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

December 2024

Dear Carson,

Heading into the new year, legislation takes effect statewide on January 1, 2025, urging hospital emergency departments to address the needs of patients with opioid use disorder. Specifically, the cross-filed SB1071 and HB1155, "requires each hospital to establish and maintain protocols and capacity to:

(1) provide appropriate, evidence-based interventions that reduce the risk of subsequent harm and fatality before discharging a patient after an opioid-related overdose or a visit for an opioid-related emergency medical condition
(2) possess specified medications used for the treatment of opioid use disorder (OUD); and
(3) treat a patient who presents in a hospital emergency department (ED) for an opioid-related overdose or emergency medical condition with a medication for OUD, as specified."

The legislation to set to provide assistance to individuals in hospital emergency departments for opioid- and non-opioid-related incidents. We will continue to share resources to help healthcare professionals navigate these changes.

In additional end-of-year news, we are highlighting several program milestones that have occurred since MACS launched in 2017:

Enrolled over 4,300 providers across all of Maryland's 23 counties and Baltimore City
Responded to over 1,900 clinical consultations
Conducted over 400 educational trainings
Hosted over 125 ECHO Clinics for primary care, maternal health, opioid treatment program, and trauma-informed providers and teams
Gained over 1,300 total followers and subscribers on social media channels including Facebook, Instagram, LinkedIn, X and YouTube

Explore this newsletter and the tools available on the MACS website for additional information about provider education and treatment resources.

We wish you a joyful holiday season and a healthy 2025 to come!

The MACS Team

EDUCATION

MACS ECHO Clinics

Take advantage of our final training opportunities of the year!

Please note that our Trauma-Informed Perspective ECHO Clinic is happening a week earlier than usual due to holiday schedules.

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

Benzodiazepines and OUD

Devang Gandhi, MD

Wednesday, December 4

12:30 p.m. – 1:30 p.m.

Maternal Health

Alcohol Use and Pregnancy

Christopher Welsh, MD

Tuesday, December 10

8:00 a.m. – 9:00 a.m.

Substance Use Disorders

Opioid Use Disorder and Cannabis: A Balanced Approach

Mike Fingerhood, MD

Wednesday, December 18

12:30 p.m. – 1:30 p.m.

Providing MOUD from a Trauma-Informed Perspective

Trauma-Informed Community Engagement

Marik Moen, PhD

Thursday, December 19

12:00 p.m. – 1:00 p.m.

Upcoming MACS Training Opportunities

MACS for MOMs Webinar

PCSS-MOUD Half & Half Training Hosted by MACS for MOMs

Friday, January 10 | 8:00 a.m. – 12:00 p.m.

Presented by MACS for MOMs Medical Director Christopher Welsh, MD, and Consultant Katrina Mark, MD

MACS Webinar

Decreasing Treatment Disparities for African Americans With OUD

Friday, January 31 | 12:00 p.m. – 1:00 p.m.

Presented by Aliya Jones, MD, Executive Medical Director of Behavioral Health for Luminis Health

MACS Webinar

Optimizing the Pharmacy Partnership in Managing Patients With OUD

Thursday, February 6 | 12:00 p.m. – 1:00 p.m.

Presented by MACS Consultant Bethany DiPaula, PharmD, BCPP

Save the date! Registration link coming soon.

MACS Webinar

Alcohol Use Disorder Review, Co-Occurring Disorders, and Pharmacologic Treatments/Pitfalls

Friday, March 7 | 12:00 p.m. – 1:00 p.m.

Presented by MACS Consultant Avinash Ramprashad, MD

Save the date! Registration link coming soon.

Upcoming Trainings of Interest

Rural Communities Opioid Response Program – Technical Assistance

The Growing Xylazine Crisis in the U.S.: Epidemiology and Treatment of Novel Wounds Webinar

Tuesday, December 3 | 2:00 p.m. – 3:00 p.m.

