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A Matter of Substance October 2017Quarterly Publication
Bureau of Substance Abuse
IDPH • Lucas State Office Building • 321 East 12th St., Des Moines, IA 50319 • www.idph.iowa.gov
1A Matter of Substance • October 2017
Lori Hancock-Muck
A Publication of the IDPH Bureau of Substance Abuse
Staff Spotlight
Lori Hancock-Muck joined the IDPH Bureau of Substance Abuse in October 2015 as the
Health Facilities Officer. In this role, Lori leads the Department’s responsibilities for licensure and regulation of substance use disorder and problem gambling treatment programs. In addition to licensing approximately 120 programs, Lori conducts complaint investigations and recently became certified as a specialized investigator/inspector through the Council on Licensure, Enforcement and Regulation (CLEAR). Lori graduated from Northwest Missouri State University with a bachelor’s degree in Psychology and a master’s in Counseling Psychology. She started her career in human services 25 years ago working at a residential care facility in Des Moines. Since then, she has worked in various areas of behavioral health, including mental health centers, substance use disorder treatment programs, managed care, an employee and student assistance program and a correctional facility. Lori lives in Altoona with her husband “Muck” and two kids, Gracie and Jimmy. In Lori’s spare time, you’ll find her on a beach somewhere soaking up the sun!
For more information about the IDPH Bureau of Substance Abuse, visit http://idph.iowa.gov/bh. For questions related to “A Matter of Substance,” contact the editors: Cara Weis: [email protected] Nelson: [email protected] Lori Hancock-Muck: Lori.Hancock- [email protected]
Parents’ Advice after Surviving Child’s Suicide
This letter, written by a fellow survivor to parents surviving a child’s suicide, offers perspective
most don’t have. Additional resources are available at YourLifeIowa.org or by calling 855-581-8111 or texting 855-895-TEXT (8398).
Written by Sam Fiorella I recently passed the one year anniversary of my 19 year old son’s death by suicide. In that time I’ve experienced the roller coaster of emotions you would expect someone in my shoes to endure.
This journey has been complicated by the creation of a mental health awareness initiative inspired by my son’s efforts while alive. By being so open about his struggles (and the fact that I was so clueless about them), I have welcomed a slew of invited and uninvited conversations with other parents who are also grieving the loss of a child to suicide or struggling to support a child who has attempted suicide.
Further, I have discovered many more families who are suffering that I don’t know or have not been able to reach out to. In some cases it’s just a matter of there being too many of them and too few of me. In others, it’s either too soon for them or too painful for me. Yet there is so much I want to say and share with them.
That is why I’m writing this particular post. It’s for all you parents who are grieving the loss of a child to suicide or those who are attempting to support grieving family and friends. If I don’t have the chance to speak to you personally, here’s what I want you to know. Please go to this link to read more: https://thefriendshipbench.org.
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 2017
Reggie’s Sleepout at Drake stadium
2
“Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence” https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf
Developed by the CDC Division of Violence Prevention and the Prevention Institute,
Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence highlights the connections between different forms of violence and their effects on communities. The document helps those working in violence prevention to think strategically and creatively about primary prevention (i.e., preventing violence from happening in the first place), and to view and respond to violence in a way that recognizes these connections and considers implications across the social-ecological model and risk and protective factors.
Reggie’s Sleepout EventIn 2001, a young man by the name of Reggie
Kelsey aged out of the foster care system in Iowa. Reggie had an endearing personality, but suffered from hallucinations and depression. With no family and no place to call home, Reggie bounced from place to place without any permanent housing. Eventually, Reggie ended up on the street. Three and a half months later, Reggie’s body was found in the Des Moines River. While the exact nature of his death was never determined, it is clear that homelessness coupled with mental illness created problems he was not able to overcome.
In 2005, YSS launched Reggie’s Sleepout. More than 1,000 people gather each fall at Des Moines’ Drake stadium and each spring at Ames’ Jack Trice stadium to sleep outside in boxes, tents and sleeping bags. The goal is to raise awareness and funding to address child and youth homelessness in our communities. All money raised stays in central Iowa to support young people facing homelessness. Since its inception, Reggie’s Sleepout has raised more than $1.7 million dollars. This outdoor, overnight event provides some insight into the lives of people who don’t have a place to call home. To learn more about Reggie and the event held in his honor, please visit www.reggiessleepout.org.
Founded in 1976, YSS serves youth and families throughout Iowa, offering mentoring programs, residential substance abuse treatment facilities, foster care and adoption services, programs for young parents facing adversity, child and youth homeless centers, and family counseling clinics. YSS is committed to providing hope and opportunity to children, youth and families. According to
SAMHSA, 20 -25%
of the U.S. homeless
population suffers from
some form of severe
mental illness.
