National Group Salutes County for its Response to Opioid Crisis

Heroin and fentanyl once ravaged the region to such a degree the coroner said Montgomery County was suffering an “emergency of mass disaster proportions.”

Now, a collaborative community response that helped bring overdose deaths to a recent three year low is drawing recognition with an award from the National Association of Counties.

“After a few rough years of being identified as the epicenter of the opioid crisis, I think we’re demonstrating again why Montgomery County is known for innovation,” said Helen Jones-Kelley, executive director of the Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) board.

The Community Over dose Action Team (COAT), formed in the fall of 2016 in response to the epidemic, will be honored in July with a human services achievement award at the association’s annual conference in Tennessee.


The effort is succeeding because of participation beyond elected officials, and beyond those in public health and law enforcement, said Montgomery County Sheriff Phil Plummer.

“The credit goes to the grassroots organizations that were in the trenches,” he said “Groups like Families of Addicts and the Drug Free Coa lit ion are doing tremendous work out there.”

More than 200 people from 100-plus organizations worked to put the opioid epidemic in retreat, said Montgomery County Health Commissioner Jeff Cooper.

“The award is a reflection of our community’s willingness to come together and work united and align our resources to respond to a public health crisis,” he said.

Heroin and fentanyl are largely responsible for the overdose deaths of more than 1,600 people in Montgomery County over the past five years, including 566 in 2017.

But last year could have been worse.

Beginning in June, the numbers took a dramatic turn for the better after 81 people died in May. By March this year, fewer people were dying each month than at any time since early 2015.

“We obviously didn’t set out to win awards when we started this. Our focus was to get organized and reduce the number of opiate deaths,” said Montgomery County Commissioner Dan Foley. “While there are still too many people dying of drug overdoses, the COAT is working and the community should feel good about it.”

Between January and May of last year, 1,773 overdose calls were reported in the county, Plummer said. The number is about a third of that this year.

Bar bar a Marsh, assistant health commissioner for Public Health-Dayton and Montgomery County, said COAT developed, expanded or enhanced more than 45-plus programs across the community.

The collaborative continues to work on eight areas of focus from increasing treatment accessibility to decreasing the illegal supply of drugs, as well as distributing Narc an, educating the public and promoting the careful prescribing of opioids.

“I think there are many counties that are very interested in the structure, and they are looking at how to implement it,” Marsh said.

New programs were put in place at the Montgomery County Jail, including medication-assisted treatment, peer support counseling and a streamlined process for getting inmates into residential and outpatient programs once released, Plummer said. But on any given day, dozens of inmates are still waiting for treatment.

“We have made great strides in dealing with the individuals who suffer from substance abuse and mental illness in our jail,” Plummer said. “We still have about 50 people per day going through withdrawal in our jail.”

Among other initiatives, COAT works with employers to give those struggling to get clean second and third chances at jobs, Jones-Kelley said.

“It was an all-out effort. It wasn’t a traditional response to a problem,” she said.

Cooper said the group effort won’t be disbanding anytime soon, the structure will stay in place to address other health crises.

“We know we still have a long way to go,” he said.

“But it truly is a model-the Community Over dose Acti on Team-that we can now build upon to respond to when the drug of choice changes in the community.”

Contact this reporter at 937-225-2442 or

Original article here on


Webinar Friday 5/25: Treatment of Pain in the Addicted Person


Friday| May 25, 2018 | 12:00 – 1:00 pm ET

Presenters: Allen Masry, MD

Sponsor: International Nurses Society on Addictions (IntNSA)

About the webinar: This webinar will cover material on chronic and acute pain in the person with Substance Use Disorders. The differences between chronic and acute pain will be described. Treatment for patients with Substance Use Disorders and pain will be discussed.

Educational objectives:

·     Describe the difference between chronic pain and acute pain

·     Discuss pain in the addicted person

·     Describe one evidence-based intervention for pain in the addicted person

Continuing education information: This webinar has been approved by the California Board of Nursing for 1 contact hour of continuing nursing education. Credit will be granted for each individual participating for the duration of the event.

Click on the Register icon below to register.