Behavioral Health System Baltimore

New OTP Regulations & How They Affect OUD Care at SNFs

Presented by MACS Consultant Aaron Greenblatt, MD

Thursday, December 5 | 12:00 p.m. – 1:00 p.m.

Substance Abuse and Mental Health Services Administration

PCSS-MOUD Webinar: Inequities in Black People Accessing and Receiving Substance Use Treatment

Thursday, December 5 | 2:00 p.m. – 3:00 p.m.

Grayken Center for Addiction Training & Technical Assistance

Initiation of Buprenorphine in Outpatient Settings

Wednesday, December 11 | 9:00 a.m. – 10:00 a.m.

Maryland's Office of Overdose Response

Maryland Overdose Response Advisory Council Regular Meeting

Thursday, December 12 | 10:00 a.m. – 11:30 a.m.

Live Stream

Yale Program in Addiction Medicine

Addiction Medicine Grand Rounds: Perinatal Substance Use

Tuesday, December 17 | 12:00 p.m. – 1:00 p.m.

CONFERENCES AND EVENTS

Maryland-DC Society of Addiction Medicine Annual Conference

Saturday, February 1

Silver Spring Civic Building at Veterans Plaza | Silver Spring, Maryland

Presentations by MACS Consultants Mike Fingerhood, MD, and Marc Fishman, MD

MACS exhibit table

Maryland Academy of Family Physicians Annual Meeting & Winter Refresher

Saturday, February 22 – Sunday, February 23

The Graduate Hotel Annapolis | Annapolis, Maryland

MACS exhibit table

NEWS

Dynamic overrepresentation of accumbal cues in food- and opioid-seeking rats after prenatal THC exposure

Researchers at the University of Maryland School of Medicine conducted a preclinical animal study on rats exposed to cannabinoids in the womb, finding that it increases the risk of addiction to opioids later in life. The study discovered that prenatal exposure to THC, the main psychoactive ingredient in cannabis, causes changes in the brain's reward system, leading to a heightened release of dopamine upon exposure to opioid drugs in adolescence.

Association between state-level medical marijuana legalization and marijuana use during pregnancy: A population-based study

Using National Survey on Drug Use and Health data from 2015 to 2021, this population-based study examined the association between pregnant women's marijuana use in the past month and the legal status of medical marijuana in their state of residence. Results indicated that about 5.7% of pregnant women reported marijuana use in the past month, and 59% of them lived in states where medical marijuana had legal status across 2015 to 2021. Pregnant women living in states with medical marijuana legalization reported past-month use at higher rates than those living in states without such legal status (6.5% v. 4.6%). Despite increased marketing of marijuana and related products, pregnant women should be informed of adverse pregnancy and birth outcomes associated with marijuana use during pregnancy.

Availability of Medications for Opioid Use Disorder in US Psychiatric Hospitals

In this cross-sectional analysis of facility-level responses to the 2022 National Substance Use and Mental Health Services Survey, psychiatric hospitals reported their medication for opioid use disorder (MOUD) availability. Survey results found that of the 1,021 responding psychiatric hospitals, 490 reported providing MOUD. With MOUD provided in less than one-half (47.99%) of the responding psychiatric hospitals, the study exposes room for improvement when it comes to MOUD provision for individuals with comorbid opioid use disorder (OUD) and mental health conditions.

Wound Characteristics Among Patients Exposed to Xylazine

This case series using data from three academic hospitals in Philadelphia, Pennsylvania, analyzed 59 wounds among 29 hospitalized patients with confirmed xylazine exposure. Of these wounds, 53 were located on patients' extremities and 41 involved their extensor surfaces. Out of the 57 wounds that were photographed, 34 contained wound beds of mostly devitalized tissue. In addition, the longer these wounds persisted, the more likely they were to have larger and necrotic wound beds. The study's authors hope to inform xylazine-associated wound identification, management and research to combat an emerging threat to public health.