Partnering for Opioid Addiction Prevention

Partnering for Opioid Addiction Prevention


Operator: Welcome to the Partnering for Opioid
Addiction Prevention webinar. During the presentation, all participants
will be in a listen only mode. Should you wish to ask a question during the
presentation, please use the chat feature located in the lower left-hand corner of your
screen. And as a reminder, this conference is being
recorded today. I would now like to turn the conference over
to David Wilson. Please go ahead, sir. David Wilson: Happy National Prevention Week
everyone and welcome to today’s webinar. I am David Lamont Wilson, Public Health Analyst
at the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse
Prevention or CSAP. I will be your moderator for this NPW 2018
Partnering for Opioid Addiction Prevention Webinar. Now, today’s discussion is a critical one
for preventionists. The opioid crisis has become our crisis next
door and as a recent White House media campaign illustrates, the opioid crisis is touching
every community around the country and the stories are heartbreaking. Now, this final installment of our National
Prevention Week Webinar series was developed specifically to support organizations working
on the front lines of opioid addiction prevention. So before we begin, I would like to make a
couple of housekeeping announcements. First, please, please, please use the chat
pod to send us your thoughts and questions throughout each speaker’s presentation. We will have time at the end to answer some
of your questions. Two, this webinar is being recorded and it
will be available on SAMHSA’s YouTube page. So if you have colleagues or coalition partners
who weren’t able to join us, they can assess it on demand when it is available. And lastly, we will make the slide presentation
available after the webinar. So you will have the information and all of
the resources that we discuss today at your fingertips. Now, I am so excited that we are joined by
four outstanding presenters. First, we have Captain Jennifer Fan, my colleague,
and SAMHSA’s Center for Substance Abuse Prevention. From the Centers for Disease Control, we have
LeShaundra Cordier. We also have Dr. William Haning, representing
the American Society of Addiction Medicine. And joining us from the Boys and Girls Club
of America, we have Lauren Barineau. Now, this presentation and all of their presentations
will highlight effective collaborations and resources at the local and community levels
to prevent opioid addiction and other practical steps. For those of you or us who are exploring partnerships
with organizations and their communities. But before I turn it over to our first speaker,
as coordinator of National Prevention Week, I wanted to say a few words about NPW, what
we’ve accomplished and more importantly, what’s next. Now, as you all may know, National Prevention
Week is an annual observation dedicated to increasing awareness and action around substance
abuse and mental health issues. Now, this year’s theme, Action Today, Healthier
Tomorrow, reminds us that simple daily actions of prevention, such as helping a friend make
positive choices or supporting a family member in need can lead to healthier lives for each
of us today and stronger healthier communities tomorrow. And as you can see, each day of NPW will focus
on different and pressing health themes and encourage you and your communities to discuss
various aspects of prevention. So far, SAMHSA has heard about communities
around the country hosting health fairs, and trainings, and town halls, and Twitter chats,
and mural paintings, and all other types of NPW activities and events to contribute to
our growing conversation around prevention. Now, there’s still time for you and your community
to get involved in NPW and it you have the NPW 2018 Planning Guide and Resource Calendar,
you can do that. And if not, you can order one from our SAMHSA
store at www.samhsa.gov. and there with that resource, you can explore ideas and resources
to help you organize an activity this month for NPW. Now, when you plan your activity or event,
let us know about it. Submit your event or activity on the website
using the link that you see on the screen and we will help you spread the word about
your event. There’s still time to participate in this
year’s prevention challenge that we call Dear Future Me. Now, throughout May, we will continue building
our National Prevention Week digital mosaic and we would love to include your contribution. All you need to do is write a letter to your
future self about the actions you are doing today to ensure a healthier tomorrow. Share your letter, or picture, or video on
Twitter and Instagram or Facebook using the Dear Future Me hashtag and we’ll add your
post to our digital mosaic. We’re so close to completing the image and
we would love for your letters to be a part of it. So again, visit www.samhsa.gov/prevention-week
to learn more. Now, make sure to visit the National Prevention
Week website to stay connected and access helpful free resources to support your prevention
work. And a good way to stay connected and involved
with National Prevention Week is to sign up for our prevention works email listserv so
you can receive NPW updates and news about NPW 2019. Scroll to the bottom of the page where it
says stay connected on the right sidebar of the main NPW page to sign up today. Our site features many resources and tools
for anyone to use to participate in NPW and engage audiences in substance abuse prevention. So check out the news and announcements section
for the latest additions and activities. And if you have any questions about NPW, please
let us know in the chat pod. Now, as we all know, prevention doesn’t only
happen once a year or once a week. Prevention should and does happen every day. Every year, National Prevention Week is the
culmination and amplification of your prevention activities that are taking place each and
every day year round. And even with all of our 2018 successes, don’t
forget that you can use the NPW tools and resources that I had mentioned to help you
keep the prevention conversation going year round. So lastly, to get ready for National Prevention
Week 2019, SAMHSA is excited to expand one of our three NPW goals to include a focus
on showcasing effective and successful evidence-based prevention programs across the country. Organizations and communities are looking
for effective models to emulate and learn more about these evidence-based programs will
help the working that you are implementing in your communities to not only prevent opioid
addiction, but other health themes featured in our NPW activities as well. Now, if you have a program that could be a
great example, we look forward to hearing about it in the months ahead. So with that, let’s start today’s program. I’d like to introduce our first speaker. Captain Jen Fan, or Jennifer Fan, is the Acting
Deputy Director of the Center for Substance Abuse Prevention. She is also CSAP’s subject matter expert on
prescription drug and opioid abuse. So without any further ado, welcome my colleague,
Jennifer Fan, and thank you, Jennifer, for kicking off today’s conversation. Jennifer Fan: Thank you, David and thank you
SAMHSA for inviting me to speak. I’m really honored to be a part of this panel. As you know, the United States has been in
the grips of an opioid crisis for a few years and I just want to put out there that the
things that we do, it’s important to evaluate those programs and the responses and see if
there’s room for improvement. And so in terms of my presentation, I’ll touch
– first I’ll touch upon the national data on the opioid crisis and then I’ll go ahead
and go into what SAMHSA is doing in regards to this and what prevention resources are
out there from SAMHSA. This chart shows misuse of prescription pain
relievers and other prescription psycho-therapeutics in 2016 from the National Survey of Drugs
used – sorry, National Survey on Drug Use and Health. It’s a long acronym, NSDUH. So basically, in 2016, when looking at people
ages 12 and older, 3.3 million people were current misusers of pain relievers. 1.8 million people had a pain reliever use
disorder and it compared to 2015, there were two million people. So the number is actually going down, which
is great. Unfortunately, nearly 600,000 people had a
heroin use disorder and compare that to 2015, that number is about the same. If you look at adolescents and young adults,
239,000 adolescents, which is ages between 12 to 17 were current misusers of pain relievers. 631,000 of young adults ages 18 to 25 had
misused pain relievers in the past month. So also in 2016, we had 42,249 opioid overdose
deaths, which is equal to 116 Americans die each day from an opioid overdose. And this is the highest and five times higher
than in 1999. 77% of opioid overdose deaths occur outside
a medical setting, so in April 2018, the Surgeon General issued an advisory to urge more people
to have naloxone on hand and know how to use it. This is a graph from CDC and it tells a story
of what has been happening since year 2000. Overdose deaths from prescription opioids
have been overall decreasing since 2011. That’s the good news. However, if you look at heroin, you see the
rise in heroin in 2010, which is slightly before the decrease in prescription drugs
and it shoots up. And heroin related overdose deaths more than
quadrupled since 2010. Nearly 13,000 people had died in 2015, more
than doubled for 18 to 25 year olds in the past decade. And the thing to note is non-medical use of