The Benefits of Having Naloxone Readily Available

Dr. Hillary Kunins, a Providers Clinical Support System Clinical expert, explains the benefits of naloxone, a medication that can immediately revive a person who has overdosed on an opioid.

Dr. Kunins discusses who should have naloxone prescribed and where should it be made available.

Dr. Kunins is an Assistant Commissioner at the New York City Department of Health and Mental Hygiene.


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Study Looks At Barriers To Getting Treatment For Substance Use Disorders

For patients with substance use disorders seen in the emergency department or doctor’s office, locating and accessing appropriate treatment all too often poses difficult challenges. Healthcare providers and treatment facility administrators share their views on delays and obstacles to prompt receipt of substance use disorder treatment after referral in a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM). This journal is published in the Lippincott portfolio by Wolters Kluwer.

Issues related to patient eligibility, treatment capacity, understanding of options, and communication problems all contribute to gaps in referral and delays to getting treatment for patients with substance use disorders, according to the new research by Claire Evelyn Blevins, PhD, of Warren Alpert Medical School of Brown University and Butler Hospital, Providence, RI; Nishi Rawat, MD, of OpenBeds, Inc., Washington. DC; and Michael Stein, MD, of Boston University and Butler Hospital.

Four Themes Affecting Obstacles to Treatment for Substance Use Disorders

The ongoing opioid crisis has drawn attention to the widening gap between the high need and limited access to substance use treatment in the United States. A recent Substance Abuse and Mental Health Services Administration report found that of 21.7 million Americans in need of substance use disorder treatment, only 2.35 million received treatment at a specialty facility. Yet there is little information on the organizational-level barriers to treatment for substance use disorders.

Beakers Full of Liquid

To address this issue, Dr. Blevins and colleagues performed a series of interviews with 59 stakeholders in the treatment referral process. The study gathered input from those who make referrals for substance use treatment, including emergency medicine physicians, addiction specialists, and other medical providers; as well as those who receive referrals, including substance use treatment facility staff and administrators.

Analysis of the interviews identified four broad themes:

  • Patient Eligibility. Healthcare providers face difficulties in determining whether patients meet criteria for admission to a particular treatment center, including the application of treatment eligibility criteria. “Eligibility requirements may prevent a patient from entering a treatment center,” the researchers write.
  • Treatment Capacity. Even if a patient is eligible, providers have trouble finding out whether space is available. “Despite the need for services, treatment centers may not run at capacity, because of frustrations encountered and time wasted on the referral and admission process.”
  • Knowledge of Treatment Options. Providers may not understand the levels of available care for substance use treatment, and how to select the best treatment for their patient. “After determining appropriate level of care, a provider must then find a program that meets the patient’s needs, which becomes more difficult with the differences in terminology and program guidelines.”
  • Communication. Difficulties in communication between referring providers and treatment facilities can contribute to delays to starting treatment. The need for direct referral – “from the emergency department to a bed” – is particularly high for patients with opioid use disorders.

“Access to substance use disorder treatment is often a maze that can be difficult to navigate for both providers and patients,” Dr. Blevins and coauthors write. Based on the themes identified, they make recommendations for improvement in the referral process, including a database of clear eligibility criteria, real-time information on treatment capacity, and increased education and training for providers on substance use treatment.

They also propose ways to improve communication and reduce treatment waiting times, including new information technologies. The researchers write: “By improving systems that enhance communication across organizations, patient referrals may be more easily completed, improving access to care and expanding the use of appropriate treatments for the many patients in need.”

In an accompanying commentary, David L. Rosenbloom, PhD, of Boston University School of Public Health discusses the underlying reasons for the current “dysfunctional referral system.” He notes that referrals for other chronic diseases “may be more effective because they are to ‘in-house’ affiliated providers.” Dr. Rosenbloom writes: “The standard of care should be to stabilize, initiate treatment, and provide a hands-on transfer to an entity that can complete a diagnostic assessment and provide evidence-based treatment” for patients with substance use disorders.

Original article here on

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Event in Chillicothe: Thursday 4/26, OHSAM President To Speak

Connection is the Opposite of Addiction. There are many local resources available to addicts and families wishing to connect; and people and organizations that are ready to help.

Join us for Addiction: Understanding Local Support and Resources, a free, community-focused forum on the health crisis of opioid addiction; and the help that is available in our region.

