We have heard the feedback from our partners in the MH and SUD provider community regarding the barriers they face in meeting the demand for these important services. Generally, financial mechanisms alone will not resolve many of the health care challenges of our state. However, by increasing Medicaid rates and removing the administrative burden of prior authorization for outpatient mental health providers, we expect that our members will have improved access to treatment services by encouraging licensed providers to enroll with Wisconsin Medicaid. To enroll in the Medicaid program, go to the ForwardHealth Portal.

DMS will invest $7 million GPR annually to increase rates for MH and SUD. This substantial investment will make Wisconsin Medicaid a rate leader in the Great Lakes region in terms of provider reimbursement for MH and SUD treatment.

This announcement will be followed soon by a ForwardHealth Update with additional details of the rate increase and billing guidance for fee-for-service providers. DMS will provide guidance to HMOs on the rate/billing guidance changes and will adjust our HMO capitation rates (and encounter data submission process) effective January 1, 2018, to assure alignment.

I hope this investment by Governor Walker will spur you to enhance and expand mental health and substance abuse services to our residents in need. We look forward to our continued partnership and collaboration on behalf of our members.

Michael Heifetz

Medicaid Director

Opioid Blocker as Good as Suboxone in First Head-to-Head Trial

Mon, 23 Oct 2017 13:54:29 GMT

by Kristina Fiore, Deputy Managing Editor, MedPage TodayOctober 20, 2017

Monthly naltrexone shots (Vivitrol) worked as well as daily buprenorphine/naloxone (Suboxone) for treating opioid use disorder, according to the first head-to-head trial between the two.

In an open-label randomized controlled trial, retention in the extended-release naltrexone group was non-inferior to buprenorphine/naloxone at 12 weeks (mean time 69.3 and 63.7 days, respectively), according to Lars Tanum, MD, PhD, of the University of Oslo in Norway, and colleagues.

Naltrexone was also non-inferior for other primary outcomes including the number of opioid-negative urine drug tests, use of heroin, and use of other illicit opioids, the team reported online in JAMA Psychiatry.

"The main clinical implication of these findings is that extended-release naltrexone seems to be as safe and effective as buprenorphine/naloxone treatment for maintaining short-term abstinence from heroin, opioids, and other illicit substances in opioid-dependent individuals newly detoxified and/or discharged from inpatient treatment or prison."

The study wasn't funded outright by Alkermes, the maker of Vivitrol, but the company was "allowed to comment on the manuscript before submission for publication," according to the study's disclosure section.

Earlier this year, investigative reports found that Alkermes was using lobbyists to get Vivitrol written into state laws about opioid abuse treatment, and has persuaded drug courts to mandate Vivitrol over other drugs.

For the study, the researchers enrolled 159 patients with opioid dependence (mean age 36; 28% were women) who went through detoxification and were then randomized to buprenorphine/naloxone 4 to 24 mg/day (with a target dose of 16 mg/day) or to monthly naltrexone injections (380 mg).

After 12 weeks, 105 (66%) participants had attended all scheduled follow-up appointments and had taken their medication as prescribed. A total of 53 participants dropped out: 24 in the naltrexone group and 29 in the buprenorphine/naloxone group.

In addition to non-inferiority for retention, naltrexone was also non-inferior for:

Number of opioid-negative urine drug tests (mean 0.9 and 0.8, respectively; P<0.001)
Use of heroin (mean difference −3.2, P<0.001)
Use of other illicit opioids (mean difference −2.7, P<0.001)

Extended-release naltrexone was superior for lower use of heroin and other illicit opioids, but not superior for the proportion of negative urine drug tests.

In terms of secondary outcomes, there were no significant differences between groups for the use of amphetamines, cocaine, alcohol, cannabis, or injecting drugs, but those on naltrexone had a significant reduction in benzodiazepine use, while the buprenorphine/naloxone group remained stable.

There were more adverse events among those on naltrexone (69% versus 34.7%, P<0.001), but only 10 participants discontinued treatment owing to adverse events: four in the naltrexone group and six in the buprenorphine/naloxone group. A number of events were related to withdrawal symptoms and were more frequent among the naltrexone group (28 patients, 39.4%, versus 10 patients, 13.9%).

There were no deaths, but more naltrexone patients reported having serious adverse events including pneumonia and withdrawal (8.5% versus 4.2%).

Tanum and colleagues noted that naltrexone induction required full detoxification to a greater extent than buprenorphine/naloxone treatment. In fact, the detoxification protocol was changed a year into the trial, which reduced the number of new adverse events related to naltrexone induction.

The researchers noted that the study was limited by a lack of blinding, as the use of placebo among newly detoxified opioid users was considered unethical. Also, participants likely recognized their treatment easily, given their long experience with opioid use.

Still, the researchers concluded that extended-release naltrexone was as effective and safe as buprenorphine/naloxone and should be considered a treatment for opioid-dependent patients.

Drugmaker Alkermes was allowed to comment on the manuscript before submission for publication.

The authors disclosed no financial relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

LAST UPDATED 10.20.2017

Primary Source

JAMA Psychiatry
Source Reference: Tanum L, et al "Effectiveness of injectable extended-release naltrexone vs daily buprenorphine/naloxone for opioid dependence: A randomized clinical noninferiority trial" JAMA Psych 2017; DOI: 10.1001/jamapsychiatry.2017.3206.

CDC: Drug OD rate now higher in rural US than cities

Mon, 23 Oct 2017 13:53:00 GMT

FRIDAY, Oct. 20, 2017 (HealthDay News) -- Drug overdose death rates in rural areas of the United States are now higher than in cities, a trend that worries federal health officials.

In 2015, drug overdose was the leading cause of injury-related death in the United States -- with 52,000 fatalities attributed to opioid painkillers, heroin and other potentially deadly drugs, researchers said in a new report.

