The latest in substance use disorders and pain management education for healthcare providers

July 2024

Dear Anna,

July is National Minority Mental Health Awareness Month, an opportunity to raise awareness about the challenges that racial and ethnic minority populations face when it comes to mental health and access to treatment and services. Mental health conditions and substance use disorders (SUDs) can occur together because they share similar risk factors such as genetic vulnerabilities, early exposure to trauma, and chronic stress. In the United States, opioid-related mortality is rising faster in Black/African American and American Indian and Alaska Native (AI/AN) populations compared to White Americans. The overdose death rates in older Black men were nearly seven times as high as those in older White men in 2020. There are racial disparities in access to SUD treatment due to structural racism, stigma, provider bias, socioeconomic disadvantage, and differential access to health care. Medication-assisted treatment for opioid use disorder (MOUD) reduces overall mortality and other adverse effects of opioid use disorder (OUD), but White patients with OUD are 3-4x more likely to receive MOUD (e.g., buprenorphine) than Black patients. Additionally, a recent study in Drug and Alcohol Dependence found that Latinx individuals report lower utilization of MOUD, buprenorphine, and harm reduction facilitators than non-Latinx individuals. Cultural humility approaches to health services, collaborating with and working within communities, and increasing access to harm-reduction strategies such as MOUD may reduce racial and ethnic disparities in SUD outcomes. For additional information on MOUD and racial and ethnic minority populations, explore the resources and the tools available on the MACS website.

The MACS Team

EDUCATION

Upcoming MACS Training Opportunities

MACS for MOMs Webinar

Co-Occurring Disorders in Pregnancy

Tuesday, August 27 | 12:00 PM - 1:00 PM

Presented by MACS for MOMs Consultant Chris Welsh, MD

MACS Webinar

An Introduction to HHS OCR and Our Legal Authorities

Thursday, August 29 | 12:00 PM - 1:00 PM

Presented by Guest speakers from the HHS Office of Civil Rights

MACS Webinar

Approaches to Treatment of OUD in the Pediatric Population

Thursday, September 19 | 12:00 PM - 1:00 PM

Presented by MACS Consultant, Marc Fishman, MD

Upcoming Trainings of Interest

Grayken Center for Addiction Training & TA

Stimulants 101

Thursday, July 11 | 2:00 - 3:00pm ET

Providers Clinical Support System-Medication for Opioid Use Disorders (PCSS-MOUD)

Disparities and Inequities in MOUD Prescribing Practices

Wednesday, July 31 | 1:00 - 2:00pm ET

MACS ECHO Clinics

Join our learning communities for continuous case-based discussions and didactic presentations linking expert specialist teams with healthcare providers and their practices. MACS ECHO Clinics count toward the required 8-hours of SUD training for DEA license renewal or registration.

Opioid Treatment Program ECHO

Xylazine

Devang Gandhi, MD

Wednesday, July 10

12:30 PM - 1:30 PM

SUD ECHO

Xylazine

Devang Gandhi, MD

Wednesday, July 17

12:30 PM - 1:30 PM

MACS ECHO: Providing MOUD from a Trauma-Informed Perspective

Preventing Retraumatization in SUD Clinics

Benjamin Israel, MD

Wednesday, July 24

12:00 PM - 1:00 PM

Conferences and Events

MACS UPMC Presentation: Caring for Individuals with Xylazine Associated with Substance Use Disorder

Tuesday, August 27 | 12:00 pm - 1:00 pm

Virtual, CME Event to prescribers and behavioral health professionals at UPMC in Western, MD

Presented by Malik Burnett, MD, MBA, MPH

Maryland Academy of Physician Assistant (MdAPA) 2024 Annual Meeting

Wednesday, September 25 - Saturday, September 28

MACS Exhibit Table, Cambridge, Maryland

Shady Grove Grand Rounds Presentation on Perinatal Substance Use Treatment

Thursday, September 26 | 6:30 pm - 7:30 pm

Virtual Event to maternal health providers at Shady Grove

Presented by MACS for MOMs Consultant, Katrina Mark, MD, FACOG

Announcement: Updated Prescriber Enrollment Requirement for Behavioral Health Practitioners

