Office Hours with Dr. C

Office Hours with Dr. C is a bi-weekly opportunity open to all grant cohorts, held every other Tuesday, from 3:00 pm to 4:00 pm ET. Bring your questions and challenges related to medication for opioid use disorder (MOUD) to this open discussion session to receive expert guidance and learn from your peers around the country.

  • Anyone directly or indirectly involved in designing and delivering MOUD services using HRSA RCORP grant funds may attend. This includes coalition members and others affiliated with grantees, so please disseminate this invitation widely.
  • Only Zoom audio will be used for this activity, to make it accessible by phone or computer audio and reduce demands on local internet bandwidth. We do not plan on having video enabled.
  • You will receive an email confirmation that will include the link for the Office Hours once you register. Please be sure to save the registration confirmation email, as it holds the call-in number needed to connect via audio and participation instructions.

Dr. Melinda Campopiano von Klimo is a family doctor, board certified in addiction medicine, and an expert in primary care. Over her 18-year career, she has led a family medical practice, served as medical director of OTPs, and treated patients with buprenorphine in an office-based setting. As a medical director at SAMHSA for five years, Dr. Campopiano von Klimo had regulatory authority for OTPs, updated the federal guidelines for OTPs, and wrote new regulations expanding access to buprenorphine. She serves as senior medical advisor at JBS.

Tuesday, May 23, 2023

Dr. C’s 5.23 Office Hours Resources

Below, you will find the resources mentioned during the session. 

MOUD in the Jail Setting

MOUD in the Hospital Setting

The CA Bridge model advances evidence-based medications for addiction treatment (MAT), particularly buprenorphine, which reduces relapse among people suffering from opioid use disorder. Lowering barriers to treatment, we eliminate unnecessary tests and provide patients in withdrawal with immediate relief from withdrawal symptoms. Once patients are stabilized, they are better equipped to engage in a conversation about long-term treatment with a substance use navigator—a peer from the community, often with lived experience. Using a harm reduction perspective that emphasizes rapid, patient-centered care, the model is proven to work effectively in any hospital setting.

Reducing Stigma in the Clinical Setting

As discussed in our session, using champion providers (nurse to nurse, MD to MD, police officer-to-police officer), when possible, can be a very effective strategy when trying to communicate new information/education and or reduce stigma related to a specific topic. If you are looking for assistance in planning or arranging a training like this, please let your JBS TEL know.

Additionally, here is a link to the Rural Health Information Hub section on stigma which also contains links to resources.

Tuesday, April 25, 2023

Dr. C’s 4.25 Office Hours Resources

Below, you will find the resources mentioned during the session. 

Testing for Xylazine

We found a few national commercial clinical laboratories offering tests for xylazine. Whether or not you can get them may depend on who is providing laboratory services in your health system. We probably don’t need to say this but, we are not advocating use of one or another of these labs.

Quest Diagnostics does not have a test that we could find.

Millennium Health specializes in drug testing and has a urine test, but it is unclear to us what geographic area they serve.

The American Clinical Laboratory association, which is a trade organization representing labs, recently made a statement in support of recent increased attention to the threat posed by Xylazine. This may be a sign that the industry is gearing up to provide testing.

Here are a couple of RCORP specific resources on Xylazine:

Buprenorphine induction in the context of fentanyl

PCSSnow.org did a webinar recently. The recording is here. The slides are attached for your convenience. The presenter starts discussing alternative induction methods at slide 17. Don’t forget, PCSSnow provides mentors. You can sign up here.  A participant shared this article Single high-dose buprenorphine for opioid craving during withdrawal (also attached).

Jails

The Legislative Analysis and Public Policy Association recently released: Performance Measures for Medication-assisted Treatment in Correctional Settings (legislativeanalysis.org). Performance measures include rearrest, reconviction, and rebooking which may be of particular interest to your corrections partners.

We found one non-academic article that discussed mortality related to drug use in jails and prisons. This article has a very compelling graph. They used Bureau of Justice Statistics, so we went to find the most recent statistics for mortality in local jails that I could find. They have reports on state penitentiaries and federal prisons as well, but we thought the local jail info would be most relevant.

  • The rate of deaths due to drug intoxication more than quadrupled between 2000 (6 per 100K) and 2019 (26 per 100) and accounted for 15% of deaths which is up from 4% in 2000.
  • The median period of incarceration for inmates who died of drug intoxication was 1 day.

We’ve attached the full report with some highlighting.

The Office of Justice Programs released a report this month on screening and treatment for OUD in local jails. This report is new, but the data is only as recent as mid-2019 however it has some nice maps showing the % of inmates for whom MOUD is continued and the % for whom it is initiated so you can see where your state is relative to others. Might be a good conversation starter.

We looked for any data on the impact of MOUD on illicit drugs entering jails and prisons or on injuries of guards, but we could not find anything at all. We will continue look and ask around but sense is that this is an area that needs to be studied.

Post-waiver training requirements

This is the recent DEA letter explaining the training requirements for ALL DEA registrants now that the waiver is gone.

Attachments:

  1. Initiating Buprenorphine for Patients using Fentanyl PCSSNOW
  2.  Bureau of Justice Statistics Mortality in Local Jails
  3. Single-High Dose Buprenorphine for Opioid 

Tuesday, April 11th 2023

Dr. C’s 4.11 Office Hours Resources

Below, you will find the resources mentioned during the session. 

