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Knock Out Opioid Abuse Day

Angela Conover, BA – Director of Opioid Response and Prevention Programs, Partnership for a Drug-Free NJ


Session/Poster Description: Knock Out Opioid Abuse Day increases understanding of the opioid crisis through a mobilization effort with a dual focus: educating prescribers and raising awareness among New Jersey citizens and families. Through collaboration with the Community Coalition for a Safe and Healthy Morris, the NJ GCADA and DMHAS, The Partnership for a Drug-Free New Jersey coordinates 10,000 volunteers across the state to share opioid abuse prevention, education and awareness messages and materials along with securing the legislative support of the initiative resulting in the passage of the designation of October 6th as Knock Out Opioid Abuse Day in New Jersey. Knock Out Opioid Abuse Day leverages community and cross system collaboration to outreach to New Jersey's 21 counties with information on the potential for dependency of the opioids prescribed and the link to heroin and fentanyl deaths in the state as well as encouraging conversations between prescribers and patients regarding the potency of prescribed opioids. Contributors: Barbara Kauffman, MA; Rebecca Alfaro, MSW; Angelo Valente, MA; Matthew Birchenough, BA



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Public Perceptions of Medications for Opioid Use Disorder Treatment

Stella M. Resko, Ph.D. – Associate Professor, Wayne State University


Session/Poster Description: Medications for Addiction Treatment (MAT) are highly efficacious in reducing opioid use, and increasing retention in treatment and prosocial behaviors (Connery, 2015). Increasing availability of MAT has been associated with fewer fatal overdoses and lower rates of disease transmission (Volkow et al., 2015). Unfortunately, negative attitudes and misunderstandings about addiction medications held by the public, providers, and patients are barriers that contribute to low MAT access and utilization (Volkow et al., 2014). This study examines public views on the efficacy of medications for treating opioid misuse among a state-wide sample of adults from Michigan (N=721). Adults (age 18+) recruited through Facebook and Instagram advertisements completed online health surveys. 41% of respondents considered MAT an effective treatment for opioid use disorders (OUD). Logistic regression analyses indicate that rural residents had lower odds of considering MAT to be effective, while individuals with greater knowledge of opioids and beliefs that OUD can improve with treatment, had greater odds of considering MAT effective. Education about MAT in rural areas may be particularly beneficial in increasing MAT engagement. Those who believed that prescription medication misuse can improve with treatment and those with more knowledge of opioids were more likely to believe that MAT is efficacious. Thus, individuals with less stigmatizing beliefs about opioid use generally may be more open to MAT, and interventions to reduce stigma may be important for increasing MAT utilization. Findings could guide targeted psychoeducation efforts to correct common misconceptions, decrease stigma associated with MAT, and increase engagement in evidence-based practices. Contributors: Elizabeth Agius, BA; Rachel Kollin, MA; Danielle Hicks, MSW



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Sexual Minority Disparities in Opioid Misuse, Perceived Heroin Risk and Heroin Access: A National Sample of Adults

Megan S. Schuler, PhD – Associate Policy Researcher, RAND Corporation


Session/Poster Description: Background: Lesbian, gay and bisexual (LGB) adults have elevated use of many substances compared to heterosexual adults. Yet, LGB disparities in specific types of opioid misuse and perceived opioid risk have not been fully characterized. Methods: Data on 126,463 adults (including 8,241 LGB adults) were from the 2015-2017 National Survey of Drug Use and Health. Logistic regression was used to estimate lesbian/gay (L/G) and bisexual disparities (relative to same-gender heterosexuals) for: lifetime prescription pain reliever misuse, heroin use and injection heroin use; past-year opioid misuse and opioid use disorder (OUD); and perceived risk of and access to heroin. Results: All LGB subgroups had elevated lifetime pain reliever misuse rates relative to same-gender heterosexuals. Lifetime heroin use was elevated among LGB women and bisexual men; bisexual women had 4 times the odds of injection heroin use. LGB women and gay men had 1.4 - 2.4 times the odds of past-year opioid misuse; bisexual women had 2.5 times the odds of OUD. LGB women reported both lower perceived risk of trying heroin and greater perceived heroin access. Conclusions: Lifetime and past-year opioid misuse is elevated among LGB adults. Bisexual women are particularly at-risk, uniquely exhibiting disparities on high-risk injection use and OUD. Lower perceived risk of and greater access to heroin among LGB women may play a role in the onset or continuation of opioid misuse. Opioid misuse disparities among LGB adults are of substantial concern given the resultant elevated risk for fatal and non-fatal opioid overdose. Contributors: Bradley Stein, MD, PhD; Andrew Dick, PhD