To comply with federal regulations, the below changes are being implemented by the Maryland Medicaid Program related to reimbursement for prescribed medications effective July 1, 2024:

All practitioners who order, refer, and/or prescribe to Medicaid participants must be actively enrolled with the Maryland Medicaid Program in order for the program to reimburse claims for prescribed medications
Effective July 1, 2024 Medicaid will deny all pharmacy claims that do not include the National Provider Identifier (NPI) of a prescribing practitioner who is actively enrolled with Maryland Medicaid
All prescribing practitioners treating Medicaid participants must enroll with Medicaid by April 15, 2024 to comply with state and federal regulations
Practitioners may check their current Maryland Medicaid enrollment status using the Provider Verification System (PVS) at https://encrypt.emdhealthchoice.org/searchableProv/main.action
To enroll, please visit the Maryland Medicaid’s Electronic Provider Revalidation and Enrollment Portal (ePREP) at https://eprep.health.maryland.gov/sso/login.do?
For information about enrollment requirements and instructions, please visit https://health.maryland.gov/mmcp/provider/Pages/eprepresources.aspx
Updated information can be found on MDH’s Ordering, Referring, and Prescribing (ORP) Providers webpage at https://health.maryland.gov/mmcp/provider/Pages/opr.aspx

Providers can reach out to MACS for more information and enrollment support.

NEWS

Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement

This simulation modeling study evaluated the potential impact of increased naloxone availability on opioid overdose deaths (OODs) and strategies to enhance the impact through integrating interventions to address solitary drug use. Results demonstrated that distributing more naloxone could reduce OODs, suggesting that more interventions are needed to address solitary drug use.

Perceptions Around Medications for Opioid Use Disorder Among a Diverse Sample of U.S. Adults

This study assessed beliefs and perceptions of medications for opioid use disorder (MOUD) among a diverse sample of U.S. adults. Negative beliefs around MOUD were common, varied by race and ethnicity, and were negatively associated with preferences for MOUD treatment.

Mental Health Distress is Associated with Higher Pain Interference in Patients with Opioid Use Disorder Stabilized on Buprenorphine or Methadone

This exploratory study examined the relationship between mental health conditions, chronic pain, and pain interference among patients with opioid use disorder (OUD). Highly symptomatic and comorbid mental health distress was associated with increased pain interference among individuals stabilized on either buprenorphine or methadone, suggesting that adequate screening and treatment of mental health conditions in patients with OUD and chronic pain is needed.

Availability of Medications for Opioid Use Disorder in Community Mental Health Facilities

This cross-sectional study examined the availability of medications for opioid use disorder (MOUD) in community outpatient mental health treatment facilities (MHTFs) in high burden states. Only approximately one-third of community outpatient MHTFs offered MOUD, highlighting the need for further research on strategies to increase MOUD uptake, either through increased prescribing at MHTFs or effective referral models.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus

Primary care has been the source of care for substance use and mental health services for many individuals in the United States. A cohort study found that the integration of behavioral health in primary care may improve access to substance use and mental health treatment, especially for individuals with opioid use disorder.

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients

A clinical trial found that a medication event monitoring system (MEMS) for monitoring opioid adherence consistently revealed greater non-adherence than traditional self-report methods. Results support the use of MEMS for detecting potential misuse and the need for further research on novel tools to assist providers in clinical decision-making.

RESOURCES

Understanding Addiction: Moving Throughout the Spectrum of Mental, Emotional, and Behavioral Interventions

Critical Dialogues: Using art to address sexism, racism, and classism in substance use disorder treatment

1-855-337-MACS (6227) | www.marylandmacs.org | MACS@som.umaryland.edu