Behavioral Interventions for Comorbid PTSD and Substance ...



Talking Points and Resources for Addressing Substance Use Disorder 10.16.20Compiled by Glenn Field, NC Office of Rural Health, 919-527-6458 NOTE: All of the following information is in the public domainDISCLAIMER: Nothing stated should be construed as an endorsementADDITIONS, EDITS ARE WELCOME! email glenn.field@dhhs.COVID-19 Resources$20 Billion Phase 3 Provider Relief Portal Opens Monday 10/5 ? HHS announced yesterday?a new $20 Billion Phase 3 Provider Relief Portal, opening for applications Monday, October 5. The Administration’s press release emphasizes the importance of mental health and substance use service providers, and their critical role addressing the COVID-19 crisis. The release?stresses?that behavioral health providers have shouldered the burden of responding and confronting expanded challenges triggered by the pandemic. Read the full announcement?here,?and stay tuned for more detailed application instructions.?The National Council also released a statement on the announcement, which can be found?here.COVID-19's Impact on Mental Health and Workplace Well-being infographic Launches SlowCOVIDNC Exposure Notification AppThe app will help North Carolinians slow the spread of the virus by alerting them when they may have been exposed to someone who has tested positive for COVID-19. It is completely anonymous and does not collect, store or share personal information or location data.?SlowCOVIDNC, which leverages Google and Apple’s Exposure Notification System (ENS), alerts users who have the app if they have been in close contact with an individual who later tests positive for?COVID-19. It is voluntary to download and use and designed to enhance the state’s existing?contact tracing efforts. The app completed Beta testing earlier this month and can now be downloaded for free through the?Apple App Store?and the?Google Play Store. To learn more about SlowCOVIDNC and to download the app, visit?, which also includes an?munity Testing Events Resource:?Campaigns and Marketing Overview with ideas on how to use marketing materials to educate and inform your community on testing, tracing, and prevention. We encourage you to use this resource and the campaign materials available on the NC DHHS website to continue engaging your community.NC Medicaid Will Cover COVID-19 Testing Costs for the UninsuredEffective Sept. 1, 2020, NC Medicaid will begin reimbursing COVID-19 testing costs for uninsured individuals enrolled in the NC Medicaid Optional COVID-19 Testing (MCV) program. For more information on eligibility, please click here. Applications are available in both?English?&?Spanish. Leveraging Existing Resources to Meet the Challenges Faced by People Who Use Drugs or Who Have Substance Use Disorders During the COVID-19 PandemicThursday, October 22, 2020, 2:00–3:00 P.M. ET use disorders linked to COVID-19 susceptibilityNIH research finds higher risk and worse outcomes for those with addiction Job Retention Grant Available for COVID Relief through NC Dept of Commerce SAMHSA Training and Technical Assistance Related to COVID-19 and Harm ReductionIntroducing NIDA’s New National Drug Early Warning System (NDEWS) lagged indicators, such as national estimates of drug use, are useful for monitoring patterns of drug use and associated consequences, a national system to detect dangerous trends as they emerge is needed.NDEWS continues to examine lagged indicators but incorporates real-time surveillance to detect early signals of potential drug epidemics with an expanded Early Warning Network utilizing novel surveillance methods to rapidly harmonize data ( HYPERLINK "" \l "fig0005" Fig. 1). A Scientific Advisory Group of 12 scientists across the US and 5 experts from the DEA, Centers for Disease Control and Prevention (CDC), and the Office of National Drug Control Policy (ONDCP) guides the new NDEWS.Scientists from 18 urban, suburban, and rural areas in the US, comprising the Early Warning Network, will regularly collect a standardized set of community-level indicators including drug availability, use and consequences of emerging drugs, morbidity, and mortality to compare sites. We will also collect data on self-reported use with accompanying biospecimens, drug seizures, prices, purity, diversion, and infectious diseases related to drug use, including COVID-19.Novel and Rapid SurveillanceBy focusing on leading-edge indicators, the resulting system is more responsive than reactive, relying on traditional, indirect sources, including data from the DEA’s National Forensic Laboratory Information System (NFLIS), Poison Control Centers, medical examiners/coroners, and emergency departments. New, direct sources will include receiving data from drug checking and on-the-ground epidemiologic investigations within the 18 sites that include hair testing for exposure to fentanyl and over 100 NPS. Other direct sources of data will include outbreak investigations, a virtual community-based HealthStreet cohort of people self-reporting drug use, and web monitoring via machine-learning algorithms deployed to darknet drug markets and forums. Another focus will be on other known high-risk populations such as nightclub and dance festival attendees and “psychonauts”.Through a new NIDA Supplement, we have begun to examine the effect of COVID-19 on reporting and detection of overdose and other drug-related outcomes through a longitudinal study of key informants involving medical examiners/coroners, funeral directors, emergency medical technicians, and syringe exchange workers in Early Warning Network cities.CDC Behavioral Risk Factor Surveillance System (BRFSS) 2019 survey data released Youth Risk Behavior Surveillance System (YRBSS) data released their June 2020 meeting, the Community Preventive Services Task Force (CPSTF) selected a set of?nine priority topics?to guide their systematic reviews on population health interventions for the?next five years (2020-2025). The priority topics are as follows:Heart Disease and Stroke PreventionInjury PreventionMental HealthNutrition, Physical Activity, and ObesityPreparedness and ResponseSocial Determinants of HealthSubstance UseTobacco UseViolence PreventionTeens who vape may be at more risk of serious infection from the coronavirus — here's why one of the nation’s?leading researchers on vaping, Ilona Jaspers, PhD, professor of pediatrics and microbiology & immunology at the University of North Carolina at Chapel Hill, has?long been warning?teens and young adults about the dangers of vaping. Now her warnings have expanded to include complications from COVID-19. “In addition, sharing vaping devices — as is common among some e-cig-using demographics —?would significantly increase the risk of spreading the infection.”“Everything we and others have shown is that vaping causes a suppression of respiratory host defense function and overall respiratory immune dysfunction,” Jaspers tells Yahoo Lifestyle. “Rodent studies have shown increased severity of respiratory viral infections in animals exposed to e-cigarettes. We now have data showing that in humans, e-cigarette use was associated with changes in respiratory immune responses that are indicative of immune suppression.” While the majority of those dying from the coronavirus are much older, data from the CDC found that as many as?40 percent?of hospitalized patients are between the ages of 20 and 54. In the midst of the continuing vaping epidemic, in which over?2 million middle and high school students?are reportedly using e-cigarettes, local government officials have?expressed concern?about seeing young patients in intensive care units.Youth Screening, Brief Intervention, and Referral to Treatment (YSBIRT) is an evidence-based practice to prevent and reduce risky substance use among adolescents ages 12 to 18. aims to equip the primary care field with the resources and support necessary to implement SBIRT in their practices. It was born out of a partnership between the?National Council for Behavioral Health?(National Council) and the?Conrad N. Hilton Foundation. The website contains:Background information on the?Facilitating Change for Excellence in SBIRT?(FaCES), an initiative executed by the National Council with funding from the Conrad N. Hilton Foundation to develop an evidence-informed, standardized, and flexible approach to adolescent SBIRT implementation in primary care.An implementation guide, or?change package, for YSBIRT in primary care.Training opportunities to enhance SBIRT education and readiness to implement within primary care.YSBIRT?Resource Hub, which provides access to the most current tools and resources.Training opportunities, including access to on-demand learning modules, national trainings, and additional assistance upon request.Questions? Email us at?ysbirt@.The Opioid Crisis and the Hispanic/Latino Population: An Urgent Issue Report highlights the opioid crisis in Hispanic/Latino populations. Details rates of illicit opioid use and prescription drug misuse, as well as overdose and death rates. Discusses measures taken in to provide treatment and prevention in Latino communities, including in rural and border areas.Sponsoring organization: Substance Abuse and Mental Health Services Administration Factsheet : Administering Naloxone During the COVID-19 Pandemic! Alcohol Data DashboardThe Alcohol Use Data Dashboard has recently been updated with new data on alcohol related harms in North Carolina. The Centers for Disease Control and Prevention (CDC) recently released resources for COVID-19 and Alcohol and Substance Use. In addition, CDC recently released an updated Morbidity and Mortality Weekly Report (MMWR) on alcohol-attributed deaths from excessive alcohol use. The MMWR can be found here.Alcohol use behavior, policy, and treatment in the age of COVID-19 PTTC Network Coordinating Office, multimedia (Video, Webinar Recording, Podcast)Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and WomenKyndal Hammock,1?Mary M. Velasquez,1?Hanan Alwan,1?and Kirk von Sternberg11Health Behavior Research and Training Institute, University of Texas at Austin, Austin, TexasFemales ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women.This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings. and Substance Use Toolkit is intended for use by pregnant and parenting people who use drugs, and their loved ones.?This toolkit is also meant to be an educational resource for birth and healthcare workers, community based organizations, and advocates working to improve the lives of people who use drugs.? Pregnant people and their families can use this information to understand their rights, access services, and find high-quality, evidence-based care. These materials can be shared with family members and service providers in order to start important conversations about your plans, hopes, goals, and dreams.?In the Pregnancy and Substance Use Toolkit, you will learn about:? Your right to quality, trauma-informed perinatal careEvidence-based considerations for ending a pregnancy?Effective harm reduction strategies for alcohol, benzodiazepines, cannabis, opioids, stimulants and tobacco + nicotine useOptions for treatment during pregnancyApproaches for navigating the health care and legal systems, including Child Protective Services, drug