prescription opioid is a key risk factor for conversion to heroin use. Approximately three out of four new heroin
users report that they had abused prescription opioids prior to using heroin. Now, if you also notice, other synthetic opioids
that has also increased dramatically and that has fueled – the target drug there is fentanyl
and that actually has fueled the rise in the heroin overdose deaths. According to DEA, the number of fentanyl reports
has been rising since 2013. So in 2013, there were 978 reports of fentanyl
seizures from DEA. 2014 – 4,697. 2015 – 14,440. And in 2016, 34,204 reports were on fentanyl. So from 2013, 978 to 2016, over 34,000. Fentanyl is 25 to 50 times more potent than
heroin. They have also seen carfentanil also being
in the heroin and carfentanil, which is an elephant tranquilizer and it only takes about
two milligrams of carfentanil to bring down and elephant. And carfentanil is 100 items more potent than
fentanyl. What the White House is doing, the White House
has put out basically three initiatives on March 19, basically to reduce drug demand
through education awareness and preventing over-prescription. Two, to cut off the flow of illicit drugs
across our borders and within our communities, and three, saving lives by expanding opportunities
for proven treatment for opioid and other drug addictions. The good thing is that many of SAMHSA’s
opioid prevention programming is already in place to support these three initiatives. HHS has also put out a five point strategy
to address the opioid crisis. The first one is better access to addiction
prevention treatment and recovery services. The second one is to have timely reporting
of data as well as increasing the quality of the data. The third is to have better pain management
protocols of evidence based methods of pain management have that readily accessible and
implemented. The fourth, having access to naloxone, not
just access to naloxone but the training of how to use naloxone and with it, it also comes
with education and increased knowledge of what an overdose is, what do you do in case
of an overdose in addition to what naloxone is, how to use it, and all of that information. And the fifth and final strategy point is
better research, not just on addiction but pain as well. Now, this is the behavior health continuum
of care fan and we know that in order to address this opioid crisis, all parts of the fan needs
to be targeted. So promotion, prevention, treatment, and recovery. And in the prevention arm where I’m at,
all three categories are programs to address. Universal, which is a broad population base. Selective, targeting those high risk communities,
and indicated, going more to the individual where they’re using but not yet diagnosed
with an addiction. Now, this data graph basically informs us
where those prevention programs needs to be targeted. If you notice the red portion of that circle,
that’s 53%. 53% of the people who misuse their prescription
drugs receive them from a friend or family, whether it’s for free, stolen, purchased,
whatnot. And
where those medications are attained from, they’re originally prescribed by a physician. The second large portion of the pie is the
lighter blue section, 38%. 38% of the people who misuse their prescription
drugs receive them from a healthcare provider, whether it’s been prescribed or stolen. The other portion, 6%, bought from a drug
dealer or stranger and 3% if other, such as online pharmacies or things of that nature. So basically, target audience for prevention
programs, your prescriber as well as the general population about providing them knowledge
of the risk of giving a friend or family member prescription meds without a prescription. This is basically a list of SAMHSA and HHS
programs that address the opioid crisis. We had state targeted response grants. That goes to states. We had block grants. We had programs that provide education, training,
and accessibility to naloxone. We do have programs that target pregnant and
post-partum women, especially in regards to the neonatal abstinence syndrome. We have criminal justice programs, recovery
housing training programs, and family inclusion medical emergencies. We definitely want to provide more outreach
to the families so that when a person is connected to treatment services and recovery, you want
to make sure that they have the support that can help them maintain the recovery process. Very quickly, we have a lot of prevention
grant programs. They basically fall into a variety of buckets. The first one, community based coalition,
enhancement grants to address local drug crises. It’s a long name but these grants are basically
your primary prevention grants to communities. These are in connection to our drug free community
support program grants. And those are relatively new, and they go
directly to the community. The second one, strategic prevention framework,
partnerships for success, SPF PFS. This is an older grant program that we have,
and it targets two of our top prevention priorities, underage drinking for those between ages 12
and 20 and prescription drug misuse and abuse among those between 12 and 25. These are also utilizing the primary prevention
programs to target these audiences. There’s 70 awards and four cohorts. The next one, strategic prevention framework
prescription drug, SPF RX. This is also the primary prevention program
use. Basically, it encourages states — these grants
go to states — it encourages states to look at their prescription drug monitoring program
data to see where those hot spots are in your communities and states. And then once you have identified those, you
use your primary prevention programs and you put those programs in those communities. So it’s a more efficient use of your resources. The next three bullets, they fall into the
naloxone bucket. The first two are basically providing education
and training to first responders about naloxone – first responders as well as communities
as well, but in regards to naloxone. In addition too, those funds can also be used
to purchase naloxone and use them for also to create the kit and to distribute the naloxone
as well. And lastly, the state targeted response to
opioid crisis grants, otherwise known as Opioid STR and this grant puts together prevention,
treatment, and recovery and the money goes to states and the states have to have a comprehensive
strategic plan that addresses all three sections of the prevention, treatment, and recovery. In the past, there was an 80% must be used
for treatment, I believe 5% for administration – administrative items, and the rest can
go to prevention and recovery. But remember, the strategic plan has to encompass
prevention, treatment, and recovery. Just recently, not too long ago, that 80%
cap has been lifted. So there is no cap. So the state can use their discretion of how
that money is going to be used. In terms of prevention resources, 2013 was
our opioid overdose prevention toolkit was released. It’s very user friendly and you can pull
out certain sections and provide it to certain types of audience. So for example, there’s a section that can
go to prescriber. There’s a section that can go to community
leaders. And basically, it talks about naloxone, what
it is, how to use it, how to identify an overdose, what to do if you come across a person who’s
going through an overdose. There’s been one revision. It’s also in Spanish and I believe we’re
going through another revision to try and incorporate the information on fentanyl since
fentanyl is so much more potent than heroin. It sometimes takes more than one or two doses
of naloxone to be successful in reversing that overdose. We also have this past December released 13
fact sheets titled prescription pain medications, know the options, get the facts. And these are designed to increase awareness
of the risks associated with prescription opioid use and misuse, as well as educate
patients who are prescribed opioids for pain about the risks and provide resources for
methods of alternative pain management. SAMHSA also sponsors online training for prescribers,
how to prescribe opioids for chronic pain, what other options there are for pain instead
of going straight to an opioid, and when a patient is on an opioid, what to do, how to
monitor a patient, urine analysis, all of that information. We also had naloxone training for the prescriber
and pharmacist online as well. And then my last slide. So we know that in order to address this crisis
effectively, we need to be able to collaborate with so many types of people in the community. On the slide, it lists a variety of stakeholders
that can be included. But you also have to think, who is not at
the table. Who do we usually not work with but can have
an impact on this crisis. So I think take a pause for a minute and just
think about who else could be part of your community that can have an impact on this. And that is the end of my presentation. Do I go ahead and hand off to the next one
or… David Wilson: You can hand it right back over
to me, Jennifer. Thank you. Jennifer Fan: Thank you, David. David Wilson: Very valuable information but
you really did a great job of giving a good overview of all the things that SAMHSA has
to offer when it comes to opioids. I just wanted to remind everybody, if you
have questions please, please, please put them in the chat box. And I saw one question that came in, so I
want to remind everybody that the slides will be available after the webinar. So you will have all of the resources and
