New Hampshire Alcohol & Drug Abuse Counselors Association

Dedicated to Advancing Addiction Professionals in New Hampshire

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  • July 21, 2020 9:31 AM | Anonymous

    Emerging Threat Bulletin from Gulf Coast HIDTA

    Isotonitazene

    July 2020

    Background:  Isotonitazene, also known as “Iso” or “Toni,” is being increasingly identified in overdose deaths throughout the United States.  This synthetic opioid was first identified in August 2019 and has been most prominent in Midwestern states.  The drug is a type of benzimidazole that is structurally similar to etonitazene, a potent internationally controlled opioid.  Isotonitazene reportedly has a greater potency than heroin and morphine, and it is similar in strength to fentanyl.  Isotonitazene has been encountered mostly in powder (brown, yellow, or white) tablet, and liquid forms as well as nasal spray to a lesser degree.  Isotonitazene has also been found concealed as counterfeit Dilaudid (hydromorphone) tablets circulating in the US.  On June 18, 2020, The Acting Administrator of the DEA issued a notice of intent to publish a temporary order to schedule isotonitazene in schedule I of the Controlled Substance Act, which are drugs that are illegal and have no medical uses.  The drug is also not approved for medical use by the FDA.

    Source: China has been identified as a main source country for isotonitazene. The restrictions placed by the US on Chinese fentanyl analogues have opened the market to the shipping of isotonitazene.  The drug has been shipped from China to European and US markets with many orders originating from Darkweb vendors.  Currently, the supply of isotonitazene from China may be limited by reduced production and speed of international shipping due to the COVID-19 pandemic.  Isotonitazene can be purchased in bulk at a low cost from China.  Bulk quantities of the drug are often mixed with other drugs to reduce costs.  Isotonitazene has been most frequently identified with flualprazolam, fentanyl, heroin, and cocaine

    Overdoses:  In November 2019, there were 40 to 50 isotonitazene-related deaths per month in the United States compared to about six per month from June 2019 to August 2019 according to forensic toxicology results reported by the Naval Criminal Investigative Service Multiple Threat Alert Center. Due to the shortcomings of preliminary testing, isotonitazene has not been widely identified in laboratories throughout the US.  While formal epidemiological studies on isotonitazine use have yet to be performed, self-reported experiences on user websites suggest that dosage regimens for the drug can differ between and within individuals depending on tolerance of the user, other drugs being concurrently used, desired effects, purity and composition of the substance, and dosage consumed.  Consumers may be at a higher risk of acute poisoning as isotonitazene is often concealed in counterfeit pharmaceuticals as seen in Figure 1.  Similar to other opioids, health risks associated with isotonitazene are often respiratory depression, which in overdose could lead to apnea, respiratory arrest, and death.  Additionally, the risk of an overdose from isotonitazine is increased due to the high potency of this drug often requiring several doses of Naloxone to reverse its effects.


    Figure 1: Isotonitazene concealed in counterfeit pharmaceutical drugs often have an “M” on one side and the number “8” on the other side – making them almost identical to an 8 mg Dilaudid tablet.  Source: International Narcotics Control Board, Global Rapid Interdiction of Dangerous Substances

    Law Enforcement Encounters:   As of March 5, 2020, there have been 8 NFLIS submissions of isotonitazene in the US. However, law enforcement within the Gulf Coast HIDTA AOR have not yet encountered this drug.

    Public Health Encounters:   While isotonitazene is on the NMS Labs Toxicology radar, 5 postmortem isotonitazene cases have been identified in the Gulf Coast HIDTA jurisdiction by NPS Discovery/CFSRE & NMS Labs as of April 2020.   This information is being released to raise awareness of the unpredictability and danger of this drug. This bulletin was produced by the Gulf Coast High Intensity Drug Trafficking Area.

    Questions or comments may be directed to Strategic Programs Coordinator Sabrina Perez at (571) 362-4851 or perezs@gchidta.org. Feedback can be provided here: https://www.nhac.org/SurveySite/SurveyPage.aspx?LMSID=046df6b7-4c7e-413b-be2c-027010e25032   Sources: Chicago HIDTA DEA, National Forensic Laboratory Information System (NFLIS) European Monitoring Centre for Drugs and Drug Addiction International Narcotics Control Board, Global Rapid Interdiction of Dangerous Substances Journal of Analytical Toxicology Krotulski, Alex J, Donna M Papsun, Sherri L Kacinko, and Barry K Logan. “Isotonitazene Quantitation and Metabolite Discovery in Authentic Forensic Casework.” Journal of Analytical Toxicology, 2020. Naval Criminal Investigative Service, Multiple Threat Alert Center, Threat Division U.S. Department of Homeland Security, U.S. Customs and Border Protection 1 Specified data for Shelby County, TN, Escambia County, FL, and Santa Rosa County, FL was not available. 

