Office Hours with Dr. C

Alcohol Resources

PCSS-MAUD

This is a version of PCSS focused on medication for alcohol use disorder (MAUD). They offer a free training on MAUD that provides CEU/CME. 

Alcohol and Public Health | CDC

CDC has excellent resources and tools to help assess the impact of alcohol on your community including a toolkit for measuring alcohol outlet density and an algorithm (with necessary SAS programming) to measure alcohol related hospitalizations.

Overdose and Stimulant Article

Overdose from Unintentional Fentanyl Use when Intending to Use a Non-opioid Substance: An Analysis of Medically Attended Opioid Overdose Events | Journal of Urban Health

This study describes demographic differences in opioid overdose based on the whether the person was seeking an opioid. The data is from the San Francisco's Street Overdose Response Team and was gathered between June to September 2022. Most often people who experienced opioid overdose but were not seeking an opioid were seeking a stimulant of some form. From the article: "Unintentional fentanyl use overdoses were significantly more prevalent among Black and Latinx individuals compared to White individuals, more prevalent among women compared to men, and more prevalent among older persons." There are a couple of limitations for this study; it is a relatively small, exclusively urban sample and all overdoses were "medically attended" by a community paramedic or peer. 

Nitazenes

Here are a few resources regarding Nitazenes. The last one is from the Center for Forensic Science Research & Education which was mentioned during the call.

• Amaducci, A., Aldy, K., Campleman, S.L., et al. (2023). Naloxone use in novel potent opioid and fentanyl overdoses in emergency department patients. JAMA Network Open. 6(8), Article e2331264. Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients.
• Drug Enforcement Administration. (2024, January). Benzimidazole-opioids, another name: Nitazenes. Diversion Control Division | Benzimidazole-Opioids
• Edinoff, A. N., Martinez Garza, D., Vining, S. P., Vasterling, M. E., Jackson, E. D., Murnane, K. S., Kaye, A. M., Fair, R. N., Torres, Y. J. L., Badr, A. E., Cornett, E. M., & Kaye, A. D. (2023). New synthetic opioids: Clinical considerations and dangers. Pain and therapy, 12(2), 399–421. New Synthetic Opioids: Clinical Considerations and Dangers
• New nitazene analogue n-pyrrolidino protonitazene impacting drug markets in North America and Europe. (2023, August 29). The Center for Forensic Science Research & Education. New Nitazene Analogue N-Pyrrolidino Protonitazene Impacting Drug Markets In North America and Europe

Long-acting Injectable Buprenorphine

Co-pay programs

• INSUPPORT® for Patients
• Braeburn-ByYourSide-Enrollment | brixadihcp

Injectable Buprenorphine Resources | Grayken Center for Addiction TTA | Boston Medical Center

Boston Medical Center has protocols and implementation resources for the use of long-acting injectable buprenorphine and a program implementation guide.

Long-acting Buprenorphine Treatment for Opioid Use Disorder

Slides from Michelle Lofwall’s webinar for PCSS on long-acting injectable buprenorphine in February 2020.

Recommendations from the CDC clinical practice guidelines for prescribing opioids for pain on the subject of benzodiazepines

Recommendation 8 of the CDC clinical practice guideline for prescribing opioids for pain states: “clinicians are advised to work together with their patients to develop strategies to reduce the risk of opioid overdose, including offering naloxone. This recommendation is backed by Category A evidence, which means that it is supported by high-quality evidence, has a more favorable balance of desirable versus undesirable effects, and is less sensitive to differences in values and preferences. Category A recommendations typically apply to all persons in the group addressed in the recommendation and indicate a course of action that can be followed in most circumstances. However, it is important to note that the evidence for this recommendation is of a lower quality (type 4).

