An NASW Online Webinar Series Presented by: Dr. Joseph Hunter, LCSW, Ph.D.
1. Introduction and Problem Overview 2. Etiology: Genetics, Neurobiology and Psychosocial Factors 3. Co-Occurring Disorders 4. Levels of Care, Addiction Medicines and Therapies
Participants will learn the macro interventions and 1. practices currently underway to prevent opiate addiction and stop opiate-caused deaths, including new initiatives that are providing funding to treat opiate use disorder. Participants will learn the admission criteria for the 2. various levels of care utilized to treat opiate dependency. Participants will learn about the evidence-based 3. treatment approaches to opiate use disorder treatment, including addiction medicine treatments. Participants will learn specific strategies that can be used 4. to successfully treat individuals with opiate use disorders.
What do you hope to gain from this webinar today? Please write this on your worksheet and post it in the chat (if you wish)
Although I am an employee of both Veterans Affairs (VA) and The University of Southern California (USC), this presentation is done independently of those positions. The views expressed in this presentation are those of the author and do not necessarily reflect the opinion, position or policy of the VA, the US Government or USC. In addition, although I am recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers (#324), this training is offered under NASW’s approved provider number. I will describe the process for administering Narcan today; however, I am not a medical professiona,l and it is recommended that you access DOH materials for step-by-step guidance.
61.8 million smoked cigarettes 175.8 million people drank alcohol 36.0 million people used marijuana 4.8 million people used cocaine 828,000 people used heroin 1.5 million people used lysergic acid diethylamide (LSD) 2.6 million people used Ecstasy 1.8 million people used inhalants 1.7 million people used methamphetamine [compare to 12.5 million misusers of prescription pain killers]
AGAIN
Drug overdose is the leading cause of accidental death in the US 52,404 lethal drug overdoses in 2015 Opioid addiction is driving this epidemic 20,101 overdose deaths on prescription pain relievers 12,990 overdose deaths on heroin in 2015
Builds tolerance: more of the drug is needed to achieve the same intensity of effect. Fosters dependency: the need to continue use of the drug to avoid withdrawal symptoms. Deteriorates the brain’s white matter Impairs decision-making abilities Impairs the ability to regulate behavior Affects responses to stressful situations. Opioid overdose is now the second leading cause of accidental death in the United States
Increases risk of the following: Fatal overdose Spontaneous abortion Infectious diseases like hepatitis and HIV Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease.
Pulmonary complications, including various types of pneumonia, may result from the poor health of the user as well as from heroin’s effects on breathing. Street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs.
Increases risk of the following: Fatal overdose Spontaneous abortion Infectious diseases like hepatitis and HIV Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, constipation and gastrointestinal cramping, and liver or kidney disease.
Jeremy is a 19 year old African-American youth who graduated from high school in the top 10 percent of his class academically. He was also a talented athlete, setting state HS records in the 200 and 400 meter track events. Toward the end of his senior year, after having received a full scholarship to a prestigious college, he was severely injured. He slipped off a trail, while running cross-country, and injured his back. He was started on Hydrocodone in the emergency room with a 30 day supply. After 30 days, his primary care doctor continued the treatment, while admitting surgery was not going to help.
Strengthen public health surveillance Advance the practice of pain management Improve access to treatment and recovery services Target availability and distribution of overdose-reversing drugs Support cutting-edge research
First responders provided with Narcan Education for middle and high school curriculums and college orientation Increased penalties for practitioners and pharmacists who abuse their position by selling controlled substances to patients illegally Requirements for insurance companies to improve access to coverage Public awareness campaigns Extensive training on the use of intranasal naloxone
Eliminate prior authorization requirements to make substance use disorder treatment available to all Add fentanyl analogs to the New York controlled substances schedule to subject emerging synthetic drugs to criminal drug penalties Increase access to life-saving buprenorphine treatment by recruiting health care providers to become prescribers Establish 24/7 crisis treatment centers to ensure access to critical support services Require emergency department prescribers to consult the Prescription Monitoring Program registry to combat “doctor shopping“ Create New York's first recovery high schools to help young people in recovery finish school.
In April, it was announced that New York State will be awarded over 25,000,000 to address opiate addiction that aims to: Increase access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for OUD (including prescription opioids as well as illicit drugs such as heroin) Supplement current opioid activities undertaken by the state agency Support a comprehensive response to the opioid epidemic using a strategic planning process to conduct needs and capacity assessments
Develop Centers of Treatment Innovation in high need areas which will include developing Telehealth capacity Increase the number of prescribing practitioners for medication assisted treatment via training and mentoring Have care managers to bridge the gap between behavioral health and primary care
Use locally placed Peer Recovery Support Staff to improve treatment engagement and retention; Enhanced clinical staff Providing reentry support for individuals being released from jails/ correctional facilities.
Utilize multi-level prevention approaches Delivery of evidence-based prevention services to underserved, hard-to-reach youth and other at risks populations, foster care settings and permanent supportive housing Provide training and distribution of Naloxone kits Targeted media campaign
OASAS will develop a youth and young adult statewide recovery network and local community networks. Establish a social media campaign that promotes health, recovery and wellness, establish peer supports and to provide technical assistance and support to local communities and networks of young people across New York State.
Require that issuers and their utilization review agents use evidence- based and peer reviewed clinical review tools designated by OASAS that are appropriate to the age of the patient and consistent with the treatment service levels within the OASAS system.
It require every large group policy or contract that provides medical, major medical or similar comprehensive-type coverage to provide coverage for medication approved by the U.S. Food and Drug Administration (“FDA”) for the detoxification or maintenance treatment of a substance use disorder .
Require every policy or contract that provides medical, major medical or similar comprehensive-type coverage and provides coverage for prescription drugs for the treatment of a substance use disorder to include immediate access, to a five-day emergency supply of prescribed medications otherwise covered under the policy (without prior authorization) … Or contract for the treatment of a substance use disorder where an emergency condition exists , including a prescribed drug or medication associated with the management of opioid withdrawal or stabilization, except where otherwise prohibited by law (which includes medication for opioid overdose reversal)
Chapter 71 amended those sections to clarify that inpatient coverage includes unlimited medically necessary treatment for substance use disorder treatment services provided in a residential setting as required by the federal Mental Health Parity and Addiction Equity Act of 2008
These new provisions prohibit issuers from requiring preauthorization . These provisions further prohibit issuers from performing concurrent utilization review during the first 14 days of the inpatient admission provided the facility notifies the issuer of both the admission and the initial treatment plan within 48 hours of the admission.
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