Understanding the Opioid Crisis

Recognizing the extent of the crisis, Governor Kay Ivey established the Alabama Opioid Overdose and Addiction Council on August 8, 2017 naming three co-chairs, the Commissioner of the Alabama Department of Mental Health (ADMH), the State Health Officer, and the State Attorney General, as the Council leadership. The Council was charged with the task of developing a comprehensive strategic plan to abate the opioid crisis in Alabama.

Per the governor’s order, six standing committees were assembled to explore the problem and make recommendations. The workgroups are identified below.

1. 1. Data
   2. Prescriber-Dispenser
   3. Rescue (Naloxone)
   4. Treatment-Recovery
   5. Prevention-Education
   6. Law Enforcement
   7. Community Engagement
   8. Workforce

Council Documents by Year

What are Opioids?

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others.

Prescription pain medicines are helpful when used correctly under a healthcare provider’s direction. However, misusing prescription opioids risks dependence and addiction.

Opioids Kill. Here’s How an Overdose Shuts Down Your Body

SCIENCE NEWS (04/10) – U.S. deaths from opioid overdoses are mounting with breathtaking speed. These powerful drugs — including heroin, morphine, and fentanyl — can relieve pain and evoke intense feelings of pleasure. But the same drugs, whether prescribed by a doctor or bought on the street, can quickly turn deadly by simultaneously messing with crucial systems in the body. Read more

Prescription Opioids

In addition to the serious risks of addiction, abuse, and overdose, the use of prescription opioids can have many side effects, even when taken as directed.

Prescription Pain Medications: Opioids Guide for Teens

Fentanyl

Fentanyl and similar compounds like carfentanil are powerful synthetic opioids — 50 to 100 times more potent than morphine. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death.

Heroin

Heroin is a highly addictive drug made from morphine, which comes from opium poppy plants. Some prescription opioid pain medicines have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use.

Drugs of Abuse, A DEA Resource Guide: 2017 Edition

The Drug Enforcement Administration’s (DEA’s) resource guide is designed to be a reliable resource on the most commonly abused and misused drugs in the United States. This comprehensive guide provides important information about the harms and consequences of drug use.

Understanding Addiction

Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. Understand Drug Use and Addiction

A key finding from Governor Ivey’s Alabama Opioid Overdose and Addiction Council was the need to establish a Central Data Repository (CDR) so that all opioid data could be evaluated holistically. The CDR is meant to hold data and distribute results to partner agencies and the public, thus allowing for rapid response to outbreaks of overdoses and other opioid-related events, as well as providing a framework to measure the progress of initiatives in place to address the crisis.
https://druguse.alabama.gov/

In order to prescribe or dispense buprenorphine, physicians must qualify for a physician waiver, which includes completing eight hours of required training and applying for a physician waiver. Physicians can complete the Online Request for Patient Limit Increase.

Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs. Chronic pain is common, multidimensional, and individualized, and treatment can be challenging for healthcare providers as well as patients.

CDC Guideline for Prescribing Opioids for Chronic Pain
CDC’s new Opioid Guideline App is designed to help providers apply the recommendations of CDC’s Guideline for Prescribing Opioids for Chronic Pain into clinical practice by putting the entire guideline, tools, and resources in the palm of their hands. Managing chronic pain is complex, but accessing prescribing guidance has never been easier.

The application includes a Morphine Milligram Equivalent (MME) calculator*, summaries of key recommendations, and a link to the full Guideline, and an interactive motivational interviewing feature to help providers practice effective communication skills and prescribe with confidence.

Naloxone: The Opioid Reversal Drug that Saves Lives How Healthcare Providers and Patients Can Better Utilize this Life-Saving Drug

SAMHSA Releases New Resources on Addressing Opioid Use Disorder in Mothers-to-be
The Substance Abuse and Mental Health Services Administration (SAMHSA) has published four Healthy Pregnancy Healthy Baby fact sheets: Opioid Use Disorder and Pregnancy; Treating Opioid Use Disorder During Pregnancy; Treating Babies Who Were Exposed to Opioids Before Birth; and Good Care While Receiving Opioid Use Disorder Treatment. The documents aim to educate patients and health care providers about the best options for mother and baby. In an announcement about the fact sheets, SAMHSA notes that the outcomes for those who participate in a program that offers medication-assisted treatment (MAT) are outweighed by the risks of not being in treatment, and that when properly managed, continuing MAT during pregnancy is the best choice for the mother and the baby.