information at your fingertips. So next, our next speaker LeShaundra Cordier,
is the communications team lead for the Center for Disease Control and Prevention’s National
Center for Injury Prevention and Controls Division of Unintentional Injury Prevention. LeShaundra Cordier: That’s a lot of prevention. David Wilson: A lot of prevention, which is
great. But in this role, Ms. Cordier provides guidance
on the planning, implementation, and evaluation of health communications and marketing activities
for the division. Previously, she has worked as a health communication
specialist at CDC with the National Center for Environmental Health in their division
of laboratory sciences, and with the Office of Public Health Preparedness and Response
in the Division of Emergency Operations. Ms. Cordier has a Bachelor’s in Psychology
and a minor in Mass Communications from the University of Georgia and researched non-verbal
communication. She also holds a Master of Public Health with
a Specialization in Maternal and Child Health from the University of Georgia. And I am so pleased to have her as one of
the speakers representing one of National Prevention Week’s federal partners, the
CDC. So take it away, LeShaundra. LeShaundra Cordier: Thank you and I am very
happy to be here so good afternoon, everybody. And as mentioned, my name is LeShaundra and
I’m a health communication lead in CDC’s National Center for Injury Prevention. And today, I’m going to talk a little bit
about some of CDC’s cross-cutting work in response to the evolving opioid epidemic. First, I’m going to highlight some data
similar to Jennifer, the previous presenter, and then I’m going to cover how CDC is partnering
in the space and working to prevent opioid related harm and overdose deaths. Finally, I’m going to highlight the importance
of partnering and increasing public awareness, along with some resources that CDC has developed
to help those fighting this epidemic on the front lines. So I’m going to start with some data and
I’m going to see if I can get my slides to work. So first up, what you’re looking at is a
snapshot of trends over the years and we all know that many have been touched directly
or indirectly, family members or friends, with opioid use disorder or an opioid overdose
death. In each of the personal stories that I think
we’ve all heard and continue to hear are really reflected in the data that we’re
seeing and what you see in front of you is a time series map that shows county level
drug overdose deaths starting from 2000 to 2016. And you can see the shift. We all know that drug overdoses are on the
rise and the trend is very evident in these maps that it continues to go up and is unrelenting. Every state is seeing dramatic increases in
death rates. Some states in the Appalachia area, the Northeast
and the Southwest being amongst the hardest it. So I just wanted to kind of showcase that,
so people can kind of see. The next slide I’m going to talk to you
about is really focusing on the change in the epidemic over the last few years. And Jennifer spoke to this a little bit in
her data, but what we’ve seen from 1999 to 2016 that there’s been more than 350,000
people that have died from an overdose involving any opioid, whether it’s prescription or
illicits like heroin. The epidemic is continuing to evolve and the
rise in opioid deaths can be outlined in three waves. The first wave we kind of see began in the
‘90s with the increased prescribing of opioids and overdose deaths increasing, involving
prescription opioids specifically. The second wave began around 2010 with rapid
increases in overdose deaths involving heroine, and then the third wave really started around
2013 where we started to see some real increases in overdose deaths involving synthetic opioids,
particularly those involving fentanyl or illegally manufactured fentanyl. And we’re finding that illegally manufactured
fentanyl can often be found in combination, as mentioned before, with heroin, counterfeit
pills, cocaine, and other drugs. So as this epidemic continues to evolve, opioid
overdoses continue to increase across all regions of the United States and for both
men, women, and most age groups. So what does that mean? I think we all know that this epidemic is
devastating families across America. In addition to the serious risk of addiction,
and abuse, and overdose, there are other opioid related harms that I want to note before I
get into the rest of my presentation. One, we’re seeing an increase in issues
that occur in newborns exposed to opioids and that includes neonatal abstinence syndrome
or neonatal withdrawal syndrome, which is withdrawal symptoms, including irritability,
seizures, vomiting, diarrhea, fever, and poor feeding in newborns. There’s also adverse childhood experiences
that are happening – both positive and negative where you’re seeing increases in children
in the foster care system, as well as other exposure to abuse, and neglect, and traumatic
experience that impact all individuals as they’re growing up in any households. So this is particularly something we’re
seeing in households where there’s substance and the negative consequences of that. Additionally, I want to point out that other
opioid related harm that we’re seeing are things like hepatitis and HIV infections,
which are increasing. And for us and I think for everyone, part
of attending to the opioid epidemic also means addressing these health outcomes, not just
focusing on opioid use disorder or opioid specifically. It’s all kind of interrelated there’s
a bigger piece of the puzzle that we have to put together. So CDC is working to do some prevention in
this space and so our focus is typically around preventing opioid overdoses, but we’re committed
to doing that and working to save lives to prevent all negative health effects of this
epidemic. And we take a public health approach to addressing
the key aspects of the epidemic and truly focus on a few things that I want to highlight. One is improving data quality and tracking
trends. So we do conduct survey and research to better
understand and respond to the epidemic. We also collect and analyze data on opioid
overdoses to better identify areas that need assistance and to evaluate prevention efforts. We’ve also been focusing on building prevention
efforts and equipping states with resources, not just improving data collection. So making sure that they have the support
that they need for evidence-based strategies. Some of the work CDC does in this space includes
three particular programs where we equip states with resources needed to address the epidemic. The three programs we focus on are prescription
drug overdose, data driven prevention initiative, and the enhanced state opioid overdose surveillance
initiative. And those three programs really provide resources
and information to help combat prescription and illicit opioid abuse and overdose and
they’re really at the heart of the work that we do here at the injury center. The other aspects of our work focus on supporting
healthcare providers and health systems and we do that by providing data, tools, guidance
like our CDC guidelines and other evidence-based decision making tools to help improve prescribing
practice and increase patient safety. We also partner with public safety and that’s
another aspect of what we’re doing. And that includes law enforcement and others
to help address the growing illicit opioid problem. And then finally, the thing that I’m going
to be talking about the most is really encouraging consumers to make safe choices and empowering
them in that space. And so part of that means for us, raising
awareness about prescription and other opioid misuse and overdose. I think in the long-term it’s important
to note that our work will hopefully reduce opioid related harms like opioid use disorder
and hepatitis and HIV and ultimately, will reduce the number of opioid overdose deaths
that we’re seeing in communities across the nation. So this slide is important to cite the importance
of connection and community. So this is a national epidemic. It does need community based solutions and
we found that some of the best ways to prevent opioid overdoses specifically are to improve
prescribing, reduce exposure to both illicit and prescription opioids, prevent misuse,
and as has been mentioned before, treat opioid use disorder and provide treatment for those
in need. So prevention and response really does take
a coordinated effort and that includes communities, healthcare providers, public health, law enforcement,
and all other sectors to really address this ongoing problem. And CDC, we think and hope that we’re helping
facilitate that prevention, that preparedness, and those response activities by supporting
states and local communities and tribes in their efforts. So I’m going to share some of the resources
that have been instrumental in our partnerships and talk about some of those partnerships
and the products that have resulted from them. So I’m going to skip to Slide 13. So I want to talk about the problem of prescription
opioid use. We’re finding that nearly 200,000 people
have died from overdoses involving prescription opioids since 1999. And in 2016, we found that we were losing
46 people a day just to prescription opioid overdose deaths. So I do want to highlight some of the more
common drugs involved in prescription opioid overdose are things like methadone, oxycodone
or OxyContin, and hydrocodone or Vicodin, things like that. And what we’re seeing is that the research
shows that there are risk factors that make people particularly vulnerable to prescription
