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

November 2025

Greetings,

Welcome to the November edition of the MACS Monthly newsletter!

This month, the MACS team is excited to celebrate National Nurse Practitioner Week (November 9 – 15) and honor the roles of over 431,000 nurse practitioners (NPs) nationwide. These healthcare professionals deliver patient-centered care in a variety of settings, from hospitals and urgent care centers to nursing homes and private practices. NPs play a crucial part in addressing substance use disorder (SUD), often serving as the initial point of contact for patients seeking treatment. MACS is proud to support NPs in their efforts to treat SUD and manage chronic pain for their patients, offering expertise and resources to enhance their life-saving work.

This month also includes National Rural Health Day on November 20, drawing attention to the unique challenges faced by rural communities in accessing care for SUDs. A recent study in the Journal of Substance Use and Addiction Treatment, "Different forms of stigma and rural primary care professionals' willingness to prescribe buprenorphine," explored the impact of stigma on rural primary care professionals' (PCPs) willingness to provide this life-saving medication for opioid use disorder (MOUD). The research identified three distinct forms of stigma acting as major barriers to buprenorphine access: stigma towards patients, where PCPs expressed fear of being harmed by patients with opioid use disorder (OUD); stigma towards providers, with concerns about clinic stigmatization upon the treatment of addiction; and stigma towards buprenorphine itself, due to worries about unintentional patient harm. These findings suggest that implementation strategies must address these different forms of stigma to improve prescribing rates and meet the essential health needs of rural residents.

To support providers in overcoming these pervasive barriers, MACS and the Maryland Department of Health have compiled comprehensive resources aimed at helping all providers effectively address and mitigate stigma in healthcare settings.

Providers can access support in caring for patients with SUDs and chronic pain by scheduling an individualized consultation or registering for an upcoming training with the MACS team of addiction medicine specialists. Call 1-855-337-MACS (6227) or visit www.marylandmacs.org to learn more.

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

– The MACS Team

NEW FACT SHEET

This new fact sheet from the MACS team explores kratom use, from its perceived benefits for pain and energy to the risks of dependence and overdose. It details clinical guidance on managing withdrawal, addresses the risk of synthetic kratom products and highlights the importance of prescribing naloxone to all patients using opioid-like substances.

Kratom (Mitragynine): Clinical Considerations

MACS IN THE MEDIA

As our director of research and evaluation, Bethea Kleykamp, PhD, served as a key expert on nicotine for the recent GQ article "Why Men Are Using Nicotine Pouches for a Pre-Workout Boost."

Dr. Kleykamp explained the science behind the trend, noting that nicotine's stimulant effects temporarily enhance focus, attention and fine motor skills, which users feel improves their concentration and performance. However, she also emphasized the high risk of nicotine dependence this trend poses for a new population and the potential for cardiovascular stress from combining concentrated nicotine with intense exercise.

Check Out the Article

EDUCATION

Upcoming MACS Training Opportunities

MACS for MOMs Webinar

Understanding the Whole Patient: Social Drivers and Prenatal Substance Use

Tuesday, November 18 | 12:00 p.m. – 1:00 p.m.

Presented by MACS for MOMs Consultant Courtney Townsel, MD

MACS Webinar

Confronting Stigma in Addiction Care

Thursday, December 4 | 12:00 p.m. – 1:00 p.m.

Presented by MACS Consultant Michael Fingerhood, MD

Upcoming Trainings of Interest

National Health Care for the Homeless Council

Increasing Buprenorphine Access and Overdose Prevention Responses

Wednesday, November 5 | 3:00 p.m. – 4:00 p.m.

NAADAC, the Association for Addiction Professionals

From Insight to Action: Affirming Clinical Strategies for LGBTQ+ Clients with Co-Occurring Disorders

Friday, November 7 | 12:00 p.m. – 1:30 p.m.

University of Pittsburgh Medical Center Health Plan

Empowering Providers: Comprehensive Care for Tobacco Use Disorder

Wednesday, November 12 | 12:00 p.m. – 1:00 p.m.

National Council for Mental Wellbeing

Where Is All This AI Going for Behavioral Health Providers? A Look Into the (Not-so-distant) Future

Wednesday, November 18 | 2:00 p.m. – 3:00 p.m.

Grayken Center for Addiction Training & Technical Assistance

Alcohol Use Disorders 101

Thursday, November 20 | 9:00 a.m. – 10:00 a.m.

Maryland Health Care Commission and MedChi, The Maryland State Medical Society

Best Practices for Coordinating Care and Managing Referrals

Friday, November 21 | 11:30 a.m. – 12:30 a.m.

MACS ECHO Sessions

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

Registration Changes to MACS ECHO Sessions

Registration procedures for MACS ECHO Sessions have been changed to better utilize electronic learning management dashboards.

Instructions to register for any of the Fall ECHO sessions are available on the MACS website.