U.S. Centers for Disease Control and Prevention Director Dr. Brenda Fitzgerald said rising overdose death rates outside metropolitan areas warrant attention.

"We need to understand why this is happening so that our work with states and communities can help stop illicit drug use and overdose deaths in America," Fitzgerald said in an agency news release.

In 1999, drug overdose death rates were 6.4 per 100,000 in urban regions and 4 per 100,000 in rural areas. But the gap gradually disappeared. By 2015, the rate was 17 per 100,000 in rural areas and 16.2 per 100,000 in cities, the study findings showed.

The researchers assessed illicit drug use and disorders from 2003 to 2014, and drug overdose deaths from 1999 to 2015 in urban and rural areas. The investigators were led by Karin Mack of the CDC's National Center for Injury Prevention and Control.

Although the percentage of people reporting illegal drug use is actually lower in rural areas, the effects appear to be greater, the researchers noted.

Overall, "most overdose deaths occurred in homes, where rescue efforts may fall to relatives who have limited knowledge of or access to life-saving treatment and overdose follow-up care," the authors explained in the news release.

Looking at where drug users live and where they die from overdoses might lead to better preventive measures, the team pointed out.

Some other findings in the report:

Rising rates of drug overdose deaths nationwide between 1999 and 2015 were consistent across gender, race and intent (unintentional, suicide, homicide or undetermined).

The actual number of drug overdose deaths remains much higher in cities. In 2015, about six times as many drug overdose deaths occurred in urban areas (45,059) as in rural areas (7,345).

The percentage of people reporting use of illicit drugs in the past month fell among those aged 12 to 17 over a 10-year period, but rose sharply in other age groups.

On a positive note, past-year illicit drug use disorders declined during 2003-2014.

"On the one hand, the decline in illicit drug use by youth and the lower prevalence of illicit drug use disorders are encouraging signs," Mack's team wrote. "On the other hand, the increasing rate of drug overdose deaths in rural areas, which surpassed rates in urban areas, is cause for concern."

Since rural residents are less likely to have access to substance abuse treatment services, the findings point to a need to beef up such services outside cities, the authors of the report said.

Moreover, doctors should be updated on guidelines for prescribing opioids for chronic pain. And communities with high opioid-use disorder rates might benefit from greater access to addiction/overdose treatments such as methadone, buprenorphine or naltrexone, Mack and colleagues concluded.

The findings were published in the Oct. 20 issue of the CDC's Morbidity and Mortality Weekly Report.

More information

The U.S. National Institute on Drug Abuse has more about drug addiction.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, Oct. 19, 2017; Oct. 20, 2017, Morbidity and Mortality Weekly Report

Symproic Now Available for Opioid-Induced Constipation

Mon, 16 Oct 2017 14:05:40 GMT

Shionogi and Purdue announced the launch of Symproic (naldemedine) tablets for the treatment of opioid-induced constipation (OIC) in adults with chronic non-cancer pain, including patients with chronic pain related to prior cancer or its treatment who do not require frequent (eg, weekly) opioid dosage escalation.

Symproic, initially approved as a CII controlled substance in March 2017, was officially descheduled by the Drug Enforcement Agency (DEA) in September 2017. It is an oral peripherally-acting mu-opioid receptor antagonist (PAMORA) that acts in tissues such as the gastrointestinal tract, thereby decreasing the constipating effects of opioids. Its ability to cross the blood-brain barrier is reduced due to a side chain that has been added, which increases the molecular weight and polar surface area.

In clinical trials (COMPOSE 1, COMPOSE 2), the proportion of responders (patient who had at least 3 spontaneous bowl movements [SBM] per week and a change from baseline of at least 1 SBM/week for at least 9 out of the 12 weeks including 3 out of the last 4 weeks) was found to be significantly higher with Symproic versus placebo: COMPOSE 1 (48% vs. 35%); COMPOSE 2 (53% vs. 34%).

Symproic is available as 0.2mg strength tablets in 90-count bottles.

For more information call (800) 849-9707 or visit Symproic.com.

ASAM: Scientific Poster and Presentation Abstracts Submission Deadline: October 2, 2017

Wed, 27 Sep 2017 13:02:54 GMT

Scientific Poster and Presentation Abstracts Submission Deadline: October 2, 2017

Don't miss your opportunity to present your abstract at the nation's leading conference on addiction medicine.

Review the criteria, develop an abstract, and submit today! It's easier than you think!

ASAM members and non-members are invited to submit abstracts and presentation proposals for poster presentations, focus sessions, and workshops.

Online Submission Deadline: October 2, 2017

Please visit the ASAM Call for Abstracts page for additional information on presenter requirements, submission categories, possible topics, and abstract awards.

Why Submit?

Presenting an abstract at The ASAM Annual Conference is a very prestigious way to contribute to the field and add to your CV. The abstract process is very competitive and accepted abstracts have opportunities for awards.

Submissions are FREE and presenters of accepted abstracts receive discounted registration to the conference.

Strive for the opportunity to present alongside the best in the field!

Abstract Awards

Primary authors of high scoring and exceptional posters abstracts could receive one of four awards.

· Best Overall

· Young Investigator

· Resident (NEW!)

· Fellow-in-Training (NEW!)

Awards will made on the basis of new ideas or findings of importance to the field of addiction medicine, their methodology and clarity of presentation, as judged by the Committee.

About the American Society of Addiction Medicine

ASAM is a professional society representing over 5,000 physicians and associated professionals dedicated to increasing access and improving the quality of addiction treatment; educating physicians, other medical professionals, and the public; supporting research and prevention; and promoting the appropriate role of physicians in the care of patients with addiction. Visit www.ASAM.org

Schimel, other attorneys general, call for insurers to review opioid-prescribing policies

Mon, 25 Sep 2017 18:00:08 GMT

September 19, Wisconsin Health News

Attorney General Brad Schimel has joined the chief legal officers for 36 other states and territories to ask that insurers revise policies to reduce opioid prescribing.

