October 2020 - Our First MNSAM Newsletter!
Join us for our first virtual MNSAM meeting!
First Quarterly Meeting: Journal and Case Discussion by the Addiction Medicine Fellows
Monday, October 26, 6:30 pm
Link will be sent Monday morning to those that register below.
Register
Brief Review - Racism in Addiction
By Alexander Hubbell, MD
Earlier this year, two publications were released highlighting racial bias in substance use patterns and substance use disorder (SUD) treatment, using both sociological and epidemiological approaches. Written by Sara Matsuzaka and Margaret Knapp, the article “Anti-racism and substance use treatment: Addiction does not discriminate, but do we?” is a comprehensive review of the difficulties faced every day by People of Color (POC) when navigating our addiction infrastructure. Their summary quote stands alone: “Despite entering into substance use treatment with a greater severity of SUD and related consequences, POC experience more barriers to treatment engagement, completion, and satisfaction than their White counterparts.”
SAMHSA backs up this claim in their recent release, The Opioid Crisis and The Black/African American Population: An Urgent Issue. Their introduction begins to spell out some of the inequities among the Black/African American community: “the rate of increase of Black/African American drug overdose deaths between 2015-2016 was 40 percent compared to the overall population increase at 21 percent”. They dive into the state-level inequities as well; for instance “of DC’s opioid-related overdose deaths, 89 percent were among non-Hispanic Blacks”. The data present a balanced look at the demographics of substance use and overdose, highlighting inequities while appropriately noting the data as a whole. Read More >
Hospital Care of Patients with Substance Use Disorder By Heather Bell, MD
It is important to remember that patients with substance use disorders can have additional complications during hospitalizations for non-related addiction issues (i.e. COVID-19). Excessive alcohol use impacts 1/5-1/3 of all patients admitted to an intensive care unit (ICU), 20-40% of inpatients have alcohol-related conditions, and up to 40% of hospitalized patients have alcohol use disorder (AUD). Patients that fit these categories have a high potential for withdrawal, and if they do not accurately disclose this information at admission, this can significantly complicate their hospital course. Five percent of patients with AUD admitted develop severe withdrawal or DTs, and many of those symptoms/signs overlap those found in patients with sepsis. Thinking of severe cases of COVID-19 with prolonged ventilation specifically, patients with AUD have a significantly higher need for mechanical ventilation and AUD serves as an independent risk factor for development of sepsis, community acquired pneumonia, and ARDS (2-4x more likely in patients with AUD). If they have concurrent hepatic dysfunction, mortality rates are higher. Read More >
Advocating for Treatment Resources During the COVID-19 Pandemic By Emily Brunner, MDUnfortunately, preliminary numbers from the Minnesota Department of Health show an increase in overdoses of 20% from 2018 to 2019 occurring BEFORE coronavirus. With a noted uptick in overdoses nationwide (no Minnesota data available), there has also been a lack of treatment resources noted in the Ramsey County area for inpatient substance use disorders treatment. Specifically, both the St. Joseph's inpatient program and the Regions Hospital ADAP program closed in 2020, leaving patients with Medical Assistance struggling to find safe treatment resources. It is important for us all to advocate for our patients to continue to obtain safe and accessible treatment.
A Licensed Alcohol and Drug Counselor Perspective By Geoffrey RiemermannInterestingly, with COVID 19 and the recent civil unrest in Minneapolis, there has been an increase in the number of clients seeking inpatient/residential treatment. Anecdotally, some of my clients have said that the stress of isolation and neighborhood strife/violence have motivated their decision to seek treatment. Doing comprehensive assessments/R25’s on the phone has been a bit of a challenge—talking to individuals about substance use disorder (SUD)—without visual cues and body language is an adjustment. However, verbal authorizations are helping me expedite clients into treatment, as many struggle to follow through with scheduled appointments, and phone assessments seem to eliminate this barrier.
Unfortunately, it has been more of a struggle to place clients into outpatient/intensive outpatient programming. Many programs are doing tele-health appointments, using video conferencing applications and email, which require smart phone or android devices. As an employee of a large city hospital, many of my clients struggle with poverty, chronic health issues, mental illness, as well as SUD. These individuals also tend to lack either the technology, or the technological savvy to participate in tele health. However, some programs are still offering in person programming, and I have so far been able to find a fit for every need.
Responses to the September 2020 MNSAM Survey16 responses
Updates
Join us for our first virtual MNSAM meeting!
First Quarterly Meeting: Journal and Case Discussion by the Addiction Medicine Fellows
Monday, October 26, 6:30 pm
Link will be sent Monday morning to those that register below.
Register
Brief Review - Racism in Addiction
By Alexander Hubbell, MD
Earlier this year, two publications were released highlighting racial bias in substance use patterns and substance use disorder (SUD) treatment, using both sociological and epidemiological approaches. Written by Sara Matsuzaka and Margaret Knapp, the article “Anti-racism and substance use treatment: Addiction does not discriminate, but do we?” is a comprehensive review of the difficulties faced every day by People of Color (POC) when navigating our addiction infrastructure. Their summary quote stands alone: “Despite entering into substance use treatment with a greater severity of SUD and related consequences, POC experience more barriers to treatment engagement, completion, and satisfaction than their White counterparts.”
