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U.S Health Officials Lift Some Barriers to Opioid Addiction Treatment

New guidelines from the U.S. Health and Human Services Department (HHS) will make it easier for health providers to prescribe buprenorphine to treat opioid use disorder (OUD). As the U.S. faces an increase in drug overdose-related deaths during the COVID-19 pandemic, this change will help more patients gain access to necessary treatment, and expand the number of providers available to prescribe buprenorphine.

As of April 28, 2021, eligible healthcare providers will not need extra hours of training to prescribe buprenorphine, and they will no longer be required to refer patients to counseling services. The providers can also treat up to 30 patients at a time with buprenorphine. Prescribers who want to treat more than 30 patients at a time must continue to follow the stricter requirements.

Addiction treatment providers should be aware that the exemption applies only to the prescription of Schedule III, IV, and V drugs, and does not apply to Schedule II medications, such as methadone.
Before prescribing buprenorphine for OUD, providers must first obtain a waiver under the Controlled Substances Act and submit a Notice of Intent to the Substance Abuse and Mental Health Services Administration (SAMHSA), following current protocols. Providers must be state licensed and registered by the U.S. Drug Enforcement Administration to prescribe controlled substances. For the full list of eligible prescribers, see the official HHS notice.

Although the American Medical Association has praised the change, it has called for Congress to further loosen restrictions to buprenorphine prescriptions. Few providers have been willing to fulfill the requirements for prescribing the drug, restricting the number of prescribers available and limiting treatment access for patients struggling with OUD.

Buprenorphine (also known by the brand name Suboxone) has been approved by the FDA as a medication-assisted treatment (MAT). It is the first medication to treat OUD that can be prescribed or dispensed in physician offices, which can make it more available to those who need it most.

Buprenorphine is available as a pill or a sublingual film for about $100 a month. It helps reduce opioid withdrawal symptoms and cravings. As an opioid partial agonist, buprenorphine produces effects such as euphoria or respiratory depression. These effects are weaker compared to stronger drugs, such as methadone and heroin, making it less likely to be misused. This helps a patient taper from powerful drugs to lower doses of more mild opioids.

SAMHSA offers numerous resources for prescribers interested in MAT, and buprenorphine specifically. Recommendations for prescribing buprenorphine for OUD include:

Patient must abstain from opioid use 12-24 hours and be in the early stages of withdrawal.
The prescriber should adjust the buprenorphine dose once the patient is seeing fewer (or no) side effects or cravings, and has significantly reduced other opioid use.
Depending on the patient’s individual needs, OUD treatment with buprenorphine may go on indefinitely.
Besides buprenorphine, providers treating OUD should prescribe additional behavioral therapies, such as counseling, for the best treatment outcomes.

Do you treat patients for OUD and other substance misuse disorders? Your EHR should support every type of addiction treatment, from counseling to MAT. Learn how BestNotes can save you time and money with an EHR solution that offers eprescribing, medication monitoring, outcome tracking, and compliance with state and federal EPCS mandates. Contact BestNotes today to schedule a free demo.

date:  May 18, 2021
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OxyContin Maker Pleads Guilty to Three Criminal Charges in Opioid Crisis

OxyContin maker Purdue Pharma pleaded guilty in November to three criminal charges, in a virtual hearing with a federal judge in Newark, N.J., as part of a criminal and civil settlement between Purdue and the Justice Department. Purdue made numerous admissions during the hearing, including that it hindered efforts by the U.S. Drug Enforcement Administration (DEA) to fight the addiction crisis.

The company has acknowledged that:

Purdue had told the DEA that it had a program to prevent diversion of prescription drugs to the black market, when it had not effectively maintained such a program.
It gave the DEA misleading information to encourage the company’s manufacturing quotas.
It has paid doctors through a speakers program to encourage them to write more painkiller prescriptions.
Purdue paid an electronic medical records company to send patient data to doctors to encourage them to prescribe opioids.

