SAMHSA provides tools and strategies to address prescription drug misuse, including medication-assisted treatment, overdose prevention education and naloxone distribution, appropriate prescribing practices, effective monitoring, and screening. SAMHSA educates physicians on safe opioid prescribing through online modules, in-person courses, clinical guidelines, and programs on screening, brief intervention, and referral to treatment. These tools aim to reduce rates of prescription drug misuse through surveillance, risk-tailored interventions, and expanding access to effective treatment.

1. SAMHSA’s Tools For
Treatment
Dr. Melinda Campopiano, MD
Medical Officer, Substance Abuse and Mental Health
Services and Administration (SAMSHA)
Suzanne Fields, MSW, LICSW
Senior Advisor to the SAMHSA Administration on Health
Care Financing, SAMHSA

2. Learning Objectives
1. Identify SAMHSA’s tools for treatment.
2. Identify the methods for medicated-
assisted treatment.
3. Analyze the ACA and its effect on
access to treatment

3. Disclosure Statement
• Melinda Campopiano has no financial
relationships with proprietary entities
that produce health care goods and
services.
• Suzanne Fields has no financial
relationships with proprietary entities
that produce health care goods and
services.

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Tools and Strategies
Addressing Prescription
Drug Misuse
Melinda Campopiano von Klimo, MD
Division of Pharmacologic Therapies
Center for Substance Abuse Treatment

6. Prescription Drug Misuse
• Surveillance
• Risk and population specific
interventions
• Medication Assisted Treatment
• Overdose Prevention Education & Naloxone
• Appropriate Prescribing
• Effective monitoring
• Effective Screening

7. Rates of Prescription Drug
Misuse

8. www.SAMHSA.gov/data

9. Prescription Drug Overdose
• 57% of fatal overdoses involve
pharmaceuticals
• Exceeds the number of overdose deaths
annually due to heroin and cocaine combined.
• Opioids were found in most deaths involving
benzodiazepines, anti-depressants,
• 29.4% of fatalities involved opioids alone
• Increase in overall overdose death rates
since 1999 driven by increased prescribing of
opioid analgesics
Morbidity and Mortality Weekly Report, November 4, 2011/60(43);1487-1492
Pharmaceutical Overdose Deaths, United States, 2010. JAMA, February 20, 2013-Vol 309, No. 7

10. Overdose Risk Factors
• Any prescription for an opioid
• High dose opioid prescription
• Poverty (Medicaid)
• Poly-substance use
• Recent abstinence (jail, detox,
treatment)
• Age
• Illness

11. Overdose Intervention
Education & Naloxone
Most overdoses occur in the presence of
others.
Fatal overdoses usually happen over the
course of several hours.
There is an antidote to opioid overdose.
Poly-drug overdoses may benefit from
naloxone if opioids are present.

12. Prevention Messages
• Don’t use drugs alone
• Know how to recognize an overdose
• Activate 911
• Position of safety
• Rescue Breathing

13. Naloxone
• Timely use of naloxone
• Greater availability of naloxone
• More first responders equipped and trained to
use it.
• Greater physician prescribing of naloxone for
patients at risk of overdose.

14. Treatment is Prevention
• methadone maintenance treatment is effective
in reducing morbidity and mortality associated
with continued use of heroin and other illicit
opiates, as well as HIV-related morbidity
• “…the all cause mortality rate for patients
receiving methadone maintenance treatment
was similar to the mortality rate for the general
population whereas the mortality rate of
untreated individuals using heroin was more
than 15 times higher.”
Modesto-Lowe et al., 2010; Gibson, 2008; Mattick, 2003; Bell and Zador, 2000; Marsch, 1998

15. Maintenance on Opioid Agonist
Therapy
1996 Subutex and methadone
600
500
French population in
No. of deaths
400
1999 = 60,000,000
300
Patients receiving
200
buprenorphine (1998): N=
55,000
100
Patients receiving methadone
0
(1998): N= 5,360
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
997 1999
1
Year
Auriacombe et al., 2001

16. Placebo Controlled Study of Maintenance
vs. Detoxification with Methadone
Whitehall, 1974

17. Placebo Controlled Study of Maintenance
vs. Detoxification with Buprenorphine
Kaplan-Meier curve of cumulative retention in treatment
20
Number remaining in treatment
15
Buprenorphine
10
5 P=0.0001
Control
0
0 50 100 150 200 250 300 350
Time from randomization (days)

18. www.pcss-o.org

19. Prescribers’ Clinical Support System
for Opioid Therapies (PCSS-O)
Supports:
• Innovative approaches to educating all
clinicians who prescribe opioids
Focus:
• Safe use of opioids in treatment of pain
including training on how to recognize
misuse, abuse, and addiction in those
with pain
• Use of opioid therapies for treatment of
opioid dependence

20. Prescribers’ Clinical Support System
for Opioid Therapies (PCSS-O)
Year
One
Year
Two
Online
Archived
Phone
App
Mentors
Mentees
Listserv
Total
Webinars
Webinars
Modules
Webinar
Downloads
Par=cipants
Number
Views
Trained
2850
2249
818
1,365
733
37
97
194
8343
• Developed 15 online modules and a 2 hr, 2
CME course available through the California
Academy of Family Physicians.
• More than 90% satisfied or very satisfied with
quality of training and information presented
and would recommend the training to
colleagues.

