In the Patient's Best Interest: Updated HIPAA Guidance Targeted for the Opioi...PYA, P.C.
This slide presentation examines the new HIPAA guidance, discuss how the guidance relates to mental health conditions and the opioid crisis, and outlines how to provide treatment to incapacitated patients, while protecting their privacy.
In the Patient's Best Interest: Updated HIPAA Guidance Targeted for the Opioi...PYA, P.C.
This slide presentation examines the new HIPAA guidance, discuss how the guidance relates to mental health conditions and the opioid crisis, and outlines how to provide treatment to incapacitated patients, while protecting their privacy.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Mystified by MAT? Navigating the Changing Regulatory Landscape Around Medicat...Epstein Becker Green
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
Presented by:
Francesca R. Ozinal – Associate, Epstein Becker Green
Andrew Martin – Chief Operating Officer, Behavioral Health Association of Providers
Despite reports identifying medication-assisted treatment (MAT) as a critical element of evidence-based treatment, confusion concerning who may dispense, associated compliance requirements, and the relationship between MAT provision and behavioral health providers continues to impede access to MAT.
This webinar will review key licensing and operational issues concerning the various types of MAT, including buprenorphine, naltrexone, and methadone, as well as misperceptions and key compliance issues in instituting MAT.
More info: https://www.ebglaw.com/events/mystified-by-mat-navigating-the-changing-regulatory-landscape-around-medication-assisted-treatment/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Drug Treatment Courts: How America’s Most Trusted Alternative to Incarceration is Providing Hope in the Midst of the Rx Drug Abuse and Opiate Epidemic - Vision Session Presented by National Association of Drug Court Professionals
Mystified by MAT? Navigating the Changing Regulatory Landscape Around Medicat...Epstein Becker Green
Part of a "first Thursdays" fall webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
Presented by:
Francesca R. Ozinal – Associate, Epstein Becker Green
Andrew Martin – Chief Operating Officer, Behavioral Health Association of Providers
Despite reports identifying medication-assisted treatment (MAT) as a critical element of evidence-based treatment, confusion concerning who may dispense, associated compliance requirements, and the relationship between MAT provision and behavioral health providers continues to impede access to MAT.
This webinar will review key licensing and operational issues concerning the various types of MAT, including buprenorphine, naltrexone, and methadone, as well as misperceptions and key compliance issues in instituting MAT.
More info: https://www.ebglaw.com/events/mystified-by-mat-navigating-the-changing-regulatory-landscape-around-medication-assisted-treatment/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
At the end of the session patient/ family/ advisors/ champions as well as health providers/ leaders/ authorities will leave with at least one practical idea to advance patient engagement in medication safety as a result of their increased understanding of:
. the role and responsibilities of patients/ families in medication safety
. different approaches to patient engagement in medication safety
. influencing factors (e.g. health literacy, culture, organizational and public policy)
. supporting resources and leading practices
It is defined as knowledge of fact through reading, study or practical experience on chemical substance that is used in diagnosis, prevention and treatment of diseases.
It covers all type of information including; objective and subjective information as well as information gathered by scientific observation or practical experience.
Characteristics and Outcomes of Adult Opiate Users in Abstinence-Based Resid...Siobhan Morse
Prior research in this population suggests that, overall, opiate and non-opiate addicted users have different issues and ought to be treated differently for their addiction—and that young and older adult opiate users present at treatment with different issues. This study investigated what significant differences in treatment motivation, length and outcome, if any, exist between opiate and non-opiate users and further investigates young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of any differences. Data for this study was drawn from 1972 individuals who entered voluntary, private, residential drug treatment and rehab. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and the University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and six-months post-discharge. Implications for addiction treatment providers and planners are discussed.
Patient-centered pharmacovigilance represents a pivotal shift in the landscape of healthcare, emphasizing the active involvement of patients in the monitoring and reporting of adverse drug reactions. Unlike traditional pharmacovigilance, which primarily relies on healthcare professionals to identify and document adverse events, this approach recognizes patients as critical stakeholders in ensuring medication safety. By empowering patients to share their experiences, concerns, and observations regarding medication effects, whether positive or negative, healthcare systems can gain a comprehensive understanding of drug safety and efficacy in real-world settings. Patient-centered pharmacovigilance fosters a collaborative partnership between patients, healthcare providers, and regulatory agencies, promoting transparency, accountability, and ultimately, better patient outcomes. Through increased patient engagement and the utilization of patient-reported data, this approach enables healthcare systems to identify potential safety issues earlier, tailor treatment strategies to individual needs, and enhance overall drug safety surveillance efforts.