CATCH My Breath vaping prevention program

Other evidence-based prevention programs

  • For a repository of evidence-based prevention programs, please follow this link: Blueprints Programs. The website allows you to search for programs that fit the issue you are addressing, the audience you seek to help, as well as the delivery venue.

LifeSkills Training:

Strengthening Families

SBIRT (Screening, Brief Intervention and Referral to Treatment): we’ve also included some information regarding SBIRT in schools.

Positive Social Norming

  • The Montana Institute and Dr. Jeffrey Linkenbach are the foremost experts regarding this strategy.
  • This link will take you to their homepage from which you can explore this approach. It also includes a success story from a rural community that has implemented the model: The Montana Institute

Workforce

Sustainability

Attachments:

  1. Universal School-Based Implementation of Screening Brief Intervention and Referral to Treatment to Reduce and Prevent Alcohol, Marijuana, Tobacco, and Other Drug Use: Process and Feasibility 

  1. A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of “CATCH My Breath”

  1. Grow Your Own

Tuesday, March 28th 2023

Dr. C’s 3.28 Office Hours Resources

Below, you will find the resources mentioned during the session.

Resources for the new

  • For people just getting started in the world of addiction and addiction treatment or who are onboarding new staff here are a couple of resources you may find useful.

Buprenorphine induction in the context of fentanyl

Consortia

Tuesday, March 14th 2023

Dr. C’s 3.14 Office Hours Resources

Below, you will find the resources mentioned during the session.

RCORP Anti Stigma Webinar: Stigma Webinar Series- Part I - Addressing Stigma: What Is It and What Can We Do About It?

Here is the organization mentioned by a participant. They provide presentations that you can use in your community and tailor to your organization.

Here is a link to the documentary that was discussed. It was produced by drugfree.org. This link will allow you to get to it on Pluto as well.

TeleECHO: Here is a link to the University of Indiana ECHO programs about opioids that are currently accepting participants: Get Involved: Opioid ECHO (iu.edu). Participants can submit deidentified patient information to have their case discussed by the experts. There are many past sessions available to view. CME/CE is available for some of the recorded sessions as well as some of the live “clinics.” If you aren’t familiar with ECHO this is a little blurb from their website explaining it.

“A teleECHO clinic is essentially virtual grand rounds. Primary care providers from multiple locations around the state of Indiana connect at regularly scheduled times with a team of specialists using low-cost, multi-point videoconferencing. During teleECHO clinics providers present patient cases to specialist expert teams who mentor the providers to manage patients with common, complex conditions – in this case, opioid use disorder. These case-based discussions are supplemented with short didactic presentations to improve content knowledge and share evidence based best practices.”

NIDA resources for health professionals on stigma.

Anti-stigma training for health professionals.

The Addiction Policy Foundation has free stigma and MOUD courses for general audiences, state and local leaders, county executives, judicial leaders.

The MOUD courses provide certificates of completion.

10 min explainer videos: Here is their stigma one as an example: What is Stigma? We Asked a Top Stigma Researcher. (addictionpolicy.org)

These could be useful for your social media, including in presentations to community stakeholders or running on a loop in waiting areas.

Tuesday, February 14th 2023

Dr. C’s 2.14 Office Hours Resources

Below, you will find the resources mentioned during the session.

Fentanyl test strips

Harm Reduction Vending machines

Naloxone Distribution from an FQHC

This document has workflows, sample standing orders, etc. for ambulatory care programs with or without an on-site pharmacy. I think the key here is not prescribing, but distribution under a standing order:

Locked medication dispensers

Improving access to telehealth

  • Minimizing Telehealth Technology Barriers in Rural and Underserved Communities (aap.org)
  • Devices to-go:
    • Put together a “to-go kit” with a smartphone or tablet, headphones, and written instructions on how to set up the device and connect for the visit. Assign “runner” duty to an office staff member or community partner (community health workers, peer navigators, etc.) to deliver the kit to the patient’s home at the time of the visit and return afterwards to pick it up.
  • Public devices
    • Are there places in the community with access to computers in public places, such as a library? Do these places afford some degree of privacy? You might be able to set up a computer kiosk in a location that provides food assistance where families could connect for a visit.
  • Parking lot practice
    • Some families/caregivers are still more comfortable in their vehicle and prefer not to enter the clinic. Set up the telehealth appointment to take place in the parking lot where they can access your Wi-Fi network. Many local recreation centers and schools have expanded their internet strength accessible from their parking lots to accommodate families during the pandemic. Contact those in your area to see if they could be available to serve as a Wi-Fi access point for a telehealth visit from the vehicle.
  • Business partnerships- use an existing relationship with a small business – such as a grocery store, restaurant, coffee shop, Pharmacy or fast-food location – to partner with customers/patients. Ask if they would consider setting aside a private, quiet space where you could set up a laptop or mobile device station. Patients could use the station, which would be connected to the store’s Wi-Fi, for telehealth visits. This partnership can also help the business as it drives customers to their establishment.

Telehealth at the library

Medicaid/CHIP coverage

  • CMS Special Enrollment Period: On January 27, CMS announced a Marketplace Special Enrollment Period (SEP) for qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the continuous enrollment condition. The SEP will allow impacted individuals and families in Marketplaces served by HealthCare.gov to enroll in Marketplace health insurance coverage outside of the annual open enrollment period. CMS will update HealthCare.gov so that Marketplace-eligible consumers who submit a new application or update an existing application between March 31, 2023, and July 31, 2024; and attest to a last date of Medicaid or CHIP coverage within the same time period, are eligible for an Unwinding SEP.