It goes on to say: ”Clinicians should offer naloxone when prescribing opioids, particularly to patients at increased risk for overdose, including patients with a history of overdose, patients with a history of substance use disorder, patients with sleep-disordered breathing, patients taking higher dosages of opioids (e.g., ≥50 MME/day), patients taking benzodiazepines with opioids (see Recommendation 11), and patients at risk for returning to a high dose to which they have lost tolerance (e.g., patients undergoing tapering or recently released from prison).” NOTE: the NY law requires naloxone to be prescribed along with the first opioid prescription of each year to people co-prescribing or co-using benzodiazepines and other sedative hypnotic drugs (zolpidem, zopiclone, zaleplon and eszopiclone AKA: Z-drugs).

Deprescribing Benzodiazepines

The VA has a thorough evidence based guide to tapering benzodiazepines. It goes over a bunch of possible schedules and strategies such as switching to longer acting benzodiazepines first. The VA is a great resource because they are such a huge health system. Their guidance tends to be less discipline or location specific.

Effective Treatments for PTSD: Helping Patients Taper from Benzodiazepines (PDF): This is the strongest and clearest description of tapering benzodiazepines for patients who have been taking them daily. As we discussed it is not necessarily going to be an effective approach for people with benzodiazepine use disorder.

Benzodiazepine withdrawal management | SA Health: The best information I could locate on withdrawal management in the context of substance use disorder if from Australia. It is very complete with assessment tools, medication, and dosing strategies as well as inpatient vs. outpatient approaches.

Free ASAM/AAAP buprenorphine provider trainings mentioned by Dr. C.

• ASAM eLearning: Advanced Buprenorphine Education free for non-members.

Advanced Buprenorphine Education: Best Practices and Emerging Evidence in Opioid Use Disorder Treatment: Free 4-hour on-line training that counts towards the DEA training requirement. Provides continuing education to a wide range of health professionals.

Rural community pharmacist willingness to dispense Suboxone® - A secret shopper investigation in South-Central Appalachia

• A study about Pharmacies investigating in South-Central Appalachia.

Here is a small resource from SE Appalachia: Rural community pharmacist willingness to dispense Suboxone® - A secret shopper investigation in South-Central Appalachia

Please note that the study was reviewed by an Institutional Review Board. The board determined that the study did not need IRB approval.

Through the link below, Nurse Practitioners can receive specialized training to prescribe buprenorphine to young adults and adults. The American Psychiatric Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. At the end of the 8-hour course, you will receive a course completion certificate for 8.0 nursing continuing professional development contact hours (8.0 contact hours in pharmacology) provided by APNA.

• Buprenorphine Training for Advanced Practice Registered Nurses (APRN)

UniteUs-This platform supports referrals for services to address social needs and coordinate care. It also has capacity to support screening for needs and payment to community-based organizations for services.

Consortia

• You may have seen this in other RCORP resources, but we think it is worth sharing here as well because it is relevant to consortium building: How One New Mexico County is Taking a Community-Wide Approach to Treating Alcohol and Substance Use Disorders | RCORPTA (rcorp-ta.org). There is also a nice training module RCORP-TA Guidance Module: Consortia Engagement & Retention | RCORPTA. You have to register for a free account to access it.

ASAM Criteria

ASAM is preparing a volume of the placement criteria specific to correctional settings. They have a draft framework on which they are seeking public comment. At the public comment site, you can download the framework. One of the appendices has a table of the different levels of care from the current edition.

• You can access the site here- SurveyMonkey Powered Online Survey.

CIDNET-This is a combined hardware/software system that supports inmate communications. A provider can use this system to receive notifications of intakes, engage inmates, and deliver care.

MOUD in the Jail Setting

• Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit

SAMHSA 2023 Reentry Resource: Contains links to examples and resources for implementing different types of reentry strategies.

• Best Practices for Successful Reentry from Criminal Justice Settings for People Living with Mental Health Conditions and/or Substance Use Disorders

Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit (Revised 2023)

• Created in partnership with Vital Strategies and faculty from Johns Hopkins University, this revised resource serves as a comprehensive guide for planning and implementing medication-assisted treatment (MAT) programs specifically tailored for opioid use disorder within correctional facilities. The toolkit addresses critical components such as staff training, policy development and collaboration with community resources to ensure a holistic and sustainable approach to MAT implementation.

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.

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.

