New Hampshire Alcohol & Drug Abuse Counselors Association

Dedicated to Advancing Addiction Professionals in New Hampshire

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  • October 07, 2019 1:49 PM | Anonymous
    Brought to you by your NHADACA Ethics Committee
    RECENT SURGE IN POPULARITY: Cannabidiol Popularity Raises Questions for Clinicians

    2018 marked the passage of the federal Farm Bill, which allows for the cultivation of industrial hemp (defined as Cannabis sativa with a THC content of less than 0.3% per dry weight) from which CBD oil can be extracted. This CBD, if grown on farms authorized by this legislation, is legal under the CSA. Further muddying the waters is that more than 30 states have now made some change to their cannabis laws. As such, in states such as California, one can find CBD products in dispensaries that are extracted from plants that are still considered “marijuana” under federal law and are thus, still illegal under the CSA (though federal enforcement of these laws has been practically nonexistent in recent years). This has led to a flurry of confusion in the marketplace as large national retailers such as Bed, Bath, & Beyond and Amazon have recently begun selling “CBD oil.” Often, the language around these products makes vague health claims, which runs the risk of reprimand from the FDA, which bans unsubstantiated health claims in consumer advertising. Additionally, the FDA has made clear that CBD (as Epidiolex is now a prescriptible medicine) cannot be included in food products, as FDA-approved medications cannot be sold as food. However, as a recent picture in The New York Times of a Brooklyn café offering CBD infused lattes would indicate, enforcement is lax. Much more well-controlled research is needed before it can be said, from the standpoint of evidence-based medicine, that low-dose CBD is an effective treatment for psychiatric ailments.

    By Andrew Penn, RN, MS, NP, CNS, APRN-BC

    Read More

  • October 02, 2019 8:50 AM | Anonymous

    Brought to you by your NHADACA Ethics Committee


    Check out the release of the most recent report from the National Academy of Medicine on October 23, 2019 at 11:30 am ET for the release of
    Taking Action Against Burnout: A Systems Approach to Professional Well-Being. The event will include an overview of the report and discussion of the report’s findings, recommendations, and key messages.

    The report will examine the scientific evidence regarding the causes of clinician burnout as well as the consequences for both clinicians and patients, and interventions to support clinician well-being and resilience. 


    Report Release Event


    October 23, 2019 | 11:30 AM EDT

    Register


    Please join us on October 23, 2019 at 11:30 am ET for the report release of the new National Academy of Medicine report, Taking Action Against Burnout: A Systems Approach to Professional Well-Being. The event will include an overview of the report and discussion of the report’s findings, recommendations, and key messages.

    The report will examine the scientific evidence regarding the causes of clinician burnout as well as the consequences for both clinicians and patients, and interventions to support clinician well-being and resilience. 
     

    Register


  • September 30, 2019 8:38 AM | Anonymous

    Brought to you by your NHADACA Ethics Committee

    As Drugmakers Face Opioid Lawsuits, Some Ask: Why Not Criminal Charges Too?    

    September 19, 20196:37 PM ET                                                                                                              

    Purdue Pharma, facing a mountain of litigation linked to the opioid epidemic, filed for bankruptcy in New York week of September 16, 2019.. The OxyContin manufacturer and its owners, the Sackler family, have offered to pay billions of dollars to cities and counties hit hard by the addiction crisis.

    Purdue and other drug companies have been forced to pay out hundreds of millions of dollars so far in civil lawsuits, which currently number more than 2,000 across the U.S.

    Prosecutors say evidence shows these firms pushed highly addictive opioid pain medication while downplaying the risk of addiction and overdose. They say executives engaged in racketeering and conspiracy, misleading doctors, insurance companies and government programs such as Medicare and Medicaid.

    But the legal action has largely remained in the civil sphere, and Rose thinks it's time for prosecutors to start treating drug companies as criminal enterprises for their role in an epidemic that — according to the Centers for Disease Control and Prevention — claimed nearly 400,000 lives between 1999 and 2017.