  • July 14, 2020 12:28 PM | Anonymous

    New Hampshire Medicaid Program

    07/14/2020

    Provider Relief Fund: Medicaid & CHIP Provider Distribution  
    On June 9, 2020, the U.S. Department of Health and Human Services (HHS) announced the distribution of approximately $15 billion from the Provider Relief Fund to eligible providers that participate in state Medicaid programs and Children’s Health Insurance Program (CHIP) and have not received a payment from the Provider Relief Fund General Distribution.
     
    The payment to each provider will be approximately 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted.
     
    Funds will be distributed to eligible providers who apply through the Provider Relief Fund portal. The portal will be open until July 20, 2020. All eligible Medicaid/CHIP providers are encouraged to apply.
     
    How to Apply For Funding:

    1. Visit hhs.gov/providerrelief and choose “For Providers.”  
    2. Click on the Enhanced Provider Relief Fund Payment Portal within the Medicaid/CHIP Provider Relief.

    More information on the Provider Relief Fund is also available at the following links:
     
    For further information about eligibility and attestation requirements, please see the Health Resources & Services Administration (HRSA) fact sheet: https://www.hhs.gov/sites/default/files/provider-relief-fund-medicaid-chip-factsheet.pdf
     
    For Program Overview:
    https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html,
     
    FAQs:
    https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/faqs/index.html#medicaid-targeted

    Thank you,
    NH Medicaid Provider Relations 
       


  • July 09, 2020 3:28 PM | Anonymous

    Brought to you by your NHADACA Ethics Committee

    Top Trump administration officials say drug overdose deaths are surging amid the coronavirus pandemic, driven by increased substance use due to anxiety, social isolation and depression. A White House drug policy office analysis shows an 11.4 percent year-over-year increase in fatalities for the first four months of 2020, confirming experts’ early fears that precautions like quarantines and lockdowns combined with economic uncertainty would exacerbate the addiction crisis.

    Click here to read the full article originally published 6/29/2020 and updated 7/3/2020 in Politico Magazine

  • July 06, 2020 9:10 AM | Anonymous

    Brought to you by your NHADACA Ethics Committee

    Strengthening Our Wellbeing during COVID-19

    Watch this video to access FREE wellness resources

    ___________________________________________________________________

    Pandemic Stress Hitting Parents Hard

    In this interview with Arthur C. Evans Jr., PhD, chief executive officer of the APA, he states “The mental health ramifications of the coronavirus pandemic are immense and growing . . . . we need to prepare for the long-term implications of the collective trauma facing the population. On an individual level, this means looking out for one another, staying connected, keeping active, and seeking help when necessary.”

    Click here to read the full article and learn more about current data being collected during Global Pandemic here in the US and what can be done to help coping with today’s stressors.


  • June 09, 2020 12:31 PM | Anonymous

    Brought to you by your NHADACA Ethics Committee . . .

    From Dan Harris, CNN News Broadcaster and author of the books 10% Happier (2014) and Meditation for the Fidgety Skeptic (2018)

    Key points for being “happy”

    1. Shift thinking from isolation & fear of being part of a global community
    2. Meditate to reduce this “anxiety”
    3. Best time is early morning while our mind is most quiet (if you are busy during the day)
    4. Acknowledge our enemies are also our brother & sister = breathe in and visualize all of this with their anger, suspicious, desperateness THEN breathe out the wish for them to be free of these burdens
    5. Visualize these people as our neighbors living beside us right now
    6. Whether we like it or not, we must live together
    7. Only way to eliminate fear is to replace it with empathic understanding for self & others

    Listen to this 40-minute podcast interview with the Dali lama and hear how Dan Harris “unpacks” the nuggets of wisdom from this interview.  The podcast ends with Dan and his meditation expert summarizing the practical steps for applying meditation.

    https://www.tenpercent.com/podcast-episode/the-dalai-lama-251?utm_source=cv_response&utm_medium=email&utm_campaign=hhdl_content

  • June 04, 2020 1:12 PM | Anonymous

    Brought to you by your NHADACA Ethics Committee

    CARE is launched in May 2020:

    The COVID-19 pandemic has not only added to the urgency of working together across the continuum of care, but fueled the demand for new, virtual and online practices. Sometimes opportunity is created amid crisis. Behavioral health industry leaders faced an immediate challenge of unprecedented size, forcing a pivot toward employing technologies to fulfill their roles in providing services to patients and communities to help them heal.

    Collaborative for the Advancement of Recovery Excellence (CARE), a vehicle to advance key principles promoting standards in high performance and outcomes measurement in behavioral healthcare was launched in May and calls on behavioral health providers, organizations, and clinicians to be part of the ongoing survey-and-feedback process to continue this important national dialogue. Read the full article with the Psychiatry and Behavioral Health Learning Network to learn how to have your voice heard and see the resulting industry data.

  • June 02, 2020 2:06 PM | Anonymous

    Urgent!

    Please support the Amendment to HB 1623, allowing telehealth and telephone options for providers and reimbursement at in-office rates.  