Reggie’s Sleepout - Lego man
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 2017 3
Take Note:
Important
information!
In a recent study, the Iowa Consortium for Substance Abuse Research and Evaluation
investigated differences between racial/ethnic groups in drug and alcohol use outcomes for Iowans participating in screening, brief intervention, and referral to treatment (SBIRT) services. Using data collected by IDPH (N=29,121) from 2012 to 2016, the Consortium examined reductions in alcohol and drug use. The study looked at the patient’s first and last healthcare center visits. Reporting alcohol and drug use at prescreen during the patient’s last SBIRT visit was significantly associated with both sex and race/ethnicity (p < 0.001). When patients enter an SBIRT facility they are asked a few short questions about drinking:
Prescreen Questions “How many times in the
past year have you had four or more drinks in a day?” (Five or more for men under 65 years of age).
“How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”
Findings indicate that both black and white patients benefit the most in terms of prescreen reductions, and men experience the most reductions. However,
looking at both sex and race/ethnicity shows a more telling story. Black men in Iowa show the greatest reductions in positive prescreens for alcohol; moreover, Black men are nearly the only group experiencing positive drug prescreen reductions.
These findings show the potential for SBIRT to address a health disparity with under-served populations. Public health policy aimed at reducing these health disparities will further improve the great asset SBIRT interventions provide to some of Iowa’s most in need of treatment. Plus, knowing that Black men experience the greatest reduction can help to target resources to specific communities, and to improve efforts for those experiencing less reductions.
Who Experiences the Greatest Substance Use Reduction Through SBIRT?
Prescreening produced the
most benefits of
substance abuse reductions.
Substance Abuse Prevention and Treatment Block Grant and Synar ApplicationThe 2018-2019 Substance Abuse Prevention and Treatment Block Grant (SABG) applicaton and SABG and SYNAR reports are available for comment and posted to the following website: http://www.idph.iowa.gov/block-grant.
As a reminder, the application and reports are a good source of up-to-date data on a variety of Bureau grants and activities. For more information, contact Michele Tilotta at [email protected].
Intervention
Target resources
Recovery
Prescreening
SBIRT Positive Prescreen Reductions at Follow-Up
PER
CEN
TAG
E PO
INT
CH
AN
GE Black White Asian/Pacific Islander Hispanic
Male Female Male Female
Alcohol Drug
2
0
-2
-4
-6
-8
-10
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 20174
Brain injuries are caused by events that damage the brain and result in physical, cognitive,
emotional or behavioral changes. Acquired brain injury is an overarching term for brain injury, which includes causes that are internal in nature, as well as external causes. Traumatic brain injury (TBI) is the term used when the cause is an external force. Examples of events that may result in a brain injury are included in the table below. Approximately one in every 50 Iowans is living with the long-term impact of a brain injury (CDC, 2008).
Many individuals who have experienced a brain injury also have a history of alcohol or other substance use. Nearly 50 percent of individuals who have had TBI have a prior history of a substance use disorder (Corrigan et al. 1995). This should not be surprising, given intoxication negatively affects a person’s motor control, vision, decision making and impulse control.
Conversely, 10-20 percent of individuals living with the effects of brain injury will develop a substance use problem for the first time after their injury. A history of at least one TBI has been linked with an increased risk for more severe substance misuse, and with an earlier age of first substance use. These individuals may develop a problem because their brain injury has affected their executive functioning (i.e., decision making, judgment) or they turn to alcohol or drugs as a coping strategy.
Because of this link between brain injury and substance use, IDPH will host a series of articles to provide information about brain injury. Future topics
Traumatic Brain Injury Causes Acquired Brain Injury Causes• Motor vehicle crash• Sports injury• Falls• Gun shot • Assault or abuse
(being hit by or against an object, or being shaken)
• Military action (blasts)
• Stroke• Toxic exposure to chemicals or
drugs (poisoning)• Near drowning• Strangulation • Traumatic brain injury (TBI)• Seizure• Tumor• Infection (encephalitis, meningitis)
will include impact, screening, and accommodating for brain injury in treatment. This article is the first in the series.
For more information and support on brain injury, contact Maggie Ferguson, IDPH Brain Injury and Disability program manager at 515-281-8465 or by emailing [email protected].