testing, and other systems?Prenatal care plan worksheets?Pain management options and expectations during labor and birthCare considerations for the first year after birth?RxAwareness: Expanding Messages and Reach – CDC has posted new RxAwareness materials to raise awareness about the dangers and risks of prescription opioid misuse and overdose. Requiring Benzodiazepine Labels to Warn of Abuse, Addiction Potential US Food and Drug Administration (FDA) has ordered changes to the labeling for benzodiazepines, requiring them to include information on the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions.The FDA is mandating an update to the Boxed Warning already used for benzodiazepines, along with changes to the Warnings and Precautions, Drug Abuse and Dependence, and Patient Counseling Information sections of the prescribing information and revisions to existing patient Medication Guides.Help for Grand families Impacted by Opioids and Other Substances is a set of resources from Generations United that includes recommendations and resources on five topics identified by kinship caregivers as uniquely challenging for grand families impacted by substance use. for Community Living - Opioids and Older Adults Fact Sheet Administration Empowers Rural Communities with New Resource to Combat Drug Addiction resources from 16 different Federal departments and agencies, the Rural Community Toolbox is a one-stop shop for those seeking help in building strong healthy, and drug-free rural communities. ?In addition to funding and technical assistance, the RCTB includes current information resources on over 40 key topics related to addiction in rural America as well as Federal resources about treatment and recovery support for individuals who have been impacted by substance use disorders.Contact C. Jamie Edwards (jedwards@) at the NC Training and Technical Assistance Center of the NC DHHS Division of MH/DD/SAS which offers no-cost expert consultation and supportive resources to implement education, community based processes and environmental strategies primarily via monthly telephone assistance. Check out their training calendar here: training calendar with recorded webinars and resources at: Erin Day, Community Impact NC at erin@ for no-cost technical assistance, particularly for using the SAMHSA Strategic Prevention Framework (required of Drug Free Communities grantees) and training in CADCA concepts.The Communities Project - Facing Addiction with NCADD (National Council on Alcoholism and Drug Dependence) equips communities and organizations with an overview and framework for conducting community organizing and mobilization programs, including fundraising. Contact Kim James of the Burke Substance Abuse Network for information and contacts (bcacdkim@) COVID-19 Guidance for Law Enforcement and First Responders Administering NaloxoneAddressing law enforcement and first responders – but applicable to everyone – this guidance document from SAMHSA emphasizes the imperative to administer naloxone as a life-saving device, as well as how to do it safely using precautions and personal protective equipment.Flex Monitoring Team, Briefing Paper #44, June 2020Maine Rural Health Research Center, Muskie School of Public Service, University of Southern MaineCritical Access Hospitals (CAHs) have implemented diverse strategies to address substance use (SU), including inpatient, outpatient, and ambulatory services and community benefit programs. This brief provides a two-part framework for CAHs to identify and address local SU needs. Part 1 provides a foundation to identify SU needs, coordinate resources, and build local capacity through needs assessments, community engagement, and SU screening activities. Part 2 identifies strategies to minimize the onset of SU and related harms (prevention); provide counseling, inpatient, outpatient, and other services to those with SU disorders (treatment); and help individuals reclaim their lives (recovery). Federal Government Announces New Pilot Program to Help Stop Illegal Availability of Unapproved Opioids Online Youth Engagement Toolkit tool kit was created for Grangers, young people, coalitions, community-serving organizations, religious organizations and any other group that seeks to meaningfully engage rural youth to address substance misuse issues in their communities. Significant contributions were provided by the Rural Youth Advisory Council, composed of rural youth trained by CADCA from throughout the country, through a series of focus groups and discussions. AWESOME RESOURCE, STILL! Review Federal Resources for Rural Communities to Help Address Substance Use Disorder and Opioid Misuse, Office of National Drug Control Policy, U.S. Department of Agriculture, October 2018 at Fentanyl Infographic from The Recovery Research institute Naloxone – check out NaloxoFind on Google Play or Apples App Store… free smartphone app that can be used to find a Naloxone carrier in a 2-mile radius. Only as good as the number of carriers who sign up, so please do so. Read more about it here: Operation Medicine Drop website at it easy to find drop boxes and take-back events nearest you. Lots of free handouts. Need help with overprescribing in your community? The North Carolina Association of Pharmacists is training pharmacist students to assist with educational interventions for prescribers. Contact Cheryl Viracola, PharmD, at the Association at 984-439-1646.SYRINGE ACCESS PROGRAMS are pipelines into treatment while helping addicted individuals avoid “patient brokers”. Syringe program participants are FIVE times more likely to enter treatment and 3.5 times more likely to cease injecting. Engage your local medical device/supply company to provide no/low-cost syringes. Attach a nurse to address health disparities (Cone Health). Find a list of all active SEPs here: Services Program Virtual Series Available OnlineThe Injury-Free NC Academy on Establishing Syringe Services Programs (SSPs) offered its first virtual series on how to establish SSPs in North Carolina. Topics in the series include the history and principles of harm reduction, the evidence base for SSPs, cultural humility, exploring data trends, NC harm reduction laws, advocacy, program operations, doing effective outreach, conducting a power analysis, the process of becoming a registered program, and creating an action plan. You can find the webinar recordings and slides from the full series here. And stay tuned for additional learning opportunities with Injury-Free NC on SSPs, harm reduction, and much more!Syringe Service Programs (SSP) Learning CollaborativeThe North Carolina Harm Reduction Coalition (NCHRC), with support from the Injury and Violence Prevention Branch, convenes quarterly meetings for staff and volunteers of NC's SSPs through its SSP Learning Collaborative. These meetings are open to all active SSPs in NC and create space for SSP workers to share best practices and lessons learned and to identify opportunities for collaboration with one another. The SSP Learning Collaborative convened virtually in August with 42 representatives from 23 SSPs attending from across the state. The meeting was an opportunity for programs to update each other on their current work, discuss adaptations made in response to COVID-19, and discuss current needs/opportunities. If you are interested in learning more about the SSP Learning Collaborative, you can contact Jesse Bennett?at NCHRC.?Ideas for starting/supporting a syringe access program from a discussion with WNCAP (Western North Carolina AIDS Project):Diffuse, overcome city and county local authorities’ resistance by marketing the exchange as a community service for anyone needing syringes for various medical conditions, such as insulin for diabetes, hormones to treat cancer, injectable iron supplements (Sorbitol) during pregnancy, for burns or stomach problems, autoimmune disease, MS. In new communities, word of mouth may work better than public media announcements.Start with offering Narcan/Naloxone to public health agencies. Offer to provide syringe disposal services to the Sheriff’s Department, organize a weekend discarded syringe clean-up event. Provide vouchers to thrift stores, food banks to get their support. Make the cost-benefit of prevention part of your marketing. to the Opioid Education for Community Health Workers FREE Online SeriesThe target audience for these modules includes community health workers, AHEC Scholars, peer support specialists and healthcare providers, particularly in rural health centers and underserved areas across the state. Produced by NC AHEC. See opioided/Video for explaining addiction to kidsThe Addiction Policy Forum has created?Addiction & the Brain - For Kids! a short video that?adults can use to explain addiction to children. The video uses simple language that is easy for kids to understand and adults to explain. A companion fact sheet is also available for download. Both items can be found on the Addiction Policy Forum website.SUD Coalition Capacity-Building and Sustainability IdeasBrandeis Opioid Resource Connector (BORC)The Brandeis Opioid Resource Connector serves community stakeholders working to combat the opioid epidemic. It is a product of the?Brandeis Opioid Policy Research Collaborative.This website provides a curated collection of community-based programs and resources to help stakeholders choose, design, and implement essential interventions. It is designed to help communities develop and launch programs that work across the continuum of care — prevention, treatment, recovery, and harm reduction.Responding to An Overdose Spike, ATTC June 2020How to assemble an Overdose Response Strike Team, pre-incident planning, immediate and longer term actions, opioid surveillance data, job action descriptions, decision tree, etc., etc. STEWARDSHIP MEASUREMENT IMPLEMENTATION GUIDE Hospital Association (AHA) Opioid Stewardship Measures Advisory Group Centers for Medicare & Medicaid Services (CMS)The Guide addresses six critical elements that can support users through a process of implementing a data-driven approach to an opioid stewardship program: 1) developing a leadership strategy; 2) conducting an environmental scan of available resources, existing efforts and available data; 3) selecting measures; 4) setting goals and developing an improvement plan to drive progress on those measures; 5) creating policies and education for care teams; and 6) providing patient education and engaging patients in shared decision-making. We believe that these elements lay the foundation for driving and measuring progress in opioid stewardship. As part of the Guide, a Menu of Measures has been curated.Trauma-Informed, Recovery-Oriented System of Care ToolkitPrepared by the National Council for Behavioral Health for the Indiana Family and Social Services AdministrationThis toolkit provides information, resources and tools to guide implementation of TI-ROSC to best serve individuals with opioid use disorder (OUD) and other SUDs. It has two sections: Part I provides foundational concepts, data on substance use in Indiana, information and examples to understand effective responses to opioid use and other SUDs, trauma-informed approaches, recovery-oriented systems of care and the need for a comprehensive and coordinated