Hear from representatives from Adena Health System who will share how it is fast becoming a catalyst in saving lives, while fighting addiction. Also hear from experts about medication-assisted treatment; ambulatory detox options; and how the City of Chillicothe and Ross County are taking a proactive approach in reaching addicts and families following an overdose.

Dr. Shawn Ryan, OHSAM president, will also be speaking at this event in Chillicothe tomorrow evening.

The event is free, but participants are asked to register. Light refreshments will be available.

To register, and get your free tickets, click the green REGISTER button below and follow the steps.


Location: Adena PACCAR Medical, Education Center 446 Hospital Road, Chillicothe, OH 45601

When: Thursday April 26, 6:00pm-8:00pm EDT

View Map

Original post here.

PDF icon

Click the above PDF icon for the official addiction panel flier and feel free to share with anyone who might be interested in this event. If the above PDF does not work, please use the link below:

Addiction Panel Flier

Gov. Kasich Proclaims April 23rd-29th, 2018 Addiction Treatment Week in Ohio

Today, April 24, 2018 in Columbus, Ohio, John Kasich, Governor of Ohio, signed a proclamation declaring April 23rd-29th, 2018 Addiction Treatment Week in Ohio. National Addiction Treatment Week, an initiative by the American Society of Addiction Medicine (ASAM), raises awareness that addiction is a disease, evidence-based treatments are available, and recovery is possible.

The adverse effects of the opioid epidemic and addiction in Ohio are evident. In 2016, Ohio had the second highest drug overdose death rate (39.1*) in the nation, according to the Centers for Disease Control and Prevention (CDC).[1]  The Ohio Department of Health reported that “unintentional drug overdoses caused the deaths of 4,050 Ohio residents [in 2016], a 32.8 percent increase compared to 2015 when there were 3,050 overdose deaths.[2]” The latest available data shows an average of 3,288 alcohol-related deaths per year in the state.[3]

The significant treatment gap for addiction in the United States (US) is an important part of the epidemic. Nearly 20.5 million Americans suffer from a substance use disorder (SUD), yet only 1 in 10 people with SUD receive treatment.[4] In 2015, nearly 2.3 million Americans suffered from opioid use disorder, yet there was only enough treatment capacity to treat 1.4 million people[5], leaving a treatment gap of nearly 1 million people.

Addiction Treatment Week Logo

“We applaud Governor Kasich’s proclamation of Addiction Treatment Week and his continued efforts to combat an epidemic that is without precedent in Ohio.  Generating awareness that addiction is a disease, rather than a moral failure, is a crucial step to saving lives,” said Shawn Ryan, MD, FASAM, president of the Ohio Society of Addiction Medicine (OHSAM). “Given the high rate of drug overdose deaths in our state, we must all work together to increase patients’ access to evidence-based addiction treatments.  OHSAM is committed to helping physicians treat addiction and reduce the barriers to successful treatment and recovery.”

To learn more about National Addiction Treatment Week, how to get involved, and how to spread the word about the need for a larger addiction medicine workforce, visit

Original announcement here.

* The number of deaths per 100,000 population [1] [2] 2016 Ohio Drug Overdose Data: General Findings [3][4] U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. CH 4-2 [5]

Join OHSAM president Dr. Ryan Tomorrow for a Webinar: Pathways to the Addiction Medicine Subspecialty

OHSAM President, Dr. Shawn Ryan is one of the main speakers in this webinar: Pathways to the Addiction Medicine Subspecialty, tomorrow, April 25 @ 12:00 pm – 1:00 pm EDT.

This free webinar will begin with an overview of the current state of the addiction epidemic and the huge gap in addiction treatment. It will then move on to the role physicians can play to help close this gap, and the importance to sit for the ABPM Addiction Medicine exam. The webinar will then move on to a representative from ABPM discussing the details of how physicians can apply for the ADM exam and any “lessons learned” from last year. This webinar is ideal for any physician interested in addiction medicine, ABAM Diplomates, DATA 2000 waivered physicians, medical directors, and others.