Schimel and the other attorneys general wrote Marilyn Tavenner, the CEO of America's Health Insurance Plans, requesting that her members review payment and coverage policies to prioritize non-opioid pain management.

"We have witnessed firsthand the devastation that the opioid epidemic has wrought on our states in terms of lives lost and the costs it has imposed on our healthcare system and the broader economy," Schimel and others wrote.

They added that they'll soon be working with state insurance commissioners and others "to initiate a dialogue" with insurers to identify practices that can reduce opioid prescription and those that don't.

"The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable," the attorneys general wrote. "We ask that you quickly initiate additional efforts so that you can play an important role in stopping further deaths."

Cathryn Donaldson, spokeswoman for America's Health Insurance Plans, said they share the attorneys general's commitment to addressing the opioid epidemic. Health plans cover approaches to pain management that include more cautious opioid prescribing, careful patient monitoring and other treatments, she said.

Many health plans have already instituted programs that are helping to "dramatically reduce how much - and how often - opioids are prescribed," she said.

"By working together, doctors, hospitals, health plans and policy leaders can provide people with better pathways to healing - without putting their lives in danger because of opioids," she said.

Media Advisory: Meeting of Governor Scott Walker's Task Force on Opioid Abuse

Wed, 20 Sep 2017 19:28:22 GMT

Governor Scott Walker's Task Force on Opioid Abuse meets on Friday to continue its work toward ending the opioid crisis in Wisconsin.

WHO: Among the presentations to the task force will be a discussion on Trauma-Informed Care presented by Wisconsin First Lady Tonette Walker, Elizabeth Hudson of the Office of Children's Mental Health, and Dr. Michael Tkach of Hazelden Betty Ford.

WHEN: Friday, September 22, 2017 from 9:00 AM to 12:00 PM

WHERE: Sauk County Human Services Building,505 Broadway Street, Baraboo, Wi.

Conference B-30 (Basement). Parking available behind the building.
Credentialed members of the media are invited to attend.

Doctor Day 2018

Mon, 11 Sep 2017 13:50:03 GMT

Doctor Day 2018 has been set for Tuesday, January 30. The event will again be held at the Monona Terrace in Madison and is hosted by over 20 medical societies.

The event provides physicians an opportunity to meet with their legislators, and have input on important health care issues. The day will conclude with a reception in downtown Madison.

Registration is available online (link).

State receives additional funding for opioid epidemic

Mon, 11 Sep 2017 13:48:39 GMT

September 7, Wisconsin Health News

The Centers for Disease Control and Prevention awarded Wisconsin additional funding to beef up its efforts to curb opioid abuse, according to a Tuesday statement.

Wisconsin received roughly $752,000 in supplemental funding that can be used to scale up prevention efforts, like increasing the use of prescription drug monitoring programs and expanding the reach of messages about opioid risks. Wisconsin is now receiving $2.6 million from the same program.

The state also received an additional $131,000 to better track and prevent opioid-involved overdoses. The state is now receiving $460,000 through the program.

CDC announced $28.6 million in funding to 44 states and the District of Columbia Tuesday.

Study Highlights Lack of Consensus in Pain Management Among Clinicians

Thu, 07 Sep 2017 13:13:02 GMT

Due to a lack of guideline-based direction for the management of chronic pain, selection of treatment is often based on institutional protocols, provider experience, and fear of legal issues, according to results of study presented at Pain Week 2017.

Online surveys were distributed nationally to US-practicing clinicians in different specialties actively managing ≥10 chronic pain patients per week. Data from 402 clinicians was collected and compiled for both descriptive and inferential analysis. Each respondent was presented with case vignettes, predominately centered on patients suffering from chronic pain due to osteoarthritis and low back pain. “These patient scenarios were designed to assess how clinicians prefer to manage, and case continuations were set up to progress the patient in pain severity,” the study authors explained.

In the first vignette, a 52-year-old patient presented with a 4-month progression of moderate-to-severe right hip pain due to osteoarthritis. For this patient, most clinicians chose to prescribe an NSAID, corticosteroid injection, or non-pharmaceutical therapy followed by surgical referral as the patient progressed. The second case involved a 50-year-old patient suffering from chronic low back pain with inadequate relief from NSAIDs, muscle relaxants, or physical therapy. Results found that clinicians generally did not agree on the best treatment option for this patient, and a variety of NSAIDs and therapy involving short-acting opioids were generally recommended. In the third vignette, a 75-year-old patient presented with well-controlled hip osteoarthritis and was receiving oxycodone for the past 6 months. Results found that only a few clinicians recommended continuing opioid-based therapy instead of initiating a different treatment.

“Many clinicians, particularly orthopedic surgeons and rheumatologists, use standardized screening tools for opioid risk assessment,” the study authors commented. They added, “Of all clinicians included in the study, orthopedic surgeons and rheumatologists are least confident in their ability to assess patient risk and to assess a patient's level of pain.”

Results of this analysis found that guideline-based direction for management of chronic pain is lacking. The study authors added, “Continued studies are needed to understand practice change and allow refinement of educational messages.”

Read more of MPR's coverage of PAINWeek 2017 by visiting the conference page.

Annual Conference Highlights - Register Today!

Tue, 15 Aug 2017 13:51:13 GMT

Annual Wisconsin Society of Addiction Medicine Conference:

Advancing the Art and Science of Addiction Prevention and Treatment in Wisconsin

September 14-16, 2017 (Thursday-Saturday), Pyle Center, Madison, WI

This conference is open to individuals working in addiction prevention and treatment across disciplines, including clinicians, social workers, recovery coaches, individuals in recovery, law enforcement and public health officials.