care delivery system. Part II identifies and describes eight recommended change components to move systems toward trauma-informed and recovery-oriented approaches. This section also describes the specific tools created or adapted to facilitate the implementation of the change components. It is most effective to implement the change components in the order presented in this toolkit. The first step is to develop a County Change Team, described in Part II, to lead the TI-ROSC planning, implementation and sustainability efforts. White House Office of National Drug Control Policy (ONDCP) and 18 farm/rural partner agencies and SUD organizations launched a Rural Community Action Guide to assist local leaders with background info, action steps, promising practices. The Guide is designed to first educate rural leaders about various SUD challenges to communities and then empower them to take local action. See the Guide at: story: while you’re planning how to approach local leaders, check out rural addiction resources at https: ics/opioidsInvite law enforcement to the table. Only 7 counties have implemented Law Enforcement Assisted Diversion (LEAD) programs. LEAD is a pre-booking diversion pilot program developed with the community to address low-level drug and crimes associated with sex work. The program allows police and sheriffs to redirect low-level offenders engaged in drug or sex work activity to community-based programs and services, instead of jail and prosecution. Go to with prescribers to co-prescribe Naloxone with opioid analgesics -- those patients have 47% fewer visits to the ED in the 6 months after receiving prescription and 63% fewer ED visits after one year. Invite your local Cooperative Extension to the table. They often have funds for event expenses. TreatmentA Shot Against Opioids - Researchers are developing vaccines to treat opioid use disorder with the?Helping to End Addiction Long-term?Initiative, or NIH HEAL Initiative, are studying whether a vaccine can treat opioid use disorder.Researchers have been trying to make vaccines to treat drug addiction for a while. For example, people who received experimental vaccines against nicotine and cocaine made some antibodies that recognize these drugs, but not enough to cause a change in a person’s substance use.Scientists have developed several experimental opioid vaccines and have shown that they are safe and effective in mice and rats.?Marco Pravetoni, Ph.D., an immunologist and pharmacologist at the University of Minnesota, has shown, for example, that if a mouse is vaccinated against oxycodone, its immune cells start producing antibodies against oxycodone. When the animal is later given this particular opioid, the oxycodone-specific antibodies stick to it and prevent oxycodone from getting into the brain. The oxycodone can no longer produce a high or interfere with breathing — typically how?an overdose becomes lethal.Pravetoni and?Sandra Comer, Ph.D., a neurobiologist and clinical researcher at the New York State Psychiatric Institute and Columbia University Irving Medical Center in New York, are now starting the process of testing the first ever opioid vaccines in humans. The study is part of the NIH HEAL Initiative’s effort to find?new medications for treating opioid use disorder and preventing overdose.An opioid vaccine given to people would teach the body to make antibodies that recognize a target opioid. Later, when the target opioid molecules appear in the body, the antibodies stick to them and prevent the opioids from entering the brain.But to get from blood to the brain, the opioid molecule (or any substance) must first pass through a physical barrier of cells called the blood-brain barrier. Normally, opioid molecules can get through because they are very small. But an opioid molecule that is stuck to an antibody would be too big to get through the barrier. The desired result: no pleasurable or rewarding effect, and no overdose death from decreased respiratory rate.Opioid vaccines could be combined with other medications currently used to treat opioid use disorder, and they wouldn’t interfere with overdose rescue drugs like naloxone. Also, because vaccines produce antibodies that are highly specific to an opioid target, they would not interfere with the body’s natural abilities to control pain or with other pain management approaches.Through the NIH HEAL Initiative, Pravetoni is also leading development of a?new fentanyl vaccine?and collaborating with researchers at Virginia Tech to?use the latest vaccine technologies. Another team is funded by the initiative?to test a heroin vaccine in humans.The Centers for Medicare and Medicaid Service (CMS) wants to make you aware of a recent Drug Safety Communication from the Food & Drug Administration (FDA). The FDA announced it now requires labeling for opioid pain medicine and medicine to treat OUD be updated to recommend that as a routine part of prescribing these medicines, health care professionals should discuss the availability of the overdose reversal drug naloxone with patients and caregivers, both when beginning and renewing treatment.Additionally, the labeling changes recommend that health care professionals consider prescribing naloxone to patients who are prescribed opioid pain medicines and who are at increased risk of opioid overdose, including those who are also taking benzodiazepines or other medicines that depress the central nervous system; those who have a history of OUD; and those who have experienced a prior opioid overdose.? A naloxone prescription should also be considered for patients prescribed opioids who have household members, including children, or other close contacts at risk for accidental ingestion or opioid overdose.We encourage you to share this information with your members as soon as possible.CMS on Required Coverage for Medication Assisted Treatment (MAT) ServicesState Medicaid programs are now required to provide coverage of Medication Assisted Treatment (MAT) services and drugs under a new mandatory benefit. The purpose of the new mandatory MAT benefit found at section 1905(a)(29) of the Act is to increase access to evidenced-based treatment for Opioid Use Disorder (OUD) for all Medicaid beneficiaries and to allow patients to seek the best course of treatment and particular medications that may not have been previously covered. States must include as part of the new MAT mandatory benefit all forms of drugs and biologicals that the Food and Drug Administration (FDA) has approved or licensed for MAT to treat OUD.?They must cover such FDA approved or licensed drugs and biologicals used for indications for MAT to treat OUD.?More from CMS: The President has signed H.R. 8337, the Continuing Appropriations Act, 2021 and Other Extensions Act. This new law made a statutory change to Section 1905(a)(29) and 1905(ee) of the Act, and now clarifies that MAT drugs when used for OUD as described under the mandatory benefit are deemed prescribed drugs, and covered outpatient drugs subject to section 1927 of the Act requirements, as appropriate.?Specifically, these amendments to the Act ensure a state’s ability to seek section 1927 drug manufacturer rebates, and apply drug utilization management mechanisms, such as preferred drug lists and prior approval, and a manufacturer’s duty to pay appropriate rebates and comply with all applicable manufacturer drug product and drug pricing reporting and payment of rebates. The change in law is effective as of the date of enactment of the original SUPPORT Act, which was October 24, 2018. Further CMS guidance will be forthcoming on other implementation issues relating to this new mandatory MAT benefit.Health on Wheels: Tricked-Out RVs Deliver Addiction Treatment to Rural CommunitiesTheir health teams perform in-person testing and counseling. And as broadband access isn’t always a given in these rural spots, the RVs also provide a telehealth bridge to the medical providers back in the big cities. Working from afar, these providers can prescribe medicine to fight addiction and the ever-present risk of overdose, an especially looming concern amid the isolation and stress of the pandemic. Each RV has a nurse, a counselor and a peer specialist who has personal experience with addiction. Patients head to a small exam room in the back, where they connect via video to a nurse practitioner or physician assistant in a brick-and-mortar clinic. If all goes well, the provider will send over a prescription for Suboxone (a combination medicine containing?buprenorphine, which reduces cravings for opioids) or for Vivitrol (a monthly injectable version of?naltrexone, which blocks opioid receptors). Once the staffers have the prescription in hand, the RV nurse can give those Vivitrol shots directly and distribute?Narcan, a medication that will reverse an opioid overdose. Suboxone prescriptions must be called into a local pharmacy.? BARRIERS TO FURNISHING SUBSTANCE USE DISORDER (SUD) SERVICES USING TELEHEALTH AND REMOTE PATIENT MONITORING FOR PEDIATRIC POPULATIONS UNDER MEDICAID to Audit Utilization of Medication-Assisted Treatment for Opioid Use Disorder the June 2020 update to its Work Plan, which identifies audits and evaluations that are underway and proposed by the OIG's Audit Services and Office of Evaluation and Inspection, the OIG added two items related to utilization of MAT to address the ongoing opioid crisis. A prior OIG report found that providers at the 275-patient limit, while only 8% of all providers holding a waiver to provide MAT treatment, could collectively treat 1 million patients at a given time. However, recent studies by SAMHSA indicate that providers with MAT waivers are not prescribing MAT at or near their patient limits.Second, the OIG will evaluate "the extent to which Medicare beneficiaries with opioid use disorder are receiving MAT drugs through?Medicare," as well as their receipt of counseling or behavioral therapies. Updates to the OIG Work Plan also include an evaluation of the challenges that OTPs face (and their responses to those challenges) in safely providing continuous care to their patients during the COVID-19 pandemic and analysis of opioid utilization by?Medicare Part?D beneficiaries.Trauma Can’t Be Shut Down in Addiction TreatmentWhile many addiction treatment providers may not feel equipped to deal with the depths of trauma work with patients, Jamie Marich, PhD, LPCC-S, LICDC-CS, REAT, RYT-200, offered a word of caution to NCAD attendees in a Saturday session: Pandora’s box is already open.“Yes, a lot of treatment centers are incredibly under-resourced,” said Marich, the founder and director of the Institute for Creative Mindfulness in Warren, Ohio. “It might be?a quick assessment, a little bit of group therapy, not enough individual therapy to really give people the one-on-one care they need to go into the full scope of what trauma care may require. But the reality is this: You cannot shut down trauma. If that is the attitude you are conveying as a clinical supervisor, a director or a treatment center, I ask you to take a good, hard look at what I’m about to present.” and PTSDA study?published by the Johns Hopkins Bloomberg School of Public Health, and reported in the media, has linked post-traumatic stress disorder (PTSD) with those who experience a drug overdose, or witness one. The study’s conclusions underscore the need to address mental health aspects that can occur from overdoses.AMA OPIOID TASK FORCE 2020 PROGRESS REPORTPhysicians’ progress toward ending the nation’s drug overdose and death epidemic Recovery program significantly reduces post-op opioid use majority of patients who followed an?Enhanced Recovery After Surgery?