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention, keynote presentation at the National Rx Drug Abuse & Heroin Summit on March 30, 2016.
Kana Enomoto, Acting Administrator, Substance Abuse and Mental Health Services Administration, keynote presentation at the National Rx Drug Abuse & Heroin Summit March 29, 2016
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Evaluation of antidepressant activity of clitoris ternatea in animals
Tx 2 joint presentation
1. Barriers
to
Access
to
Care:
American
Society
of
Addic4on
Medicine’s
Advancing
Access
to
Addic4on
Medica4ons
Ini4a4ve
Na4onal
RxDrug
Abuse
Summit
Atlanta,
GA
April
22,
2014
2. Panelists
–
Commercial
Disclosures
Kelly
J.
Clark,
MD,
MBA,
FASAM
-‐
Medical
Affairs
Officer,
Behavioral
Health
Group
-‐
Medical
Director,
CVS
Caremark
Stuart
Gitlow,
MD,
MPH,
MBA,
FAPA
-‐
Consultant;
Orexo
US
(US
Medical
Director)
-‐
Consultant;
UNUM,
Metlife,
Pruden4al
Mark
Publicker,
MD,
FASAM
-‐
none
3. Learning
Objec4ves
1. Explain
the
scien4fic
and
economic
data
suppor4ng
evidence
based
medica4on
treatment
of
opioid
addic4on.
2. Describe
the
current
barriers
for
pa4ents
in
accessing
appropriate
addic4on
treatment.
3. Outline
opportuni4es
for
pa4ents
to
access
treatment.
4. American Society of Addiction Medicine
(ASAM)
Professional society founded in 1954 representing 3,100+
physicians & other associated professionals
Mission:
– Increase access to & improve the quality of addiction
treatment
– Educate physicians, other health care providers & public
– Support research & prevention
– Promote appropriate role of the physician in patient care
– Establish addiction medicine as a recognized specialty
5. ASAM
Defini4on
of
Addic4on
Addiction is a primary, chronic disease of brain reward, motivation, memory and
related circuitry. Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations. This is reflected in an
individual pathologically pursuing reward and/or relief by substance use and
other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in
behavioral control, craving, diminished recognition of significant problems with
one’s behaviors and interpersonal relationships, and a dysfunctional emotional
response. Like other chronic diseases, addiction often involves cycles of
relapse and remission.
Without treatment or engagement in recovery activities, addiction is progressive
and can result in disability or premature death.
Adopted by ASAM Board of Directors April 12, 2011.
6. Project
Approach:
Key
Phases
Mission: Advocate for patient access to
appropriate evidence-based, cost-effective
medication treatment for opioid dependence.
Phase
I
Start-‐up
and
Data
Collec4on
Phase
II
Data
Synthesis
and
Repor4ng
Phase
III
Collabora4on
and
Outreach
7. Project
Phases,
Cont’d
PHASE ONE
1. Patient Advocacy Task Force appointed by ASAM Board
Members: Drs. Kraus and Soper (Co-chairs); Drs. Clark, Christiansen, Gaskin,
Publicker, Roy, and Shore
2. ASAM secured financial and endorsement support from public and private partners
3. Payer policy and legal research conducted by leading organizations
PHASE TWO
1. Advancing Access to Addiction Medications Report issued June 2013; stakeholder
summit and press conference in Washington, DC
2. Online outreach toolkit developed
3. National Speakers Bureau organized
PHASE III
1. Federal briefing in October 2013; ongoing participation in stakeholder conferences
and briefings
2. Communications strategy approved; outreach continued
3. Targeted policy briefs and payer policy updates under development
8. AAAM
Research
• State
Medicaid
survey
of
coverage
&
access
• Commercial
insurer
survey
of
coverage
&
access
• Literature
reviews
of
clinical
and
cost
effec4veness
of
medica4ons
to
treat
opioid
addic4on
• TRI
and
Avisa
Group
retained
to
do
research
• Available
on
ASAM
website
(www.asam.org)
9. Advancing
Access
to
Addic4on
Medica4ons
(AAAM)
May
2011:
Dr.
Mark
Publicker,
an
ASAM
addic<on
specialist
physician,
alerted
ASAM
to
Maine
legisla<on
that
limits
pa<ent
access
to
addic<on
medica<ons.