RCORP Data Coordinator/Collection Resources

• RCORP-TA Data Learning Collaborative Spring 2023 (recordings, slides & resources)
• RCORP-TA Data Learning Collaborative Winter 2022-2023 (recordings, slides & resources)
• Data Coordinator Meetings: July 2022 – July 2023 (recordings & slides; co-facilitated with RCORP-TA)
• 12/14/22 Webinar: Strategies for Collecting RCORP Data for New Grantees (Implementation 4, Psychostimulant Support 2, Behavioral Healthcare Support, and MAT Access) (recording & slides; co-facilitated with RCORP-TA)
• 9/14/22 Webinar: Utilizing Google Forms to Collect RCORP Data (recording, slides & resources; co-facilitated with RCORP-TA)
• RSV 2022 Session 6B: Coordinating the Biannual Progress Report with Consortium Members: Perspectives from a Project Director and Data Coordinator (recording, slides & resources)
• 6/24/20 Webinar: Data Sharing among Criminal Justice & Behavioral Health Partners: Addressing Data Sharing Agreements & Confidentiality Concerns (slides & resources)

ASAM eLearning: Utilizing Low-Threshold XRBUP to Address Stimulant-Fentanyl Overdose Risk in Rural Alaska: This training is $29 for ASAM members and $39 for nonmembers. The fees give you access to a recording and CME. The slides for the training are freely available and attached here.

Fentanyl and Buprenorphine

• Here is the recent study we mentioned suggesting people using fentanyl may require a higher maintenance dose of buprenorphine.

Note: This study is not enough to officially change practice but is something to be thinking about.

Buprenorphine induction in the context of fentanyl

• PCSS-Now  (providers clinical support system) is a trusted source of information. They have a webinar coming up (April 7) on buprenorphine induction for patient’s using fentanyl.
• The discussion of low dose v. high dose induction is ongoing. Yet there is no accepted “standard of care.” There is a feasibility study underway that concludes in June. It will be a while before there are results available though. Studies like this one will begin to establish an evidence base. In the meantime the state of NY produced an expert consensus document last year that summarized the evidence available at that time. The CA bridge program published some data (abstract 294) on induction in the field by paramedics using the high dose approach.
• A participant shared this article Single high-dose buprenorphine for opioid craving during withdrawal (also attached).

Data about incidence of precipitated withdrawal due to buprenorphine administration among people using fentanyl.

• This is the retrospective chart review quantifying precipitated withdrawal (N=13). Be aware that you have to look at the supplementary data to find out this is 13 out of 931 charts which is 1.4%.
• Attached is the prospective study (N=1200) that found incidence of precipitated withdrawal to be 0.7%.

Fentanyl test strips

• For community organizations or health care providers. The link below contains citations and resources. Best Practice of the Month So you have fentanyl test strips: Now what? | RCORPTA (rcorp-ta.org)
• For people who use drugs:
  • Fentanyl Test Strips: A Harm Reduction Strategy
  • How To Test Your Drugs Using Fentanyl Test Strips (nyc.gov)

Grief and Loss during the Holidays

• Mayo Clinic: Grief and loss throughout the holiday season
• Grief.com: GRIEF & THE HOLIDAYS

MOUD Integration Model in the Hospital Setting

• CA Bridge: Resources for Implementing Mood 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.

Media Toolkit

• RCORP Media Toolkit for Grantees

MOUD Training

Bridge (formerly CA Bridge) has training for care navigators and a few for nurses. One important training for nurses is on the “culture of care.” It addresses “discrimination, stigma and moral injury related to substance use disorder.” They have some great courses for prescribers as well. There is no cost for the trainings. You must create a free account which means you get a transcript which is good for record keeping.

Being and Becoming a Rural MOUD Provider: Live Sessions

• RCORP offers a session similar to Office Hours for clinicians.

RCORPodcast on Medication for Opioid Use Disorder

• 06: Breaking Down the Myths and Facts about Medication for Opioid Use Disorder with Dr. C (buzzsprout.com)

MAT/MOUD Implementation

Article on recruiting medical providers.

• Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model

Boston Medical Center OBAT Clinical Guidelines: You can navigate the table of contents by clicking on a topic of interest, keep in mind information related to the data waiver no longer applies. (Also attached as a pdf)

• 2021 Boston Medical Center OBAT Clinical Guidelines | RCORP-TA  

Medication-Assisted Treatment for Opioid Use Disorder Playbook: This is an interactive, web-based guide offering tools, and resources that address key aspects of implementation. The MAT for OUD Playbook aims to address the growing need for guidance as more primary care practices and health systems begin to implement MAT. The Playbook’s framework is designed to be useful for practices implementing any array of MAT services.

• Integration Academy: Medication-Assisted Treatment for Opioid Use Disorder Playbook

For assistance and TA related to implementing treatment to include MOUD you can also reach out to the HRSA Funded Center of Excellence  

• University of Rochester Recovery Center of Excellence

Providers Clinical Support System (PCSS): Free education/training for clinicians and providers related to OUD/SUD treatment and MOUD prescribing.

• Clinical mentoring for treating OUD: PCSS-now offers mentors, a discussion board and has an “Ask a Clinical Question” feature. All for free.

TIP 63: Medications for Opioid Use Disorder:

• SAMHSAs TIP 63 offers very complete guidance for OUD treatment. The executive summary is useful for making the case. Other sections can help counselors and support staff learn about MOUD. The document has been updated to include newer medications, but the general evidence has not otherwise changed substantially.

Prescribe to Prevent has great naloxone resources and training for clinicians.

The CDC has trainings and fact sheets on naloxone. According to their website: “Rural counties are nearly 3 times more likely to be ranked low dispensing than metropolitan counties.” Even if the providers are right that there is “a lot” of naloxone out there, it probably isn’t in your rural county.

These are the most clinician fact sheets:

• When to Offer Naloxone to Patients (cdc.gov)
• Naloxone: Talking About Naloxone with Patients prescribed Opioids

They also have a fact sheet for health systems:

• Increase Naloxone Prescribing in Your Health System

Participant discussed strategies related to distributing naloxone to their patient population and community below are links to Naloxone access laws by state (always confirm with your state Department of Health any plans you have distribution as needed)

• Naloxone Access Laws (50 states)
• California Naloxone

RiVive 3mg OTC naloxone

I tracked down the FDA decision document approving RiVive for over-the-counter use. It does not appear that the manufacturer published any of their studies but that is not strictly necessary. The report presents more information that we strictly need but I didn’t want to provide a response without giving you the source.  

“In this NDA, the Applicant submitted comparative bioavailability (BA) data referencing the prescription product approved under NDA 016636 (Narcan [naloxone hydrochloride] 0.4 mg/mL injection) to support clinical efficacy as well as systemic safety of the proposed product. In the pivotal comparative BA study, RiVive demonstrated sufficient systemic absorption of naloxone as well as rapidity of onset compared to the listed drug, particularly in the early critical period after drug administration.”

The go on to say:

• The available data provide substantial evidence to support the effectiveness of RiVive in the treatment of opioid overdose in the adult and pediatric population.
• RiVive is expected to be effective as a nonprescription product as supported by findings of the pivotal label comprehension study.

The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews - PMC (nih.gov): This is a very comprehensive overview of the evidence supporting overdose prevention with naloxone with a nice summary of the evidence for different outcomes and the quality of the evidence. Much of the foundational research is from about a decade ago already.

This study from 2022 provides a nice model for determining how much naloxone is needed. Estimating Naloxone Need in the USA Across Fentanyl, Heroin, and Prescription Opioid Epidemics: A Modelling Study (thelancet.com)

The CDC has basic informational resources on naloxone for the public: Lifesaving Naloxone | CDC.