(ERAS) protocol did not need opioids for?pain?management at multiple time?points?following elective spinal and?peripheral nerve?surgery. The findings come from an expanded analysis and study from researchers in the?Perelman School of Medicine, published in?Pain Medicine. Researchers found that when an ERAS protocol was employed—which optimizes patients’ surgical care before, during, and after surgery—fewer patients needed?pain medications?at one, three, and six months after surgery.The ERAS protocol developed at Penn includes a personalized, safe, and effective pain management plan to help prevent opioid addiction, which is an ongoing public health crisis in the United States. ERAS engages patients in their care before, during, and after their hospitalization—this process includes patient education, text reminders, nutrition information, early mobilization, and recovery plans. ERAS also relies on collaborative care between all individuals involved in the patient’s surgical journey, including anesthesiologists, rehabilitation therapists, nurses, and neurosurgeons, to improve clinical outcomes and optimize a safe recovery.SAMSHA Treatment of Stimulant Disorders (thanks Heather!) The U.S. Food and Drug Administration today announced it is requiring that labeling for opioid pain medicine and medicine to treat opioid use disorder (OUD) be updated to recommend that as a routine part of prescribing these medicines, health care professionals should discuss the availability of naloxone with patients and caregivers, both when beginning and renewing treatment. See announcement here: the Overdose Epidemic: Low-threshold Buprenorphine InitiationThe New England Journal of Medicine interviews Brown University’s Alpert School of Medicine’s Dr. Justin Berk in this podcast on low-threshold buprenorphine initiation. Dr. Berk discusses how this promising practice – conducted in a variety of settings and conditions – is serving to lessen the likelihood of opioid use that leads to overdose.Screening and Follow-Up for Unhealthy Alcohol Use: Quality Improvement Change Package for Health PlansThe National Committee for Quality Assurance (NCQA) is pleased to announce the release of? a toolkit to help health plans address unhealthy alcohol use among their members and improve reporting of the HEDIS alcohol?measure?using electronic clinical data.This toolkit is rich with successful strategies and resources from a three-year Learning Collaborative with health plans, which NCQA conducted with funding from the CDC and SAMHSA. It was updated throughout the Learning Collaborative as additional ideas, resources and best practices were identified.What’s inside this toolkit?Effective strategies guided by experts and thought leaders in the field of alcohol screening and brief intervention.Best practices for improving measure performance from health plan innovators in electronic clinical data systems (ECDS) reporting.Examples of real-world implementation of quality improvement methods and tools.Guidance for reporting the HEDIS alcohol measure using ECDS.Up-to-date evidence on the effectiveness of alcohol screening and brief intervention.What can health plans do?Health plans are in a unique position to improve the quality of care for individuals with unhealthy alcohol use by helping their providers increase their capacity to provide preventive alcohol screening and brief intervention in primary care. As outlined in the toolkit, the Learning Collaborative identified a number of successful strategies such as:Improving standardized documentation of information on unhealthy alcohol useEngaging with key stakeholders (e.g., providers, electronic health record vendors, data aggregators) to enable efficient sharing of information on alcohol useUsing telemedicine to conduct unhealthy alcohol use screening and brief intervention or counselingProviding available resources on brief counseling and treatment of unhealthy alcohol useDownload the Toolkit?here?for additional strategies, evidence-based practices, and resources to improve care for unhealthy alcohol use.Fact Sheet – 42 CFR Part 2 Revised RuleConsidering the recent revisions of 42 CFR Part 2, SAMHSA has issued several guidance documents, including a new fact sheet that includes implementation guidance.How to Reduce No-shows to Virtual AppointmentsFrom ATTC/NIATx Service Improvement Blog -- ? for Rural Communities for Addressing Substance Misuse among Families Involved with the Child Welfare System brief describes nine programs and highlights ways they have addressed challenges to serving child welfare-involved parents with substance use issues, with a focus on their applicability to rural communities. These programs offered various types of services, including parent mentoring, case management, home visiting, treatment for opioid use disorders, or an array of substance use disorder treatment and family services. ? These programs implemented strategies that could address challenges in rural and non-rural communities. The strategies included improving timely access to substance use disorder treatment, better coordinating services and sharing information among key entities, providing transportation to reduce barriers to treatment, providing other services necessary for reunification, and delivering intensive treatment and support services in a transitional housing setting. ? The need for family services beyond substance use disorder treatment required organizations to identify multiple funding streams to provide childcare, transportation, and housing. RTI Study Finds Low Rates of Compliance with Buprenorphine Prescribing Guidelines for Treating Individuals with an Opioid Use DisorderResearchers analyzed data from 38,517 commercially-insured patients with an OUD diagnosis who received buprenorphine treatment for their OUD. They found a large portion of patients did not receive care consistent with treatment guidelines recommended by the American Society of Addiction Medicine:Guidelines recommend testing all patients who receive buprenorphine for Hepatis C and HIV – however, only 6 percent of patients were tested for hepatitis C and 29 percent for HIV. This is critical, as both Hepatitis C and HIV are treatable.Guidelines recommend that all patients initiated on buprenorphine receive liver functioning testing to monitor for liver injury, but only 8 percent of patients were given liver functioning tests.Guidelines recommend urine drug testing at initiation of buprenorphine treatment and frequently during treatment. However, only 33 percent of patients received at least one urine drug test over a six-month period after starting medications for OUDs.Staying on treatment a long enough time is critical recovery from OUDs. Yet only 47 percent of patients stayed on buprenorphine for at least 6 months.“The treatment with medications is expanding,” said Dr. Mark. “Between 2014 and 2018, new starts for OUD medications increased by more than 300 percent. Now we need to make sure that those life-saving medications are being used optimally to maximize their benefit.” FOR MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER, RETENTION, AND CONTINUITY OF CARE SCREENING AND BRIEF INTERVENTION FOR PEOPLE WHO CONSUME ALCOHOL AND USE OPIOIDS was involved in 22% of deaths caused by prescription opioids and 18% of emergency department visits related to the misuse of prescription opioids in the United States in 2010.1 Screening and brief intervention for excessive alcohol use (ASBI) is an effective clinical prevention strategy for reducing excessive drinking, but it is underused in clinical settings. The purpose of this document is to familiarize health departments and healthcare providers with ASBI, discuss its usefulness for helping people who drink excessively who may be prescribed an opioid to drink less or stop drinking altogether while using opioid medications, and assist state health departments in supporting health systems and other community partners carrying out ASBI in various settings as a part of routine practice. A reference for routinely implementing ASBI in health systems is also included. Temple researchers receive $1.77M grant to explore therapy for cocaine addictionResearchers at Temple University have received a $1.77M grant from the National Institute on Drug Abuse to explore whether a drug called clavulanic acid can help patients recover from cocaine use disorder. Clavulanic acid is part of an existing therapy known as Augmentin.A Cohort Comparison of Differences Between Regional and Buncombe County Patients of a Comprehensive Perinatal Substance Use Disorders Program in Western North Carolina Shelley L. Galvin, Melinda Ramage, Catherine Leiner, Margaret H. Sullivan, E. Blake Fagan and Buncombe County women engaged in prenatal care equally. However, a more formal transition into the postpartum period is needed, especially for regional women. A “hub-and-spokes” model that extends delivery of perinatal substance use disorders care into rural communities may be more effective for engagement retention.'Iso,' a Deadly New Synthetic Opioid, Has Hit American Streets Clinical Support System (PCCS) Launches New Technical Assistance InitiativeFunded by SAMHSA, the PCSS program is led by the American Academy of Addiction Psychiatry with a coalition of national professional organizations. PCSS Implementation offers free technical assistance facilitated by clinical and implementation experts to clinical site teams to support and guide the integration of substance use disorder (SUD) services.ASAM Releases Updated Guidelines for OUD TreatmentThe American Society of Addiction Medicine (ASAM) updated the National Practice Guideline for the Treatment of Opioid Use Disorder for various stakeholders, including clinicians, administrators, criminal justice professionals and policymakers. The document provides guidance in implementing evidence-based practices aimed to improve outcomes for people with opioid use disorders (OUD).Telehealth Resources Related to Substance Use Treatment (shared by the NCCHCA Health Center Controlled Network) Telehealth Learning Series for SUD Tx and Recovery Support Providers?Curated Resources on Telehealth for SUD Tx and Recovery Support ProvidersFAQs for Treating Opioid Use Disorder via Telehealth Tips for Primary Care Providers (Providers Clinical Support System)Use of Telephone Evaluations to Initiate Buprenorphine Prescribing (DEA Policy Guidance)Use of Telemedicine While Providing Medication Assisted Treatment (MAT) (DEA Policy Guidance)Understanding the New SAMHSA/OCR Guidance for Telehealth SUD and MH ServicesOpportunities for Peer Support Workers, Supervisors and ProgramsNegative side effects of opioids could be coming from users' own immune systemsThose who take opioids long term can develop chronic inflammation and heightened pain sensitivity. Scientists report that some side effects might be influenced by the body's own immune system, which