  • Shawn Ryan, MD, MBA  President of OHSAM (Ohio state chapter of ASAM)
  • Michael Weaver, MD, FASAM  Professor at The University of Texas Health Science Center at Houston (UTHealth)
  • Steve Daviss, MD  Senior Medical Advisor, Office of the CMO at SAMHSA

Click on the blue “register” icon below to register or visit this link. 



Ohio Addiction Policy Inventory and Scorecard

This report is the first in a series of inventories and scorecards analyzing Ohio’s policy response to the addiction crisis and outlining areas where the state could be more effective.

The report provides policymakers and other stakeholders with the information needed to take stock of Ohio’s policy response to the addiction crisis over the past five years by reviewing state-level policy changes enacted in Ohio from 2013-2017. It includes:

  • An inventory of policy changes (legislation, rules, regulations and new or expanded state agency initiatives, programs, systems changes or guidelines) 
  • A scorecard that indicates the extent to which Ohio is implementing strategies that are proven effective by research evidence
  • Opportunities for improvement in both the public and private sectors

The report focuses on the first three elements of a comprehensive policy response to addiction: prevention, treatment and recovery. HPIO plans to develop similar inventories and scorecards for other key elements in 2018 and 2019 (see graphic below).

3 key findings for policymakers

In 2016, 4,050 Ohioans died because of  unintentional drug overdoses, and preliminary 2017 data indicates that the number of deaths has continued to rise.

The consequences of addiction are widespread. For example, the number of babies born with neonatal abstinence syndrome (NAS) increased 500 percent in the past 10 years and thousands of children experience trauma because they live in families struggling with addiction. Employers report difficulty hiring drug-free workers, and researchers estimate that the opioid crisis cost Ohio $3,385 per capita in healthcare and criminal justice spending and reduced worker productivity in 2015. 

Public and private stakeholders have worked hard to understand and address the crisis. Policy changes advanced by the executive and legislative branches have led to implementation of many evidence-based programs in Ohio, reduced the amount of opioid prescriptions dispensed and increased health insurance coverage and treatment access for thousands of Ohioans through expanded Medicaid eligibility.


Although this report has a strong focus on prescription opioids and other opiates, the detailed inventory and scorecard (available below) also review policy changes related to several other substances (alcohol, tobacco, methamphetamine, cocaine, etc.).

HPIO logo

The report is part HPIO’s Addiction Evidence Project, which provides policymakers and other stakeholders with information needed to address substance use disorders in a comprehensive, effective and efficient way. This inventory and scorecard addresses three topics: prevention, treatment and recovery. Future reports will address the other topics listed below, including overdose reversal (naloxone).

Additional resources on addiction prevention, treatment and recovery

Link to original site here.

Opioid Crisis Takes Personal Toll on Washington

The opioid crisis is hitting families across the nation regardless of income, race or gender. Lawmakers are no exception. In the past few months, The Hill has talked to a number of House and Senate members who have a personal connection to addiction and the opioid epidemic. This is the first in a five-part series presented by Partnership for Safe Medicine.

The epidemic has put enormous strain on health care responders, treatment providers and communities across the country, creating a health emergency that shows no signs of abating.

Yet despite the gravity of the problem, there’s a sense from some that the nation isn’t doing enough to stem the crisis.

Congress has approved $6 billion in new spending over the next two years to combat opioid abuse and bolster mental health services, but some say that is a drop in the bucket compared to what’s needed.

“If it were some other illness, we would be throwing exponentially more dollars at this than we are,” said Patrick Kennedy, a former Rhode Island Democratic congressman who’s now a vocal advocate for fighting drug addiction.


“We would be mobilizing significantly more federal resources toward tackling this. We would be marshaling every agency within the federal government to attack this,” said Kennedy, who served on the president’s commission to combat the opioid epidemic last year and has since been critical of the White House’s response to the crisis.

Deaths involving opioids have been rising since 1999. They increased nearly 28 percent from 2015 to 2016, an increase largely driven by a synthetic opioid packing up to 50 times more power than heroin.

An estimated 115 people are dying of an opioid-related overdose every day. When members of Congress return to their districts, they say they hear first-hand how painkillers, heroin and fentanyl are wrecking lives — and that’s resulted in a sea change in attitudes about drug abuse.

The notion that addiction is a disease, rather than a moral failing, is increasingly the consensus.