This year's conference will feature a number of workshops, lectures, and a special presentation by Joseph LMS Green (poet. performer. educator.).

Our post-conference workshop options on Saturday, September 16th, 2017 are:

"ASAM Treatment of Opioid Use Disorder Course: Focus on Buprenorphine", a case-based course which counts towards the 8 hours required to obtain the waiver to prescribe buprenorphine.
"Naltrexone in Practice: A Valuable Treatment Option for Both Opioid and Alcohol Use Disorders"
"Mitigating the Risk of Prescription Drug Abuse: The Wisconsin Medical Examining Board Opioid Prescribing Guidelines"

Click here to download the conference brochure.

Click here to register for the conference.

Fulfill your 2 hour opioid prescribing education requirement by attending the Saturday PM workshop "Mitigating the Risk of Prescription Drug Abuse: The Wisconsin Medical Examining Board Opioid Prescribing Guidelines."

This activity has been approved by the Wisconsin Medical Examining Board (MEB) as an educational course (MED-1035) related to the opioid prescribing guidelines issued by the board under s. 440.035 (2m), Stats. For Wisconsin-licensed physicians with a DEA number, this activity meets the requirement under s. Med 13.02 (1g) a) and 1r) as minimum of 2 hours related to the guidelines of 30 hours of continuing medical education required for licensure every two years.

Doctor Day 2018

Mon, 17 Jul 2017 21:48:50 GMT

Doctor Day 2018 has been set for Tuesday, January 30. The event will again be held at the Monona Terrace in Madison and is hosted by over 20 medical societies.

The event provides physicians an opportunity to meet with their legislators, and have input on important health care issues. The day will conclude with a reception in downtown Madison.

Registration is available online (link).

Prevention driving health response to opioid epidemic: CDC prescribing guide shifting approach

Fri, 30 Jun 2017 15:31:46 GMT

Kim Krisberg

Confronting an opioid overdose epidemic that kills nearly 100 Americans every day takes a combination of interventions across sectors. But a common thread throughout, says Andrew Kolodny, MD, should be viewing the problem not as an epidemic of abuse, but as an epidemic of addiction.

Jennifer Stepp and her daughter, Audrey, 8, hand out trainer boxes of a Naloxone auto-injector that can help with opioid overdoses after a November 2015 training class in Louisville, Kentucky. As the number of Americans with opioid addictions has grown, CDC has created new tools that support prevention.

“If you refer to it as an abuse problem, it leads people to believe the problem is a lot of folks behaving badly and abusing drugs,” said Kolodny, co-director of opioid policy research at Brandeis University. “But that’s not at all what’s going on. The majority of deaths happen in people suffering from opioid addiction — these are people who aren’t taking opioids for fun but to avoid feeling the agonizing pain of withdrawal.”

In fact, Kolodny sees the opioid addiction crisis as similar to a disease outbreak — “you have to contain the outbreak by preventing new people from becoming infected and make sure everyone already infected gets the best possible care so they don’t die from infection,” he told The Nation’s Health.

Preventing further “infection,” or new cases of opioid addiction, he said, boils down to one overarching strategy: more cautious prescribing.

“For a while now, CDC has been pointing out that the rise in deaths has corresponded with a rise in prescribing,”said Kolodny, who also serves as executive director of Physicians for Responsible Opioid Prescribing. “And now we see much greater recognition that it’s overprescribing that’s driving this epidemic.”

The Centers for Disease Control and Prevention reports that drug and opioid-related overdose deaths keep rising in the U.S., with rates up among men and women and among all racial and age groups. In the U.S., more than three of every five drug overdoses involve an opioid, with overdose deaths due to both prescription opioids and heroin quadrupling since 1999. According to data published last year in CDC’s Morbidity and Mortality Weekly Report, opioid-related overdose deaths increased by 14 percent between 2013 and 2014, including a sharp increase in deaths associated with the synthetic opioid fentanyl. Such findings, the researchers wrote, “indicate that the opioid overdose epidemic is worsening.”

CDC guidelines tell clinicians to discuss the risks of opioids when prescribing them, and to start patients on the lowest dose.

At public health departments nationwide, prevention is guiding work to stem the overdose epidemic, with efforts focused on both avoiding addiction in the first place and preventing fatal overdoses in people already addicted. On the addiction side, changing the way medical professionals prescribe highly addictive opioid painkillers is a key intervention point, with CDC releasing its “Guideline for Prescribing Opioids for Chronic Pain” in 2016. Noting that opioid prescriptions went up 7.3 percent per capita from 2007 to 2012, the evidence-based guidelines recommend prescribers consider nonpharmacologic and nonopioid therapy for chronic pain, concluding the “clinical evidence review found insufficient evidence to determine whether pain relief is sustained and whether function or quality of life improves with long-term opioid therapy.”

The guidelines recommend prescribers fully discuss the risks and benefits of opioids with patients, start patients on the lowest effective dose if opioids are needed and assess a patient’s risk of opioid-related harm, among other measures. In an article accompanying the new guidelines and published in the Journal of the American Medical Association, researchers with CDC’s National Center for Injury Prevention and Control concluded that “of primary importance, nonopioid therapy is preferred for treatment of chronic pain.” Kolodny said the CDC guidelines marked a substantial shift in how to address the role of prescribing in rising opioid addiction.

Since their release last year, the CDC guidelines have become a frontline tool in public health efforts to stem opioid addiction and overdose risk. Also on the frontline are prescription drug monitoring systems, which are often administered by health departments and allow prescribers to view a patient’s prescription drug history. In fact, the CDC guidelines recommend prescribers use such systems when prescribing opioids. The systems, which can serve as an early warning of addiction and risky drug behaviors as well as highlight signs of drug sharing, operate in every state and Washington, D.C., except Missouri, though the state’s legislature was considering a bill to create such a system earlier this year.