can make antibodies against the drugs.Safer Use of Stimulants: A guidance document on safer use of stimulants during the COVID-19 pandemic: Foundation Opioid Resources: FORE Foundation: : Lots of resources related to promising practices and their sustainable implementation is vital to ending the opioid crisis, including COVID-19 specific guidance in treating OUD.Behavioral Interventions for Comorbid PTSD and Substance Use DisorderSonya B. Norman, PhD and Denise A. Hien, PhD, ABPPPTSD Research Quarterly, VOLUME 31/NO. 2, 2020The common clinical presentation of PTSD and co-morbid Substance Use Disorder (SUD) has been a perennial challenge to clinicians.?This issue of the Research Quarterly reviews the, mostly recent, literature on rigorous (psychotherapy and/or medication) clinical trials for PTSD + SUD. It also reviews the literature on whether the best outcomes come from concurrent or sequential treatment of co-occurring PTSD and SUD.SAMSHA FAQs: Provision of methadone and buprenorphine for the treatment of opioid use disorder in the COVID-19 emergency at: Systematic Review of Opioid Treatments for Chronic Pain Agency for Healthcare Research and Quality (AHRQ) 134 new studies in this meta-analysis. Key Findings:Opioids are associated with small improvements versus placebo in pain and function, and increased risk of harms at short-term (1 to <6 months) follow-up; evidence on long-term effectiveness is very limited, and there is evidence of increased risk of serious harms that appear to be dose dependent.? At short-term follow-up, evidence showed no differences between opioids versus nonopioid medications in improvement in pain, function, mental health status, sleep, or depression.? Evidence on the effectiveness and harms of alternative opioid dosing strategies and the effects of risk mitigation strategies is lacking, although provision of naloxone to patients might reduce the likelihood of opioid-related emergency department visits, a taper support intervention might improve functional outcomes compared to no taper support, and co-prescription of benzodiazepines and gabapentinoids might increase risk of overdose.? No instrument has been shown to be associated with high accuracy for predicting opioid overdose, addiction, abuse, or misuse.Implementing SUD Treatment in Pediatric Primary Care. Go to Opioid Response Network, Promising Models section. Also, AMA Wire at than 10% of adolescents with SUD are even recommended for treatment and most all referrals originate in the justice system. Less than 2% who are receiving treatment for an OUD receive medications despite recommendations from the American Academy of Pediatrics. This article describes an innovative multi-disciplinary model in which a SUD subspecialty “hub” supports the entire practice staff. Developed by the Boston-based Adolescent Substance Abuse and Addiction Program (ASAP) New Medicare Benefit Will Grant Beneficiaries Access to Opioid Use Disorder Treatment recipients are the fastest-growing group of patients with opioid use disorder (OUD),?increasing by 377 percent?in the past decade. From 2017 to 2018, the number of Medicare beneficiaries receiving Food and Drug Administration (FDA)-approved medications for opioid use disorder?increased by 22 percent. Additionally, the number of beneficiaries receiving prescriptions for naloxone—the opioid overdose reversal drug—through Medicare Part D more than doubled in the same time span. Beginning 1/1/20, Medicare recipients can receive Methadone at an OTP under the SUPPORT for Patients and Communities Act. Study: Treating service members without painkillers reduces risk of mental health concerns are often used when military personnel return from service with the common pain concerns seen in this study. The most common complaints were?chronic pain?in the joints, back and neck. But this study found treating that pain with alternatives to painkillers, such as acupuncture, heat and ice therapies, spinal manipulation and even stimulation devices to treat pain lowers the risk for mental health problems and reduces the risk of suicide. Researchers looked at military?health records?of more than 140,000 active Army personnel who had reported chronic pain after deployment to Iraq or Afghanistan from 2008 to 2014. They say U.S. Army service members who received non-drug therapy had a significantly lower risk of alcohol or drug use disorders, accidental poisoning with opioids, thoughts of suicide and self-inflicted injuries, including suicide attempts.Researchers say this is an important finding because as many as half of all service members report chronic pain, and suicide among those returning to civilian life is on the rise. These other therapies not only teach coping mechanisms, they also reduce the risk of accidental overdoses and addiction to these?prescription?painkillers.NIH funds $945 million in research to tackle the national opioid crisis through NIH HEAL Initiative. Approximately 375 awards in 41 states will accelerate scientific solutions. To sign up for updates, go to of cocaine and methamphetamine use, clinical challenges, current review of treatments at: Medication to Treat Meth Addiction? Some Take A New Look at Naltrexone Therapeutics Reduce Burden on Providers, Improve EfficiencyIn the first study, computer-based and therapist-based outpatient modalities produced similar results in continuous abstinent weeks among patients, while the computer-based model required less therapist intervention time, which cut down on costs. A second study showed that patients in computer-based CBT therapy had more drug-free urine tests, stayed in treatment longer and evaluated their treatment more positively. See can see the following report and other emerging research at the RTI Opioid Newsletter: A Stakeholder-driven Action Plan for Improving Pain Management, Opioid Use, and Opioid Use Disorder Treatment Through Patient-Centered Clinical Decision Support see it here: can find an excellent comprehensive update on clinical best practices, medication risk assessment, restorative and alternative/complementary therapies, chronic pain with SUD patients, managing chronic pain for various special populations, public/patient/provider education best practices at Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations Medical Society Foundation is looking for sites to try out their MAT dashboard software -- The Recovery Platform as part of their Project OBOT. Addiction is a treatable disease, but it requires significant care coordination and collaboration among providers and car resources. Providers given proper training and surrounded with professionals to share in their patient’s treatment strategy can successfully treat those suffering opioid Use Disorder. With the formation of Project OBOT, the NCMSF has established a coalition of organizations including: Governor’s Institute NC Association of Local Health Directors, LabCorp, The Recovery Platform, UNC School of Public Health, Project Echo, MAHEC and others to facilitate expansion of MAT. Through the establishment of research-based, data driven pilots, Project OBOT will provide increased patent access by using a care-specific platform for opioid treatment and recovery. Project OBOT helps ensure compliance with standards, tracks patient drug court involvement/status, direct feed of testing to LabCorp, supports counseling via smart phone, attending group via telehealth connection. Contact Franklin Walker at FWalker@New Strategies for Using Patient-Centered Technology to Improve Pain Management and Opioid Treatment is a very compelling vision of better practice developed by the CDS’ Patient Centered Learning Network, featuring 19 High-Value Interventions you can try for no or low-cost in their Opioid Action Plan. View webinar slides at the Plan at If you hold a waiver, but are not currently prescribing buprenorphine, please visit , safer, for technical assistance on how to begin utilizing your waiver. For waivered providers that are prescribing buprenorphine, there are a variety of technical assistance resources through Project ECHO? (Extension for Community Healthcare Outcomes), PCSS, MAHEC, and other professional organizations. Do in-reach with persons with a SUD to offer tobacco cessation. Smoking rate is as high as 84% compared to 15.50% for all U.S. adults, and mortality is higher from tobacco-related illnesses. 70-90% of pregnant women with a SUD smoke which aggravates NAS. Less than 50% of SA residential programs offer tobacco cessation. Quitting tobacco associated with lowered intensity of symptoms of SA, MI and increases probability of employment and better housing: of overdose deaths included benzodiazepines. Concern about benzo abuse reaching epidemic levels persists. Recommend that all prescribers add benzodiazepines and stimulants to their patient Controlled Substance Agreements (CSA) and verbally check with all patients before prescribing opioids. Email Timothy Shelton at tsdhelton@ for an excellent example of a complete CSA.Kentucky’s Sobriety Treatment and Recovery Teams (START) improves outcomes for children. (SUD and ACES are strongly correlated). Contact Dan Pizzo at The START Program of Buncombe County, NC at Dan.Pizzo@ TIP: Help pregnant women receiving MAT by having them sign Releases for the hospital and DSS so their treatment will not be interrupted. Naltrexone Seems Effective for Opioid Use Disorder in Pregnancy. See other evidence-informed strategies to support families impacted by opioid use and NAS, check out HRSA’s Home Visiting Program: Supporting Families Impacted by Opioid Use and Neonatal Abstinence Syndrome, October 2018 at: SupportHEY! 