opioid abuse and overdose, and that includes things like taking overlapping prescriptions,
taking high daily doses of prescription pain medication, having mental illness or a history
of alcohol or other substance abuse, and living in areas — rural areas — or having low income. So we’re seeing an increase and the data
on the slide really shows that in 2016, there were over 214 million prescriptions dispensed
in the U.S. and over 17,000 deaths involving a prescription opioid specifically. And as part of our efforts to combat that,
we launched a campaign. So for us, it was really important to help
Americans understand the severity of the epidemic and raising awareness, as I’ve mentioned
before, about opioid use disorder and overdose is kind of the key component of prevention. So we launched the Rx Awareness Communication
Campaign, which features testimonials from people who are recovering from opioid use
disorder and those who have lost loved ones to prescription overdose. The goal of the campaign was really to educate
about the risks and then focus on the importance of discussing safe and more effective pain
management options with healthcare providers and also promoting awareness of risks associated
with recreational or non-medical use. So the campaign itself targeted adults 25
to 54 and as I mentioned, features real stories of real people. So it only takes a little to lose a lot is
our tagline and the campaign, which is evidenced driven, really looked at folks who were negatively
impacted by prescription opioid use. We ran a 14-week pilot in four states – Ohio,
Oregon, Rhode Island, and West Virginia. And in 2017, after a successful completion
of our pilot and evaluation of that pilot, we launched the campaign in four additional
states – Kentucky, Ohio, Massachusetts, and New Mexico. We chose those states and some of the counties
specifically in those states because of burden and level of interest and readiness around
the campaign. However, we anticipate partnering with others
to increase launch and reach of the campaign message. So what we did was we designed this campaign
specifically for states and local health departments, and community organizations really to use
and tailor the Rx Awareness campaign messages themselves because they were pre-tested materials
that we knew were successful and effective. We developed these resources and made them
available for free, so partners could launch campaigns of their own, support local prevention
activity that were going on with the shared message, and then again, raising awareness
about risk. And so the materials that we’ve developed
included digital advertisements, everything from static to animated web ads. We created social media advertisements and
post. We created radio PSAs, television commercials,
as well as digital videos, and then billboards and out of home placements like posters and
bus ads. Then I
just want to move into some other resources that we have available. So we also partner with quite a few providers
and health systems to create and disseminate education and training. So in an effort to really help support healthcare
providers, which is one of those elements that I showed earlier, we really wanted to
improve the way opioids were being prescribed. So we launched a series of interactive online
training specific to providers. The trainings feature recommendations from
the CDC guidelines. They provide sample scenarios, feedback, resources,
conversation scripts to help patients and providers discuss opioids and the series is
available completely for free with continuing education and medical education credits offered. There are going to be 11 modules in this training
series. We’ve got five that have been posted to
date and then previous to this, we released a seven part webinar series as part of our
clinician outreach and communication activity, in partnership with the University of Washington
to help providers in general choose the most effective pain treatment options and improve
patient safety for prescribing. So we really focused on getting providers
what they needed and training them after listening to what they were looking for, and needing,
and providing them with something that could also give them medical education. Then we developed a mobile app as well, because
we heard that there was a need for readily available information at your fingertips. So to help that, we worked with providers
as well on content to develop a free mobile app that is available to all that are on Android
or Apple and it has the clinical recommendations from the CDC guidelines and helps put them
into practice by providing you immediate tools and resources. So we know that managing chronic pain is complex,
but we feel like accessing prescribing guidance shouldn’t be. And so the app is free, as I mentioned before. It includes an MME or a morphine milligram
equivalent calculator, which is helpful to providers, physicians, pharmacists. And then it also has a summary of the recommendations,
an interactive interviewing feature to help providers again practice effective communication
skills and a series of other links and resources to other activities and options for them if
they need information. We also partnered to develop patient materials
and public facing materials. And so we’ve developed a series of educational
resources, including those with partners. We worked with federal partners and others,
like the American Hospital Association, to develop factsheets and other materials that
can raise awareness among patients about the opioid epidemic and the role that they truly
play in the prevention aspect of that. So we’ve got infographics around outlining
ways to manage chronic pain, key concepts around our CDC guideline, talking about discussing
and conversation starters for patients. So we’ve got a lot of information in that
space. We’ve got audio podcasts available at the
link that you see on the screen. We also have informational factsheets about
what you need to know about opioids, if you’re prescribed opioids. Another one-pager that can be easily read
and used to help really increase patient knowledge and their confidence and safety regarding
pain management. So there are several factsheets that we cover
topics like opioid and pregnancy, opioid and chronic pain as I’ve outlined, and then
also acute pain and knowing the symptoms of an overdose. So we have a tip card. That’s the image on the screen here that
talks about signs and symptoms of an overdose, what to do if someone is overdosing, and the
steps you need to take in terms of helping prevent that. So this is my final slide. And I put this here for several reasons. One is a reminder that everyone really plays
an important role in preventing opioid overdose deaths. I think through education, partnership, and
collaboration we really get to our goals a lot quicker and we’ve learned in our space,
at CDC, that we’ve had a lot of successes with partnering and working with communities
to get this information out and to create more. I feel like as an individual, we can all learn
more about opioids to help people who are most at risk for opioid use disorder or overdose
in their own community, really increasing awareness and sharing best practices, whether
that’s with providers, or patients, or community members. Also, making sure that there’s tools available. We developed these tools but work with states
and others to help disseminate them and really is important for healthcare professionals
and others working in overdose prevention and treatment to have the information that
they need. And then as a reminder, I think helping those
struggling with addiction is important and that we need to help find people care and
treatment necessary, and then truly supporting the work in your states. I mentioned the overdose programs that we
have here at CDC. But I think there’s just so much more that
can be done at the state level and at the federal level, and we can all better collaborate
in that space and I think Prevention Week is a nice opportunity for us to talk about
it and continue the conversation. So I thank you guys for letting me take some
of your time today. My contact information is on the slide and
then I will turn it back over to David for the next presenter. David Wilson: Thank you and I cannot thank
you enough for not only that wealth of information. I was particularly struck with all of the
infographics that I know as I talk to folks around the country, those are the resources
that they use the most and I’m glad that we have them in your slide deck, so they can
be available to the people who are listening to our webinar. But one last thing, LeShaundra. Your presentation also exemplifies how we
at the federal level are coordinating against this one common goal to address this issue. So thank you. Our next speaker is also a National Prevention
Week Partner organization and Dr. William Haning is going to be sharing with us what
he does at the organization of ASAM. Dr. Haning is an emeritus professor of psychiatry
and the task director of MD programs in the Office of the Dean at the University of Hawaii. He directs training and resource programs
in addiction medicine and addiction psychiatry. He is certified in psychiatry, addiction psychiatry,
and addiction medicine. Dr. Haning is an at-large director of ASAM. He chairs the ASAM publications council. He sits on the policy committee, participates
in the chapter council, and is editor in chief of the ASAM weekly and co-editor, co-author
of the ASAM pain and addiction handbook. And I know he is going to have a wealth of