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Need for Mandatory Clinical Rotation in Addiction for Medical Students

Tanvir Singh, MD – Professor, University Toledo


Session/Poster Description: Impact of clinical rotation in Addiction on 100 Medical students after 4 week exposure to patients with Opioid Addiction in inpatient and outpatient setting. During rotation students given opportunity to assess patients and gather all the historical information about their personal life, Opioid addiction and its complications, treatment response and challenges of sustaining recovery 97 out of 100 reported significant better understanding of Opioid addiction as brain disease as relapsing nature of illness was not necessarily related to lack of motivation and desire to seek and sustain recovery. Something majority of would be physicians were not aware at all. 99 out of 100 felt change in their stereotype “junkie” image of opiid addicts change to people with addiction as regular, generally respectful, soft spoken people but just had their lives devastated by their “persistent drug use”. 95 out of 100 felt more appropriate to use word “trapped” rather than “choice” in cases of opioid addiction. 95 out of 100 students felt comfortable and motivated to help patients with addiction including use of Medication Assisted Treatment. 99 out of 100 students felt purely lectures and didactics do not change perception and understanding as exposure to patients with opioid addiction in clinical rotation in Addiction. Contributors: Emily Cooper, MS; Ashish Rungta,MD



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Co-dispensing Naloxone and Opioids to Patients at High-Risk for Opioid Overdose

Rachel Barenie, Pharm.D, J.D., M.P.H. – Research Fellow, Harvard Medical School/Brigham and Women's Hospital


Session/Poster Description: This poster/session is aimed at describing patterns of co-dispensing naloxone to patients filling prescriptions for opioids and who are at high-risk for opioid overdose. This research is important because it uses a large, national commercial insurance claims database to demonstrate how infrequently naloxone is dispensed to high-risk patients. The findings further highlight the high copays that patients may pay for naloxone, which may be a barrier to increased access. Contributors: Joshua Gagne, Pharm.D, Sc.D; Aaron Kesselheim, MD, JD, MPH; Aijinkya Pawar, PhD; Angela Tong, MS; Jing Lup, MD, MPH; Brian Bateman, MD, M.Sc



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Using Surveillance Data to Implement A Telephone Navigation Intervention to Improve Hepatitis C Treatment Rates among People Who Use Drugs in New York City

Alexis Brenes, BA (Sociology) – Health Care Access Specialist, NYC Health Department


Session/Poster Description: The NYC Health Department adapted and implemented an evidence-based telephone navigation intervention that used surveillance data to identify people with untreated Hepatitis C Virus (HCV) and to connect them to care. Specifically, people co-infected with HCV and HIV or referred from a correctional facility were targeted, as both groups have high reported rates of drug use. Core elements included: 1. Structured interactive assessment of barriers to HCV care; 2. Health promotion and harm reduction counseling; 3. Appointment scheduling, reminders, and referrals to substance use treatment, including intensive community-based care coordination programs, medication-assisted treatment, and harm reduction services. Of 1,186 people identified, two patient navigators reached 340 (29%) during June 2017–July 2019. Of these, as of July 2019, 70% (239/340) were linked to care (based on confirmed follow-up appointment or subsequent surveillance report in surveillance system), and 31% (105/340) have since initiated HCV treatment after outreach (subsequent negative RNA test in surveillance system). This poster will show how health departments can use surveillance data to target HCV patients with untreated infection and facilitate access to HCV treatment. Contributors: Jessie Schwartz, RN, MPH; Nirah Johnson, LCSW; Farma Pene, MPH Candidate; Kelly Huang, MPH; Liz Tang, LMSW; Miranda Moore, MPH



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Safer Dental Opioid Prescribing via Peer to Peer Academic Detailing in Utah