There are some nice, short videos. They have more information for a clinician audience here (I would update this to say: The CDC has short naloxone videos available for a clinician audience.) : Naloxone | Opioids | CDC

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:

• Exemplary Guide for Naloxone Distribution Grayken Center for Addiction at Boston Medical Center: Training and Technical Assistance (mcstap.com)

ASAM/AAAP Management of Stimulant Use Disorder Webinar Series #1: Stimulant Use Prevention and Harm Reduction

Some communities are hearing concerns about the presence of gabapentin (Neurontin) in the illicit drug supply. This is a longstanding issue that has waxed and waned over the last decade. The significance of the presence of gabapentin in an overdose fatality is difficult to discern. It can be present without directly contributing to mortality.

• Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020 | MMWR (cdc.gov)
• Gabapentin misuse | CMAJ

Harm Reduction Vending machines

• Expanding the accessibility of harm reduction services in the United States: Measuring the impact of an automated harm reduction dispensing machine - ScienceDirect
• How Ready Is Your County to Help with Addiction Recovery? | The Daily Yonder (Hardin Co. KY)
• Vending machines dispensing free, life-saving medication - North Carolina Health News
• Naloxone Vending Machine Implementation Report (ncsc.org) (note: Appalachia)

Locked medication dispensers

• Vermont's Take-Home Methadone Dispenser Program Could Be a 'Game Changer' | Health Care | Seven Days | Vermont's Independent Voice (sevendaysvt.com). It looks like they are using something by this company: Automatic Pill Dispensers - Never Forget Medications Again (epill.com).
  • The article is about methadone for which it appears they somehow combine this pill dispenser with a steel box. There are many other similar devices.

SAMHSA (the Substance Abuse and Mental Health Services Administration) has multiple fact sheets for pregnant women with OUD. They can provide new staff with a good overview of OUD and its treatment in pregnancy. The link for SAMHSA’s overview on medications for addiction including those for alcohol that was shared during the meeting is here.

Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder

• A big study about access to addiction treatment.

SAMHSA’s Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants is similarly comprehensive.

• The first 2 or 3 pages of each section cover the necessary information followed by a deeper explanation of the evidence. The recommendations for treatment of this population have not changed meaningfully since the document was released.

This is the DEA manual that goes over the process for receiving and storing schedule III drugs for dispensing to patients.

• DEA Diversion Control Division Practitioner's Manual

• SUD 101 Core Curriculum (2023): PCSS-now offers a free training that meets the DEA training requirement and grants CME/CE. It is very well done and up to date.

RCORP Podcast: 33: New DEA Training Requirements and Information with Dr. C

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:

• Initiating Buprenorphine for Patients using Fentanyl PCSSNOW
  • Document

    Initiating Buprenorphine for Patients Using Fentanyl PCSSNOW pdf Adobe Portable Document Format file type (3.05 MB)
•  Bureau of Justice Statistics Mortality in Local Jails
  • Document

    Bureau of Justice Statistics Mortality in Local Jails PDF Adobe Portable Document Format file type (3.78 MB)
• Single-High Dose Buprenorphine for Opioid 
  • Document

    Single high-dose buprenorphine for opioid PDF Adobe Portable Document Format file type (776.47 KB)

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:

• Prevention program for students teaching healthy life skills and can be implemented in health classes or other class environments: Blueprints Programs: LifeSkills Training

Strengthening Families

• Involves parents and youth: Blueprints Programs: Strengthening Families

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

• Below, the link will take you to a research article regarding: 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
• The following webpage has some good information regarding delivering SBIRT in schools, including FAQs and videos: Wisconsin Safe and Healthy Schools Center: School SBIRT Implementation Project
• The following is a toolkit developed in Massachusetts for implementing SBIRT in schools: SBIRT in Schools Resource Toolkit (PDF)

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

Attachment: 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 ​​​​​​

The below link include support groups for people in recovery as well as their family members

·         Digital Support Groups – Includes Family Support

Peer Recovery Support Specialist

• This is the document that was shared during office hours: 2023-OCT-02-prcoe-peer-specialist.pdf.
• SAMHSA published a very comprehensive guide on peer recovery support that could be useful to consortium members:  Incorporating Peer Support Into Substance Use Disorder Treatment Services.
• This year they released a guide called “How Can a Peer Specialist Support My Recovery From Problematic Substance Use?”