Free Download
CDC’s new Opioid Guideline App is now available for free download on Google Play (Android devices) and in the Apple Store (iOS devices).

The American Medical Association is leading the effort to end the opioid epidemic

About the Addiction Medicine Subspecialty

Addiction Medicine (ADM) is now a recognized physician subspecialty of the American Board of Medical Specialties (ABMS). Credentialed ADM subspecialists serve as clinical experts, faculty, teachers, researchers and change agents. They provide prevention, evaluation, diagnosis, and treatment services for patients with unhealthy substance use or substance-related health conditions. ADM physicians also help family members who are affected by a loved one’s substance use or addiction.

CME/CE Activities
Access to relevant CME/CE courses on topics related to opioid and substance use disorders and addiction.

OUDEP is an accredited, free, online medical education program for the identification and management of opioid use disorder. This program was designed for nurses, nurse practitioners, physicians, social workers and other health care providers collaborating to treat parents with substance use disorders. This project was funded in part with federal funds from the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services.

Understanding ADDICTION

Identification, Counseling, and Treatment of OUD

Collaborative Care Approaches for Mgmt. of OUD

Take advantage of the ADA’s free online continuing education courses covering the latest techniques for prescribing opioids safely and effectively. The webinars are:

• free;
• convenient to access;
• tailored to pain management in dentistry; and
• available to members and non-members alike.

Plus, the ADA CERP credential provides a sound basis for state regulatory agencies to accept continuing education (CE) credit for licensure.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. The SBIRT model was incited by an Institute of Medicine recommendation that called for community-based screening for health risk behaviors, including substance use.

Nonopioid Therapies for Pain Management

CDC’s New Quality Improvement and Care Coordination Resource
Providers wrote approximately 4.45 billion opioid prescriptions in 2016—with wide variation across states. In addition, almost 1.8 million Americans, aged 12 or older, either abused or were dependent on prescription opioids in 2016. Improving the way opioids are prescribed through clinical practice guidelines, can ensure patients have access to safer, more effective pain treatment while reducing the number of people who misuse or overdose from prescription opioids.

The CDC National Center for Injury Prevention and Control has developed and released the Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain. The quality improvement (QI) measures provided in the resource are meant to be flexible so that healthcare systems and practice leaders can pick interventions that will work best for their practice and patient population. They are offered as voluntary measures that could help incorporate the evidence contained in the CDC’s Guideline for Prescribing Opioids for Chronic Pain in clinical workflow. The purpose of the resource is to encourage careful and selective use of long-term opioid therapy in the context of managing chronic pain through:

1. evidence-based prescribing,
2. quality improvement (QI) measures to advance the integration of the guideline into clinical practice; and
3. practice-level strategies to improve care coordination.
4. A resource toolkit

Learn More

• CDC Opioid Overdose
• CDC Opioid Data
• Annual Surveillance Summary Report 2018

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the public about the potential for abuse of medications. DEA provides a tool for locating drug disposal locations near you. Although some medications are safe to throw away at home, learn how to properly dispose of your expired prescriptions.

Disposal of Unused Medicines: What You Should Know

• Standing Order for Naloxone
  HB208 was signed into law in 2015 and provided immunity for prescribing and administering an opioid antagonist, such as naloxone. This is commonly known as a “Good Samaritan Law”. In 2016, HB379 was signed into law, providing the State Health Officer or a county health officer the authority to write a standing order for dispensing naloxone.
• Individual/family/friend request for free Naloxone (Narcan) Nasal Spray
  To receive your free Narcan kit, you will need to complete an online training Naloxone Training. After completing the training your kit will be mailed to you at the address you provide.
  To access the training:  https://www.jcdh.org/SitePages/Programs-Services/CommunityHealth/SubstanceUseandAddiction/NaloxoneTrainingReg.aspx
• First Responders (Law enforcement, Fire Departments, Volunteer Fire Departments, etc.) request for Naloxone (Narcan) Nasal Spray
  If you are an agency that responds to emergencies involving individuals who may be at risk of experiencing an opioid-related overdose or to an emergency that may place the first responder at risk for exposure to opioids there are several steps that must be completed prior to receiving Narcan. Email narcanadmh@mh.alabama.gov
  1. Before receiving Narcan, you will need to complete the Narcan Law Enforcement Roll Call video training module. In this training module, you will learn:
     • How to identify an opioid overdose and check for a response.
     • Proper administration of Narcan Nasal Spray.
     • How to place a patient in the recovery position until emergency medical assistance arrives.