Research finds that prescription drug monitoring programs can impact opioid prescribing. For example, a 2015 report prepared for the Kentucky Cabinet for Health and Family Services found that since the state began requiring prescribers to register with and use such systems in 2012, opioid prescriptions have decreased with no negative impact on patients who need opioids for chronic cancer pain. Findings from Pennsylvania’s monitoring system, which began in 2016, showed that doctor-shopping, in which patients visit multiple doctors to procure medications, fell by 94 percent.

“Prescription drug monitoring systems have emerged as a very useful tool (in confronting the opioid epidemic),” said Peter Kreiner, PhD, principal investigator of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, which assists local officials in implementing and enhancing their monitoring systems. “And because they’re run at the state level, it fosters a lot of innovation and allow states to specifically respond to what’s happening in their own communities.”

Besides shifting prescribing practices, Kreiner said monitoring system data also let public health practitioners track trends and patterns over time, which helps officials know where and when to deploy proactive prevention efforts. For instance, he said, the data can reveal areas of a state where providers need more education on the latest prescribing guidelines or communities where expanded access to naloxone could stem fatal overdose rates. Naloxone is a prescription medicine that can reverse an overdose.

Kreiner said work is underway in many states to make the systems easier for prescribers to use, such as connecting the data to electronic health records and generating daily opioid dosages across a patient’s multiple prescriptions. He also noted that in communities without access to addiction treatment services, monitoring systems data may be particularly useful in identifying patients who need greater engagement with their medical providers.

“These programs are a major public health asset,” Kreiner told The Nation’s Health.

In addition to better linking public health and physicians, the monitoring systems also connect public health to pharmacists. Heather Free, PharmD, a practicing pharmacist in Washington, D.C., and spokesperson for the American Pharmacists Association, emphasized that the systems are not for “policing” patients, but for identifying those who need help. The data, she said, alert her to patients who need more information on nonopioid therapies and those who should have naloxone on hand as a precaution.

Free noted that many states allow pharmacies to have a standing order to dispense naloxone, which is nonaddictive, as part of efforts to reduce fatal overdoses. Pharmacists can also help with the diversion of opioids for nonmedical use, such as partnering with law enforcement to install secure take-back boxes outside of pharmacies. Free said she recently began dispensing a new tool to prevent diversion: a small, biodegradable bag that neutralizes painkillers’ active ingredients when water is added and allows for the safe disposal of opioid medication at home.

Of course, because the opioid epidemic is such a complex problem, one of public health’s greatest tools is its expertise in convening multisector solutions. In 2016, the Los Angeles County Department of Public Health helped convene and launch Safe Med LA, a cross-sector coalition that includes local health and law enforcement agencies, health insurers and health care providers and organizations. An overarching mission of the coalition is to carry out the public health agency’s five-year plan to reduce prescription drug overdose deaths by 20 percent by 2020.

Gary Tsai, MD, medical officer and science officer in the agency’s Substance Abuse Prevention and Control program, said Safe Med LA allows for a more coordinated response to the problem.

“One of public health’s real strengths is seeing things from a population perspective,” he said. “So when we have complicated problems like this, we know the solutions needs to be similarly sophisticated.”

For more information, including links to opioid-related prevention tools, visit www.cdc.gov/drugoverdose/epidemic.

NIDAMED Updated Website Annoucement

Fri, 30 Jun 2017 13:46:33 GMT

NIDAMED has just updated its webpage, streamlining the content into categories such as, For Your Practice, Health Professions Education, and Patient Resources.

Content incudes resources on:

Opioid prescribing & pain management
The federal government’s response to the opioid crisis
Medical marijuana
Screening and treatment
Addiction science
CME/CE programs related to opioids
Drug abuse and addiction-related health education curriculum for faculty at health professions institutions

Please encourage your members to visit the updated webpage and browse for resources to help them fight drug abuse and addiction—and ultimately improve individual, community, and public health.

If you have suggestions for improvements to the NIDAMED webpage, please contact the NIDAMED coordinator, Michelle Corbin: michelle.corbin@nih.gov.

Kind regards,

Senator Baldwin Announces Grant Funding to fight Heroin and opioid abuse

Mon, 26 Jun 2017 16:12:59 GMT

As a partner working to fight opioid and heroin abuse, Senator Baldwin wanted to make sure you were aware of new federal grant funding for critical treatment initiatives to help address this epidemic:

Improving Access to Overdose Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is accepting applications for fiscal year (FY) 2017 Improving Access to Overdose Treatment (Short Title: OD Treatment Access). SAMHSA will award OD Treatment Access funds to a Federally Qualified Health Center (FQHC), Opioid Treatment Program, or practitioner who has a waiver to prescribe buprenorphine to expand access to Food and Drug Administration (FDA)-approved drugs or devices for emergency treatment of known or suspected opioid overdose. The grantee will partner with other prescribers at the community level to develop best practices for prescribing and co-prescribing FDA-approved overdose reversal drugs. Click here for more information regarding OD Treatment Access grants and note applications are due by July 31, 2017.

Rural Health Opioid Program

The Health Resources and Services Administration is currently accepting applications for the Rural Health Opioid Program (RHOP), which seeks to promote rural health care services outreach by expanding the delivery of opioid related health care services to rural communities. The program will reduce the morbidity and mortality related to opioid overdoses in rural communities through the development of broad community consortiums to prepare individuals with opioid-use disorder (OUD) to start treatment, implement care coordination practices to organize patient care activities, and support individuals in recovery through the enhancement of behavioral counselling and peer support activities. The program supports three years of funding. Click here for more information regarding the Rural Health Opioid Program and note applications are due by July 21, 2017.

First Responders – Comprehensive Addiction and Recovery Act Cooperative Agreement

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), is now accepting applications for fiscal year (FY) 2017 First Responders-Comprehensive Addiction and Recovery Act (FR-CARA) Cooperative Agreements. The purpose of this program is to allow first responders and members of other key community sectors to administer a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose. Click here for more information regarding FR-CARA grants and note applications are due by July 31, 2017.