It presents a good overview in a more concise format. Peer Support Workers for those in Recovery | SAMHSA

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.
  • The Surgeon General’s Report on Alcohol, Drugs, and Health has a nice glossary and a list of abbreviations with their definitions in the back. This is an excellent resource to learn about addiction and addiction treatment if you have time to read it.

Attachment: Resources for Recovery

Attachment: Mutual Support meetings (to include virtual options)

Anti-Stigma Toolkit: A Guide to Reducing Addiction-Related Stigma

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.

• AMA: Ending the Stigma of Opioid-use Disorder in the Emergency Department

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

• Substance Use Disorder Help and Prevention - Overdose Lifeline

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.

• Partnership to End Addiction launches new documentary - Partnership to End Addiction (drugfree.org)

The CDC has resources for stigma reduction that includes basic educational information about addiction: Stigma Reduction | CDC

NIDA resources for health professionals on stigma.

• Both grant CME/CE are free and take about 45 minutes.
• Words Matter - Terms to Use and Avoid When Talking About Addiction: A CME/CE Activity | National Institute on Drug Abuse (NIDA) (nih.gov)
• Your Words Matter – Language Showing Compassion and Care for Women, Infants, Families, and Communities Impacted by Substance Use Disorder: A CME/CE Activity | National Institute on Drug Abuse (NIDA) (nih.gov)

Anti-stigma training for health professionals.

• It is free and grants CME. It does takes some time to complete: Reducing Stigma Education Tools (ReSET) | Dell Medical School | The University of Texas at Austin (utexas.edu)

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.

• Scroll down to find the courses linked here:  Training and Courses (addictionpolicy.org)

10 min 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.

 Attachment: Language Matters Document  

Sustainability

• Substance Use Prevention and Treatment Block Grant (SABG) Contacts: SAMHSA Single State Authority as mentioned on the call, it is good to check with your state and county on options related to block grant funding and other funding for those who are uninsured.
• Module 6: Funding and Sustainability Considerations for Substance Use Disorder Programs: Rural Health Hub: Sustainability
• New Funding Opportunities: The list of funding opportunities updates continually. Here is a list by closing date. Check the portal regularly to view all new listings.

Syringe Services

• Syringe Services Programs (SSPs) | CDC has fact sheets, FAQs, infographics, and a “technical package” that has everything you would need to know to start a program. There is also a nice summary of the evidence: Summary of Information on The Safety and Effectiveness of Syringe Services Programs (SSPs) | CDC. Much of the seminal work on syringe exchange efficacy in preventing HIV and Hepatitis was published in the 1990s and early 2000s and not included here. It is well summarized in the above.
• Establishing a Syringe Services Program in Rural America - National Harm Reduction Coalition: Specifically addresses the public health need in rural communities.
• Syringe Services Programs Communications Toolkit | CDC: This includes training slide decks, social media posts, talking points, etc.
• NASEN | North America Syringe Exchange Network: NASEN Directory: This directory may help you locate the nearest syringe exchange that might be able to offer some guidance.
• In a few states, syringes can be received in the mail: Get NEXT - Harm Reduction Supplies — NEXT Distro. This organization also provides naloxone by mail.

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.”

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

• Readiness and implementation: R4 Connections. Implementation of Telemedicine in Rural Public Libraries | NNLM (national library of medicine)
  • Examples: Libraries Add Telehealth to the Rural Communities They Serve | Southwest Telehealth Resource Center (southwesttrc.org)
• The Affordable Connectivity Program: The Affordable Connectivity Program (ACP) is a U.S. government program run by the Federal Communications Commission (FCC) to help low-income households pay for internet service and connected devices like a laptop or tablet. Research shows that tele-SUD/MH is safe and efficacious, and we also know that rural areas experience access challenges with broadband and acquiring HIT technology and resources (phones, phone minutes, laptops) making it difficult to utilize and receive tele-SUD/MH treatment.  
• In case you haven’t seen it yet: Recovery Ecosystem Index Map (norc.org)

Treatment models and policies

RAND has been analyzing various policies related to SUD/OUD treatment. They assess their impact on a variety of measures of patient outcomes and feasibility and make a recommendation to “support” vs. “don’t support.”