information for us. So welcome, Bill. Dr. William Haning: Thank you, David. Well, I’m afraid that uses up most of the
time. So thank you all very much. I’ve actually got a fairly simply job here
compared to both Jennifer and LeShaundra. I’m going to try and give a real brief overview
of what the American Society of Addiction Medicine Strategic Plan is as well as its
focus, talk a little bit about a collaboration we’ve had with two partner organizations as
an example of how those things work and then talk a little bit more about our publications
and particularly one that has just come out. I think it’s probably not general knowledge
that the American Society of Addiction Medicine started up as far back as 1954 and it was
intended to fill a gap in terms of physician understanding of the process of addiction
and the then available remedies for it or interventions possible. What started out with an incredibly cumbersome
name, the American Medical Society for Alcoholism and Other Drug Dependencies, or AMSAODD, fortunately
became abbreviated to ASAM, American Society of Addiction Medicine and a number of the
listeners may be familiar with that from the ASAM Criteria, which are a formal algorithm
for knowing where to place people in treatment who are seeking care or who are in fact being
directed to care for substance use disorders. We’ve got about 5,000 members, most of whom
are doctoral level providers, actually most of whom are physicians, MD or DO and there
is a – present in most states, there is also a subordinate organization or collaborating
organization in the form of state societies so each of these societies forms a part of
a confederation that contributes to the larger mission of ASAM. They are all expected to support the same
ethical code and pursue the same mission as ASAM, but they provide – on an individual
state basis – the opportunity for folks who are listening now to actually advocate for
and intervene with legislative bodies and to promote care intervention practices and
policies. So I encourage folks to find out who is representing
your American Society of Addiction Chapter in your particular state and be willing to
make contact with them because if there is one thing that of course will ensure that
we’re not successful in managing this public health issue, it will be fragmentation of
our efforts. Probably only cohering together is going to
work well and that’s of course part of why we’ve got a webinar today involving several
different agencies. Addiction – I’ve thrown up a component of
the long definition that comes on the ASAM website – that addiction is a primary, chronic
disease of brain reward, motivation, memory and related circuitry. Now the definition goes on for another three
paragraphs. It makes good reading because it does, in
fact, amplify understanding of how best to provide intervention. We can distinguish between addiction and a
great many other chronic, relapsing, progressive disorders based on one peculiarity of it;
the disease itself tends to conceal the disease from the person with it. So when we’ve got someone who has an alcohol
use disorder, for example, or in this case, opioid use disorder, the drugs themselves
are solvents for judgment. If you are subjectively experiencing addiction,
then it acts to the exclusion of an understanding of addiction. So the biggest obstacle is one you don’t encounter
quite so much – when you’re trying to manage diabetes or tuberculosis, and that is a failure
on the part of the person who is suffering to actually understand that they are sick,
full stop. Let me move on to the strategic plan here. This is something that ASAM has developed
on a cyclical basis since its inception and the most recent iteration of it really emphasized
the need to form what Lou Baxter, Dr. Lou Baxter called the big tent and that is an
effort to try and bring together as many of the organizations that have an interest in
treatment and intervention as possible. Now present here on this call are a number
of federal agencies and one public organization which is the Boys and Girls Clubs. ASAM is one really of many professional organizations
that have this targeted mission which is to intervene successfully with want is an endemic,
periodically bursting out as an epidemic. The other ones, just to give you an idea of
the word salad involved, American Academy of Addiction Psychiatry, the Association for
Medical Education and Research in Substance Abuse or AMERSA, another federal agency or
federally supported one, the Office of National Drug Control Policy. There are many examples of these organizations
that share a similar intent and what ASAM can provide with them, at least, the professional
organizations, is a large tent in which to congregate. Dr. Fan’s presentation emphasized that a public
health model is probably the most appropriate way of conceiving of this issue, in large
part because the public health model describes primary, secondary and tertiary interventions
which means preventing it in the first place from ever starting, interdicting at an early
enough stage to effect a cure or in the case of the tertiary prevention efforts, minimizing
the transmission or the likelihood of transmission to other folks. Otherwise, opioid use in the fashion we’re
seeing in this country really does follow the same model as propagation of the influenza
virus, from person to person to person and a lot of the factors that are essential to
preventing propagation of influenza apply when we’re talking about suppressing and ultimately
dealing with opioid use disorders. Quick emphasis, our new strategic plan is
really just an adaptation to the available resources to try and bring in more folks. The issue at hand is one that goes back several
centuries and this is not an opportunity to start a lecture about opioid use disorder
in this country but it’s actually, in some respects, a pretty mundane issue. The same drugs have been around for a long,
long time causing the same kind of disability and disruption. The plan focuses on really a future where
there is effective prevention, treatment, remission and recovery accessible to everybody
and profoundly improve the health of everybody, bearing in mind that addiction of all sorts,
not merely opioid dependence, is very much a family illness or very much a community
illness. There’s the one identified official sufferer,
the person who is using the drugs, and then of course, there are all the other folks whose
impairment or difficulties derive from the experience of the identified person with substance
use disorder. Somebody out there help me and come up with
a much better term than addict for a person with substance use disorder. This is an ongoing discussion or theme in
a number of the fore mentioned organizations so we’ll come up with something. Meanwhile, people with addiction impact, whether
intentionally or otherwise, many more folks than just themselves. So a great deal of the prevention access of
this involves interdiction at schools, working with patients and families and then of course
ensuring that the providers themselves are in a position to actually offer substantive
aid. It’s one thing to be sympathetic, it’s entirely
another thing to be effective. The collaborations that we’ve had, just wanted
to give a quick example of that. I’m going to try to be brief by the way here,
folks because I am anticipating that with over 500 folks signed on, we might just might
have some questions. We already, or ASAM, speaking of we, collaborate
with a number of organizations. I gave three examples here on the slide that
you can read through. A couple that are particularly useful to keep
in mind were the American Academy of Nurse Practitioners, excuse me, American Association
of Nurse Practitioners and the American Academy of Physician Assistants who have collaborated
most recently with ASAM in providing access to education surrounding medication-assisted
treatment. That’s what this slide is meant to refer to,
it’s just a mnemonic for me to remember to mention how this works. The three organizations got together and effectively
came up with an improved access to the training course that would ensure that these other
physician surrogates or other health care providers, beyond simply MDs and DOs would
be in a useful and safe position for prescribing buprenorphine or other agents that interdict
against opioid use. Folks may not be aware but there’s actually
a certification process associated with using buprenorphine, any of its brand names. That certification process is fairly brief,
but that’s not quite the same thing as saying the folks feel comfortable using the medication
in all contexts. If I am a naïve 15-year-old and I open the
operations manual for an automobile, I may get the sense that I know how to drive it,
but at my own peril when I actually get behind the wheel and start steering. Panic should then rightly set in and so it
is with a lot of folks who will be trained in buprenorphine administration, it’s commonly
necessary to have after trainings and on-going mentoring in order to make people comfortable
about safe usage of these medications, but we have programs that ASAM and in fact other
professional organizations support such as ACSS. Of course, I slipped by this slide which was
to give some credit to the other folks with whom ASAM works in a general partnership. These are folks who sit under the big tent. They are by no means all the same act, everybody
brings a different set of skills and a different set of aptitudes to this. I think probably if there is one thing that