SAMHSA backs up this claim in their recent release, The Opioid Crisis and The Black/African American Population: An Urgent Issue. Their introduction begins to spell out some of the inequities among the Black/African American community: “the rate of increase of Black/African American drug overdose deaths between 2015-2016 was 40 percent compared to the overall population increase at 21 percent”. They dive into the state-level inequities as well; for instance “of DC’s opioid-related overdose deaths, 89 percent were among non-Hispanic Blacks”. The data present a balanced look at the demographics of substance use and overdose, highlighting inequities while appropriately noting the data as a whole. Read More >
Hospital Care of Patients with Substance Use Disorder By Heather Bell, MD
It is important to remember that patients with substance use disorders can have additional complications during hospitalizations for non-related addiction issues (i.e. COVID-19). Excessive alcohol use impacts 1/5-1/3 of all patients admitted to an intensive care unit (ICU), 20-40% of inpatients have alcohol-related conditions, and up to 40% of hospitalized patients have alcohol use disorder (AUD). Patients that fit these categories have a high potential for withdrawal, and if they do not accurately disclose this information at admission, this can significantly complicate their hospital course. Five percent of patients with AUD admitted develop severe withdrawal or DTs, and many of those symptoms/signs overlap those found in patients with sepsis. Thinking of severe cases of COVID-19 with prolonged ventilation specifically, patients with AUD have a significantly higher need for mechanical ventilation and AUD serves as an independent risk factor for development of sepsis, community acquired pneumonia, and ARDS (2-4x more likely in patients with AUD). If they have concurrent hepatic dysfunction, mortality rates are higher. Read More >
Advocating for Treatment Resources During the COVID-19 Pandemic By Emily Brunner, MDUnfortunately, preliminary numbers from the Minnesota Department of Health show an increase in overdoses of 20% from 2018 to 2019 occurring BEFORE coronavirus. With a noted uptick in overdoses nationwide (no Minnesota data available), there has also been a lack of treatment resources noted in the Ramsey County area for inpatient substance use disorders treatment. Specifically, both the St. Joseph's inpatient program and the Regions Hospital ADAP program closed in 2020, leaving patients with Medical Assistance struggling to find safe treatment resources. It is important for us all to advocate for our patients to continue to obtain safe and accessible treatment.
A Licensed Alcohol and Drug Counselor Perspective By Geoffrey RiemermannInterestingly, with COVID 19 and the recent civil unrest in Minneapolis, there has been an increase in the number of clients seeking inpatient/residential treatment. Anecdotally, some of my clients have said that the stress of isolation and neighborhood strife/violence have motivated their decision to seek treatment. Doing comprehensive assessments/R25’s on the phone has been a bit of a challenge—talking to individuals about substance use disorder (SUD)—without visual cues and body language is an adjustment. However, verbal authorizations are helping me expedite clients into treatment, as many struggle to follow through with scheduled appointments, and phone assessments seem to eliminate this barrier.
Unfortunately, it has been more of a struggle to place clients into outpatient/intensive outpatient programming. Many programs are doing tele-health appointments, using video conferencing applications and email, which require smart phone or android devices. As an employee of a large city hospital, many of my clients struggle with poverty, chronic health issues, mental illness, as well as SUD. These individuals also tend to lack either the technology, or the technological savvy to participate in tele health. However, some programs are still offering in person programming, and I have so far been able to find a fit for every need.
Responses to the September 2020 MNSAM Survey16 responses
- Preferred frequency of MNSAM gatherings: Quarterly
- What kind of activities are you interested in seeing from MNSAM?
- Zoom meetings: 94%
- In person, socially distanced educational: 75%
- Written communication: 31%
- Small committees for projects: 31%
- Topics: medication assisted treatment, non-physician providers, DNA targeted medications, COVID-19, journal article review, racial inequities, advocacy, clinical research, controversies in outpatient settings, hepatitis C treatment in addiction settings, contraception in addiction settings, psychosis, synthetic drug intoxication,
- Advocacy efforts:
- Opioid use disorder treatment in the jail setting: 56%
- Fellowship funding: 18%
- Sober housing: 13%
- How do you think MNSAM could most effectively address racial disparities?: blind dividing factors, understand perceived differences, partner with community non-profits, cultural competence training (panel q and a ), education (book club, journal club, lectures), advocacy to change legislation, decriminalization substance use, increase treatment access and engagement.
There is still time for you to share your opinion! The survey remains open until our meeting on the 26th. Complete it now >
Updates
- Collins, Bennet Introduce Legislation to Significantly Expand Opioid and Substance Use Training Nationwide for Providers: Bipartisan Bill Would Standardize Opioid Addiction Treatment and Training for Health Care Providers 9/22/20
- Fact Sheet: SAMHSA 42 CFR Part 2 Revised Rule: https://www.samhsa.gov/newsroom/press-announcements/202007131330
- Senate Republicans Introduce the HEALS Act: A Response to the COVID-19 Pandemic July 27, 2020
- Renewal of Determination That A Public Health Emergency Exists for 90 days from July 25, 2020