If you would like to request a letter of support from Senator Baldwin to include with your application(s), please contact Grants & Special Projects staff in the Senator’s Madison office. You can also visit Senator Baldwin’s website to learn more about additional federal resources and funding opportunities that may be available to your community.

Sincerely, The Office of US Senator Tammy Baldwin

4 Insurers to End Pre-Approval Process for Addiction Meds

Tue, 30 May 2017 14:58:33 GMT

The Rhode Island health insurance commissioner says the state's four major health insurers will end a practice that has been criticized for delaying treatment for patients with opioid dependency disorders.

Read full article here.

Training tomorrow’s physicians to help reverse the opioid epidemic

Tue, 30 May 2017 14:53:12 GMT

Communities in northeast Ohio are affected daily by the rising incidence of opioid overdoses. The Cuyahoga Medical Examiner’s Office reported at least 61 heroin- or fentanyl-related deaths in a single month earlier this year. The alarming death rate brings the gravity of the situation home to physicians in the area.

“There’s no more playing around with this,” said Jason Jerry, MD, until recently an addiction psychiatrist at the Cleveland Clinic’s Alcohol and Drug Recovery Center. Dr. Jerry, now with FirstHealth Moore Regional Hospital in Pinehurst, N.C., is a recognized leader in efforts to curb opioid abuse and misuse, and he and his colleagues use medication-assisted treatment (MAT) to help patients with substance-use disorders through recovery. They have cared for patients with opioid substance issues since the mid-1990s.

Dr. Jerry told AMA Wire® that it is important for medical students and residents to think about the state of the opioid crisis and consider joining the specialty of addiction medicine “because there is no end in sight. ... We’re trying to teach the next wave so they can have an impact going forward.”

To that end, Dr. Jerry and other physicians at the center were joined on their rounds by medical residents, who rotate on the center’s inpatient detox unit. He served as a mentor to one resident each year, in addition to teaching medical students interested in addiction medicine.

Dr. Jerry offers this advice based on what he taught those who rounded with him every day in the detox unit. It includes:

Think twice about putting patients on opioids for chronic pain.
Minimize the prescriptions you write when you do need to write them for acute situations like postoperative care.
Consider alternatives. After arthroscopic knee surgery, for instance, why prescribe an opioid when ibuprofen works just fine and has an anti-inflammatory effect that opioids don’t have?
Don’t write a one-month prescription. Write for just a week, maybe two.

“I think we need to get away from writing blanket prescriptions for one-month supplies because what’s happening is people are abusing them, or we’re having supplies of opioids that are sitting idle in patient’s medicine cabinets at home that are getting swiped by loved ones or by people that visit their houses,” Dr. Jerry said. “It’s a big source of diversion so I think that’s one of the major steps that we can make in terms of moving in the right direction.”

Before they leave the Cleveland Clinic, many patients also benefit from Project DAWN, an opioid overdose education and naloxone-distribution program that was founded by Cleveland emergency physician Joan Papp, MD, an assistant professor at Case Western Reserve University’s medical school.

“Many have already enrolled in DAWN and so they have their naloxone kits,” Dr. Jerry said. “They’re readily available if you’re around the Cleveland area.”

The AMA Opioid Task Force has been working for several years to increase access to naloxone, the life-saving opioid overdose antidote, increase access to MAT for patients struggling with substance-use disorder, encourage physicians to register for and use prescription drug monitoring programs (PDMP), reduce the stigma of substance-use disorder and educate patients and physicians on the matter.

Two new educational modules on what every physician needs to know and on chronic pain management are available in the AMA Education Center. They can help physicians in their efforts to battle against opioid abuse and misuse in their practices.

The American Board of Preventive Medicine now offers physicians who are certified by a member board of the American Board of Medical Specialties the opportunity to become certified in the subspecialty of addiction medicine. During the next five years following the date of the first exam, physicians are eligible to become board certified in addiction medicine without completing an addiction-medicine fellowship.

Physicians interested in taking the exam and becoming certified in addiction medicine need to complete the application on the ABPM website by June 30. The exam takes place in several locations Oct. 16–28. Learn more.

Full article

Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis.

Tue, 30 May 2017 14:51:46 GMT

Journal of Addiction Medicine - Read more

Objectives: We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of nonmedical prescription opioid (NMPO) use among young adults.

Methods: Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study, we identified associations between physical pain in the past 6 months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression.

Results: Of 199 participants, the mean age was 24.6, and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (P < 0.001) and reporting greater physical pain (P = 0.002). Among females, older age (P = 0.002) and monthly or greater nonmedical benzodiazepine use (P = 0.001) were independently associated with weekly NMPO use.

Conclusions: Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use to improve harm reduction and pain management interventions.

Board modifies drug monitoring regulation after health systems, doctors request changes

Tue, 16 May 2017 15:30:35 GMT

WI Health News

The Controlled Substances Board modified rules regarding the use of the Prescription Drug Monitoring Program to align with a recently approved change to the state budget, but rejected other proposals from health systems and doctors.

The proposed rule and emergency rule involve the implementation of laws that recently went into effect, including a requirement that prescribers review patient records before prescribing a controlled substance.

The board approved changes Friday clarifying that prescribers can delegate review of a patient's record and that the board would only refer prescribers to an appropriate law enforcement agency if it determines a criminal violation occurred.

Both changes square with a motion approved by the Legislature's Joint Finance Committee last week. They were also requested by the Wisconsin Medical Society and Wisconsin Hospital Association at the public hearing.

"There's always room for improvement," Mark Grapentine, the society's vice president of government relations, told board members.

But the board pushed back against recommendations to provide more specifics on what has to be contained in a record to satisfy the review requirement.