53 to 64% of people involved with illicit substance use are attending peer support groups as their Only intervention! If a person is involved with TASC, groups count.Providing Culturally Responsive Recovery Supports: Recommendations for Engaging Black Young Adults Anonymous: “We Do Recover”A new report – authored by William White, Dr. Marc Galanter, Dr. John Kelly and Dr. Keith Humphreys – highlights what the scientific research indicates about the efficacy of Narcotics Anonymous for people seeking recovery from drug addiction. This?pamphlet?summarizes the findings.People Advocating Recovery (PAR) and Young People in Recovery (YPR) are hosting a week long Rally 4 Recovery via Facebook this year that includes special events, live streaming content, educational information, treatment options in Louisville, KY, speakers, and a watch party for The Anonymous People. We encourage you check out the Rally 4 Recovery FB page and learn more about why others are advocating for treatment and recovery! (thanks Lisa H!)What Is Recovery? A review Alcohol Research: Current Reviews NIAAA@From Benjamin Rush to the Big Book of Alcoholics Anonymous, Americans have long debated the definition of recovery from alcohol use disorder. Although the debate continues, a consensus is forming that recovery is a dynamic process with multiple pathways and may not always include abstinence. In this literature review, Katie Witkiewitz and colleagues examine the latest research on the recovery construct and the importance of including functioning and general well-being in one’s definition of recovery.SAMHSA: Virtual Recovery ResourcesThis tip sheet describes resources that can be used to virtually support recovery from mental/substance use disorders. It also provides resources to help local recovery programs create virtual meetings.SAMHSA list at of RCOs, RCCs with address, contact info here: virtual meetings and online support resources for those struggling with substance use disorders and behavioral health issues, access these at . When you land on the home page click on Virtual Resources.? Once you've reviewed the list, if you know of resources to add please forward those to Deborah Kopytowski at debk@. We can easily update the list as we get new resources and we encourage you to share this information with anyone who might benefit.??Recovery LIVE! Providing Digital Peer Support Services Role of Peer Recovery Coaches and Navigators During the COVID-19 Pandemic Guide to Using Text Messages to Improve Substance Use Treatment OutcomesPublication Date:?October 14, 2019 Developed By:?Mountain Plains ATTCHelping individuals remain in treatment or continue to participate in recovery support services can be difficult. However, with advances in both technology and science, text messages can be used to increase engagement, enhance education about the individual’s condition, and help patients manage craving and other negative thoughts/moods. This step-by-step guide contains information for treatment and recovery support providers on how to use text messages to expand the reach of their services. The guide can be used in conjunction with the webinar or as a stand-alone resource. Webinar and Discussion: Recovery Houses and COVID-19COVID-19 has presented specific challenges for recovery residential settings, inspiring creative responses and solutions. This weekly learning event, hosted by the National Alliance of Recovery Residences, gives a forum to recovery house operators to share current realities, perspectives and problem-solving.Recovery from OUD: Prevalence and RoadmapsWith little still known about OUD recovery, this study from the Recovery Research Institute documents patterns of recovery and factors related to both early and mid-level recovery status. These findings will help inform and establish recommendations in prevention, practice and policy.Burke Substance Abuse Network is offering Virtual Community Engagement videos that are currently being aired on Burke Substance Abuse Network's Facebook page (http:BurkeSubstanceAbuseNetwork).? There are three "shows;" Real Talk with Real People, Recovering Families and Journey to Hope. These are all locally created and filmed.? They started airing on March 30, 2020 and since then have reached over 211,000 people and had over 100,000 engagements.ASTOUND YOUR FRIENDS with your knowledge and informed attitudes about overdose as demonstrated by your good OOKS and fine OOAS ! Seriously, these two questionnaires can be used to engage and empower clients. Knowledge is power and power supports informed decisions, right?Opioid Overdose Knowledge Scale (OOKS) Williams A, Strang J, Marsden J. 2013 Assesses knowledge of opioid overdose, including risk factors, symptoms, emergency response, and naloxone use. Assessment Instrument Copyrighted, Freely Available Overdose Attitudes Scale (OOAS) Williams A, Strang J, Marsden J. 2013 Assesses attitudes related to how one would respond to an opioid overdose. of recovery resources from SAMHSA at BRSS TACS (Bringing Recovery Supports to Scale – Technical Assistance Center) Strategy at brss-tacs, like:Value of Peers Infographics in Spanish and English: Peer Recovery, Family Parent Caregiver Support,General Peer Support, Mental Health Support, Youth Peer Support in English For the full list of BRSS TACS Peer Resources, please go to: check out Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan Volume 2 Tools and Resources, Table 4 – Tools for Preventing or Responding to Opioid Overdose, from Agency for Healthcare research and Quality (AHRQ) at out Peer VOICE NC at , a statewide peer movement to enhance peer leadership and engagement, coordinate existing efforts to build qualified and competent per professionals and providers and improve mental health and substance use recovery. PCORI Research on Community Health Worker/Peer Provider Programs.?This report reviews results from nine recent studies funded by the Patient Centered Outcomes Research Institute (PCORI) on community health workers (CHWs) and peer providers (PPs) as effective participants in addressing health and healthcare inequities, particularly for diverse communities.?Each study presented focuses on a distinct function of utilizing CHWs and/or PPs such as mentoring, managing chronic conditions, and navigator support for serious mental illness and depression.Vaya Health, a state behavioral LME-MCO in Asheville, has a Peer Learning Community they describe as “a collaboration of certified peer support specialists who value idea-sharing, education about innovative support tools and methods, system updates, networking and seeking solutions to common challenges.” Meetings are held quarterly and posted on Vaya’s Calendar of Events. Check out MAHEC’s Peer Book, “a compilation of personal narratives involving substance use disorders and their impact”.Recovery Just Ahead Sign Image: School-Based Health Centers and colleges to start recovery programming. Get your foot in the door with a soft sell about no-cost expansion of the school’s “student assistive services” (see Rhode Island’s RISA program). Contact Chris Campau, Director of Scholastic Recovery, Addiction Professionals of NC at ccampau@.Check out North Carolina Recovery All Ways Podcast, Stephen Steen, Host ncrawsteve@ ncraw.Life A unique and very effective way to assist teens, young adults with their recovery. Stephen started this on a small scale out of a personal interest, but it has caught on like wildfire; he is thinking of making this his life’s work and is seeking sources of support to keep up with the demand. Direct students who may be interested in starting a program to the Collegiate Recovery Leadership Academy, a dependent or addicted patient has access to a smart phone, computer or tablet, encourage them to use a recovery-supportive app to self-monitor symptoms, help react to setbacks in a helpful and timely manner. reviews apps for credibility, user experience and transparency (in terms of using, sharing patient data). myStrength is free to persons if accessed through a sponsoring organization with a user license: Therapeutics’ reSET-O (prescribed 12-week CBT), FDA approved. 24/7 Digital Peer Support by Sober Grid at funkhouser@A new tool aims to help patients sort through 200 mental health apps — and counting out the American Psychiatric Association’s App Evaluation function. For an example of what they rate, see this example using PTSD Coach here: learn more about technology-assisted treatment and research and answers to a variety of SUD-related issues, check out this Relias blog: OpportunitiesBipartisan Group of Legislators Request Flexibility on SUD Grants. This week, a group of 19 bipartisan Members of Congress, led by Rep. John Curtis (R-UT), sent a letter to Assistance Secretary Elinore McCance-Katz at SAMHSA encouraging the agency to offer greater flexibility in administering grants aimed at addressing substance use disorder issues across the country. This letter comes as the rates of individuals living with SUD and mental illness are on the rise due to the stress associated with the COVID-19 pandemic. Grants Management from How should recipients of rural health grants and cooperative agreements manage activities and services in the event that critical staff members are unable to work due to either illness or COVID-19 quarantine??(Added: 3/27/2020)HRSA’s FORHP recognizes that many recipients are working to address or may be impacted by COVID-19 emergencies within their communities, which may impact their ability to meet grant requirements.? We encourage recipients to continue to provide rural health services and grant activities in a safe and efficient manner.? Please talk with your project officer regarding alternative approaches to planned activities. Once the emergency has waned, we will work with you on the completion of required activities.What flexibilities are available to recipients of rural health grants if our projects and activities are interrupted or we are unable to complete required reports??(Added: 3/27/2020)Please see the?HRSA COVID-19 Grantee Frequently Asked Questions?and discuss your specific situation with your FORHP project officer.Subscribe to SUD grant notifications at Also check HRSA grant opps at grants/find-funding?status=Open&bureau=All&page=1HRSA has a lot of resources to help grantees. Check out their technical assistance resources at heep://hrsa/grants/applyAlso review the HRSA SF-424 Application GuideLocal date resources at data. to get HRSA Fact Sheets by county/state/nationalSign up for the Dogwood Health Trust Monthly Funding Opportunity Update here: leveragefund@We?are pleased to share our most recently curated list of?funding opportunities?that?may be a fit for your organization. We encourage you to look through the list and search for?grant?options?that would potentially?align with the work?you're doing now,?your mission?and?the Leverage Fund. Please keep in mind that this list is by no means exhaustive. We continue to advise that you?conduct your own internet searches based on your organization's focus areas and programs, but we hope this helps.?To learn more,?simply send us an email at?leveragefund@.?Dogwood Announces New Racial Equity GrantsRacial Equity Community?Grants?are designed as a first step from Dogwood Health Trust to infuse capital into historically underfunded organizations whose primary purpose is serving Black, indigenous and communities of color, and whose leadership is? representative of the communities they serve. Our goal is to recognize and support the great work and leadership that is already taking place, and help to solidify or expand that work.Grants of up to?$25,000?from this fund may be used for immediate needs, program support, general operating support – whatever applying organizations believe will best support their work and increase their impact. Both 501(c)(3) organizations and government agencies are welcome to apply.The online application is quick and easy, and there are minimal reporting requirements.?U.S. DEPARTMENT OF LABOR ANNOUNCES AVAILABILITY OF $40 MILLION TO ADDRESS RURAL HEALTHCARE WORKFORCE SHORTAGES Department’s Employment and Training Administration (ETA), which administers the program,?seeks to address this shortage through the release of funding to invest in successful, employer-driven, training models and community partnerships to establish sustainable programs to address rural healthcare shortages. Through the investment in these rural communities,?ETA aims to help individuals gain the skills necessary to fill these vacancies and allow employers to find skilled workers more readily.?Rural Healthcare Grants will be awarded to partnerships of public and private sector entities. Eligible lead applicants include?employers in the healthcare sector; nonprofit healthcare organizations affiliated with hospitals and other medical facilities; healthcare industry and/or occupation associations; organizations designated as “Primary Care Associations” by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA); Workforce Innovation and Opportunity Act (WIOA) State or Local Workforce Development Boards and federally recognized Indian/Native American Tribal Governments; and?Native American Program entities eligible for funding under Section 166 of WIOA (29 U.S.C. 3221).?These public-private partnerships will leverage resources across federal and state funding streams as well as from the private sector. They will work together toward a coordinated approach to preparing a skilled healthcare workforce for rural areas.?The Department encourages applicants to generate at least 15 percent of the total amount of requested funds as leveraged funds to support the grant project.?The Department also encourages applicants to incorporate new and emergent technologies – such as interactive simulations, personalized and virtual instruction, educational gaming or digital tutors – into the educational component of their training design.Agency: Employment and Training AdministrationDate: September 15, 2020Release Number: 20-1776-NATContact:?Eric HollandPhone Number: 202-693-4676Email: holland.eric.w@Combatting Opioid Overdose Through Community-Level InterventionThe University of Baltimore’s?Center for Drug Policy and Prevention?