Adrienne Butterwick, BS, MPH – Project Manager, Comagine Health


Session/Poster Description: Utah has ranked within the top 10 in the nation for overdose deaths over the last 10 years and presently prescription drug overdoses remain the leading cause of injury in Utah, surpassing deaths due to firearms, motor vehicle crashes and falls. (1) Dental professionals frequently prescribe opioid pain relievers (2,3) and may be missed by public health interventions that typically focus on medical prescribers of opioids. Recently, Utah mandated the use of the state prescription drug monitoring program (PDMP). To ensure dental providers were updated on best practices and mandates, an academic detailing (AD) intervention was deployed from March - December 2019 through a partnership between Comagine Health, a dental university, and public health. A comprehensive curriculum for AD for dentists was developed and individual and group sessions were conducted with dentists and their support staff. Data were collected via pre, post, and follow-up surveys to evaluate effectiveness of AD sessions, determine changes to prescribing behavior, awareness and usage of resources. As of August 15, 2019, a total of 10 AD sessions have been completed in Utah, Carbon, Weber and Salt Lake Counties with a total of 104 attendees, 37 of which are active prescribing dentists. Results based on preliminary review show an increase in the intent to use the PDMP and a planned reduction of unnecessary opioid prescriptions. AD sessions and post-intervention evaluation continue until 2020 and final results will be shared during this presentation. Contributors: Sarah Woolsey, MD, MPH, FAAFP; David Anderson, DDS, MS



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Together is Better: Shared Medical Appointments for Treating Patients with Chronic Pain and/or Opioid Use Disorder in Primary Care

Nida H. Corry, PhD – Senior Associate, Abt Associates


Session/Poster Description: The Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain (Guideline) in March 2016 and is working to implement the Guideline recommendations within health systems around the nation. To support this effort, CDC funded the Opioid Quality Improvement Collaborative (Collaborative). As part of the Collaborative, eleven health systems in 11 states engage in shared learning, participate in regular peer-to-peer webinars, and are provided technical assistance related to clinical and implementation challenges. Some health systems in the Collaborative are utilizing behavioral health integration in primary care as a means of Guideline implementation. This session will focus on the clinical and operational components (i.e., sustainability, scaleability) of Shared Medical Appointments (SMA’s) for the treatment of patients with chronic pain and/or opioid use disorder (OUD) in primary care. SMAs are a well-researched modality for treatment of various conditions and, when implemented correctly, provide a useful vehicle for delivering evidence-based treatments for chronic pain and OUD. SMAs serve to support “cross-pollination” between behavioral health and medical providers, diminish patient isolation and stigma, and enhance patient/provider satisfaction. In this session, we will explore the potential benefits of various types of SMAs for chronic pain treatment. We will discuss how behavioral health specialists can support implementation of the Guideline, broadly and in the context of SMAs. SMA case illustrations will showcase the opportunities and challenges of securing team buy-in and success stories demonstrating enhanced practices aligned with Guideline recommendations (e.g., enhancing referrals to non-pharmacological therapies). Contributors: Wesley Sargent, EdD, MSHE, BSN; Laura Heesacker, LCSW; Erin Massey, LCSW



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Opioid Management Improvements in Primary Care Clinics: Insights from Practices and Clinical Staff

Leigh Evans, PhD – Associate, Abt Associates


Session/Poster Description: The Six Building Blocks for Improving Opioid Management (6BBs) provides an evidence-based quality improvement (QI) roadmap to help primary care teams implement effective, guideline-driven care for chronic pain and long-term opioid therapy patients (see: https://www.improvingopioidcare.org/). The objective of this presentation is to synthesize insights on how practices launch an opioid management QI effort and self-assess their current opioid management practices. The study involves refining and developing accompanying implementation guidance for the 6BBs and an evaluation, which is a mixed-methods evaluation to i)understand barriers and facilitators to implementing the 6BBs and ii)evaluate the effect of the program on care processes and outcomes. The project team has recruited primary care practices from health care organizations across the country. Over 40 primary care practices from 11 health care organizations located in 11 states across the country. This presentation will present a summary of baseline self-assessments, baseline survey and interviews of practices and clinicians, and other documentation from clinics. Improving opioid management is a difficult, slow moving effort for primary care clinics to pursue, in part, because it involves de-implementing previous practices, changing several processes of care, and difficult conversations with patients. These preliminary findings may provide insight into how to help clinics get underway in their opioid QI efforts. Understanding how to guide primary care practices in initiating an opioid management QI effort is important for supporting future practices as they tackle the opioid crisis in their practices and communities. Contributors: Sarah Shoemaker-Hunt, PhD, PharmD; Holly Swan, PhD; Olivia Bacon, BA