Matthew Stanford, the hospital association's general counsel, said they've heard from members who are concerned there isn't a list of information that is required to be in a record that has to be reviewed.

"It's both an issue of regulatory clarity but then where that ultimately becomes a bigger issue is when you start thinking about integrations and options for integration," he said. Having more clarity could help electronic health record vendors connect with the program, he said.

Board member Dr. Tim Westlake said that, as a prescriber, he didn't want "a checklist of all this."

"I could see this as becoming burdensome," he said. The board decided not to change its current definition of review.

Other speakers at the public hearing raised concerns about the integration of electronic health records with the program.

Wisconsin Statewide Health Information Network CEO Joe Kachelski said the process to connect with the updated Prescription Drug Monitoring Program, which was launched in January, has been "a little bit bumpy."

"Our validation processes have revealed some substantial data quality completeness issues," he said. "Although we have worked through many of them, some of them do remain."

The board requested the Department of Safety and Professional Services work on ways to better facilitate health system and user adoption of the new version of the program.

Medicaid approves additional treatments for opioid addiction

Mon, 15 May 2017 13:29:32 GMT

May 12, Wisconsin Health News

The state added an additional opioid-addiction treatment to its preferred list for Medicaid patients Wednesday, after law enforcement and legislators raised concerns about a current preferred drug that they say is being smuggled into jails.

The Medicaid Pharmacy Prior Authorization Advisory Committee classified the medication Zubsolv, which comes in a tablet, as a preferred drug for treating opioids. The committee also kept Suboxone, a film strip that dissolves under the tongue, on its preferred list.

In April, two associations representing sheriffs in Wisconsin wrote Medicaid Director Michael Heifetz that the "thin and malleable" strips have become "leading contraband" in jail, as inmates can abuse the drug. The associations suspected Medicaid-eligible families were "partially responsible" given jail demographics.

Rachel Currans-Henry, director of the Bureau of Benefits Management in the department's Division of Medicaid Services, said Wednesday that adding Zubsolv gives providers and members another option.

"There is an increased cost of this for the department," she said. "But in the interest of ensuring that we are addressing a public health epidemic in the state and the country, we believe that the benefits outweigh the costs."

Heifetz said they have "to balance all these things."

"We cannot just look through one lens," he said. "We have to look through a number of lenses, the taxpayer lens, the clinical lens and in this situation the law enforcement lens as well, which is a rarity for us."

Marquette County Sheriff Kim Gaffney, president of the Badger State Sheriffs' Association, hoped the decision would make a difference.

"On behalf of sheriffs across the state, we are hopeful that more opioid treatment options in the Medicaid program will reduce the prevalence of film strips and them being smuggled into jails," he said in a statement.

At a public hearing before the committee took its vote, Assembly Committee on Corrections Chair Mike Schraa, R-Oshkosh, demonstrated how the strip could be concealed under a stamp.

The strip is easier to "sneak into" jails than pills, cigarettes and other contraband, sometimes coming in through children's artwork or Bibles, he said.

"There's no good reason for the government to fuel the black market with this product," he said.

He was also concerned because Wisconsin Attorney General Brad Schimel has joined more than 40 other states to sue Indivior, the maker of Suboxone, alleging that the company switched from a tablet to a film to ensure patent protection and discourage the development of generics.

William Mullen, managed care clinical advisor for medical affairs at Indivior, encouraged the committee to "open the formulary for all" medication-assisted treatments approved by the Food and Drug Administration for opioid addiction.

That would allow doctors to choose what works best for their patients, he said. But Mullen cautioned that all drugs that contain buprenorphine, like Suboxone and Zubsolv, have a potential for abuse, misuse and diversion.

"The company will continue work with the FDA to address misuse, abuse and diversion," he said.

Lawmakers approve bills targeting opioid addiction

Wed, 03 May 2017 15:18:49 GMT

Lawmakers approve bills targeting opioid addiction

The Senate and Assembly passed a number of bills that are part of Gov. Scott Walker's special session targeting opioid addiction Tuesday.

The proposals originated from a preliminary report issued in January by a task force co-chaired by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch.

"With the nine special session bills advanced today, the Senate has taken several great strides towards helping to combat our state's ongoing opioid crisis," Senate Majority Leader Scott Fitzgerald, R-Juneau, said in a statement.

But Democrats questioned whether the bills go far enough.

"After years of struggles, we're taking baby steps when we should be making major strides to improve outcomes and strengthen community safety," Senate Democratic Leader Jennifer Shilling, D-La Crosse, said in a statement.

The Senate approved proposals that would:

prohibit the dispensing of schedule V controlled substances containing codeine, dihydrocodeine, ethylmorphine and other substances listed under the section of law the bill targets.

allow school district personnel and college and university residence hall directors to administer naloxone.

provide $2 million a year for alternatives to prosecution and incarceration for those with substance use disorders, $150,000 a year to expand those alternatives to more counties and $261,000 a year for an additional pilot program.

provide $50,000 to help establish a recovery charter school.

provide $63,000 a year to expand graduate medical training on addiction.

provide $1 million a year to create more opioid treatment programs in the state.

provide $500,000 a year to establish an addiction medicine consultation program.

provide $420,000 a year to hire four additional drug trafficking investigators at the Department of Justice.

provide $200,000 a year to expand substance abuse screening by the Department of Public Instruction.

provide limited legal immunity to overdose victims.

allow those with substance abuse disorders to be involuntarily committed.

The Assembly approved the bills last month, so they now head to Walker's desk for his approval.

The chamber also approved two additional bills Tuesday that are part of the package but haven't been taken up by the Senate. Those measures would:

Senate education committee backs bills targeting drug addiction

Mon, 01 May 2017 13:45:15 GMT

April 25, Wisconsin Health News

The Senate Committee on Education approved two bills Monday that are part of a special session ordered by Gov. Scott Walker to tackle the opioid epidemic.