    Sen. Maggie Hassan, a New Hampshire Democrat, has called for hearings to investigate why the Justice Department hasn't put more of these drug company executives on trial. She's also demanding that the Justice Department give her office a full copy of a 2006 prosecution memo focusing on Purdue, parts of which appeared in The New York Times last year.

    Hassan says she believes the document will show that some federal attorneys wanted more serious criminal charges filed against Purdue.

    visit All Things Considered for the full story

  • September 24, 2019 9:37 AM | Anonymous

    Brought to you by NHADACA's Ethics Committee:


    On May 28-29, 2019, the Action Collaborative on Clinician Well-Being and Resilience hosted a public meeting in Chicago, IL to explore ways to redesign the clinical learning environment (CLE) with a focus on clinician well-being.

    Holly Humphrey expressed that systemic efforts can stimulate positive culture change. She urged the following stakeholders to take action to positively transform the culture in the CLE:

    • Academic and health care organization governance and executive leadership should invest in resources, physical and virtual spaces, policies, and processes that support optimal learning and engender clinician well-being across the clinical education continuum.
    • Accrediting organizations across health professions should periodically evaluate CLEs to hold administrators and leadership accountable for supporting positive and humanistic cultures.
    • Faculty and staff should engage in professional development to prioritize their personal well-being, support learner well-being, and improve learning environments.
    • Policymakers should enact policy improvements that prioritize clinician well-being in CLEs.
    • The research community should continuously investigate the drivers of clinician burnout and systems-level solutions to improve clinician well-being, as well as evaluate CLEs to ensure they uphold positive cultures that promote clinician well-being.

    Closing Remarks: The End is a Beginning

     

    Timothy Brigham, Chief of Staff and Senior Vice President of Education at the ACGME, closed by reminding participants of the remaining work to improve clinician well-being in the CLE. He identified that some of the key factors of an ideal CLE are:

    • Empathy and compassion.
    • Enlightened leadership.
    • Prioritized well-being for everyone including students, trainees, faculty, practicing clinicians, and patients.
    •  Role models who demonstrate professional joy, curiosity, and discovery.
    •  Safe quality care for patients.

    In closing, he urged participants to consider time as the key to creating the ideal CLE; to find ways to return clinicians the gift of time to care for their patients, to care for each other, and to care for themselves.

    To view a full list of meeting minutes please visit https://nam.edu/initiatives/clinician-resilience-and-well-being/action-collaborative-events/action-collaborative-on-clinician-well-being-and-resilience-may-meeting-5-key-takeaways/.

  • September 24, 2019 6:00 AM | Anonymous

    Our Day of Giving Is Here!

    Give today and help us work to create a healthier New Hampshire, where everyone can get the prevention, substance use treatment, and recovery supports they need.

  • September 18, 2019 8:39 AM | Anonymous

    New Hampshire PBS

    Roads to Recovery: Overdose and Brain Injury


    (Durham, August 29, 2019) - For years, Laurie Branchaud lived in fear of a phone call. “I was scared every day,” she says. Her son Ryan was struggling with opioid addiction and she dreaded a call from authorities telling her he had overdosed and died. “I always used to say he would turn around or he would die. There were two options. I never thought of the middle option.”

    While Ryan Branchaud did eventually overdose, he survived due to medical intervention but sustained a severe brain injury. His story and others are featured in the upcoming New Hampshire PBS documentary Roads to Recovery: Overdose and Brain Injury that premiered on Thursday, September 5th . The latest in a series of programs on substance misuse and recovery in New Hampshire, this installment investigates how brain injury can result from an overdose and how it can complicate addiction treatment.

    A recent increase in brain injuries among overdose survivors is partially a result of improved medical treatment of overdoses. While the injuries are not always severe, they can complicate the treatment and recovery process.

    “Brain injury symptoms can be misinterpreted as ‘they’re not really trying,’” says Lindy Keller, a Treatment and Recovery Specialist with the New Hampshire Department of Health and Human Services. “If this person has had multiple overdoses they may be trying as hard as they can, but they’re limited in their capacity.”

    John Corrigan, a psychologist at Ohio State University, concurs, “One of my missions is to help substance use professionals to understand the importance of knowing what the brain injury history is of the person across from them.”   Corrigan notes that an individual with a brain injury often requires greater support, over a longer period of time, from providers, friends and family. “When you think treatment is over, it’s not.” To view this series, online please visit nhpbs.org/recovery. 

    Funding for Roads to Recovery: Overdose and Brain Injury is provided by Dartmouth-Hitchcock Health and the Brain Injury Association of New Hampshire.

    About New Hampshire PBS:  New Hampshire PBS inspires one million Granite Staters each month with engaging and trusted local and national programs and services on-air, online, via mobile, in classrooms and in communities. Beyond its award-winning television programs, New Hampshire PBS is a leader in education and community engagement. www.nhpbs.org


    Visit the NHBS PRESSROOM at www.nhpbs.org/pressroom  •  Follow NHPBS on Facebook and Twitter


    New Hampshire PBS | 268 Mast Road |  Durham, NH 03824 |  603.868.1100  •  nhpbs.org

    NHPBS | NHPBS EXPLORE | NH WORLD | NH CREATE | NHPBS KIDS
    Digital channels
    11 Durham, 34 Pittsburg, 48 Littleton, 49 Keene, 50 Hanover


  • September 03, 2019 9:51 AM | Anonymous

    HHS 42 CFR Part 2 Proposed Rule Fact Sheet

    The 42 CFR part 2 regulations serve to protect patient records created by federally funded programs for the treatment of substance use disorder (SUD). SAMHSA is currently proposing to revise part 2, to facilitate better coordination of care for substance use disorders which will also enhance care for opioid use disorder (OUD). These provisions will be an important part of the Federal response to the opioid epidemic, while maintaining part 2 confidentiality protections.

    What's Not Changing Under the New Part 2 Rule: The proposed rule will not alter the basic framework for confidentiality protection of SUD patient records created by federally funded treatment programs. Part 2 will continue to prohibit law enforcement use of SUD patient records in criminal prosecution against the patient. Part 2 will also continue to restrict the disclosure of SUD treatment records without patient consent, other than as statutorily authorized in the context of a bona fide medical emergency; or for the purpose of scientific research, audit, or program evaluation; or based on an appropriate court order for good cause.

    What Is Changing Under the New Part 2 Rule: The proposed rule will modify several sections of part 2, as follows:

    Provision What Is the Proposed Change? Why Is This Being Changed?
    Applicability and Re-Disclosure Treatment records created by non-part 2 providers based on their own patient encounter(s) will not be covered by part 2, unless any SUD records previously received from a part 2 program are incorporated into such records. Segmentation or holding apart of any part 2 patient record previously received can be used to ensure that new records created by non-part 2 providers will not become subject to part 2. To facilitate coordination of care activities by non part-2 providers.
    Disposition of Records When an SUD patient sends an incidental message to the personal device of an employee of a part 2 program, the employee will be able to fulfill the part 2 requirement for "sanitizing" the device by deleting that message. To ensure that the personal devices of employees will not need to be confiscated or destroyed, in order to sanitize per part 2.
    Consent Requirements An SUD patient may consent to disclosure of his part 2 treatment records to an entity (e.g., the Social Security Administration), without naming a specific person as the recipient for the disclosure. To allow patients to apply for benefits and resources more easily, for example, when using online applications that do not identify a specific person as the recipient for a disclosure of part 2 records.
    Disclosures Permitted w/ Written Consent Disclosures for the purpose of "payment and health care operations" are permitted with written consent, in connection with an illustrative list of 17 example activities. In order to resolve lingering confusion under part 2 about what activities count  as "payment and health care operations," the list of examples will be moved into the reg text from the preamble.
    Disclosures to Central Registries and PDMPs Non-OTP (opioid treatment program) providers will become eligible to query a central registry, in order to determine whether their patients are already receiving opioid treatment through a member program.