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Moving Beyond Refusal to Provision of Naloxone and Medication Assisted Treatment

Marc L. Fleming, PhD, MPH, RPh – Associate Professor and Chair, University of North Texas System College of Pharmacy


Session/Poster Description: Prescription drug monitoring programs are recognized by the CDC to be one of the most effective tools to combating prescription drug misuse. Still to date, a lack of guidance exists for pharmacists as to next steps when encountering patients that raise concern of opioid overdose risk and are subsequently denied prescriptions based on PDMP data review. The literature overwhelming shows that pharmacists’ review of PDMP data leads to contacting the prescriber and greater refusal to dispense opioids. One can argue that simply refusing to dispense only sends the individual to the next pharmacy or to illicit channels, including heroin. Pharmacists can play a valuable role in providing medication assisted treatment (MAT) and naloxone. Further, pharmacists can assist in referrals to substance abuse treatment. Yet, the literature suggest that ambiguity exists regarding the pharmacist’s role in addressing opioid misuse. Pharmacists are often taking on the role of policing, which leads some to avoid these situations altogether, whereby telling patients that the drug is “out of stock.” A call to action is needed to empower pharmacists nationwide to engage patients that exhibit misuse upon review of the PDMP. State boards of pharmacy should mandate at least one hour of training on naloxone and two hours on medication assisted treatment. Many pharmacists do not have training in the areas of opioid risk screening, treatment and referral. Further, pharmacists have reported being reluctant and uncomfortable stocking many of the medications that are necessary to manage opioid use disorder and prevent death. Contributors: Douglas Thornton, PharmD, PhD; Anesha White, PharmD, MS, PhD



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Embedding ORT in the ORTHOPEDICS Department: SBIRT Application for Pain Management and Reducing the Risk of Developing an Opioid Use Disorder2. Topic: Clinical for Pain and Addiction Management

David Hartman, MD, Addiction Medicine certified, Board certified Psychiatrist – Associate Professor, Virginia Tech Carilion School of Medicine


Session/Poster Description: Orthopedic surgeons are the third highest prescribers of opioid pain medication. Only recently orthopedic surgeons have recognized the role opioids play in worsening the opioid crisis. By April 2020 the investigators will report on a pilot project, in which 20 orthopedic providers will have completed SBIRT (Screening, Brief Intervention and Referral to Treatment) training using the Opioid Risk Tool (ORT) and motivational interviewing. SBIRT is structured to identify motivations/ strategies to promote behavioral change, intervening to reduce risk among patients identified at higher risk and making referrals into treatment, if a patient is likely dependent on opioids. Training includes an online component and in-person interactive session to acquire SBIRT principles and develop interviewing skills. During a six week period, trainees will track their use of SBIRT to evaluate its utility in identifying opioid misuse risk and for adjusting one's opioid prescribing approach during the brief intervention. The hypothesis is that SBIRT training will increase providers' Medical Condition Regard Score toward patients with an opioid use disorder, comparing scores pre and post training, using paired student's t-tests. Daily provider journals for one week pre-training and for six weeks post-training will record the number of patients screened using the Opioid Risk Tool, the number who score as "at risk" and who receive a brief intervention, and the number who are identified as "likely dependent" and are referred for treatment. Qualitative data from the diaries will be analyzed using a content analysis to inform future SBIRT training in the orthopedics department. Contributors: Cheryl Hartman, PhD; Mierisch Cassandra, MD; Crusta Som, BS



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Reducing Stigma, and Improving Compassion, Engagement, and Knowledge Among Nurses Treating Patients With Opioid Use Disorder

Cindy M. Ketcham, EdD, MSHE, BSN, RN, CARN, CNOR, LNCC, HCAP – Director, CEO, Insieme Consultants, LLC


Session/Poster Description: This session outlines a novel educational workshop program designed for nurses, which has been successful in reducing the stigma of OUD, while improving knowledge about OUD as a medical disease (i.e. basic neurobiology and pharmacology), and thus improving how nurses communicate with, and care for patients with OUD. This session discusses a process of interweaving traditional didactic methods, participant story telling (to make the topic personal, and increase engagement), case studies, and roll playing, to not only increase knowledge, but to change perspective, and empower nurses to be confident they can make a difference in the lives of patients with OUD. The hope is that other organizations will develop similar novel programs, or improve upon this model, to further advance nursing education about OUD, and reduce the stigma of OUD among nurses. Contributors: Eric Ketcham, MD, MBA



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Leveraging Triadic Leadership for Hospital Opioid Reduction

Jason Little


Session/Poster Description: To reduce opioids in the hospital environment, a unique combination of evidence based initiatives supported quality patient pain management and drastically reduced overall inpatient opioid consumption. Central steps taken were the formation of an interdisciplinary opioid reduction team, identification of an expert in pain management and an innovative adoption plan through the formation of triadic teams. Interventions utilized focused on identifying high risk patients, ensuring pain goals were set, managing pain with opioid sparing options and providing education at every level. A surgical screening tool of opioid exposure was developed to better assess a patients’ prior use of opioids. This assessment aids in identifying patients based on their opioid exposure so appropriate doses of medications using tailored multimodal order sets. These are a foundation that can be tailored to fit the needs of both surgical and medical patients. Providers were engaged by peer to peer discussions and early successes. Clinical staff were provided opioid safety education focused on opioid exposure assessment, setting realistic goals with patients, and educating patients on safe use, storage and disposal of medications. Compliance was measured through a scorecard. There was a 35% overall reduction of opioids, measured by morphine milliequivalents (MME), from 49, 532 to 32,061 in one year. Patients who required opioids, used 27% less from 34.4 MME average per patient stay to 25 MME average per patient stay. There was no impact on the average numeric rating scale therefore, opioids were reduced while still providing exceptional pain relief for patient’s. Contributors: Alison Partridge, PhD, MSN; Jeffrey Frohock, MD



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Implementing Shared Decision Making Training for Clinicians Prescribing Opioids to Chronic Noncancer Pain Patients

Lauren A. McCormack, PhD, MPH – Division Vice President, Public Health Research, RTI International


Session/Poster Description: Up to one-third of Americans suffer from chronic noncancer pain (CNCP) and are treated primarily with pharmacologic approaches. The evidence supporting the effective long-term use of opioids is limited, and the field has recognized the need to change the conversation about opioids for managing chronic pain. Supporting both patients and clinicians by providing information, education and training to engage in Shared Decision Making (SDM) is one approach to promoting more evidence-based decisions. We tailored an existing, evidence-based SDM program for clinicians who treat patients with CNCP. We trained all clinicians participating in a PCORI-funded large, pragmatic trial to use the SDM approach. The trial is comparing the effectiveness of SDM versus motivational interviewing/cognitive behavioral therapy for patients currently receiving moderate-to-high dose opioids in three academic medical centers. The SDM curriculum provides Continuing Medical Education (CME) credit and includes a patient-facing decision aid packet. The training can be easily implemented and scaled up to promote sustainability. SDM is an essential component of patient-centered health care that seeks to promote informed decision-making considering benefits, risks, and uncertainties related to the evidence. While SDM principles have been well documented, clear guidance is lacking about how to implement it in routine clinical practice. We will present our experiences and lessons learned implementing the program from both the patient and clinician perspective. Our focus will be on real-world challenges and success stories with chronic pain patients and insights about best practices for promoting the uptake of evidence-based interventions. Contributors: Rowena Dolor, MD, MHS; Lynn Bowlby, MD; Jenna Walters, MD



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Curation and Application of Diagnosis Code Listings for Surrogate Disease States to Manage Patients at High Risk for Opioid Use Disorder

Julie Nguyen, PharmD Candidate 2021 – Enterprise Research Pharmacy Intern, axialHealthcare


Session/Poster Description: Despite the escalating opioid overdose epidemic, opioid misuse, abuse, and dependence remain underdiagnosed and underreported in administrative healthcare claims. An analysis of 2017 Medicaid claims data from McKinsey and Company reported that over 80% of patients were at risk for having an undiagnosed opioid use disorder (OUD). Increased intravenous drug use (IVDU) has been observed in conjunction with the opioid overdose epidemic and has resulted in the spread of infectious diseases. In the absence of a documented OUD diagnosis in administrative claims, the presence of these disease states, in combination with other risk factors, can be indicative of undiagnosed OUD. These surrogate markers for IVDU can provide population health intervention programs with intelligence needed to manage individuals at risk for continued disease progression and worsened outcomes. This poster will describe the methods used to develop a list of IVDU surrogates from primary literature as well as secondary and tertiary drug information databases. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes matching this list of IVDU surrogate diagnoses were identified and subsequently curated into a reference table. This reference material may be used to identify patients without a documented OUD diagnosis in administrative claims who are in need of formal assessment for OUD and facilitation into OUD treatment. This poster will also provide descriptive analyses and quantitative insights around these surrogates in a large administrative claims dataset. Contributors:Amber Watson, PharmD; Meridith Peratikos, BA



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Practicum to Professional- Strategies for Effective Workforce Development

Kenneth L. Roberts, MPS, LPCC, LADC – Chief Clinical Officer, NUWAY


Session/Poster Description: The convergence of a national substance use crisis and substantive legislation to increase care access make the Behavioral Health field one of the fastest growing workforces in the country. This positive future is undercut by a severe deficit in current workforce and inadequate commitment to quality clinical development. In this atmosphere, it is incumbent upon industry providers to identify and cultivate long term strategies for developing future professionals in support of client focused care. This session/poster will identify best practices in support and professional supervision during the critical phases of practicum and transition to new professional as key organizational strategies for recruitment, development and retention of quality long term team members. Contributors: Monique Bourgeois, MPNA, LADC; Kris Washington, BS; Lindsay Battuello, MA, LPCC, LADC



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Increasing Access and Engagement for OUD in Rural Pennsylvania Communities

Amy Shanahan, MS, CADC – Director of Clinical Care Services of Addiction Medicine Services, UPMC Western Psychiatric Hospital Ambulatory Services


Session/Poster Description: Access to services for people with opioid use disorders (OUD) has increased over recent years, however, rural areas still struggle with engaging people in long-term treatment. Through a collaborative effort of the Pennsylvania Department of Drug and Alcohol Programs and UPMC work is being done to assist practitioners in four rural Pennsylvania counties to improve access and engagement in OUD services. The main goal of the grant-funded project is to increase access to medication assisted treatment. While the project employs various strategies to accomplish this goal, one of the main aspects centers around the creation of a Motivational Interviewing (MI) learning environment. MI has become a widely used approach to engage people in conversations about change. Dissemination of MI can be challenging as resources are needed for ongoing practice and effective adoption. Research (Miller and Mount, 2001) has underscored that workshops produce relatively little change in practice behavior but that workshops followed by coaching and feedback have shown changes in practice behaviors. Based on this research and the experience of the training team, a training approach was developed that allows providers to continue their practice and receive coaching and feedback to enhance their skills. Currently, the project has trained over 200 providers across the four counties in a two-day, in-person workshop that lays the foundation for ongoing practices through a monthly online learning community. In this session, the presenters will explore and share strategies that were used to enhance provider practice and create learning opportunities to improve engagement in services. Contributors: Jessica Meyers, MSEd



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Forensic Epidemiology Of Opioid-Related Deaths In Central Nebraska, United States Of America

Elizabeth Soladoye, MD, MPH – Member, Phi Beta Delta Honor Society for International Scholars


