SAMHSA’s Tools ForTreatment              Dr. Melinda Campopiano, MD  Medical Officer, Substance Abuse and Mental Health   ...
Learning Objectives1.  Identify SAMHSA’s tools for treatment.2.  Identify the methods for medicated-     assisted treatmen...
Disclosure Statement•  Melinda Campopiano has no financial   relationships with proprietary entities   that produce health...
The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link pointsto the ...
Prescription Drug Misuse•  Surveillance•  Risk and population specific   interventions  •    Medication Assisted Treatment...
Rates of Prescription Drug          Misuse
www.SAMHSA.gov/data
Prescription Drug Overdose•  57% of fatal overdoses involve   pharmaceuticals•  Exceeds the number of overdose deaths   an...
Overdose Risk Factors•  Any prescription for an opioid•  High dose opioid prescription•  Poverty (Medicaid)•  Poly-substan...
Overdose Intervention    Education & NaloxoneMost overdoses occur in the presence of others.Fatal overdoses usually happen...
Prevention Messages•    Don’t use drugs alone•    Know how to recognize an overdose•    Activate 911•    Position of safet...
Naloxone•  Timely use of naloxone•  Greater availability of naloxone  •  More first responders equipped and trained to    ...
Treatment is Prevention•  methadone maintenance treatment is effective   in reducing morbidity and mortality associated   ...
Maintenance on Opioid Agonist                            Therapy                                                 1996 Subu...
Placebo Controlled Study of Maintenance    vs. Detoxification with Methadone Whitehall, 1974
Placebo Controlled Study of Maintenance  vs. Detoxification with Buprenorphine Kaplan-Meier curve of cumulative retention ...
www.pcss-o.org
Prescribers’ Clinical Support System   for Opioid Therapies (PCSS-O)Supports:• Innovative approaches to educating allclini...
Prescribers’ Clinical Support System        for Opioid Therapies (PCSS-O)Year	  One	     Year	  Two	     Online	      Arch...
Prescribers’ Clinical Support System for  Opioid Therapies (PCSS-O)-Content • A Review of Considerations in the Assessment...
www.pcss-b.org
Treatment ImprovementProtocols and Advisories
Clinical Practice Guidelines•  Treatment Improvement Protocols (TIPs)    •  Detoxification and Substance Abuse Treatment  ...
“Prescribing Opioids for ChronicPain: Balancing Safety & Efficacy”                25	  
“Prescribing Opioids for Chronic Pain: Balancing Safety & Efficacy”In-person course using national and local faculty47 sit...
Course Content•  best practices and clinical protocols for the use of   methadone and other opioids to treat pain,•  evide...
Course Impact•  Evaluations of the courses by   participants and independent experts   have been very positive,•  average ...
www.opioidprescribing.com
www.opioidprescribing.com•  a series of 30-minute modules•  each targeted to a specific audience or   addressing a particu...
Online Modules•  Opioid Efficacy and Safety; Assessment and   Monitoring Tools for Primary Care Settings•  Communicating w...
Course Impact•  Developed in partnership with Boston University•  Consistently receives highest rating for content•  The A...
Prescription Drug Monitoring          Programs•  Real-time data entry and access•  Easy Prescriber Access•  Cross-boarder ...
Screening, Brief Intervention and Referral to Treatment•  Systematic screening for harmful or   hazardous substance use an...
SBIRT Billing and Coding       Guidance
Tools and Strategies•    Overdose education•    SBIRT•    PDMPs•    Treatment•    Physician Education•    Surveillance
Contactmelinda.campopiano@samhsa.hhs.gov
Samhs as tools_for_treatment
Samhs as tools_for_treatment
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Samhs as tools_for_treatment

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Treatment Track
National Rx Drug Abuse Summit
April 2-4, 2013
SAMHSA's Tools for Treatment
Dr. Melinda Campopiano and Suzanne Fields

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Samhs as tools_for_treatment

  1. 1. SAMHSA’s Tools ForTreatment Dr. Melinda Campopiano, MD Medical Officer, Substance Abuse and Mental Health Services and Administration (SAMSHA) Suzanne Fields, MSW, LICSW Senior Advisor to the SAMHSA Administration on Health Care Financing, SAMHSA
  2. 2. Learning Objectives1.  Identify SAMHSA’s tools for treatment.2.  Identify the methods for medicated- assisted treatment.3.  Analyze the ACA and its effect on access to treatment
  3. 3. Disclosure Statement•  Melinda Campopiano has no financial relationships with proprietary entities that produce health care goods and services.•  Suzanne Fields has no financial relationships with proprietary entities that produce health care goods and services.