I’m going to provide here that may be of some utility, it’s going to be really just the
web address for American Society of Addiction Medicine dot org and note to all of you that
there is a great deal there in resource material and in links that will lead you to a more
informed practice of intervention and treatment. So on that topic, we actually are a publications
agency of our own. We have our own Publication Council, it produces
texts, it produces journals, the Journal of Addiction Medicine is a leader in the field
among physicians and principally doctoral level providers. There is a weekly that we put out in free
electronic or email form that is actually kind of a blog of available links for current
publications in addictions. That comes out on a let’s say on a weekly
basis. We try to keep it as current as items that
have popped up in the journals within the past couple weeks. By way of disclosure, I do edit that journal,
but it is a free membership for anybody who goes online to ASAM.org. Look for ASAM Weekly and it’s simply a question
of submitting your email address and we’ll send you that copy on a weekly basis. A recent publication and again, acknowledging
my own complicity in this, I’m one of the editors, is the text Pain and Addiction, but
the real reason for mentioning the fact that we have a text is that it filled a gap. In the course of discussing ASAM’s response
to the pain management difficulties that are associated with ongoing substance use disorder,
it occurred to us there was no one text that attempted to address both problems simultaneously
and the overlap between them so a composite of views was drawn together in this most recent
publication. It’s just come out in the course of the past
month and some references to it are already beginning to pop up elsewhere. The most important element about this text
is that it reflects an on-going curriculum that occurs on an annual basis at the ASAM
Scientific Conference. We’ve had most of two decades of a pain and
addiction course, which attempts to educate folks at every level of intervention, Master’s
level and above, in how best to deal with the very challenging issue of management of
pain in the context of addiction. So there, I think I have probably been blissfully
brief. For anybody who is listening in on this, I
have to tell you, staring at a wall while addressing a partnership of 600 folks is a
little daunting because I can either imagine you all sitting back there and being bored
to tears or I can delude myself into thinking that what I’m saying is really interesting. If you have any doubt about either, my address
is Haning – H-A-N-I-N-G – @hawaii.edu and no, we are not plagued by volcanos across
the entire chain right now, merely on a corner of one island. I’ll turn this back, I think, to David at
this point and we’ll stand by for the next speaker. David Wilson: So thank you, Bill. What I love about you being a part of this
presentation is that I think it’s always valuable when we’re talking about opioids to know that
pain and addiction is part of the discussion. So thank you for bringing that piece to it,
and also thank you for being on the phone with us because I imagine that it’s somewhere
around 5:00 or 6:00 am in Hawaii. So our final speaker is Lauren Barineau, and
she’s the Senior Director of Youth Development at Boys and Girls Club of America overseeing
health and wellness strategies, initiatives and programs to enhance health in our school
time through social and emotional development and health promotion practices. She brings to us 10 years of expertise in
adolescent health, curriculum development and training and technical assistance to this
role having previously been an integral part of the adoption of adolescent health programs
in Georgia School Districts. And just as a side note, Lauren is proud to
have been recently recognized as one of Boys and Girls Club of America’s rookie of the
year. Congratulations and welcome, Lauren. Lauren Barineau: Thanks so much, David. I didn’t realize that last note would be included
about me, but it is something I’m excited about. David Wilson: We do our homework. Lauren Barineau: Sure, thank you. So welcome, all. My name is Lauren Barineau and I’m a Senior
Director of Health and Wellness at Boys and Girls Clubs of America. We’re excited to be presenters on this webinar
to share our substance use prevention strategy and a very specific resource guide that we
just recently released to support its adoption in clubs. So I’ll walk through sort of some of Boys
and Girls Clubs’ history and then dive into the resource. So as an organization, Boys and Girls Clubs
of America is in a unique position because more than – more than 150 years we have
really opened our doors during out of school time to give young people a safe place to
learn and grow in those after school, evening and summer hours. And that out of school time gives us some
really vital opportunity to reach young people who need use the most. Our vision to keep all members on track to
graduate from high school with a plan for their future; to demonstrate good character
and citizenship and to live a healthy lifestyle. What really makes our clubs unique is that
we are everywhere. Boys and Girls Clubs are in almost every congressional
district in the US. We are in urban, suburban and rural neighborhoods,
we are on military installations and we serve native youth. We have over 4300 clubs and reach over 4 million
youth annually. And so we define what we call the Club Experience
as the sum total of everything that a child receives or experiences when they walk through
the door, so the facility, the staff and their staff practices, the programs, the schedule
of activities, and through a lot of research we’ve determined that there are really five
core key elements that create a high quality club experience for kids. So members should, when they come through
our doors, feel physically and emotionally safe; they should have fun; they should receive
support and recognition from caring adults who set expectations for them; and they should
always feel a sense of belonging. And so by setting the club experience, we
have realized that young people that have a high quality club experience have stronger
outcomes, so kids are more likely to graduate from high school, be physically active and
have healthier choices, to volunteer and to believe that their schoolwork is meaningful. So here at BGCA we are highly focused on providing
high quality youth development experiences so that every young person who enters a club
has the highest quality experience possible. So what we were hearing is that many of our
clubs are located within areas of the US who’ve been particularly hard hit by the opioid epidemic. And clubs with – exist within communities
and so as a result they’re really grappling with the effects of the opioid epidemic. So what we were specifically hearing is that
clubs were looking for how to support staff and youth members dealing with trauma from
loss as a result of the opioid epidemic; clubs were looking for tools to really promote substance
use prevention within their clubs and within – with their members. And really clubs were also looking for resources
and guidance for working with communities more broadly on this issue as several previous
presenters have mentioned, this sort of work does not happen in one space alone but among
communities broadly. And so as a response to this call for action,
BGCA developed a substance use prevention strategy and a resource guide to very specifically
get clubs started in implementing some of this strategy work. So based on evidence-based practices and current
research, BGCA developed a substance use prevention strategy and key pieces of established research
and framing that really guided our work were both NIH’s prevention principles and SAMHSA’s
strategic planning framework. And from this – and really guided by this
– we developed a strategy that we knew would best meet the needs of really diverse group
of clubs. So our primary work is to recognize that many
of our youth, and therefore subsequently the staff that serve them, their families and
people in their broader communities, have very likely experienced trauma in their lives. And in many ways the use of opioids in their
communities was compounding this trauma or introducing new trauma. So therefore we developed a strategy that
recognizes this trauma and integrates specific trauma informed principles and approaches. And you’ll see this referenced and described
throughout the guide and really included in many of the tools and activities. In addition, we focused specifically on building
social and emotional development skills as a core health promotion practice. As many of you know, substance use prevention
research indicates that youth with more developed SCB skills are less likely to use substances. So our strategy focuses on building the four
core skills of healthy relationships with self, healthy relationships with others, emotional
regulation and responsible decision making to drive the building the skills necessary
to avoid substance use. And then finally our strategy is guided by
sort of a whole child approach to really ensure that club members are seen as responded to
as their whole selves. So we are responding to emotional, physical
and mental wellbeing and we’re guiding and supporting young people to be successful over
a lifetime. And so this means that we’re integrating
and engaging families and communities within substance use prevention work to ensure that