Opioid Treatment Program

Beyond "Benita and Quinine": Cuts, Buffs and Adulterants in Maryland

Aaron Greenblatt, MD

Wednesday, November 5

12:30 p.m. – 1:30 p.m.

Maternal Health

Social Determinants of Health and Maternal/Neonatal Outcomes in Pregnancies With SUD

Courtney Townsel, MD, MS

Tuesday, November 11

12:00 p.m. – 1:00 p.m. New time!

Substance Use Care for the General Practitioner

Pre-Exposure Prophylaxis (PrEP)

Michael Fingerhood, MD

Wednesday, November 19

12:30 p.m. – 1:30 p.m.

Providing MOUD from a Trauma-Informed Perspective

Returns in January 2026!

Please join us in January as we kick off a thoughtfully curated curriculum led by trauma-informed care experts!

CONFERENCES & EVENTS

Advanced Practice Provider Clinical Conference

Wednesday, November 5

SMC Campus Center | Baltimore, Maryland

MACS exhibit table

Hospice & Palliative Care Network of Maryland 2025 Annual Conference

Thursday, November 6

Maritime Conference Center | Linthicum Heights, Maryland

MACS exhibit table

35th Annual Mid-Maryland Emergency Nurses Association Memorial Conference

Friday, November 7

Holy Cross Hospital | Silver Spring, Maryland

Presentation by MACS Consultant Tracy Lui, DO

MACS exhibit table

University of Maryland School of Nursing Psychiatric Mental Health Nursing Program 70th Anniversary Conference

Saturday, November 8

University of Maryland School of Nursing | Baltimore, Maryland

MACS exhibit table

2025 Nurse Practitioner Association of Maryland Fall CE Conference

Saturday, November 15

Howard Community College | Columbia, Maryland

MACS exhibit table

Pregnancy and Substance Use Disorder Workshop

Friday, December 5

MedStar Franklin Square Medical Center – Kotzen Auditorium | Baltimore, Maryland

Presentation by MACS for MOMs Consultant Katrina Mark, MD.

NEWS

Creation of a telehealth addiction consultation service at a rural hospital: a case study

A recent case study details the successful launch of a telehealth addiction consultation service at a rural Massachusetts hospital. Due to a low volume of addiction treatment services in the area, the program connected rural hospital staff with outpatient addiction medicine experts via telehealth. Over eight months, these experts provided 36 consults, assisting with diagnosis, inpatient management and the initiation of MOUD. The service was paired with hospital staff trainings focused on harm reduction strategies and reducing stigma. This Community Addiction Consult service demonstrates the feasibility and efficacy of using a telehealth model to bridge the gaps in rural addiction care. By leveraging existing local resources and data-driven approaches, this model offers a scalable, equitable solution for improving access to SUD treatment in underserved rural settings.

Trends in nonmedical ketamine use, poisonings, related deaths, pharmaceutical diversions, and law enforcement seizures: results from annual population-based repeated cross-sectional studies

A recent study analyzed various datasets on illicit ketamine use. The findings show that nonmedical ketamine use is increasing among adults in the United States, even as its use continues to decline among adolescents. This rise in adult use is mirrored by an increase in poisonings, pharmaceutical diversions and law enforcement seizures, suggesting a growing illicit supply.

Pharmacy Barriers to Receiving Buprenorphine Among Patients Undergoing Telemedicine Addiction Treatment

In this study, researchers used AI to analyze community coalition meeting minutes from the HEALing Communities Study (HCS) to identify key themes and how they intersected with decisions when selecting evidence-based practices (EBPs) to reduce overdose deaths. Researchers utilized various AI tools to analyze minutes from meetings of 13 New York communities participating in the HCS. The study explored how often stigma was discussed in relation to EBP implementation, including MOUD, overdose education and naloxone distribution (OEND), safer opioid prescribing practices and stigma-reducing communication campaigns. Findings showed stigma was more frequently discussed when coalitions focused on MOUD use and delivery, compared to other EBPs, such as OEND or safer prescribing. Researchers believe this may be due to persistent misconceptions that MOUD is simply substituting one drug for another. Additionally, stigma-related conversations were 57% more likely to occur when racial or ethnic disparities were mentioned.

Low-Threshold Buprenorphine in Non-Traditional Settings: A Scoping Review

A new scoping review analyzed 41 studies on low-threshold buprenorphine programs delivered in non-clinical settings like syringe service programs, mobile units, community centers, and street medicine. The review identified community partnerships as a crucial facilitator for success and funding as a common barrier. Programs varied widely in how they defined and measured outcomes, especially retention in treatment. The findings highlight the need for further research to determine which outcomes matter most, particularly to people who use drugs and use these services.

RESOURCES

EMS encounters for nonfatal ketamine-related overdoses in the US (National Drug Early Warning System)

Opioid Adulterants: Is Medetomidine the New Xylazine? (American College of Medical Toxicology)

The Guide to Addiction & Recovery (Baltimore Sun, Helping Up Mission)

When Pharmacists Accidentally Become Gatekeepers (Doximity Op-Med)

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