  4. 4. The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link pointsto the correct file and location. Tools and Strategies Addressing Prescription Drug Misuse Melinda Campopiano von Klimo, MD Division of Pharmacologic Therapies Center for Substance Abuse Treatment
  5. 5. Prescription Drug Misuse•  Surveillance•  Risk and population specific interventions •  Medication Assisted Treatment •  Overdose Prevention Education & Naloxone •  Appropriate Prescribing •  Effective monitoring •  Effective Screening
  6. 6. Rates of Prescription Drug Misuse
  7. 7. www.SAMHSA.gov/data
  8. 8. Prescription Drug Overdose•  57% of fatal overdoses involve pharmaceuticals•  Exceeds the number of overdose deaths annually due to heroin and cocaine combined.•  Opioids were found in most deaths involving benzodiazepines, anti-depressants,•  29.4% of fatalities involved opioids alone•  Increase in overall overdose death rates since 1999 driven by increased prescribing of opioid analgesics Morbidity and Mortality Weekly Report, November 4, 2011/60(43);1487-1492 Pharmaceutical Overdose Deaths, United States, 2010. JAMA, February 20, 2013-Vol 309, No. 7
  9. 9. Overdose Risk Factors•  Any prescription for an opioid•  High dose opioid prescription•  Poverty (Medicaid)•  Poly-substance use•  Recent abstinence (jail, detox, treatment)•  Age•  Illness
  10. 10. Overdose Intervention Education & NaloxoneMost overdoses occur in the presence of others.Fatal overdoses usually happen over the course of several hours.There is an antidote to opioid overdose.Poly-drug overdoses may benefit from naloxone if opioids are present.
  11. 11. Prevention Messages•  Don’t use drugs alone•  Know how to recognize an overdose•  Activate 911•  Position of safety•  Rescue Breathing
  12. 12. Naloxone•  Timely use of naloxone•  Greater availability of naloxone •  More first responders equipped and trained to use it. •  Greater physician prescribing of naloxone for patients at risk of overdose.
  13. 13. Treatment is Prevention•  methadone maintenance treatment is effective in reducing morbidity and mortality associated with continued use of heroin and other illicit opiates, as well as HIV-related morbidity•  “…the all cause mortality rate for patients receiving methadone maintenance treatment was similar to the mortality rate for the general population whereas the mortality rate of untreated individuals using heroin was more than 15 times higher.”Modesto-Lowe et al., 2010; Gibson, 2008; Mattick, 2003; Bell and Zador, 2000; Marsch, 1998
  14. 14. Maintenance on Opioid Agonist Therapy 1996 Subutex and methadone 600 500 French population in 
No. of deaths 400 1999 = 60,000,000 300 Patients receiving 200 buprenorphine (1998): N= 55,000 100 Patients receiving methadone 0 (1998): N= 5,360 19691971197319751977197919811983198519871989199119931995 997 1999 1 Year Auriacombe et al., 2001
  15. 15. Placebo Controlled Study of Maintenance vs. Detoxification with Methadone Whitehall, 1974
  16. 16. Placebo Controlled Study of Maintenance vs. Detoxification with Buprenorphine Kaplan-Meier curve of cumulative retention in treatment 20 Number remaining in treatment 15 Buprenorphine 10 5 P=0.0001 Control 0 0 50 100 150 200 250 300 350 Time from randomization (days)
  17. 17. www.pcss-o.org
  18. 18. Prescribers’ Clinical Support System for Opioid Therapies (PCSS-O)Supports:• Innovative approaches to educating allclinicians who prescribe opioidsFocus:• Safe use of opioids in treatment of painincluding training on how to recognizemisuse, abuse, and addiction in thosewith pain• Use of opioid therapies for treatment ofopioid dependence
  19. 19. Prescribers’ Clinical Support System for Opioid Therapies (PCSS-O)Year  One   Year  Two   Online   Archived   Phone  App   Mentors   Mentees   Listserv   Total  Webinars   Webinars   Modules   Webinar   Downloads   Par=cipants   Number   Views   Trained  2850   2249   818   1,365   733   37   97   194   8343   •  Developed 15 online modules and a 2 hr, 2 CME course available through the California Academy of Family Physicians. •  More than 90% satisfied or very satisfied with quality of training and information presented and would recommend the training to colleagues.