Brain Injury and Substance Use
SAMHSA Monitoring Site VisitSAMHSA conducted an onsite monitoring review of
Iowa’s Substance Abuse Prevention and Treatment Block Grant (SABG) and the Mental Health Block Grant (MHBG) the week of September 11, 2017. The review focused on IDPH’s administration of the SABG, including the SYNAR tobacco regulations, and DHS’s administration of the MHBG. During the three-day visit, SAMHSA reviewed protocols, fiscal records, and met with IDPH and stakeholder staff. IDPH will receive a preliminary report in about 30 days and a final report within 18-24 months.
IDPH extends a special thank you to those involved: Alcoholic Beverage Division Amerigroup Iowa, Inc. Area Substance Abuse Council Ben Khan Division of Tobacco Use and Prevention and Control Helping Services for Youth and Families Iowa State University Prairie Ridge Integrated Behavioral Health Care United Community Services YSSLook for additional information in the coming months.
IDPH Bureau of Substance Abuse team members (left to right): DeAnn Decker, Bureau Chief; Eric Preuss, Program Manager, Office of Problem Gambling Treatment and Prevention; Michele Tilotta, Substance Abuse Block Grant Manager/Synar Coordinator; Kathy Stone, Director, Division of Behavioral Health; Julie Hibben, Iowa Partnerships for Success Project Director; Kevin Gabbert, ATR/MAT-PDOA Project Director; Jennifer Robertson-Hill, PPW/POMW Project Director and Lori Hancock-Muck, Health Facilities Officer
Take Note:
Important
information!
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 2017 5
New Program for Impaired Nurses
The Iowa Board of Nursing is offering a new alternative program for impaired nurses.
The Iowa Nurse Assistance Program (INAP) is a confidential monitoring program for nurses who are impaired because of a substance use disorder or mental or physical condition. The voluntary program provides an opportunity for licensed professionals to receive treatment while maintaining their licensure status.
This alternative program directs nurses into treatment and early monitoring, rather than to the disciplinary process. INAP can help quickly remove someone from practice and provide a path to treatment. Once the nurse is determined to be safe to practice, INAP can also retain nurses in the workforce.
Health care professionals have unique workplace risk factors that may increase their chances for developing a substance use disorder and/or mental health conditions, including medication access, workplace stress, and even a belief they should be able to handle it. Although the rates of substance use disorders in the nursing profession are no higher than the general population (National Council of State Boards of Nursing, 2011), they do present unique challenges. This program helps create an environment that encourages nurses to self-report impairment issues and promotes public protection.
Programs like INAP offer a voluntary, non-punitive opportunity for impaired nurses to begin recovery, which benefits both the nurse and the public. Participation in the program is confidential as long as the nurse complies with program requirements and adheres to his/her individualized contract.
For more information or questions about the program, contact INAP Coordinator, Rhonda Ruby, at [email protected].
Important
information!Licensure Standards FAQ Please submit any licensure questions to [email protected].
What changes have been made to 42 CFR Part 2 and how will that impact our program?42 CFR Part 2 regulates the disclosure and use of patient records by a federally-assisted program that holds itself out as providing substance use disorder treatment, diagnosis and/or referrals to treatment. The law was originally written in 1975, and was last updated in 1987. Earlier this year, the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) updated its regulations for 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records. The final rule is published in the Federal Register and took effect on March 21, 2017. Some of the changes include:
Allowing patients to include a general designation for individuals and/or entities with a treating provider relationship (e.g., “my treating provider”) in the “To Whom” section of the consent form.Terminology changes for clarity, consistency and to modernize the regulations (e.g., from “alcohol and drug abuse” to “substance use disorder”). Electronic signatures are permitted to the extent that they are not prohibited by any applicable law. Requiring an explicit description of the amount and kind of substance use disorder treatment information. The Legal Action Center has provided sample consent forms to assist programs. Those consents can be found on an IDPH’s website at https://idph.iowa.gov/substance-abuse/resources.
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 20176
Maureen Fitzgerald, Communications Coordinator, ATTC Network, Editor, NIATx
The APT Foundation in New Haven, CT, provides substance use disorder treatment and recovery
services to nearly 8,000 adults. APT began to offer methadone treatment in 1971 and today, its medication-assisted treatment (MAT) program also includes buprenorphine and extended release naltrexone.
Lynn Madden, President and CEO of the APT Foundation, told us about the organization’s open access to treatment policy: no appointment is necessary. In aless than two-minute video, Dr. Madden shared two strategies that organizations can use to secure buy-in for MAT:1. Share information on best practices, and2. Start small with a pilot test, also known as a rapid-cycle test or PDSA Cycle in the NIATx model.