(CDPP) invites sub-award applications for the Combating Opioid Overdose Through Community-level Intervention Initiative (COOCLI) Initiative, funded by the Office of National Drug Control Policy (ONDCP, CFDA=95.007).Sub-recipients must focus on opioid-involved overdoses or overdoses involving stimulants in the regions of the United States with the highest rates of fatal and non-fatal overdoses.? Also, they must:Use evidence-based or promising approaches to implement or enhance new or on-going community-based programs that aim to reduce opioid or other drug overdoses.Once implemented, evaluate these community-based efforts to assess their efficacy in reducing overdoses and other harms of opioid (mis)use and other substance use.Support and promote collaboration between public safety and public health agencies to ensure that overdose reduction efforts are aligned and that communities benefit from a comprehensive and coordinated responseThese funds will help identify innovative solutions that move beyond traditional health and law enforcement policies. UB’s center, housed in the College of Public Affairs, will act as the authority for all administrative and financial aspects of the grant. The center encourages local government agencies, public and private universities, advocacy organizations and nonprofits nationwide to apply for funding.CDPP and UB officials will begin accepting applications for subawards from the grant on October 1, 2020.?Applications are due to UB no later than midnight Eastern Standard Time, Nov. 2, 2020. Organizations that wish to apply for funding for their opioid-related intervention effort may do so by following the instructions provided in the application guidelines found below.Application GuidelineApplication Cover Sheet COVID-19 Solutions to Scale – Apply Now to Enhance Harm Reduction Services? The COVID-19 pandemic has significantly exacerbated the challenges and risks for people with substance use disorders, necessitating a rapid public health response that identifies and supports best practices and novel harm reduction strategies.Are you looking to implement innovative harm reduction strategies to reduce the risk of overdose in the communities you serve?We are pleased to extend the opportunity for up to 15 organizations to participate in the 2020-2021 Preventing Overdose and Increasing Access to Harm Reduction Services program, with support from the Centers for Disease Control and Prevention (CDC).Organizations will receive up to $33,000 each to participate in a six-month project to implement innovative harm reduction strategies. This opportunity will launch in November 2020 with virtual coaching and technical assistance, and conclude in May with lessons learned for implementing better systems of care for individuals with substance use disorders now and in the future.? ? Apply Today ? ? ? Since much of the funding to address the opioid crisis is being awarded to states, it is important to know that?State Opioid Response (SOR) grant funds can be used for the provision of substance use disorder services by faith-based organizations. For more information, please read this?letter from Shannon Royce, Esq., Director of the Partnership Center for Faith and Opportunity Initiatives, as well as this set of?FAQs from the Substance Abuse and Mental Health Administration (SAMHSA)?- PDF?that affirms states are allowed to use a portion of their funds through indirect funding or voucher programs to enhance client choice and increase program participation by a variety of groups, including faith-based partners. If you have any questions, please call the Partnership Center at 202-358-3595.CDC-RFA-PS19-1909National Harm Reduction Technical Assistance and Syringe Services Program (SSP) Monitoring and Evaluation Funding OpportunityDepartment of Health and Human ServicesCenters for Disease Control - NCHHSTP three year program will strengthen the capacity and improve the performance of harm reduction programs throughout the United States; and implement a monitoring and evaluation of syringe services programs. The purpose of this project is to strengthen harm reduction programs in order to prevent infectious disease resulting from injection drug use, and improve health outcomes for people who inject drugs, including strengthening linkage to medication-assisted treatment. It is comprised of two components: technical assistance, and monitoring and evaluation, and two one-year demonstration projects. Activities will include: providing technical assistance to SSPs, developing a national training network; and implementing a SSP monitoring and evaluation program.Deadline for applications: Oct 28, 2020??The Federal Communications Commission (FCC) Telehealth COVID-19 Program provides funds as part of the CARES Act to providers for telecommunications services. Check your practice’s eligibility at: LEAF Foundation – Open Grants Program: Treatment (MAT) Training and Mentoring/DATA 2000 Waiver Training to provide medication-assisted treatment (MAT) for clinicians in high-need communities. Clinicians who complete the training may be priority applicants for some NHSC loan repayment programs, and qualified disciplines can become eligible for the Loan Repayment Program Continuation Contract MAT Award Enhancement.Geographic coverage: Nationwide and U.S. territories Applications accepted on an ongoing basis Sponsors: Bureau of Health Workforce, Health Resources and Services Administration, National Health Service Corps, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services HRSA-21-021Rural Health Network Development Planning ProgramThe purpose of this grant is to promote the development of integrated health care networks in order to: (i) achieve efficiencies; (ii) expand access to, coordinate, and improve the quality of basic health care services; and (iii) strengthen the rural health care system as a whole. This program brings together key parts of a rural health care delivery system, particularly those entities that may not have collaborated in the past, to work together to establish or improve local capacity and coordination of care. The grant program supports one year of planning to develop and assist integrated health care networks in becoming operational. For purposes of this program, an integrated health care network is defined as an organizational arrangement among at least three (3) regional or local health care organizations that come together to develop strategies for improving health services delivery systems in a community. An integrated health care network should be an independent organization with signed agreements, defined policies and, often by-laws based on a long-term vision for achieving systemic change. These networks can include a wide range of community partners including social service agencies, State Rural Health Associations, Primary Care Associations, academic medical centers, mental health agencies, charitable organizations, educational institutions, employers, local government agencies or other entities with an interest in a community’s health care system. The Network Planning Grants Program offers rural health care organizations the opportunity to better address community needs and respond to challenges such as supporting providers in the transition from volume-based to value-based care through the formation of an integrated health care network. The intent is for health networks to expand access to care, increase the use of health information technology, explore alternative health care delivery models, and continue to achieve quality health care across the continuum of care. Closing Date for Applications:Nov 16, 2020Southeast Rural Community Assistance Loans – Ongoing.?The nonprofit Southeast Rural Community Assistance project makes loans of up to $250,000 to local governments and other community-level organizations for the development and/or construction of large-scale community projects.?Eligible applicants are rural communities in Delaware, Maryland, Virginia, North Carolina, South Carolina, Georgia, and Florida. Services Grant Program for Residential Treatment for Pregnant and Postpartum Women (PPW)SAMHSA grants to expand comprehensive treatment, prevention, and recovery support services for women and their children in residential substance use treatment facilities, including services for non-residential family members of both the women and children.This funding will support programs that utilize evidence-based parenting and treatment models including trauma-specific services in a trauma-informed context.Award is up to $525,000 per year, up to 3 years. to expand comprehensive treatment, prevention, and recovery support services for women and their children in residential substance use treatment facilities, including services for non-residential family members of both the women and children. This funding will support programs that utilize evidence-based parenting and treatment models including trauma-specific services in a trauma-informed context.Details at and HHS Partner to Create Recovery Housing in Rural CommunitiesThe U.S. Department of Agriculture (USDA) Rural Development and HHS Substance Abuse and Mental Health Services Administration (SAMHSA) will coordinate efforts to sell USDA’s Real Estate Owned (REO) single-family housing properties at a discount to non-profit organizations that provide housing, treatment, job training and other key services for people in substance misuse treatment and recovery. See press release at Initiatives, Current State Bills Bill to expand support for community addiction treatment passes House Medication Access and Training Expansion (MATE) Act will require doctors who prescribe controlled substances to receive addiction training, preparing them to identify and treat substance use disorders with compassion and science.The bipartisan MATE Act was introduced in the Senate last week as a companion to an existing bipartisan House bill.Versions of the Mainstreaming Addiction Treatment (MAT) Act have been introduced in both