    They have made it incredibly easy to sign in and support the bill and the amendment - this will take you 3 minutes

    Go to: - http://www.gencourt.state.nh.us/senate/onlinemtgs/hhs/HHS_Notice_-_06-04-2020.pdf  

    Click on the link in #1. You can put in your name and information then select "support not speaking" for both the bill and the amendment.

    To submit your testimony to the committee, please send all documents via email to remotesenate@leg.state.nh.us. 

    Please use the following talking points for letters of support:

    • Clinicians need to be reimbursed by private insurance for telehealth at the same rate as in-office. It is the same work, being done differently.
    • We must remove all barriers to substance use disorder treatment.
    • Mental health needs are more crucial now than ever before.
    • Telehealth is a necessary component to maintaining the mental and behavioral health needs of our NH residents, especially in the many rural areas where clients lack necessary transportation, and inclement weather makes it hard to travel to appointments. 

    Remember to put your reasons for this request (number of clients, client needs & safety).

    HB 1623 and the amendment to HB 1623 will be heard this Thursday at 8 am in the Senate Health & Human Services Committee   - http://www.gencourt.state.nh.us/senate/onlinemtgs/hhs2.aspx

    This bill and amendment would put into statute the language of Governor Sununu's Emergency Order #8 and allow reimbursement for clinicians to provide telehealth and telephone therapy at in-office rates.

    Warmest Regards,

    Suzanne L. Thistle, MA, MLADC

    Chair, NHADACA Public Policy Committee

    NHADACA.org


  • May 29, 2020 12:27 PM | Anonymous

    On June 9-10, you can support NHADACA as part of New Hampshire Gives, the statewide giving event focusing on state nonprofits and the good they do.

    You can help us! 

    • Sign up to be a fundraising champion and share YOUR story about NHADACA with friends and colleagues.
    • Donate on June 9-10. A $250,000 site-wide match will be available starting June 9th at 6PM! That means every donation you make (while funds are still available) will be matched dollar for dollar (up to $1,000 per individual donor). So if you want to give NHADACA $50, but only have $25, give as early as you can!

    • Does your/your partner or spouse's workplace have a matching gift program? You can make every dollar go even further!

    Every dollar we receive will go to supporting our work supporting substance use professionals in the state. 

    Mark your calendar today, or sign up now!

  • May 15, 2020 4:17 PM | Anonymous

    Creating Connections NH requests your expertise for the development of an Alternative Peer Group model for youth and young adults in New Hampshire as part of a federally-funded project to develop and implement a system of care for youth (ages 12-25) with substance use and co-occurring mental health disorders. They would appreciate you taking a brief survey, as well as sharing and distributing the survey with other organizations or stakeholders in NH with an interest in Youth Peer Support, and substance use treatment for adolescents and young adults. We appreciate you completing the survey by Sunday, May 24, 2020.

    If you have any questions please email Heidi Cloutier at Heidi.Cloutier@unh.edu.   Thank you! 

  • May 15, 2020 3:41 PM | Anonymous
    STARTS MONDAY...
    ATTENDEES DO NOT HAVE TO BE ASSOCIATED WITH ECHO

    Best Practices in Adoption of TeleHealth: COVID and Beyond mini-series


    This series is open to all primary and ambulatory healthcare workers across the globe using or planning on using electronic information and telecommunication technologies to support and promote long-distance clinical health care and patient education.  

    Telehealth can address COVID-19 and other epidemic situations by limiting exposure to infection for vulnerable populations and health care workers while expanding the reach of resources to communities that have limited access to needed services. This allows patients to receive health services away from settings where the potential for contracting COVID-19 is high, such as hospitals, health clinic waiting rooms, private practices, etc.

    Each session will include facilitation by Dr. Sanjeev Arora, Director of Project ECHO and Dr. Matt Bouchonville, Associate Medical Director, ECHO Institute, a didactic presentation, and the following panel of experts for Q&A:
    • Joseph C. Kvedar, MD; Vice President, Partners in Health
    • Christian B. Ramers, MD, MPH, AAHIVS; Medical Director, Laura Rodriguez Research Institute
    • John D. Scott, MD, MSc, FIDSA; Medical Director, University of Washington Digital Health
    • Kristin Sohl, MD, FAAP; Executive Director, ECHO Autism


    Session 1:     Monday, May 18, 2020    8:00 AM – 09:30 AM MDT
                           Ideal Integration of Telehealth into the New Normal

    Session 2:     Wednesday, May 27, 2020   8:00 AM – 09:30 AM MDT
                           Virtual Visits – Maximizing the Experience
                        

     Session 3:     Monday, June 1, 2020    8:00 AM – 09:30 AM MDT
                           Telehealth Technology, Privacy and Payment Policy
                          



    Series Flyer

    For additional information, please email telehealthECHO@salud.unm.edu
     
                                 

    This series has been created with the generous support of the Bristol Myers Squibb Foundation.

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