The settlement includes $8.3 billion in penalties and forfeitures. The company will pay a smaller amount of $225 million directly to the federal government as long as it executes a settlement pending in federal bankruptcy court with numerous entities. State and local governments have also sued the company for its role in the opioid epidemic.

As part of the bankruptcy settlement, Purdue has proposed that the company will become a public benefit corporation, using its proceeds to fight the opioid crisis. Members of the Sackler family, who own Purdue Pharma, have also agreed to pay $225 million to the federal government to settle civil claims.

Advocates, state attorneys general, and family members of individuals affected by opioids are dissatisfied with the company’s admission. Opponents to the federal settlement had hoped that company employees and members of the Sackler family would face individual penalties, including prison.

According to the CDC, 128 people a day die in the United States after overdosing on opioids. Prescription opioid misuse in the United States is estimated to have an economic burden of $78.5 billion a year, which includes not only healthcare costs, but also law enforcement, lost productivity, and addiction treatment.

The company has made its admissions at a time of renewed concern about opioid misuse and overdoses. Data from the CDC show that opioid deaths dropped 4.6 percent during a 12-month period in 2017 and 2018. (This did not include opioid deaths related to illegally made fentanyl, which increased 11.1 percent during that period.) In March 2020, CDC reported that prescription opioid-involved overdose death rates decreased by 13.5 percent.

During the COVID-19 public health emergency, however, addiction and mental illness rates have increased. U.S. lawmakers and healthcare providers have reported increases in overdoses and deaths associated with opioids and other drugs. In some locations, opioid misuse is still declining, but use of illicit drugs, such as fentanyl and heroin, have increased.

Research has found an increased rate of overdoses in areas where automotive assembly plants have closed. The ongoing financial difficulties during the pandemic could lead to further overdoses.

Is your behavioral health practice seeing an increased demand for addiction treatment services? Without the right tools, you may struggle to keep up, stay profitable, and take care of clients. BestNotes EHR and CRM tools offer online assessments, lead tracking, telehealth appointments, billing, outcomes tracking, and reporting in one easy, customizable solution to help you increase profits and make your life easier. Contact us today to learn more or request a live demo.

date:  Feb 05, 2021
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How to Approach Adolescents With Behavioral Health and Substance Misuse Needs

Substance use, including alcohol and illicit drugs, has increased during the COVID-19 pandemic. Many people who already struggled with substance use have faced social isolation, financial distress, limited healthcare access, and anxiety symptoms. This can increase their use of drugs or alcohol as a way to cope.

Addressing substance misuse in adolescents

Unfortunately, this trend has not only affected adults, but adolescents. Research published by Boston University found that, among adolescents who consumed drugs or alcohol, the use of alcohol and cannabis increased significantly after social distancing measures were implemented.

When it comes to addressing substance use among adolescents, many clinicians have taken an approach known as “screening, brief intervention, and referral to treatment (SBIRT)”. The SBIRT approach includes:

Screening the individual adolescent with validated surveys
Brief, patient-centered intervention, mainly with motivational interviewing
Referring the individual to behavioral treatment for more severe symptoms

Motivational interviewing is a type of counseling that helps individuals make necessary, healthy changes to their behavior. This method does not try to force clients to change or tell them specifically what to do. Instead, the counselor converses with their client to guide them through their feelings and consider how they may need to change. This method was originally developed for individuals struggling with alcohol problems, but may help others who need to make changes in their lives and struggle to do so.

What new research shows

The SBIRT approach has had a positive effect in the short term, but there’s been a lack of research on its longer-term effects. Now, a team of researchers report in Pediatrics that 185 adolescents who received SBIRT by a pediatrician or behavioral clinician showed better outcomes compared to 104 adolescents randomized to receive usual care.

Adolescents in the “usual care” group were assigned to pediatricians who had access to EHR screening tools but did not have formal SBIRT training.

