As you may know, State Bill 273, the Opioid Reduction Act, was signed into law and will take effect on June 7, 2018, and may have an impact on your daily practice.
It is important to note that current legislation allows for the following exemptions to the new prescribing regulations:
- Patient undergoing active cancer treatment
- Patients under hospice care
- Patients residing in long-term care facilities
- Patients undergoing active addiction treatment
- Patients receiving chronic opioids prior to January 1, 2018. (Chronic is defined as longer than three continuous months)
Areas of potential impact include:
- Emergency Department and Urgent Care practitioners are limited to writing a 4 day supply of opioids
- Pediatricians, Dentists, and Optometrists are limited to writing a 3 day supply of opioids
- All other practitioners, including surgeons post-operatively, are limited to writing a 7 day supply of the lowest effective dose of opioids. Documentation for these prescriptions must include:
- A thorough history of non-opioid medication, non-pharmacologic treatment, and substance abuse history
- Physical exam pertinent to the problem requiring the prescription
- Treatment plan
- Documentation of a review of the Controlled Substance Monitoring Program (CSMP)
- These prescriptions can be refilled in 6 days. For the first refill:
- Must document discussion of risk of opioid addiction with the patient
- Must document the risk of use of sedatives and alcohol
- For the second refill:
- Referral to a pain specialist and/or alternative treatments must always be considered. Patient acceptance or refusal of such must be documented prior to refill.
- Must assess the patient’s addiction/dependence
- For practitioners who choose to continue prescribing chronic opioids:
- Must assess medication therapy at least every 90 days
- Must attempt to decrease dosage, stop medication, or use other modalities every 90 days
- Practitioners are required to enter into a narcotics contract with the patient whenever a Schedule II opioid is prescribed
TBI symptoms often present similarly to Substance Abuse Disorders; People who have TBIs are more likely to turn to substances (alcohol or drugs) to cope with their injury. It can be difficult to decipher whether the symptoms (aggression, confusion, etc) are from TBI or substance use.
2. When working with patients- “Don’t open and unload someone’s ‘baggage’ unless you have the time and energy to help them pack it back up. Let them show pieces of their baggage on their own terms”
3. Crisis Call Center (775-784-8090) 24-hour crisis line providing a safe, non-judgmental source of support for individuals in any type of crisis; National Suicide Prevention Lifeline (1-800-273-8255) 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis
4. When working with veterans- The VA only tests for TBI in post-9/11 veterans. Anyone before 9/11 has not been tested (Korean, Vietnam, etc.) unless they’ve sought out services; The VA has adapted a “polytrauma/TBI System of Care” which is an integrated network of specialized rehabilitation programs for veterans. This allows them to access most services needed under one roof. https://www.polytrauma.va.gov/system-of-care/index.asp https://www.polytrauma.va.gov/ConcussionCoach.asp
5. Medicaid 1115 Waiver expands treatment options for people with Substance Abuse Disorder. What DHHR’s website doesn’t mention is that it can be used to help patient’s seek alternative treatments such as cannabis/CBD oils https://dhhr.wv.gov/News/2017/Pages/DHHR%E2%80%99s-Medicaid-Program-to-Expand-Substance-Use-Treatment-and-Services.aspx.
6. WVU CED programs and services are expansive. Their website provides good insight on what they offer- http://www.cedwvu.org/ http://tbi.cedwvu.org
Strengthening Training for Addiction Recovery Project
The West Virginia University School of Social Work seeks applications for the position of Project Coordinator for the Strengthening Training for Addiction Recovery (STAR) grant. This position is grant-funded through September 30, 2019 and we anticipate a strong likelihood of funding renewal. The STAR project is part of WVU’s role in West Virginia’s Statewide Opioid Response. The Coordinator position will focus on administrative coordination of the STAR project, academic support to social work students participating in the STAR program, engagement with community-based providers, and interface with STAR project leaders. Apply online here.
May 15-17, 2019
Certified Tobacco Treatment Training Program (CTTTP)
WVU Health Sciences Center in Morgantown, West Virginia
This flier outlines a three-day certification program, as well as, a one-day option that will highlight pharmacological interventions for tobacco cessation and discussions regarding the electronic cigarette (i.e., continuing education hours but not certification).
Please contact Susan Morgan at (304-293-1154).
Each September, SAMHSA sponsors National Recovery Month to increase awareness and understanding of mental and substance use disorders, and to celebrate individuals living in recovery. The Toolkit and PSAs can be used to organize events, issue proclamations, and increase public awareness. Learn more about Recovery Month 2018 and how you can get involved.
SAMHSA is accepting applications for $930 Million to combat the opioid crisis through State Opioid Response Grants (Short Title: SOR). The program aims to address the opioid crisis by increasing access to medication-assisted treatment, reducing unmet treatment need, and reducing opioid overdose related deaths. The application due date is August 13, 2018 by 11:59 p.m. (ET).
SAMHSA is accepting applications for up to $50 million in Tribal Opioid Response Grants. The grants, which will go to tribes and tribal organizations, will fund prevention, treatment, and recovery activities in response to the opioid crisis. The grants will reduce unmet treatment needs and opioid overdose-related deaths. The application due date is August 20, 2018 by 11:59 p.m. (ET).
SAMHSA has published an update to this brochure that offers emergency department providers tips for enhancing treatment for people who have attempted suicide. It also offers information about communicating with families, HIPAA, patient discharge, and resources for medical professionals, patients, and their families.
You asked, and we listened! At the 2018 CMS National Training Program (NTP) Workshops, you can expect 2½ days of tailored training to meet a variety of learning needs. Whether you’re building a foundation of basic Medicare knowledge, or you want to expand your expertise, there’s something for everyone. You can attend the entire 2½-day workshop, or only the days that meet your varied interests and needs. Day 1 provides the basics, Day 2 has cross-cutting information including legislative and program updates, and Day 3 provides a deeper dive into more advanced topics. It will be helpful if you bring a laptop or tablet to participate in the casework activities. The locations and dates for the workshops are listed below. Attend the location that works for you. And, it’s free!
July 31–August 2
The Westin Kansas City at Crown Center
1 E Pershing Road Kansas City, MO 64108
Region II—New York
New York Hilton Midtown
1335 6th Avenue New York, NY 10019
The Artic Club Seattle
700 3rd Avenue Seattle, WA 98104
Loews Atlanta Hotel
1065 Peachtree St NE Atlanta, GA 30309
7000 Church Ranch Boulevard Westminster, CO 80021
The NTP training materials will be available for download on the registration website prior to the workshops. If you would like hard copies, please download and print. You can also download the materials to your tablet, laptop, or on a USB. NOTE: Registration requests will be considered on a first-come, first-served basis until each meeting reaches capacity. The number of attendees from the same organization may be limited.
Please send all correspondence to: