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

June 2024

Dear Anna,

Established in 2014, National Post-traumatic Stress Disorder (PTSD) Awareness Month is an annual observance that takes place in June. It is a time to raise awareness about issues related to PTSD, and to help ensure those living with PTSD receive proper treatment and support. PTSD is an anxiety disorder that is caused by a traumatic experience in a person’s life, such as sexual assault or military combat; about 8% of Americans will experience PTSD. Substance use disorders (SUD) and PTSD often co-occur and people seeking treatment for PTSD are 14 times more likely to receive a SUD diagnosis. Studies show that traumatic, extremely stressful experiences can make people more vulnerable to developing a substance use disorder, for example, someone may use drugs or alcohol to self-medicate or temporarily cope with symptoms related to PTSD. Effective treatments for individuals with co-occurring SUD and PTSD include trauma-informed care, cognitive-behavioral therapy, and medications. Health professionals can reach out to the MACS team of addiction specialists or participate in our ongoing Providing MOUD from a Trauma-Informed Perspective ECHO Clinics to learn more about enhancing patient care related to trauma and substance misuse.

A recent study in JAMA Psychiatry found that an estimated 321,566 children in the United States lost a parent to drug overdose from 2011 to 2021. During this period, the rate of children who experienced parental loss due to drug overdose more than doubled. Children who experience the sudden death of a parent from drug overdose may experience complex grief, trouble functioning, symptoms of PTSD, and increased risk of SUD. Explore the tools available on the MACS website for additional resources for youth, trauma, and substance use.

The MACS Team

MACS Survey

The Maryland Addiction Consultation Service (MACS) is surveying practitioners to better understand prescribing practices in Maryland. Please take a moment to complete this quick survey. Your input will improve both access to lifesaving treatment and how we support you.

EDUCATION

Upcoming MACS Training Opportunities

MACS for MOMs Webinar

Plans of Safe Care: Supporting Pregnant Patients Living with Substance Use Disorders

Friday, June 14 | 12:00 PM - 1:00 PM

Presented by MACS for MOMs Consultant Katie Mark, MD, FACOG and guest speaker Shawnett Mills, LCPC

Save the date for a 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

Save the date for a MACS Webinar

Improving Treatment for OUD in Youth

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

Presented by MACS Consultant, Marc Fishman, MD

Upcoming Trainings of Interest

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

Mental Health and SUD: Working with LGBTQ+ Individuals

Thursday, June 13 | 12:00 - 1:00pm ET

National Council for Mental Wellbeing

Introduction to Psychedelics for the Treatment of Substance Use Disorder

Thursday, June 13 | 1:00 - 2:00pm ET

Grayken Center for Addiction Training & TA

Family Members and Addiction Treatment Outcomes: Applying Research to Clinical Practice

Tuesday, June 18 | 8:00 - 9:00am 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

Ethical Issues in Opioid Treatment Programs

Wednesday, June 5

12:30 PM - 1:30 PM

Maternal Health ECHO

High-Risk Pregnancy

Tuesday, June 11

8:00 AM - 9:00 AM

SUD ECHO

Adolescents and Opioid Use Disorder

Thursday, June 20

12:30 PM - 1:30 PM

MACS ECHO: Providing MOUD from a Trauma-Informed Perspective

Early Interventions for Comorbid OUD and Trauma-Related Disorder

Wednesday, June 26

12:00 PM - 1:00 PM

Conferences and Events

Maryland Pharmacists Association 142nd Annual Convention

Friday, June 7 - Sunday, June 9

MACS Exhibit Table, Ocean City, Maryland

Luminis Health Anne Arundel Medical Center Grand Rounds Presentation

Friday, June 14 | 11:30 am - 1:30 pm

Virtual Event

Presented by MACS Consultant Bethany DiPaula, PharmD

MACS CME Event on Overcoming Barriers to Prescribing MOUD

Tuesday, June 25 | 6:00 pm - 7:00 pm

In-person CME Event to St. Mary's County and southern Maryland prescribers

Presented by Avi Ramprashad, MD

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

Buprenorphine Dispensing After Elimination of the Waiver Requirement

This letter to the editor highlights a study that assessed the changes in buprenorphine prescribing patterns after the elimination of the requirement for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. The authors found that the number buprenorphine prescribers increased after the elimination of the waiver requirement, but the total number of patients using buprenorphine changed little, suggesting the need for strategies to meaningfully impact buprenorphine use.

Rapid Initiation of Injection Naltrexone for Opioid Use Disorder: A Stepped-Wedge Cluster Randomized Clinical Trial

A clinical trial found that more patients successfully initiated injectable extended-release (XR)-naltrexone using a rapid procedure to withdraw from opioid treatment compared to a standard procedure. The findings suggest that a rapid approach to withdrawal management could make XR-naltrexone a more viable treatment for patients with OUD, although it may require more intensive medical management and safety monitoring.

Adult Use Cannabis Legalization and Cannabis Use Disorder Treatment in California, 2010-2021

An observational study found that the legalization of adult-use of cannabis was associated with an overall decline in cannabis use disorder (CUD) treatment admissions in California. Adult-use legalization was also associated with increases in the probability of CUD admissions for criminal justice referrals, Black Americans, and Hispanic Americans, suggesting that further research is needed on disparities in adult-use legalization and CUD treatment.

Rural-Urban Disparities in the Availability of Hospital-Based Screening, Medications for Opioid Use Disorder, and Addiction Consult Services

This study assessed the availability of transitional opioid programs across rural and urban hospitals in the United States. Results demonstrated that rural hospitals had lower odds of offering medications for opioid use disorder and utilizing addiction consult services, potentially contributing to rural-urban disparities in health outcomes related to opioid use disorder.

Exploring Racial and Secondary Substance Use Differences in Route of Administration of Opioid Drugs: Analysis of the 2015-2019 Treatment Admission Data

This study found significant racial and ethnic differences in polysubstance use and route of administration of heroin and other opioids for individuals entering treatment. The findings highlight the need for culturally-tailored interventions to address the needs of under-represented racial and ethnic minority groups.