  20. 20. Prescribers’ Clinical Support System for Opioid Therapies (PCSS-O)-Content • A Review of Considerations in the Assessment and Treatment of Pain and Risk for Opioid Misuse • Advances in Recognition and Treatment of Substance Use Disorders in Primary Care • Clinical Guidelines for Opioid Use in Chronic Non- Cancer Pain • Considerations in Medication Assisted Treatment of Opiate Dependence • Implementation of Evidence Based Practice • Medication Assisted Treatment for Substance Use Disorders in Primary Care
  21. 21. www.pcss-b.org
  22. 22. Treatment ImprovementProtocols and Advisories
  23. 23. Clinical Practice Guidelines•  Treatment Improvement Protocols (TIPs) •  Detoxification and Substance Abuse Treatment •  Medication Assisted Treatment (MAT) for Opioid Addiction in Opioid Treatment Programs •  Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders •  Hepatitis C•  Advisories •  Prescription misuse, Oxycontin®, methadone, Opana® (TTP) •  Vivitrol®
  24. 24. “Prescribing Opioids for ChronicPain: Balancing Safety & Efficacy” 25  
  25. 25. “Prescribing Opioids for Chronic Pain: Balancing Safety & Efficacy”In-person course using national and local faculty47 sites in 25 statesCollaborate with local organizations or agencies.Tailored to local issues based on state-specific surveillance data.Specialized courses developed for IHS and DODAlmost 9,000 practicing health professionals trained Physicians, Advance Practice Nurses, Physician’s Assistants, Dentists, Oral Surgeons
  26. 26. Course Content•  best practices and clinical protocols for the use of methadone and other opioids to treat pain,•  evidence-based strategies for patient selection, risk assessment, and education,•  techniques for effective patient monitoring, including the use of state prescription drug monitoring programs,•  the risks and benefits of opioids, as well as how to incorporate clinical and administrative practices that reduce such risks and enhance patient outcomes•  how to use state Prescription Drug Monitoring Programs (PDMPs)
  27. 27. Course Impact•  Evaluations of the courses by participants and independent experts have been very positive,•  average score of 6.0 on a scale of 1 to 7, with 7 designated “superior.”•  In a 2012 follow-up survey, more than 76% of physicians who had completed a course reported that they made changes in the way they practice as a result of what they learned.
  28. 28. www.opioidprescribing.com
  29. 29. www.opioidprescribing.com•  a series of 30-minute modules•  each targeted to a specific audience or addressing a particular aspect of opioid prescribing.•  In 2012 alone, more than 7,330 registrants completed at least one module for CME credit•  another 15,163 certificates of completion were issued to individuals who completed more than one module•  a total of 22,493 modules completed
  30. 30. Online Modules•  Opioid Efficacy and Safety; Assessment and Monitoring Tools for Primary Care Settings•  Communicating with Patients About Chronic Opioid Use•  Managing Patients with Pain, Psychiatric Co- Morbidity and Addiction•  Case Studies in Opioid Prescribing•  Issues in Clinical Practice•  Exit Strategies from Outpatient Opioid Therapy for Pain•  Managing Chronic Pain in Returning Military Personnel and Their Families•  Use of State Prescription Drug Monitoring Programs (PDMPs) in Clinical Practice
  31. 31. Course Impact•  Developed in partnership with Boston University•  Consistently receives highest rating for content•  The Accreditation Council for Continuing Medical Education (ACCME) “Accreditation with Commendation.”•  The American Nurses Credentialing Center (ANCC) awarded BU “Accreditation with Distinction, the highest recognition awarded by the American Nurses Credentialing Center’s Accreditation Program.”•  The American Academy of Family Physicians (AAFP) “The procedures established for conducting CME activities at your institution are exemplary.”
  32. 32. Prescription Drug Monitoring Programs•  Real-time data entry and access•  Easy Prescriber Access•  Cross-boarder sharing of state data.•  Physicians encouraged or required to use PDMP.•  Opioid Treatment Programs must check PDMP
  33. 33. Screening, Brief Intervention and Referral to Treatment•  Systematic screening for harmful or hazardous substance use and risk factors for overdose where most opioid prescribing is done.•  Brief motivational discussion focused on feasible, positive behavior change.•  Education targeted to specific risks.•  More effective treatment referral.
  34. 34. SBIRT Billing and Coding Guidance
  35. 35. Tools and Strategies•  Overdose education•  SBIRT•  PDMPs•  Treatment•  Physician Education•  Surveillance
  36. 36. Contactmelinda.campopiano@samhsa.hhs.gov

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