“My old boss, Michael Botticelli [former President Obama’s drug czar], would say all the time, ‘you can’t hate up close,’ ” said Regina LaBelle, the White House Office of National Drug Control Policy’s chief of staff under Obama.

Opioid Overdose Deaths Graph 1

Opioid Overdose Deaths Graph 2

The shift in perspective has resulted in a less punitive response than in the past. In the 1980s, for example, policymakers responded to the crack cocaine epidemic by launching the “war on drugs” and creating mandatory minimum prison sentences for drug offenders.

“If your brother or your sister or your neighbor is dying of a drug overdose, you are less likely to want to have a punitive response, and the difference in what happened today than what happened in the ’80s reflects that,” LaBelle said.

Advocates working on addiction policy say it has also gotten easier to publicize the problem.

More than 15 years ago, when Andrew Kessler first began working in the field, he said advocates “had to fight for every bit of attention we got.”

Kessler, the founder of the behavioral health consulting firm Slingshot Solutions, recalled a presentation he gave in 2013 on addiction advocacy.

“The reason we can’t get a lot of traction is because no member of Congress is going to go home to their districts and say, ‘I’m running on a platform of treating substance abuse and addiction,’ ” Kessler recalled telling the crowd.

“Three years later, in the 2016 election — boom — I was already wrong,” Kessler said.

Kessler attributes the turnaround to the increasing number of opioid overdose deaths, which rose nearly 70 percent between 2013 and 2016.

Drug Overdose Deaths Map

The response from policymakers is improving, though much more is needed, said Patty McCarthy Metcalf, the executive director of Faces and Voices of Recovery.

“Getting Congress to take this issue up took a lot of work and a lot of advocacy from the grass roots to put pressure on Congress to understand that this didn’t happen overnight, it’s been coming for a while,” she said. “The rate [of opioid-related overdose deaths] has been increasing — we haven’t seen it decreasing, so something is not working.”

Efforts are underway in both chambers to produce opioid legislation, which could be one of the only larger legislative packages to pass before the midterm elections in November.

The House Energy and Commerce Committee has held three legislative hearings on more than 65 separate bills with the goal of getting an opioid package to the House floor before Memorial Day weekend.

On the other side of the Capitol, a bipartisan group of eight senators introduced a follow up to the Comprehensive Addiction and Recovery Act, passed in 2016, dubbing the bill “CARA 2.0.” One of the bill’s most controversial provisions is a three-day limit on first-time opioid prescriptions for patients with acute pain.

Earlier this month, the leaders of the Senate Health Committee released a bipartisan discussion draft of an opioid bill, which the panel reviewed at a hearing last week and will mark up April 24.

The Trump administration is also pushing for action.

Declaring “we can be the generation that ends the opioid epidemic,” President Trump made opioids a national public health emergency in late October. But some advocates have expressed frustration with that move, saying it has led to little concrete action.

Last month, Trump released a three-pronged approach to tackle the opioid epidemic, which included some measures popular with public health advocates.

But a portion of Trump’s rhetoric, and a bulk of the subsequent media attention, focused on the inclusion of a controversial provision — mandating that the Department of Justice seek the death penalty for some drug traffickers, when appropriate under current law.

Advocates have said the concept is reminiscent of the war-on-drugs approach that failed in the past.

Instead, they say a focus on prevention, treatment and recovery is what’s needed, as advocates work to stomp out the stigma of addiction. Some progress is being made on that front, advocates say, with more people coming forward to say they have an addiction or lost a loved one to a drug overdose.

“You can see it in the obituaries,” Kennedy said, “literally for the first time ever, you’re seeing on a regular basis people actually acknowledge the true cause of death for people dying of overdoses.”

Kaitlin Milliken contributed to this report. Graphics and illustration by Nicole Vas. Video by Tom Pray.

Original article here on

Naltrexone: What Should Patients Expect With First Dose?

This two-part video gives both providers and patients detailed information about naltrexone, including benefits and possible side effects following the injection.

Dr. Mariani, Associate Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University, is a PCSS clinical expert.  He discusses naltrexone with a patient who has chosen that medication to treat her opioid use disorder.

Part 1

Part 2


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