April
2012:
ASAM
Board
of
Directors
appointed
a
Pa<ent
Advocacy
Task
Force
(PATF)
to
advocate
for
pa<ent
access
to
evidence-‐
based,
cost-‐effec<ve
medica<on
treatment
for
opioid
dependence.
June
20,
2013:
PATF
Stakeholder
Summit
at
The
Na<onal
Press
Club
in
Washington,
DC;
Report
results
are
disseminated.
September
30,
2013:
ASAM
Hill
Briefing
on
pharmacotherapy
for
opioid
addic<on
treatment.
October
23,
2013:
ASAM
Legisla<ve
Day
on
Capitol
Hill;
ASAM
members
bring
awareness
of
the
issue
to
policymakers.
10. What
is
Medica4on
Assisted
Treatment
(MAT)
of
Opioid
Addic4on?
– Use
of
medica4on
with
FDA
approved
primary
indica4on
for
the
maintenance
treatment
of
opioid
dependence:
• Methadone
in
Opioid
Treatment
Programs
(OTPs)
• Buprenorphine
(Suboxone,
Zubsolv
brand
names)
• Extended
release
naltrexone
shots
(Vivitrol
brand
name)
– While
we
don’t
have
special
alcohol
or
methamphetamine
or
cocaine
brain
receptors,
humans
do
have
opioid
receptors
– At
adequate
doses,
these
three
medica4ons
sit
on
the
receptors
and
block
their
availability
for
other
opioids
to
be
used
to
“get
high”
11. Clinical
provision
of
MAT
– Methadone
• Daily
dosing
in
specially
licensed
centers
(OTPs)
• Increasing
privileges
earned
over
4me
• Required
counseling,
call-‐backs,
drug
tes4ng
– Buprenorphine
• Prescrip4ons
can
be
given
at
a
doctor
office
• Ability
to
refer
to
counseling
is
required
– Extended
release
naltrexone
• Once
monthly
shot
must
be
procured
by
and
given
in
provider’s
office
12. Keep
in
mind:
– Addic4on
is
a
chronic
disease
– These
medica4ons
are
FDA
approved
for
Opioid
Dependence,
and
act
on
the
opioid
receptors
• We
do
not
expect
them
to
have
any
significant
impact
on
use
of
non-‐opioids,
even
though
they
“treat
addic4on”
• 12
step
mee4ngs,
individual/group/family
counseling
,
and
reward/repercussion
systems
address
other
drug
sue
13. What
do
effec4veness
and
cost
effec4veness
mean
-‐
Pa4ents
– Health
Effec4veness
Outcomes:
mortality
(
not
dying),
morbidity
(
not
geing
Hep
C,
HIV,
other
skin
and
heart
infec4ons,
liver
disease,
etc)
– Interpersonal:
Regaining
child
custody,
marriage,
func4oning
in
family
system
– Voca4onal:
improved
work/school
func4oning
– Legal:
decreased
legal
involvement
– Financial:
money
to
be
used
produc4vely
rather
than
on
drugs
14. What
do
effec4veness
and
cost
effec4veness
mean
-‐
Community
– Health
cost-‐effec4veness:
less
ED
visits,
hospitaliza4ons,
costs
of
trea4ng
addic4on-‐caused
condi4ons
– Interpersonal:
ability
to
parent
children
(
not
orphan
them;
not
involving
child
services
/
foster
care
system)
– Voca4onal:
improved
workforce
contribu4on
– Criminal
Jus4ce:
decreased
legal
involvement
AND
decreased
engagement
in
illegal
ac4vi4es
– Financial:
money
to
be
used
produc4vely
rather
than
fuel
drug-‐
based
economy
15. Methadone
and
Buprenorphine:
-‐ Reduce
opioid
use
more
than:
-‐ No
treatment
-‐ Outpa4ent
treatment
without
medica4on
-‐ Outpa4ent
treatment
with
placebo
medica4on
-‐ Detoxifica4on
only
-‐ Reduce
overall
medical
costs:
-‐
Related
to
Emergency
Department
use
-‐
Related
in
inpa4ent
hospitaliza4ons
16. TRI
Review
of
Effec4veness
of
MAT
• Hundreds
of
effec4veness
studies
(methadone)
• All
medica4ons
have
demonstrated
modest
or
beker
cost
effec4veness
in
maintenance
• No
evidence
for
effec4veness
in
detoxifica4on
• All
medica4ons
are
under-‐u4lized
17.
18. Barriers
to
Access
– S4gma?
– Lack
of
understanding
of
the
data?