Looking for the latest information on best practices for MAT?For anyone interested in learning more about MAT, SAMHSA offers a variety of resources. Three to get started with include: Medication-assisted Treatment: A comprehensive website with links to information on the medications, regulations, and training resources MATx: A mobile app for health care practitioners that offers quick access to info on the medications, overdose prevention and treatment, and training resources Decisions in Recovery: Online decision support tool for people with an opioid use disorder who are considering MAT
From the ATTC Network: Taking Action to Address Opioid Misuse: a portal to information, resources, and training materials produced by the ATTC Network. Visit this page to find links to the Network’s online courses as well as webinars, toolkits and other resources.
How to Secure Buy-In for Medication-Assisted Treatment: Information and Pilot-Testing
And from NIATx: Getting Started with Medication-Assisted Treatment Buprenorphine Implementation Toolkit
Does your organization offer MAT? How did you secure buy-in from treatment staff, patients, family members, or the community? Share your strategy in the comments section below at this website: https://attcniatx.blogspot.com/2017/09/how-to-secure-buy-in-for-medication.html.
MATxA mobile app to support MAT of opioid use disorder
For health care practitioners
New “Your Life Iowa” Coming Soon! Enhancement of the Your Life Iowa website is
nearing completion and will soon be ready for launch as a reliable resource for Iowans with questions about alcohol and drug use, problem gambling, and suicide prevention. Upon launch, the website will complete what is intended to be an integrated YourLifeIowa information and services hub connecting Iowans to services and helpful information for substance use, problem gambling, and suicide prevention via the website, phone, text, and online chat. The current website domains for 1800BETSOFF.org, DrugFreeInfo.org and YourLifeIowa.org) will all point to the new YourLifeIowa.org website. Foundation 2, which is nationally accredited for suicide prevention, was awarded a contract in July to manage the expanded YourLifeIowa. For more information, please contact Eric Preuss at [email protected].
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 2017 7
A Matter of Substance
In 2014, RoxAnn Smith, Problem Gambling Prevention Specialist with Jackson Recovery Centers, received a
phone call from Todd Abbott, Vice President of Regulatory Compliance with Warner Hospitality. Todd was involved in an application for a new casino, the Hard Rock Casino, which was in the running for a new license in Sioux City. A few months later, Todd flew from Las Vegas to Sioux City where he and RoxAnn met to discuss how Hard Rock and Jackson Recovery Centers could work together. After the Iowa Racing and Gaming Commission (IRGC) awarded a license to Hard Rock, RoxAnn and casino compliance and security staff began planning for problem gambling education. Topics included the type of education to provide and finding a quiet location where casino noise would not affect private conversations about problem gambling and related addictions. After several meetings, RoxAnn developed a problem gambling education presentation and began training casino employees. Hard Rock made the training part of their new staff orientation. Post-training, each new employee had to pass a quiz on the signs of problem gambling and identification of patrons who might be problem gamblers. After the casino’s grand opening, RoxAnn and the Hard Rock administrative team continued meeting to brainstorm ideas to improve the problem gambling education program. One idea agreed upon was to set a monthly time and date that Jackson Recovery Centers staff would be at the Hard Rock to visit with employees and patrons. The problem gambling education table and Jackson Recovery Centers staff are at Hard Rock the first Wednesday of each month, which is one of their highest traffic days – “Give Away Day” when regular casino patrons receive free merchandise.
Both Hard Rock and Jackson Recovery Centers staff have found this arrangement to be beneficial. Casino staff encountering patrons with a concern about gambling or other addictive problems can not only offer literature and information, they can also let the patron know when Jackson Recovery Centers specialists will be in the casino each month. Hard Rock Casino and Jackson Recovery Centers have established a winning combination, with a shared interest in serving their community and preventing problem gambling and other addictive disorders.
A Publication of the IDPH Bureau of Substance Abuse
Jackson Recovery Booth at Hard Rock.
For the complete story go to: http://siouxcityjournal.com/lifestyles/health-med-fit/partnership-between-jackson-recovery-hard-rock-encour-ages-responsible-gaming/article_7bc8eb74-2b96-5f65-ad-fb-8e0cc416fa5c.html.
Building a Partnership with a Casino – A Winning Combination
Important!
1-800-BETS OFF
is a free helpline
that crosses state
boundaries.
Iowa Youth Survey Resources on Website
The Iowa Youth Survey (IYS) website has a new Resources section. The section features several
tools, such as an Excel file, “2016 IYS Trend Figures Sample,” which was used to create 2016 IYS trend figures and may be used for any reporting need. The second tool is a webinar on Assessing Trends in Iowa Youth Survey Data that provides a brief overview of the IYS and step-by-step directions to create trending figures, as well as suggestions to ensure accuracy and appropriateness. The third tool is the webinar’s PowerPoint presentation. Please take a look, use as you see fit, and share with other school and community partners.