Here are links to briefs describing specific policies, their assessment of them, and their recommendations. There are briefs on other treatment and naloxone policies. A link to all the briefs is further down. The experts considered the two policies marked with an asterisk optimal for both impact and feasibility.

• Hub-and-Spoke Type Policies | RAND
• Medicaid Enrollment for Individuals Leaving Jail or Prison | RAND*
• Emergency Department Treatment-Linkage Financial Incentive Policies | RAND
• Facilitated Access to Medication for Medications for Opioid Use Disorder (MOUD)* Requirements | RAND
• Telemedicine-Based Collaborative Care Policies | RAND

All briefs: OPTIC Policy Profiles | RAND

Here is a guide to help make sense of policy evaluations. It is intended for state policy makers but could be helpful at the local level.

• PolicyEvaluationBasics | jhu.edu

ASAM’s guidelines are succinct and clinician friendly. The standards ASAM created for the use of urine toxicology are also extremely valuable.

• The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder
• Appropriate Use of Drug Testing in Clinical Addiction Medicine

Reducing Vaping Among Youth and Young Adults | SAMHSA

CATCH My Breath vaping prevention program

• This link will take you to the website where you can learn more about the program, how it is delivered, and its research-base: Catch My Breath: Proven Effectiveness
• This link will take you directly to the research article that has been published regarding the program (attached is the full article): A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of “CATCH My Breath”

Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model - PMC (nih.gov)

• This article provides interesting insights into provider recruitment strategies. The two components they relied upon were leveraging support from health system leadership and “early MOUD adopters.” They also highlight the importance of connecting to a shared vision such as providing the highest quality care to patients, better serving the community, and fulfilling the professional mission of healthcare providers.

Workforce recruitment and retention:

• This is a series of recorded webinars with slides you can look at as separately. The first webinar in the series discusses developing career pathways that start in high school. Other topics are recruitment and retention: Growing More Than Corn: Nebraska Behavioral Health Workforce Development | Mental Health Technology Transfer Center (MHTTC) Network (mhttcnetwork.org)
• Here are a couple articles from the medical literature about the national Health Service Corp that could be useful.
  • The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers - PMC (nih.gov)
  • Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care | Health Affairs
• Here’s some info about how to become a site where clinicians in the National Health Service Corps can work. FQHCs automatically qualify you just have to sign up. Other sites need to go through a few steps. Here is where you can find out all about it.
• Rural Health Information Hub-Workforce: https://www.ruralhealthinfo.org/topics/health-care-workforce
  • This link discusses strategies for growing your own workforce: Rural Health Hub Workforce Education and Training
  • Also attached is a guide to “Growing Your Own Workforce” specifically related to social workers.

 Attachment: Grow Your Own

RCORPodcast on Xylazine.

• 08: Xylazine with Dr. C (buzzsprout.com)
• 22: Xylazine and Wound Care with Robert Childs and Jason Bienert

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.

• Test Catalog Search | NMS Labs
• 703025: Synthetic Opioids, Screen With Reflexed Confirmation, Urine | Labcorp

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:

• Best Practice of the Month Xylazine in Unregulated Drug Supply and Health Considerations | RCORPTA (rcorp-ta.org)
• Xylazine and Opioid Use: An Update | RCORPTA (rcorp-ta.org)

Risk and Protective Factors | Youth.gov

SAMHSA resources:

• Keeping Youth DRUG FREE (samhsa.gov) (Content is useful. Audience is parents.)

This is NIDA for teens: Parents & Educators | National Institute on Drug Abuse (NIDA) (nih.gov) (If you scroll down a little there are 1–3-minute videos from their “Mind Matters” series.)

CDC has some resources here: High Risk Substance Use in Youth | Adolescent and School Health | CDC. (If you scroll down, there are links to resources on “parental monitoring” and “what parents and families should know.”)

Don't Do It! Ineffective Prevention Strategies (state.co.us): This is the best resource on what NOT to do