youth are receiving consistent messages about substance use and feel supported throughout
all aspects of their lives. And again, you’ll see these elements show
up throughout the substance use guide as the underpinning of our approach. So let’s talk about the guide a bit more
specifically. We designed this tool to support the adoption
of our strategy and within it, and the front matter, we provided a broad overview of the
opioid epidemic and the role that clubs can play. So this includes pullout infographics or FAQ
sheets that describe adverse childhood experiences and other types of trauma, the use of opioids
and substances and the ways those are related and other helpful information to frame and
contextualize the issue. Now I’ll be clear, our guide is certainly
not brief, it’s a rich 130 pages and so what we did was divide it into four clear
sections for maximum usability. So first we really built the capacity of staff
to be prepared to address opioid use with club members in the club setting. We, secondly, engaged youth in their own prevention
efforts to really facilitate youth-led prevention work. Third, we engaged families and partners in
this work to echo messages and start conversations between adults and children that mirrored
what was happening in the club. And then lastly, to partner with communities
to enhance prevention work more broadly. And so when we were discussing this guide
with local clubs to get feedback on it, shape our work and this resource guide development,
it was absolutely clear that the clubs that were most successful in substance use prevention
were successful because they were working with partners within their communities to
make this work most effective. So we recognize that substance use prevention
doesn’t happen in a Boys and Girls Club alone, but really also in partnership with
other community agencies and subject matter experts who are able to coordinate and guide
collaborative efforts. So if there’s one thing that we could really
leave you with outside of our resource guide today, it’s that I encourage you to find
and partner with the local Boys and Girls Club in your community. It’s very likely that they’re already doing
this work or they’re currently primed and ready to lead this work in your community. So they can really serve as a valuable partner. So within the guide, you will find many strategies
within each of those four domains, so staff, youth, families and communities, and then
to supplement each individual strategy there are really specific tools and templates. So for example, there’s an environmental
assessment to help determine what you’re already doing in a substance use prevention space,
what some agencies gaps may be and that substances might be most prevalent in communities. There’s a local funding template we developed
that we pre-included some information about the opioid epidemic and helped guide folks
that are newer to this work into where they might be able to find some of their local
data. We provided a sample MOU so that we could
help formalize many of the partnerships that we know are somewhat existing but could really
be strengthened around this work. And then we provided another example is a
community mapping assessment to really identify who key partners, people, agencies and resources
in communities, who we could connect with related to this work. And then there are several very specific activities
that you could utilize with club members, young people in your community or families. So for example, we’ve developed lesson plans
focused on opioid prevention that are for each age level including elementary. So I noticed one person’s comment was specifically
about how to address young people – people younger than 12 and so we want to make sure
that we’re reaching kids as young as 6-8. Second, we have an example parent night or
family night agenda if you’re looking to develop some programming specifically to engage families
or trusted adults within a community and get young people talking together, and then hopefully
later talking specifically about substance use. And then we have a lesson planning template
so if you’re a local agency and you’re looking to design or develop your own lessons around
substance use prevention, there’s a template that includes some really great high quality
youth development practices and elements that can use to guide and make your opioid lesson
most effective. So just want to show you briefly what this
looks like on paper. So this is an example of our resource or some
of the resources we’ve got. This would be like a pullout page or something
that a site could easily make copies of to distribute to you know, Board members, community
partners, to really frame and contextualize issues around opioids and other substance
use issues. We’ve also included a lot of templates as
I mentioned. This is an example of the community asset
map to identify and come up with some specific ways that you can partner with different agencies
in your community so working through this with a community collaborative might be really
beneficial. And then we’ve included a bunch of activities
so like I mentioned, this is a sample lesson for elementary schoolers called I’ve Got
Big Plans where they really outline an think about themselves as middle school, high school
and adult people, and what they think that using substances might do to those visions
they have for their future selves. So to get access to the guide you are welcome
to email me as soon as I finish my piece, I will put my email in the chat box so I can
send you a direct PDF and I believe that the organizers of today’s webinar will send out
this information as a follow up so you’ll get a link to the actual PDF of our guide
as well. So I really appreciate you all – for taking
the time to learn a bit about our resource and hope that it is helpful as well as encourage
you to think more about a Boys and Girls Club in your local community as a place to get
started and really doing this work collaboratively. David Wilson: Thank you, Lauren. Thank you for sharing your perspective. We can’t talk about this issue without talking
about youth development so that was very valuable. Everyone, we do have time for a few questions
and answers. I just want to remind everyone that we’ve
been trying to answer your questions in the chat box. I’m going to read out some questions that
I think are pertinent to specific panel members and then a few questions that I would like
the whole panel to address before we close. So my first question is for my colleague,
which is, “Is SAMHSA working with the medical schools and organizations to train students
and professionals around this issue?” Jennifer Fan: Okay. On the prevention side I’m not sure. I know on the treatment side especially in
regards to buprenorphine, they have linked with faculty members and teaching physicians
in getting to the medical students so that they go through the training for the buprenorphine
and so that they are data waivered by the time they graduate or in the process of. And so hoping to increase the number of prescribers,
healthcare professionals who can, you know, as they do practice in the primary care setting
or anywhere else, that they do have the background so that as they do have a patient that’s become
dependent on an opioid that they’re able to treat that dependency and addiction eventually. So helping to increase the capacity for treatment. And then even beyond. Even when a physician has graduated medical
school. You know, there’s a lot of courses in terms
of how to use opioids appropriately. How to monitor patients. What to do in terms of when you find that
a patient becomes dependent or addicted. And then that – and how do we refer patients
to the appropriate sources then and provide resources for them? SAMHSA does have the PCSS Mentoring Network. I believe it’s called Practitioner Clinical
Support System. And basically it connects outside prescribers
if they have any questions on how to prescribe opioids, what to do when their patient becomes
addicted to opioids. You can actually link up to a health care
professional who is knowledgeable in that area and they’ll walk you through. And the resource also contains other materials
as well that can help the prescriber out there in the community. (Crosstalk) LeShaundra Cordier: Hey… David Wilson: That’s good… LeShaundra Cordier: …David, is it possible
for me to answer that too? This is LeShaundra. David Wilson: Absolutely. LeShaundra Cordier: Just because it was very
distinct to something that we’re doing. So the provider training that we’re developing
— the Applying CDC Guidelines for Prescribing Opioids — that series was originally developed
intentionally to help medical schools and nursing schools. So when the guideline was first released we
had a series of voluntary commitments — from 60 medical schools, I believe 90 nursing schools,
and about 50 colleges of pharmacy – schools of pharmacy — that were going to be committed
to educating their students about opioid use, whether that’s counselling patients or appropriate
use of naloxone or whatever specific to opioid prescribing. And so we started development of that series
in conjunction with those organizations. We worked with them and did a series of listening
sessions to find out what topics they wanted covered, what kind of content they wanted
to be addressed, whether that was for – whatever standing you were in medical school and for
those who had already completed their medical training. And so our series for training is developed