     To access the training module: https://www.youtube.com/watch?v=WkWXX5DPmpg&t=45s

  2. Review and print the Standing Order of the State Health Officer Naloxone Distribution for Overdose Prevention
  3. Please download the Naloxone Agency Form, complete it, and send it in via email: fillable PDF or Word doc.
  4. For replacement kits, you will need to submit the following information to opioidcrisis@adph.state.al.us
     • Date/Time used
     • Age/Race of recipient
     • Nonfatal or fatal results
     • Name and phone number of the person requesting the replacement

Alabama Opioid Strategic Targeted Response (STR) Grant

The Alabama Department of Mental Health (ADMH) proposes to enhance and expand opioid use disorder prevention, treatment, recovery support and related services for unserved and underserved populations and locations in Alabama. This statewide initiative, the Alabama Opioid Strategic Targeted Response (STR), will seek to implement life-saving strategies to aid in combating the state’s current opioid epidemic. ADMH will utilize the Alabama Opioid STR to:

1. expand access to medications approved by the FDA for treatment of opioid use disorders;
2. improve retention in care for individuals who have been diagnosed with an OUD;
3. improve the skills of Alabama’s workforce for delivery of evidence-based services for OUDs;
4. reduce stigma and improve public awareness of Alabama’s opioid misuse and addiction crisis and of treatment options available;
5. increase the availability of Naloxone in unserved areas of the state with high overdose death rates; and
6. enhance statewide coordinated efforts of the strategic prevention framework (SPF) in areas identified as high need and target prescription drug misuse with youth and adults.

Find providers with CURES funding

A 24/7 hotline has been established and a treatment related media campaign has been implemented to promote improved access to care.

Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PODA)

The Alabama MAT-PDOA project has funded non-profit substance abuse treatment providers Jefferson and Walker Counties to provide:

1. Recovery Support Services,
2. Care Coordination,
3. MAT, and
4. Detoxification Services.

The grant goals are to:

1. Expand access to Medication Assisted Treatment (MAT) for treatment of opioid use disorder (OUD);
2. Increase the number of peer support specialists (PSSs) involved in MAT;
3. Improve Opioid Use Disorder (OUD) treatment retention rates; and
4. Decrease rates of prescription and illicit opioid drug use and overdose related deaths in Jefferson and Walker Counties.

ADMH Certified Substance Use Providers

Buprenorphine Treatment Practitioner Locator
Find physicians authorized to treat opioid dependency with buprenorphine by state. Select a state from the map or use the drop-down lists to view all of the physicians certified to provide buprenorphine treatment in a city, state, or zip code.

SAMHSA’s National Helpline (also known as the Treatment Referral Routing Service) is a confidential, toll-free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can order free publications and request other information. Call (800) 662-HELP (4357) or visit the online treatment locators.

Five Signs of Quality Treatment
You can use these questions to help decide about the quality of a treatment provider and the types of services offered. Quality programs should offer a full range of services accepted as effective in treatment and recovery from substance use disorders and should be matched to a person’s needs.

The Prescription Drug Monitoring Program (PDMP) is a program developed to promote public health and welfare by detecting diversion, abuse, and misuse of prescription medications classified as controlled substances under the Alabama Uniform Controlled Substances Act.