    OTPs will be permitted to enroll in a state prescription drug monitoring program (PDMP), and permitted to report data into the PDMP when prescribing or dispensing medications on Schedules II to V, consistent with applicable state law.
    The revised central registry and PDMP provisions will help to prevent duplicative enrollments in SUD care, duplicative prescriptions for SUD treatment, and adverse drug events related to SUD treatment.
    Medical Emergencies Declared emergencies resulting from natural disasters (e.g., hurricanes) that disrupt treatment facilities and services will meet the definition for a "bona fide medical emergency," for the purpose of disclosing SUD records without patient consent under part 2. To ensure clinically appropriate communications and access to SUD care, in the context of declared emergencies resulting from natural disasters.
    Research Disclosures for research under part 2 will be permitted by a HIPAA covered entity or business associate to individuals and organizations who are neither HIPAA covered entities, nor subject to the Common Rule (re: Research on Human Subjects). To facilitate appropriate disclosures for research, by streamlining overlapping requirements under part 2, the Privacy Rule and the Common Rule.
    Audit and Evaluation Part 2 will be revised to clarify that some specific situations fall within the scope of permitted disclosures for audits and/or program evaluation. To resolve current ambiguity under part 2 about what activities are covered by the audit and evaluation provision.
    Confidential Communications The standard for court ordered disclosures of SUD records for the purpose of investigating "an extremely serious crime" will be revised, by dropping the phrase "allegedly committed by the patient." To correct an earlier technical error from the 2017 rule-making, in which this phrase was inadvertently added to regulatory text without notice or public comment.
    Undercover Agents and Informants Court-ordered placement of an undercover agent or informant within a part 2 program will be extended to a period of 12 months, and courts will be authorized to further extend the period of placement through a new court order. To address DOJ concerns that the current policy is overly restrictive to some ongoing investigations of part 2 programs.
  • August 22, 2019 4:13 PM | Anonymous

    Do you strive to be a leader in the profession and give back to the SUD community?

    Well, now you can!

    NHADACA currently has two positions open on the Board of Directors.

    We are looking for a Connecticut Valley Representative and an At Large Representative (which can be from anywhere across the state).

    For more information, check out the website's Board of Directors page!

    If you're interested in becoming part of NHADACA's board, reach out to Amelia.


  • August 22, 2019 11:32 AM | Anonymous

    The Department of Defense (DOD) today released the 2019 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide(link is external). This clinical practice guideline (CPG) is the result of a thorough review of recently published evidence for suicide interventions by a multidisciplinary panel of experts. The CPG’s recommendations are intended for dissemination among and implementation by providers who care for military service members and veterans. 

    Below is a summary of the CPG’s main recommendations for the identification of suicide risk, evaluation of risk level, and management of patients at risk for suicide. Providers are encouraged to consult the full CPG for more details about these recommendations.

    Identification of suicide risk (Algorithm A)

    An evidence-based, recommended screening tool – such as item 9 of the Patient Health Questionnaire-9 – should be administered to individuals who …

    • Exhibit warning signs, such as suicidal ideation or recent self-directed violence (suicide attempt or intentional self-injury)
    • Are identified as at-risk for suicide by computer-driven prediction models (e.g., VA’s REACH VET program(link is external))
    • Present in a setting in which routine suicide screening is used (e.g., behavioral health)

    If the suicide screen is positive or if there is evidence that suggests the need for additional screening or evaluation, then the provider assesses for safety concerns like access to a firearm or a detailed suicide plan. 

    • For individuals with safety concerns that require immediate management, initiate management procedures for High Acute Risk for suicide
    • For all other individuals with suicide risk, initiate evaluation procedures

    Evaluation by provider (Algorithm B)

    The evaluation is used to gather information to determine the patient’s current suicide risk level so that management procedures matched to that risk level can be initiated.

    A comprehensive evaluation of suicide risk must include an assessment of:

    • Current suicidal ideation
    • Ability to maintain safety
    • Intent to die by suicide
    • Prior suicide attempt(s)
    • Current psychiatric conditions and symptoms
    • Prior psychiatric hospitalization
    • Recent bio-psychosocial stressors
    • Availability of firearms

    The provider will map the results of his/her evaluation to the following risk levels:

    High Acute Risk

    • Suicidal thoughts with intent to die by suicide
    • Requires external assistance to maintain personal safety

    Intermediate Acute Risk

    • Suicidal thoughts with intent to die by suicide
    • Ability to independently maintain personal safety

    Low Acute Risk

    • No current suicidal thoughts, specific suicide plan, or preparatory suicide behaviors
    • Ability to independently maintain personal safety

    Management of patients at acute risk of suicide (Algorithm C)

    Below are a subset of the CPG’s recommended actions for providers, organized by suicide risk level.

    High Acute Risk

    • Initiate direct observation of the patient and ensure patient has no access to lethal means (e.g., sharps, cords, tubing, toxic substances, firearms)
    • Hospitalization of the patient is typically required for safety, including involuntary hospitalization
    • During hospitalization, initiate evidence-based treatment aimed at reducing suicide risk
    • Discharge only if risk level has sufficiently decreased
    • Following discharge, consider checking in on the patient via telephone, home visit, or mail (depending on your clinic’s policy and procedures) and assisting the patient with engaging in case management services as well as counseling or other psychosocial interventions

    Intermediate Acute Risk

    • Hospitalization may be indicated after considering the ability to maintain safety as well as the risks and benefits of outpatient and inpatient care
    • Outpatient management should include frequent contact with the patient, a carefully constructed safety plan, and the involvement of the patient’s support network whenever possible
    • Mental health treatment should address co-occurring conditions and concerns
    • Re-evaluate risk level regularly and adjust management plan accordingly

    Low Acute Risk

    • Patient can be managed in primary care
    • Outpatient mental health may be indicated, especially with co-occurring suicidal ideation and psychiatric symptoms
    • Focus care on strengthening protective factors and mitigating risk factors
    • Re-evaluate risk level regularly and adjust management plan accordingly
  • July 23, 2019 2:29 PM | Anonymous

    The New Hampshire Division of Public Health Services, in collaboration with the New Hampshire Board of Licensing for Alcohol and Other Drug Use Professionals, will be collecting key practice and capacity data from New Hampshire-licensed alcohol and drug counselors (LADCs/MLADCs) who are due to renew their license, with an online survey. The survey coincides with the board’s license renewal cycle, and will be available to complete at the time the renewal cycle opens until the close of the cycle (6/30).

    Pursuant to RSA 330-C:9-a, licensees will be “required, as part of the license renewal process,” to complete the survey. However, providers may also opt out of participation by completing the NH Health Professions Data Center (HPDC) the opt-out form found on the HPDC website.

    The data will be used for functions requiring accurate statewide data on provider supply and capacity. It will serve as a key resource in statewide healthcare workforce assessment, healthcare access planning, informing educational and training programs, emergency preparedness, and recruitment and retention initiatives including the National Health Service Corps and the New Hampshire State Loan Repayment Program. 

    The survey link will be available on the same website you will access to renew your license. The survey link will also be available on the New Hampshire Department of Health and Human Services’ Health Professions Data Center page, as soon as the survey opens. Providers can also locate the survey by searching for “NH Alcohol and Drug Counselor Survey” in a web browser. 

    Contact Danielle Weiss, Primary Care Workforce Program Manager, at danielle.weiss@dhhs.nh.gov. Please do not contact the Board or NHADACA with technical questions regarding the survey.

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