based on that and continues to be in conjunction with our partners at SAMHSA and other federal
agencies as well. So our training is specifically designed for
those individuals. David Wilson: Thank you LeShaundra. And keep your line unmuted, because this is
a question that came in several times from many people… LeShaundra Cordier: Okay. David Wilson: …that I’m going to direct
to you first. And then I hope that the other panellists
can chime in. The question is Have physicians been open
to dosing suggestions? LeShaundra Cordier: So — and I’m going to
start with a non-answer, so maybe you shouldn’t have kicked it to me — no. Yes, and no. I think what we’re finding is that we have
a lot of physicians that were looking for guidance. And a lot of the tools that we — clinical
tools — that we developed for physicians around dosing have been very well received. So we actually have dosing information in
our mobile app. We have a pocket guide around tapering. And then dosing specific fact sheet that we
have — Calculating Dose for Opioids — and a few others. So we’ve had a lot of successful engagement
with those products. That to us is an indicator that it’s being
utilized. In terms of direct complaint or vocalization
in terms of not supporting that, it’s been very minimal. But that doesn’t mean that it doesn’t exist. So I would say yes over our – over-arching. But we have had some issues with folks being
concerned about the dosing that we’re suggesting and recommending. But that’s in alignment with other guidelines
and clinical practice. So. David Wilson: Thank you. Dr. Haning, did you have anything else to
add to that? Dr. William Haning: We’ve actually — just
using this medical school as an example — have been teaching the use of naltrexone and of
buprenorphine for a number of years as well as addressing this as a side bar in the behavioural
health curriculum. I just wanted to emphasize that it takes repetition. Takes reiteration. When we do it with the students they of course
aren’t in a position to do any prescribing, even when they graduate. They will be going into residencies and their
prescribing capability will be under supervision and will also be tied to whatever their hospital
training pharmacy license is. So they’re really not – they’re not flying
solo until they’re out of the residency. And if we don’t maintain contact with them
— or continue to provide reinforcement over time — then they’ll lose both the initiative
– lose the incentive to go ahead and prescribe as well as the capability of doing it. So very much as LeShaundra said. The PCSS is a valuable tool in trying to bring
people back into the fold and get them to use this. The only difficulty that I think I’ve had
in our area — with regard to the tool kit — is an over-interpretation of what the morphine
milliequivalence means for two specific drugs, buprenorphine and methadone. Which are not intended to be included in that
list of other opioids for equivalency purposes because they work differently. The pharmaco-kinetics and pharmaco-dynamics
are different. Why that’s an issue is that legislators get
a hold of these things and they begin to start — well-meaningly — putting restrictions
on how the medications are prescribed. That’s really about all I need to say on that. David Wilson: Thank you. This question is specific I think to you Lauren,
but I think it could also be answered maybe by other panellists. The question is Have you found engaging families
in your prevention difficult? Lauren Barineau: Yes. I think it’s a great question. We find that — as an out of school time provider
— families are often at our sites every day doing pickup. And so there is a real opportunity for families
to engage in our sites. So whether that means schools can leverage
Boys and Girls Clubs — as the after school time provider or summer provider — to get
additional information out about initiatives that might actually be happening on school. Or — for example — I know one Club site
does – is really effective at doing what they call Stay and Play. So inviting family members to stay an additional
20 minutes at pick up to help encourage a really specific activity like doing a craft,
creating a healthy recipe, learning a bit about substance use prevention. Right? That small interaction provides real opportunity
to strengthen and echo the messages that are happening in the Club and have them be shared
in families. And the second piece I’ll add is we would
really encourage families to not dive in to the substance use conversation first, but
rather encourage families to start talking about other things. How are you? How was your day? What’s going on with your friends? And being a real ask-able parent or ask-able
trusted adult from the beginning makes those substance use conversations much easier as
time goes on. So we find — you know, with anyone I would
think — that of course engaging families in today’s busy lives is a bit challenging. But we present a real value add as an out
of school time provider in creating that space for happening – having that happen during
pick up, after pick up, or because of the strong relationships we have with families. David Wilson: Thank you. Anyone else want to add to that before I move
to the next question? Okay. Jen I have one for you. How does SAMHSA envision partnerships? And I like this question since the genesis
of this webinar is around Partnering for Opioid Addiction Prevention. How does SAMHSA envision partnerships with
federally qualified health centres and community centres to treat the opioid epidemic? Jennifer Fan: Well, I know it talks about
treatment, but from the prevention side — grant-wise — we actually do have a grant program. One was just announced pretty recently — and
I believe the first offering was last year — in where SQHCs as well as OTPs are qualified
– are eligible to apply for this grant. Where
the SQHC or OTP — with the community — to be engaged and develop — well community prescribers
— to develop protocols and training for naloxone. How to reach out to the community about education
on overdose. About using naloxone for overdose reversal. And of that nature. So I think that in itself is a good partnership
in trying to have these community centres and Opioid Treatment Programs to be engaged
in their communities to help combat the crisis. I do know there is a HRSA SAMHSA partnership
in terms of treatment – using evidence-based treatment, training and all of that nature. I don’t really have the specifics of that. But if you would need any more specifics,
please contact me and I can get you that information. But I think it’s a good pathway, it’s a good
avenue to begin. And because SQHCs, they’re so much into – they’re
very embedded in the community and they can have an impact at the community level this
– on this crisis. And get the word out there, reach out to prescribers,
reaching out to the population in general. And I think it’s – I hope that there will
be a – more of a partnership in our future. David Wilson: Thanks Jen. Don’t mute because I’m going to start this
last final question with you and then open it up to the panellists. Is SAMHSA or any of the other organizations
on the panel working with the medical schools and organizations to train students and professionals
specifically around this issue? Male: What? Jennifer Fan: Is that similar to the one that
we – you had asked before in terms of providing the education with the buprenorphine in a
medical school? And then I had mentioned also the PCSS program. David Wilson: A little. I think – yes. Jennifer Fan: A different angle? David Wilson: One of the – or two of the questions
that came in really wanted the other organizations to expand on that if they could. Dr. William Haning: So the driving organizations
for the medical school education initiatives are the American Academy – American Association
of Medical Colleges and the organization that accredits medical schools, the LCME or Liaison
Committee for Medical Education. And for graduate programs — residency — programs,
the ACGME. My reason for giving you the letter salad
there is because there are a bunch of folks involved in this who push and drive education
within medical education environs. And they’ve all been very active and they’ve
all been very forceful. SAMHSA and CSAP have been quite active in
providing us the materials with which to initiate and understand proper pain management and
opioid use disorder treatment. That stuff is – we’re not at a loss for what
to teach folks. What is obligatory here is getting people
to develop a routine or a tradition of being educated in intervention. David Wilson: Thank you, sir. Well, unfortunately we weren’t able to address
all of your questions. I do want to say that when we do send out
the slide presentations to everybody who has registered you will also get a copy of the
chat pod, which had many of the resources that people were asking questions about. And some of the questions that were answered. I do want to end by saying thank you to all
of our presenters. And to all of you who participated in the
webinar today, we do hope that the information has been valuable to you. So please — if you can — tell us what you
think about this webinar by filling out the post-meeting survey that will pop up once
this meeting ends. Because your feedback is so very valuable
as we continue to do this webinar series. Again, I want to thank you for your time. I want to thank you for your participation
in National Prevention Week. And we hope for your continued collaboration. Have a great day.

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