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

August 2024

Dear Anna,

In August, communities throughout Maryland and nationally take pause to acknowledge two substance use awareness days, "International Overdose Awareness Day" and "National Fentanyl Prevention and Awareness Day." In the United States, there were 107,543 drug overdose deaths in 2023. While the national rate of overdose deaths declined from 2022 to 2023, overdose mortality rates have increased for some racial and ethnic minority populations, specifically older Black men and non-Hispanic American Indians or Alaska Natives. August 31 is International Overdose Awareness Day, a time to honor those who have died from overdose, raise awareness about substance use disorder (SUD), and promote treatment and recovery. To help Maryland communities combat overdose, the Maryland Department of Health released a new Overdose Data Dashboard. This enhanced dashboard provides current state-level data on fatal overdoses, non-fatal emergency department visits, and harm reduction services to assist in community-level programming. Health professionals can also play a pivotal role in reducing drug-related harm and preventing overdose; in fact, a recent study in Addiction found that higher buprenorphine dosing in clinical settings can improve outcomes in patients with opioid use disorder. To learn more about patient care, healthcare providers can reach out to MACS for guidance and support with screening, resources, referrals, or clinical consultation.

In 2023, there were 174.1 drug overdoses per 100,000 people in Baltimore, MD and the majority of deaths were attributed to fentanyl. Furthermore, 87 percent of the over 2500 overdose deaths in Maryland were in combination with fentanyl. National Fentanyl Prevention and Awareness Day is August 21, an opportunity to educate individuals about the dangers of fentanyl and provide communities with resources to prevent fentanyl overdose. Explore this newsletter and the tools available on the MACS website for additional resources on opioid treatment guidelines and harm reduction strategies.

Call MACS and join our upcoming Fall webinars to expand your knowledge in caring for individuals with SUD and chronic pain management. Our team of addiction specialists are here to support you and your healthcare team in providing services for SUD and chronic pain management.

The MACS Team

EDUCATION

Upcoming MACS Training Opportunities

MACS for MOMs Webinar

Co-Occurring Disorders and Pregnancy

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

Presented by MACS for MOMs Consultant Chris Welsh, MD

MACS Webinar

Introduction to HHS Office of Civil Rights

& 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

Alcohol Use Disorders 101

Wednesday, August 21 | 2:00 - 3:00pm ET

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

What Now: Xylazine in the Age of Opioid Use Disorder

Tuesday, August 27 | 1:00 - 2:00pm ET

MACS ECHO Clinics

There will be no MACS ECHO programming (OTP, SUD, Maternal Health, and SUD-Trauma) during the month of August. All ECHOs will return in September with new curriculums and case-based discussions. Be sure to check out the ECHO homepage for additional information!

Conferences and Events

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

Wednesday, September 11 | 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

Hospice and Palliative Care Network of Maryland 2024 Annual Conference

Wednesday, September 25

Benzodiazepine Use in the Older Adult Population

Conference Presentation by MACS Consultant, Mike Fingerhood, MD

MACS Exhibit Table, Linthicum, Maryland

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

Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit

This cohort study investigated whether patients with opioid use disorder (OUD) who started medication for opioid use disorder (MOUD) after a hospital visit had lower odds for future opioid overdose. Initiation of MOUD was associated with reduced odds of opioid-related overdoses at 6 months, suggesting that hospitals should consider implementing protocols to offer initiation of MOUD to patients with OUD.

Impact of an Alcohol Withdrawal Screening and Treatment Protocol for Hospitalized Patients

This retrospective cohort study found that that Alcohol Withdrawal Syndrome (AWS) screening and treatment protocol was associated with a significant reduction in total benzodiazepine dose and progression to delirium tremens in hospitalized patients. The findings support implementing universal screening with validated screening tools and standardized treatment protocols to improve clinical care in hospitalized patients at risk for AWS.

Physician Reluctance to Intervene in Addiction: A Systematic Review

This systematic review found that the most common reasons for physician reluctance to intervene in SUD were lack of institutional support, knowledge, skill, and cognitive capacity. The results suggest that targeting these reasons with education, training, and program implementation may improve adoption of evidence-based practices for substance use and addiction care.

Heavy Lifetime Cannabis Use and Mortality by Sex

A cohort study using data from the UK Biobank examined the associations between lifetime cannabis use and all-cause, cardiovascular disease (CVD), and cancer mortality. Results demonstrated that heavy lifetime cannabis use was associated increased risk of CVD mortality among females, suggesting that more longitudinal studies are needed to investigate the potential effects of cannabis on mortality.

Knowledge, Attitudes, and Beliefs About Opioid Use Disorder Treatment in Primary Care

A cross-sectional survey found that most adults were unaware that a primary care physician (PCP) can provide medication for opioid use disorder (MOUD). Findings highlight the need for interventions and targeted messaging to raise awareness about the opportunity to receive MOUD from PCPs in the United States.

Systematic Biases Promoting the Under-Inclusion of Marginalized Groups in Randomized Controlled Trials for Co-Occurring Alcohol Use and Posttraumatic Stress Disorder: An Intersectional Analysis

This study assessed the inclusion of people by race and sex in randomized controlled trials (RCTs) for co-occurring posttraumatic stress disorder and alcohol use disorder. Results demonstrated that people of color and White women were significantly under-included in RCTs, suggesting that efforts must be made to include marginalized groups in substance use and mental health research.