Session/Poster Description: Abstract Abuse of illicit drugs poses a severe threat to the health and wellbeing of a given community. This has a ripple effect, affecting the quality of life and economic development of the country. This study determines the mortality rate of opioid-related deaths and the cumulative incidence of abuse in rural counties in central Nebraska. This will provide a template to develop evidence-based recommendations to address the current opioid crisis in the US. This ten-year retrospective study examined opioid-related deaths and cumulative incidence of opioid abuse in all medico-legal deaths investigated by the County’s Coroner in central Nebraska. Forensic autopsies and toxicological screening were performed. Samples from 1078 cases between 2010 and 2019 were submitted for toxicology and blood alcohol analysis. The report examined the presence of heroin, fentanyl, prescription opioids, and other medications. Data analysis revealed that more men succumbed to drug toxicity than women with a male to female ratio of 1.74:1 (64% vs. 34%) and 94% of the victims were Caucasians amongst other racial groups. The mean age of the victims was 45.43years (±15.56years) with a high mortality rate among ages 50-59. 80.3% of decedents abused more than one drug, prescription opioids were most abused, and alcohol was a contributing factor in 70.8% of cases. The overall opioid mortality rate from this study indicates 46 cases per 100,000. Therefore, the toxicological findings from this study provide an insight into the most abused opioid and the need to develop innovative ways to tackle the epidemic. Contributors: Matthias Okay, MD, JD, FRCP



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Using Technology to Combat the Opioid Epidemic - New and Faster Way Doctors in the Nordics Are Creating Tapering Plans

Kjartan Thorsson, M.D. – Medical Doctor, Landspitali University Hospital


Session/Poster Description: Last two years, I worked at the largest orthopedic department in Iceland. I was managing patients after physical trauma and large operations. Due to their condition, these patients were often discharged on high doses of opiods. Patients receiving prescription opioids are at increased risk of developing opioid addiction. It's good clinical practice for physicians to provide discharged patients with a personalised tapering plan, explaining how they should reduce their opioid dosing in the weeks after discharge. Too often, doctors at my hospital didn't have time to provide patients with these tapering plans, since creating a personalized plan can be very time-consuming. Me and my colleague realized a better and faster way to create tapering plans, by using technology to make that process more efficient. We created a simple web-based tool to create personalized tapering plans, reducing the process from several minutes to a few seconds. From our launch, we estimate that our tool has been accessed by around 1500 devices in the Nordics. We've received considerable publicity within the Nordic healthcare systems and in the media, and have gotten positive feedback from many physicians and patients advocacy groups. Our user base is steadily growing and we'll release an international version in the coming months. We plan on expanding our scope from opioids to more classes of addictive prescription medications, and are also looking to develop an interface for patients. Our goal is to provide a new and effective tool in the fight against the opioid epidemic. Contributors: Ami Johnsen, MD



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Redefining Pain and Addiction: Creation and Metrics of a Statewide Curriculum

Lisa Villarroel, MD MPH – Medical Director, Division of Public Health Preparedness, Arizona Department of Health Services


Session/Poster Description: In 2018, The Arizona Department of Health Services brought together the Deans / Curriculum Representatives from every Arizona medical, dental, naturopathic, podiatry, nursing practitioner and physician assistant school to develop one, core Arizona Pain and Addiction Curriculum (www.azhealth.gov/curriculum). The Arizona Pain and Addiction Curriculum’s vision is to redefine pain and addiction as multidimensional, public health issues. It has garnered national interest based on its content establishing the link between pain and addiction; destigmatization, pharmaceutical industry influence; and introspection of clinicians and systems. The curriculum’s “accordion-style” structure allows expansion/contraction of detail, making it applicable to all program types. In 2019, a statewide program evaluation found that most Arizona programs were implementing the curriculum and that it was “neutral”, “moderately easy” or “extremely easy” to implement. A statewide evaluation of first year compared to last year trainees found significant improvements in their confidence to manage pain and addiction (e.g. “I am prepared to treat someone with chronic pain”; p<0.0001) but no significant improvements in biases (e.g. “People with addiction don’t want help for their addiction”; p<0.74). In some instances, biases appeared to worsen (e.g. “People with chronic pain don’t try to get better”; p<0.009). This process represents the first time a health department has facilitated a wide-sweeping, transformational approach to pain and addiction education. Other states and programs can replicate this process, albeit quicker if using the Arizona Pain and Addiction Curriculum content and its evaluation metrics as a base. Contributors: Jacqueline Kurth; Aram Mardian, MD



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