Calculating Daily Morphine Milligram Equivalents (Technical Assistance Guide No. 01-13)

Opioid Overdose Toolkit for first responders, treatment providers, and those recovering from opioid overdose

SAMHSA Overdose Prevention and Response Toolkit
Video Fentanyl: The Real Deal hosted by U.S. Customs and Border Protection

ADAPT Pharma® has developed a short Law Enforcement Roll Call Training Module.
In this training module, you’ll learn:

• How to identify an opioid overdose and check for response
• Proper administration of NARCAN® Nasal Spray
• How to place the patient in the recovery position until emergency medical assistance arrives

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released an updated version of its Opioid Overdose Prevention Toolkit. The toolkit offers information and facts from the literature, and links to resources to prevent opioid-related overdoses and deaths. The toolkit is divided into four sections each target a specific audience: community members, first responders, prescribers, patients, and families.

Living with chronic pain can be devastating, and effective pain management is important to getting your life back. You and your doctor must discuss treatment options, carefully considering all of the risks and benefits. Some medications, such as prescription opioids, can help relieve pain in the short term but also come with serious risks and potential complications—and should be prescribed and used carefully.

The American Physical Therapy is actively working to educate the community on the role physical therapy plays in managing chronic pain. The CDC has also recommended safer alternatives like physical therapy to manage pain.

Prescription opioids are sometimes used to treat moderate-to-severe pain. Because prescription opioids have several serious side effects and risks, you need to ask questions, learn more about opioids, and understand their risks. Make sure you’re getting care that is safe, effective, and right for you.

Chances are good that even young teenagers will have heard about opioids and overdose deaths at some point.

Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

Talking to kids about drugs: “What if she finds out the truth?”
“Debbie” has been drug-free for years. She wants her daughter to stay away from drugs. But she’s afraid to talk to her daughter about her past. (This story is based on the experiences of real people whose names have been changed.)

 “My life was built around getting cocaine and getting high.”
“Stacey” is recovering from her cocaine addiction. She’s thankful that her life is different now than it was before. (This story is based on the experiences of real people whose names have been changed.)

 Pain medicine addiction: “All I wanted was more of the drug.”
“Max” was addicted to prescription drugs. The addiction slowly took over his life. (This story is based on the experiences of real people whose names have been changed.)

Quitting marijuana: “I need different people around me.”
To stop using marijuana, “Cristina” is making positive changes in her life. She finds support from family and friends who don’t use marijuana. (This story is based on the experiences of real people whose names have been changed.)

Say This. Not That. Let’s end the cycle of stigma. Stop Judging. Start Healing.

It’s okay to talk about it. Let’s face addiction together. One act of courage at a time. Courage for ALL

Get smart about prescription drugs. My Smart Dose

Evidence-Based Practices Resource Center

National Institute on Drug Abuse (NIDA) published Preventing Drug Use among Children and Adolescents: A Research-Based Guide

White House announced the launch of the “Stop Youth Opioid Abuse” public awareness campaign, aimed at young adults ages 15-25.

Youth Opioid Toolkit

Youth Opioid Abuse Prevention Toolkit

Opioids: The Crisis Next Door

Understanding Addiction
Many people don’t understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to.

DRUG FACT with a listen guide
Video: Anyone Can Become Addicted to Drugs
Video: Why Are Drugs So Hard To Quit?

SAMHSA Releases New Resources on Addressing Opioid Use Disorder in Mothers-to-be
The Substance Abuse and Mental Health Services Administration (SAMHSA) has published four Healthy Pregnancy Healthy Baby fact sheets: Opioid Use Disorder and Pregnancy; Treating Opioid Use Disorder During Pregnancy; Treating Babies Who Were Exposed to Opioids Before Birth; and Good Care While Receiving Opioid Use Disorder Treatment. The documents aim to educate patients and healthcare providers about the best options for mother and baby. In an announcement about the fact sheets, SAMHSA notes that the outcomes for those who participate in a program that offers medication-assisted treatment (MAT) are outweighed by the risks of not being in treatment and that when properly managed, continuing MAT during pregnancy is the best choice for the mother and the baby.

What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.

Alcohol and Drug Addiction Happens in the Best of Families
Describes how alcohol and drug addiction affect the whole family. Explains how substance abuse treatment works, how family interventions can be a first step to recovery, and how to help children in families affected by alcohol abuse and drug abuse.

Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

A guide for employers to identify and prevent opioid and other substance misuse in the workplace.
https://www.opioidpreventionatwork.org/assets/opioidpreventionatwork2.pdf