21. Prescribers’ Clinical Support System for
Opioid Therapies (PCSS-O)-Content
• A Review of Considerations in the Assessment
and Treatment of Pain and Risk for Opioid
Misuse
• Advances in Recognition and Treatment of
Substance Use Disorders in Primary Care
• Clinical Guidelines for Opioid Use in Chronic
Non- Cancer Pain
• Considerations in Medication Assisted
Treatment of Opiate Dependence
• Implementation of Evidence Based Practice
• Medication Assisted Treatment for Substance
Use Disorders in Primary Care

22. www.pcss-b.org

23. Treatment Improvement
Protocols and Advisories

24. Clinical Practice Guidelines
• Treatment Improvement Protocols (TIPs)
• Detoxification and Substance Abuse Treatment
• Medication Assisted Treatment (MAT) for Opioid
Addiction in Opioid Treatment Programs
• Managing Chronic Pain in Adults With or in Recovery
From Substance Use Disorders
• Hepatitis C
• Advisories
• Prescription misuse, Oxycontin®, methadone,
Opana® (TTP)
• Vivitrol®

25. “Prescribing Opioids for Chronic
Pain: Balancing Safety & Efficacy”
25

26. “Prescribing Opioids for Chronic
Pain: Balancing Safety & Efficacy”
In-person course using national and local faculty
47 sites in 25 states
Collaborate with local organizations or agencies.
Tailored to local issues based on state-specific
surveillance data.
Specialized courses developed for IHS and DOD
Almost 9,000 practicing health professionals trained
Physicians, Advance Practice Nurses, Physician’s
Assistants, Dentists, Oral Surgeons

27. Course Content
• best practices and clinical protocols for the use of
methadone and other opioids to treat pain,
• evidence-based strategies for patient selection, risk
assessment, and education,
• techniques for effective patient monitoring, including
the use of state prescription drug monitoring
programs,
• the risks and benefits of opioids, as well as how to
incorporate clinical and administrative practices that
reduce such risks and enhance patient outcomes
• how to use state Prescription Drug Monitoring
Programs (PDMPs)

28. Course Impact
• Evaluations of the courses by
participants and independent experts
have been very positive,
• average score of 6.0 on a scale of 1 to
7, with 7 designated “superior.”
• In a 2012 follow-up survey, more than
76% of physicians who had completed
a course reported that they made
changes in the way they practice as a
result of what they learned.

29. www.opioidprescribing.com

30. www.opioidprescribing.com
• a series of 30-minute modules
• each targeted to a specific audience or
addressing a particular aspect of opioid
prescribing.
• In 2012 alone, more than 7,330 registrants
completed at least one module for CME
credit
• another 15,163 certificates of completion
were issued to individuals who completed
more than one module
• a total of 22,493 modules completed

31. Online Modules
• Opioid Efficacy and Safety; Assessment and
Monitoring Tools for Primary Care Settings
• Communicating with Patients About Chronic Opioid
Use
• Managing Patients with Pain, Psychiatric Co-
Morbidity and Addiction
• Case Studies in Opioid Prescribing
• Issues in Clinical Practice
• Exit Strategies from Outpatient Opioid Therapy for Pain
• Managing Chronic Pain in Returning Military Personnel and
Their Families
• Use of State Prescription Drug Monitoring Programs (PDMPs)
in Clinical Practice

32. Course Impact
• Developed in partnership with Boston University
• Consistently receives highest rating for content
• The Accreditation Council for Continuing Medical
Education (ACCME) “Accreditation with
Commendation.”
• The American Nurses Credentialing Center (ANCC)
awarded BU “Accreditation with Distinction, the
highest recognition awarded by the American
Nurses Credentialing Center’s Accreditation
Program.”
• The American Academy of Family Physicians (AAFP)
“The procedures established for conducting CME
activities at your institution are exemplary.”

33. Prescription Drug Monitoring
Programs
• Real-time data entry and access
• Easy Prescriber Access
• Cross-boarder sharing of state data.
• Physicians encouraged or required to
use PDMP.
• Opioid Treatment Programs must
check PDMP

34. Screening, Brief Intervention
and Referral to Treatment
• Systematic screening for harmful or
hazardous substance use and risk
factors for overdose where most opioid
prescribing is done.
• Brief motivational discussion focused
on feasible, positive behavior change.
• Education targeted to specific risks.
• More effective treatment referral.

35. SBIRT Billing and Coding
Guidance

36. Tools and Strategies
• Overdose education
• SBIRT
• PDMPs
• Treatment
• Physician Education
• Surveillance

37. Contact
melinda.campopiano@samhsa.hhs.gov