The benefits included:

Lower risk of depression after one year and three years
Lower risk of being diagnosed with substance use three years later
Fewer emergency department visits

These findings are important because adolescents with co-occurring substance use and mood symptoms are more likely to develop other comorbidities. They may use more health resources, such as emergency departments, and their substance use may escalate. Evidence-based interventions can help reduce health costs as well as improve quality of life.

In a blog post about this study, the American Academy of Pediatrics noted that the study was limited because it was conducted in a health system that provides behavioral health, and the participants were insured. Most pediatric primary-care practices lack behavioral health providers. Many young people with substance use disorder may be uninsured or underinsured, which can make it more difficult for these clients to have access to SBIRT and its benefits. Because of these complicating factors, additional studies of the use of SBIRT in other settings are still needed.

Even after the COVID-19 pandemic has ended, it is likely that the behavioral health consequences will persist for months and even years afterward. As a behavioral health provider, you need the right tools to serve your clients and stay efficient. That’s why BestNotes EHR solutions offer many customization options to help you work more effectively, improve profitability, and get the results you and your clients want. Contact us today to learn more or schedule a demo!

date:  Jan 20, 2021
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Why Don’t More Residential Substance Abuse Programs Offer MAT?

Although the use of opioids has declined in recent years, substance abuse and addiction remains a persistent problem. Every day, 128 people in the United States die after overdosing on opioids, according to 2018 data. While nearly 21 million Americans have at least one type of addiction, only about 10 percent of them receive treatment.

Addiction and substance abuse treatment remains a critical need for Americans, especially in the wake of the COVID-19 public health emergency. Widespread anxiety about the novel coronavirus and social isolation due to stay-at-home orders has contributed to an increase in the use of drugs and alcohol as a coping mechanism. This could have serious, long-term effects on behavioral health in the United States.

Medication-Assisted Treatment Shows Effectiveness

One of the most successful types of treatment for opioid addiction is medication-assisted treatment (MAT), also known as medications for opioid use disorder (MOUD). In fact, it has been called the “gold standard” for treating opioid addiction.

The FDA has approved naltrexone, buprenorphine, and methadone for use in MAT for opioid use disorder. These drugs help reduce cravings or block the effects of opiates.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has been shown to:

Improve addiction treatment client survival
Help keep individuals in treatment
Help reduce criminal activity
Increase ability to get and keep a job
Improve birth outcomes in pregnant women with SUD

Despite its effectiveness, however, it remains largely underused in most U.S. addiction treatment programs.

New Research on MAT Underutilization

Most U.S. residential treatment facilities for opioid use disorder (OUD) do not use MAT, a new study shows
Researchers looked at data from 2,863 residential treatment centers and 232,414 patient admissions for OUD in 2017. Only 15 percent of all patients included in the study had MAT as part of their treatment plan.

Some key findings of the study:

60 percent of facilities in the study did not offer any MAT.
Only 1.3 percent offered all three FDA-approved MOUDs.
Buprenorphine was the most common MOUD, used by one-third of facilities.
Only 2.1 percent of facilities offered methadone.

“There was no appreciable difference in MOUD availability in residential facilities in states that did or did not expand Medicaid,” the researchers noted. However, more treatment plans for patients admitted in Medicaid expansion states included MOUDs than plans for patients in non-expansion states.

The researchers note that addiction treatment providers face numerous barriers when it comes to offering MATs. These restrictions include:

Prior authorization to prescribe buprenorphine or extended-release naltrexone
Requiring buprenorphine to be distributed by an opioid treatment program
Lifetime limits on buprenorphine doses larger than 8 mg
Assigned levels of care and reimbursement, often determined by insurance coverage, do not always match what the provider or client think are appropriate for treatment

Get the full study from JAMA Network Open.

Treating OUD and other forms of addiction is a complex issue that requires different plans for different clients. BestNotes EHR solutions allow you to customize your experience so your behavioral health or addiction treatment organization can treat clients as individuals, improving outcomes and revenue. Contact us today to learn more.

date:  Aug 20, 2020
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