If you need assistance, contact [email protected].
A Matter of SubstanceA Publication of the IDPH Bureau of Substance Abuse
A Matter of Substance • October 20178
Take Note:
Important
information!
SPF Rx Media Campaign MaterialsThe Strategic Prevention Framework for Prescrip-tion Drugs media campaign materials, including the just released “Prescription Drugs Are Still Drugs” brochure, are available. Additional media pieces include a 30-second TV commercial, two 30- second radio spots, and billboard, poster and banner ads. The audience for the SPF Rx media campaign is youth 12-17 and adults 18-25. View the media on the IDPH website at https://idph.iowa.gov/substance-abuse/programs/spfrx. Contact Janet Nelson, SPF Rx Project Director, for more information or materials [email protected].
On September 25, 2017, IDPH sponsored the Youth and Recovery Event at the FFA Enrichment
Center in Ankeny. Over 160 professionals from across Iowa attended the Event to explore prevention, treatment and recovery strategies for youth ages 12-25. Presenters included: Ned Presnall, Cortney Lovell, Steve Arndt, Barbara S. Marie, Daniel Wesemann, Sarah Nerad, Austin Eubanks, Rachelle Gardner, Doug Wolfe, and Darcie Davis-Gage. A wide variety of topics were discussed including: Medication Assisted Treatment, Peer Recovery Coaching, Collegiate Recovery, the Iowa Youth Survey, and more.
An interactive feature of the Event was the “Hidden in Plain Sight” display facilitated by Prairie Ridge Integrated Healthcare. The display, which is a staged teenager’s bedroom, encouraged attendees to identify seemingly harmless objects that may indicate signs and symptoms of substance use.
The final keynote of the day was Austin Eubanks, who shared his inspiring personal story of the Columbine shooting, how he became dependent on prescription medications following the incident, and his journey to recovery. The Youth and Recovery Event concluded with a round table discussion of the key takeaways to encourage attendees to think about how they will use the information learned.
The Event was funded by IDPH’s State Youth Treatment – Implementation (SYT-I) grant through SAMHSA and the Iowa Gambling Treatment Program. For more information about SYT-I visit: https://idph.iowa.gov/substance-abuse/families-in-focus or contact Cara Weis at [email protected]. For more information about the Iowa Gambling Treatment Program, contact Eric Preuss at [email protected].
Photo: Austin Eubanks presented, From the Darkness of Columbine and Addiction into the Light of Recovery.
Promote the Prescription Monitoring Program!
An Iowa Prescription Monitoring Program (PMP) infographic, created through a
partnership that includes IDPH, the Iowa Board of Pharmacy, and the Iowa Pharmacy Association is available to increase healthcare provider understaning of the PMP and the importance of registering and using the PMP. PMPs has proven to be one of the most effective ways to reduce opioid over-prescribing. The infographic is easy to read, includes important facts, and is available to anyone in both online and print versions. Contact [email protected] for printed copies to distribute.
PRESCRIPTION Monitoring Program (PMP)
Checking the PMP: An important step to improving opioid prescribing practices
What is a PMP? The PMP is a health care tool for practitioners to assist in identifying potential diversion, misuse or abuse of controlled substances by their patients while facilitating the most appropriate and effective medical use of those substances.
PMPs improve patient safety by allowing clinicians to: Identify patients who are obtaining opioids from multiple providers.Calculate the total amount of opioids prescribed per day (in MME/day). Identify patients who are being prescribed other substances that may increase risk of overdose – such as benzodiazepines.
Multiple Providers Counsel your patient and coordinate care with their other prescribers to improve safety and discuss the need to obtain opioids from a single provider. Check the PMP regularly and consider tapering or discontinuation of opioids or use of other non-pharmacologic methods.
Drug Interactions When indicated, avoid prescribing opioids and benzodiazepines concurrently. Communicate with other prescribers to prioritize patient goals and weigh risks of concurrent opioid and benzodiazepine use.
Dosage Consider explaining to your patient what Morphine Milligram Equivalents (MME) are and risks associated with exceeding 50MMEs per day. Discuss the possibility of tapering/reducing opioids as well as prescribing naloxone for patients taking 50MME/day or more.
When should I check the PMP? The CDC recommends checking:■ Prior to prescribing any opioid or controlled substance. ■ Every three months. ■ Utilize support staff as your delegates or agents for checking the PMP when a patient arrives to the clinic or hospital to save time.
Check every 3 months!
What should I consider when prescribing controlled substances?
Iowa’s
IDPH billboard for SPF Rx media campaign.
Austin Eubanks
Youth and Recovery Event Highlights