A bill that would provide $50,000 to help establish a recovery charter school, which would serve 15 high school students in recovery from substance use disorder, passed out of committee 6-1. Sen. Steve Nass, R-Whitewater, voted against it.

An additional proposal providing $200,000 a year to expand the use of a substance abuse screening by the Department of Public Instruction passed 7-0. The Assembly has already approved both measures.

FDA approves abuse-deterrent form of oxycodone

Fri, 28 Apr 2017 13:43:40 GMT

April 26, 2017

Today, Inspirion Delivery Sciences LLC announced that RoxyBond (oxycodone hydrochloride) tablets CII have been approved by the FDA for oral use to manage severe pain requiring an opioid analgesic and for which alternative treatments are insufficient, according to a press release.

“Inspirion is pleased to receive FDA approval for our second abuse-deterrent product, RoxyBond, which is intended to address the long-standing unmet need for immediate-release abuse-deterrent opioids,” Stefan Aigner, MD, CEO of Inspirion, said in the release. “There are nearly 18 million prescriptions for immediate-release oxycodone hydrochloride annually in the U.S. alone.”

RoxyBond uses physical and chemical barriers without aversive agents or opioid antagonists to deter abuse even when subjected to manipulation or extraction, and it is the first and only immediate-release opioid analgesic approved with abuse-deterrent label claims, according to the release. The drug is approved in dosages of 5 mg, 15 mg and 30 mg. According to the release, inactive ingredients in RoxyBond make misuse and abuse more difficult, and in head-to-head trials with another approved oxycodone immediate-release tablet, RoxyBond had higher resistance to cutting, crushing, grinding or breaking, as well as passage through a needle. Furthermore, RoxyBond indicated resistance to extraction in selected household and laboratory solvents under various conditions, whether intact or manipulated. The tablet also makes developing solutions for IV injection difficult. However, it is still possible for abuse to occur via the intranasal, oral and IV route, according to the release.

Researchers performed a clinical abuse potential study.

“As reflected in the prescribing information, the data from the clinical study, along with support from in vitro data, also indicate that RoxyBond has physicochemical properties that are expected to reduce abuse by the intranasal route of administration,” Lynn R. Webster, MD, principal investigator from PRA Health Sciences, said in the release.

The FDA’s Anesthetic and Analgesic Drug Products Advisory Committee and Drug Safety and Risk Management Advisory Committee voted 19 to 0, with one abstention, to recommend approval of RoxyBond on April 5, 2017, according to the release.

“Oxycodone immediate-release opioid tablets are widely abused and the development of RoxyBond will offer clinicians a new approach for treating patients in pain while also fighting against the potential for abuse,” Jeffrey Gudin, MD, department director of the Pain Management Center Englewood Hospital and Medical Center, said in the release.

Curbing opioid abuse has been a focus over the last several months for the FDA, which earlier this year approved several pain relief agents that are specifically manufactured to make them more difficult to abuse.

Citing the “epidemic of overdose deaths,” the CDC issued guidelines for primary care physicians and other medical professionals for opioid prescriptions last year.

Original Article Link

Walker approves CBD oil bill

Mon, 24 Apr 2017 15:00:05 GMT

April 18, Wisconsin Health News

Gov. Scott Walker has signed into law a bill ending state penalties for those who possess cannabidiol without psychoactive effect if they have written certification from a doctor.

The bill also directs the state's Controlled Substances Board to reschedule CBD oil, which is derived from marijuana and sometimes used to treat seizures in children, within 30 days following a change at the federal level. The bill passed the Senate 31-1, and the Assembly 98-0.

The bill builds on a 2014 law that aimed to make the drug available with a prescription in the state. But supporters said that providers weren't able to prescribe the drug, which is still illegal to obtain under federal regulations.

Wisconsin receives $7.6 million to fight opioid addiction

Thu, 20 Apr 2017 15:06:00 GMT

Wisconsin will receive $7.6 million from the federal government to combat opioid addiction, the Department of Health and Human Services announced Thursday night.

HHS is providing $485 million to all 50 states, the District of Columbia and six U.S. territories. The funding, made available under the 21st Century Cures Act, will go toward prevention, treatment and recovery services.

States were awarded funding based on rates of overdose deaths and unmet need for treatment. Florida received the most money at $27.2 million, while five territories received $250,000 each.

Gov. Scott Walker directed the Department of Health Services to seek the funding in an early January executive order. DHS can re-apply for additional funding next year.

Source: WI Health News

ASAM Letter To Congress Regarding Proposed Changes To The Affordable Care Act.

Thu, 06 Apr 2017 15:35:20 GMT

by Bob Davis | March 9, 2017

On Monday, March 6th, Republican leadership introduced the American Health Care Act (AHCA). The AHCA is Republican’s plan to repeal and replace the Affordable Care Act (ACA).

The American Society of Addiction Medicine (ASAM) is very concerned that the AHCA’s proposed changes to our health care system will result in reductions in health care coverage, particularly for vulnerable populations including those suffering from the chronic disease of addiction, and we cannot support this bill in its current form.

More than 20 million Americans currently have health care coverage due to the ACA, including millions of Americans with addiction. The ACA expanded Medicaid, required health plans to cover essential health benefits such as addiction treatment, and mandated plans to treat mental health services at parity with medical and surgical services. This coverage is a critical lifeline for people with addiction, many of whom were unable to access treatment before the ACA’s expansion of Medicaid, and has reduced the burden of the opioid epidemic and saved lives.

The AHCA will roll back these important provisions and will certainly reduce access addiction treatment and reverse much or all progress made on the opioid crisis last year.

The AHCA passed out of the House Ways and Means Committee and is being considered by the House Energy and Commerce Committee.

Read the letter sent to Congress yesterday HERE.