the House and Senate. Among its provisions, the bill would eliminate training and licensure requirements, as well as patient limits, for buprenorphine prescribers, bringing regulations around buprenorphine in line with other prescription medications. The bill has received bipartisan support in both chambers of Congress.?Final Rule: Confidentiality of Substance Use Disorder Patient Records.?Effective August 14, 2020, this final rule makes changes to the U.S. Department of Health & Human Services’ regulations governing these records to facilitate information exchange for safe and effective SUD care, while addressing the legitimate privacy concerns of patients seeking treatment for a SUD.?Track state bills at Office of Rural Health Policy FORHP Policy page to see recent updates and send questions to ruralpolicy@. Federal Weekly Opioid Policy Report at: : Funds for Statewide Telepsychiatry Program. to the Com on Appropriations, if favorable, Rules, Calendar, and Operations of the House on 05/27/2020S106: Clarify Limited immunity/Overdose Victims. to the Com on Judiciary, if favorable, Rules, Calendar, and Operations of the House on 06/06/2019S544: Establish Non-Opioid Treatment Alternatives. to Com on Rules and Operations of the Senate on 04/03/2019H318: Opioid Prescription & Treatment Opt-out Act. to the Com on Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of the House on 03/12/2019H887 Substance Abuse Prof. Practice Act [Detail][Text][Discuss] 2019-04-22 To House Health CommitteeH539 Intro Temp. Fin. Asst./SA Facilities [Detail][Text][Discuss] 2019-04-03 To House Health CommitteeH360 Intro Guilford County Mental Health Facility/Funds [Detail][Text][Discuss] 2019-03-18 To House Health CommitteeH203 Intro Amend Social Work Practice Act.-AB House Health CommitteeHB 91 ABC Laws Modernization/PED Study. Text:?Latest bill text (Amended) [PDF] Pending:?House Finance CommitteeHB 536 ABC Omnibus Regulatory Reform [H536 Detail] Temp Outdoor Restaurants for Outdoor SeatingStatus:?(Enrolled)?2020-05-28 - Pres. To Gov. 5/28/2020?SB 251 Modernization of Drug Court Program Text:?Latest bill text (Amended) [PDF]. 2019-04-09 - Re-ref Com on Appropriations/Base Budget. Pending:?Senate Appropriations/Base Budget CommitteeGov. Cooper signs bill increasing judicial discretion for low-level drug crimes MOVES MEDICAID TRANSFORMATION BILL ALONGThis week,?S808, now called?Medicaid?Funding Act, was substantially changed through a committee substitute that was passed in the Senate Appropriations Committee.? Here is the breakdown of the substitute bill:Related to Medicaid TransformationChanges start date for Standard Plans to?no later than July 1, 2021;Authorizes each PHP, including the regional PHP contract, for the Standard Plan to be paid $4 million, for each full month after June 30, 2021, that the State is not able to make Medicaid capitated payments;$19.42 million appropriated for infrastructure needs such as NC FAST upgrades, data management tools, program integrity;Allows DHHS to make a request for a transfer of funds that will cover qualifying needs such as the State share and will not be more than $63.12 million;Allows for the Tribal Medicaid managed care option;Revises the Supplemental?Payment?Program;Establishes the Medicaid Contingency Reserve;Establishes the Hospital Assessment Act;Amends the Gross Premium Tax to include PHP capitated contracts;Establishes the Hospital Uncompensated Care Fund;$50 million from the Coronavirus Relief Fund appropriated to the LME/MCOs to address the COVID-19 behavioral health and crisis service response.?New Law Requires State and Local School-Based Mental?Health PlansGovernor Cooper signed into law?S476/SL 2020-7:School-Based Mental Health.? The bill requires the State Board of Education to develop a school-based mental health plan for the State.? The State Board will also establish minimum requirements for each school district to also develop a school-based mental?health plan?and a mental health training program and model suicide risk referral protocol. The bill was effective when it became law. for Transforming Local Treatment-Centric Coalitions into A Whole Community RECOVERY ECOSYSTEMSExpand your purview, position your group for state funding by aligning goals, strategies with the NC Opioid Action Plan Version 2 at opioid-epidemicCreate a regional substance use disorder coalition/consortium to include prevention, treatment and recovery support activities:Include academic center(s) as they represent ways to obtain planning and evaluation expertise at little to no cost. Drug Free Communities grantees are required to report “active participation” from schools and businesses. Engage the business, secondary education and child-serving agency sectors by providing them with consultation on benefit design, training to reduce stigma and increase MH/SA literacy, promote adoption of fair chance hiring practices, and improve access to treatment (talk to Rural Health Group, Lincoln FQHC). Don’t Forget Employers and Employees!U.S. Equal Employment Opportunity Commission NEW Guidance on Opioid Use and The ADA:Use of Codeine, Oxycodone, and Other Opioids:?Information for Employees: Could I get reasonable accommodations for a medical condition related to opioid addiction?Yes, if the condition is a disability. Medical conditions that are often associated with opioid addiction, such as major depression and post-traumatic stress disorder (PTSD), may be disabilities. For more information on mental health conditions and the ADA, see?Depression, PTSD, & Other Mental Health Conditions in The Workplace: Your Legal Rights?at?, If you are permanently unable to do your regular job, you may ask your employer to reassign you to a job that you can do as a reasonable accommodation, if one is available. For more information on reasonable accommodations in employment, including reassignment, see?Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act, available? EEOC guidance for healthcare providers:How to Help Current and Former Patients Who Have Used or Misused Opioids Stay Employed?at?. Also see:The Mental Health Provider’s Role in a Client’s Request for a Reasonable Accommodation at Work?at? general information, visit the Equal Employment Opportunity’s (EEOC’s) website (), or call the EEOC at 1-800-669-4000 (voice), 1-800-669-6820 (TTY), or on our sign language access line at 1-844-234-5122 (ASL Video Phone).?“As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths.” From Macroeconomic Conditions and Opioid Abuse, Alex Hollingsworth,?Christopher J. Ruhm,?Kosali Simon, NBER Working Paper No. 23192, Issued in February 2017, Revised in March 2017NEW COMPLETE WORKPLACE Program! The National Safety Council published the Opioids at Work Employer Toolkit at: pages/prescription-drug-employer-kitThis is a comprehensive, self-guided 12-month program with workplace-tailored prevention, treatment and recovery support strategies. It includes vetted samples of policies, fact sheets, videos, presentations, safety talks, posters, and reports. Make sure to read the Nationwide case study… “The impulse is to overlook someone who is impaired unless they’re being disruptive. But more and more leaders are coming forward because of the training…some people who were mistakenly seen as (drug) impaired had undiagnosed diabetes.” - Kathleen Herath, Nationwide Industry Voices—Healthcare companies and employers must act on the opioid crisis approaching your community’s Chamber of Commerce, County Workforce Development Board staff and business association(s) to modify their policies, practices and procedures toward supporting screening, treatment and recovery. Share this brief article, get your local newspaper to do a similar story: Addiction professionals urge employers to work with people in recovery: up the Recovery Friendly Workplace Initiative at Workplace Facts:Approximately 75% of U.S. employers say their workplace has been directly affected by opioid usage, but only 17% feel well prepared to deal with the issue, according to a 2019 National Safety Council?survey.Workplace overdose deaths involving drugs or alcohol have increased by at least 25% for five consecutive years, and the prescription opioid crisis caused nearly one million people to miss work in 2015. The Centers for Disease Control and Prevention estimates that the opioid epidemic costs the U.S. economy approximately $78.5 billion a year.32% of 344 surveyed companies report that employees are addicted to prescription drugs, yet 31% said they had no policies in place to address the increased absenteeism, accidents, poor job performance and health problems related to addiction. HELP THEM!One in 9 full time American workers binge drank in the past month and/or used illegal drugs, and one in ten abused or were dependent on alcohol or illicit drugs in the past year. Only 10% of them get treatment. Promoting Medication Assisted Recovery with Reluctant PrescribersHelp providers understand that Medication-Assisted Recovery is not “trading one addiction for another”. Numerous studies have shown that MAR contributes to significant reductions in illicit drug use, criminal activity, overdose, and other risky behaviors. MAR helps lower cravings, helping patients to engage in healthcare, increase level of functioning and non-drug lifestyles. Contact MAHEC at opioideducation@ about their OUD education programs such as MAT 101, MAT Waiver Training, SUDs 101 for the Clinic Team.Engage with UNC Project ECHO to expand access to treatment via telepsych, Email echo@unc.edu with specific questions. FREE waiver training, 5 ECHO sessions per week with CME. Onsite, phone, email support for providers and staff. JOIN THE INVITE session list at Imccall@email.unc.eduCheck out El Futuro’s TeleECHO Clinic for LatinX clients. 64% of people with a SUD are concerned about their health and 37% say they need health treatment. Engage primary care providers to become “SUD Friendly Practices” for their current patients: Offer to help review their SUD diagnostic assessment practices, and to consider offering pre-Medication-Assisted Recovery (MAR) supportive/adjunctive services such as:Review/help write clinic’s policy about screening all patients for substance misuse at admission and again annually, at minimum.If a patient screens positive, discloses or displays signs of prescription misuse or illicit drug use, what is the clinic’s practice regarding getting a diagnostic assessment for a substance use disorder?Does the practice provide any of the following treatments or services when a patient screens positive for substance use disorder, or discloses such use, or displays signs or symptoms of misuse?Screening, assessment, treatment referral for very common co-occurring mental disorders, primarily depression, anxiety, trauma.Use treatment of medical conditions related to substance misuse such as frequent infections, abscesses, endocarditis, Hepatitis C as an opportunity to engage patient through Motivational Interviewing techniques Provide maintenance medications like Naltrexone/Vivitrol for patients who are in recovery and for whom a medication will help with relapse preventionProvide Naloxone/Narcan and overdose prevention educationReferral to a syringe exchange program ? ................
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