– Lack
of
providers?
• 30/100
pa4ent
limit
for
bupe?
State
wai4ng
lists
for
methadone?
• Lack
of
geographical
access
to
treatment?
– Cost?
– Health
Plan
coverage?
– U4liza4on
Management
Protocols?
– Legisla4ve
and/or
Regulatory
Restric4ons?
19. AAAM
State
Medicaid
Survey
Results
• Every
state
Medicaid
program
covers
at
least
one
of
the
FDA-‐
approved
medica4ons
• Many
state
Medicaid
programs
have
a
variety
of
authoriza4on
requirements
which
must
be
met
for
these
medica4ons
to
be
approved
• Requirements
for
approval
range
from
limited
to
severe,
and
may
include
“fail
first”
policies
or
a
history
of
frequent
service
u4liza4on
20. Commercial
Insurer
Findings
• No
commercial
plans
covered
methadone
• Inclusion
in
a
plan’s
formulary
does
not
equate
to
easy
access
• U4liza4on
management
(UM)
can
reduce
access
• Most
common
UM
requirements
are:
– Prior
authoriza4on
– Quan4ty
and
dosage
limits
– Step
therapy
or
“fail
first”
requirements
21. Coverage
of
All
Three
FDA-‐Approved
Medica4ons
for
the
Treatment
of
Opioid
Dependence
23. Types
of
limita4ons:
• Limits
on
dose
• dura4on
of
treatment
• number
of
treatment
episodes
• life4me
limits
• required
tapering
schedules
• required
ancillary
services
(
counseling)
which
may
not
be
covered
24. Direct
Costs
• Methadone
=
$70-‐$130
per
week
(includes
medica4on,
counseling,
doctor,
urine
screens,
nursing/pharmacist
dispensing
service)
• Buprenorphine
medica4on
=
$7
per
tab/film.
Package
insert
may
be
up
to
5
individual
tab/
films
per
day
(2
“large”
and
3
“small”)
• Extended
release
naltrexone
$700+
injec4on
once
per
month.
25. Buprenorphine
a
“top
cost”
for
Medicaid
pharmacy
plans
Example:
In
the
State
of
Michigan
buprenorphine
products
are
the
#1
cos4ng
medica4ons
in
their
Medicaid
formulary.
However,
note
that
“pain
pills”,
like
hydrocodone
plus
acetaminophen,
have
mul4ple
generics
and
are
typically
inexpensive.
They
are
“low
cost”
medica4ons!
26. Issues
of
Diversion
• Methadone
requires:
• random
call
backs
• urine
screens
• inges4on
in
front
of
nurses
• daily
dosing
un4l
earning
take
home
doses
• take
home
doses
must
be
in
locked
box
• Formula4on
(liquid,
5
mg
and
40
mg)
different
than
methadone
formula4on
for
pain
(10
mg)
27. Issues
of
Diversion
• Buprenorphine:
• Reports
of
pa4ents
receiving
higher
than
necessary
doses
and
selling
or
sharing
“extra”
doses
• Payer
then
is
subsidizing
this
costly
diversion
• Diversion
highest
where
access
is
lowest
• No
counseling,
call
backs,
drug
screens,
inges4on
in
front
of
staff,
specific
formula4ons
are
required
• Extended
Release
Naltrexone:
no
diversion
poten4al
reported
28. How
can
we
help
pa4ent’s
access
treatment?
Educate
and
Advocate!
– For
MAT
to
be
including
in
health
plan
coverage
under
Parity
as
part
of
the
con4nuum
of
care
– Improving
the
coordina4on
of
care
throughout
the
con4nuum
of
care
– Educa4ng
stakeholders
about
the
medical
and
economic
benefits
of
MAT
– Helping
educate
stakeholders
about
what
cons4tutes
appropriate
care
for
opioid
addic4on
guideline
development
29. ASAM’s
Next
Steps
• Partnering
on
the
development
of
ASAM’s
Na<onal
MAT
Guidelines
• Partnering
at
the
chapter
and
na4onal
level
with
a
variety
of
concerned
stakeholders
• Crea4ng
briefs
and
toolkit
from
research
for
use
by
all
for
local
outreach
• Building
and
training
speakers
bureau
• Planning
for
2014
na4onal
outreach
day
30. Thank
you!
Stay
tuned
for
next
steps.
All
reports
are
available
online
at:
hkp://www.asam.org/docs/advocacy/
Implica4ons-‐for-‐Opioid-‐Addic4on-‐Treatment