March webinar: Come learn about Cannabis Hyperemesis Syndrome from Ethan Russo, MD!

Ethan Russo

Join us on March 19 (12pm PT) for our next webinar, featuring renowned expert Ethan Russo, MD, in a session co-sponsored by the University of Washington Addictions, Drug & Alcohol Institute's Cannabis Education & Research Program (CERP)!

In this session, titled Cannabinoid Hyperemesis Syndrome (CHS): Understanding an Emerging Public Health Challenge, Dr. Russo will provide an overview of Cannabinoid hyperemesis syndrome (CHS), a constellation of intractable vomiting, and abdominal pain and hot bathing behavior that solely occurs in the context of certain heavy chronic use of THC-predominant cannabis, including synthetic cannabinoids.

He'll also discuss theories of its cause, including several that have been debunked, describe the serious nature of the condition (which causes considerable illness and even death), and talk about ways to provide symptomatic relief.

Learn more about this session and register here!

Webinar: Cannabinoid Hyperemesis Syndrome (CHS): Understanding an Emerging Public Health Challenge

Ethan Russo, M.D.

Ethan Russo

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Yvonne Elmendorf - watch the video

chelsea kimura

Chelsea Kimura

Stephanie Stillwell

stephanie stillwell

Stephanie Stillwell

Lindsay Worth

Lindsay Worth

Lindsay Worth

Successful Contingency Management Implementation Strategy in Indiana Funded by State Opioid Response Grant

What’s the Question?

Contingency management (CM) is an effective and well-studied intervention for substance use disorders (SUDs), and one of the few that has been demonstrated to work well for people with stimulant use disorders in particular. Nevertheless, its adoption in SUD treatment settings has been limited.

Someone handing a red and white gift card to another hand

In 2020, SAMHSA’s State Opioid Response Grant (SOR) initiative included CM as an allowable activity to treat simulant use disorder and improve retention in care, which has the potential to expand CM implementation across the nation.

This study looks at a SOR-funded program to disseminate CM in Indiana -- how they developed their implementation plan and how well that implementation worked. Their experiences may provide helpful information for organizations or states/communities looking to also implement CM in their programs.

How Was This Study Conducted?

Indiana government and university partners developed a multi-component, statewide CM dissemination and implementation plan that included:

Researchers for this study collected data on provider/staff characteristics; CM knowledge and attitudes, readiness, and perceived barriers; and CM implementation at pre- and post-training workshop and at 3- and 6-month follow-up. In year 2, they also collected client-reported quality assurance data.

What Did Researchers Find Out?

Staff (N=72) from 12 selected agencies attended the CM workshop. A little more than half (57%) reported some familiarity with CM, but only 14% had any prior CM training or experience. After the workshop, participants reported increased CM knowledge and confidence in their ability to implement CM.

Sites completed 3-7 technical assistance sessions and developed CM programs tailored to their organizations. By 6 months, 9 sites had begun CM implementation. These sites averaged 57 days of implementation (ranging from 25-122), engagement of 23 clients (range: 4-77), delivery of 208 CM reinforcers (gift card codes, range: 8-366), and per-client payouts of $33.77 (range: $11.24-$49.48).

Barriers to CM implementation reported by the sites included lack of time, client referrals, and resources (administrative and economic). Client-level quality assurance data indicated provider adherence to CM.

Overall, the multi-component training model funded by the SOR team was effective at yielding several new CM programs that operated successfully within SAMHSA’s guidelines.

What Are the Implications for the Workforce?

Sites participating in this SOR-funded training and implementation opportunity expressed positive feedback about their experiences. Other state SOR programs may want to consider similar models for implementation, as Indiana’s model was successful at increasing CM knowledge and confidence for providers and staff and got 9 of 12 sites up and running in just 6 months.

Programs should also note, however, that organizational barriers like readiness/capacity, turnover, and buy-in remained a challenge for the Indiana sites, suggesting that addressing these issues earlier on in the implementation process may be useful.

elmendorf

Yvonne Elmendorf

Workforce Spotlight Initiative

There is a national shortage of addiction care professionals and societal needs for this workforce are projected to increase over the next decade. While many things contribute to this circumstance, a pervasive challenge is the stigma that often surrounds people with substance use disorders and the care available to them.

To combat such stigma about addiction care, the Northwest ATTC is committed to offering positive public portrayals of individual workforce members in our region, via "Spotlight" interviews.

We'll be featuring different members of the Region 10 (AK, ID, OR, WA) workforce on a bimonthly basis over the coming years. Sign up for our newsletter to find out when a new video has been added!

Spotlight videos

Yvonne Elmendorf play video

Yvonne Elmendorf
Substance Use Disorder & Violence Prevention Behavioral Health Director
Consejo Consulting & Referral Services



AK-2025

Alaska board members

Eliminating Hepatitis C (webinar)

webinar-202501

Sarah Canavese

sarahcanavese

Sarah Canavese

Emily Mossberg

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Emily Mossberg

Pharmacy-Based Preventive Services for Opioid Use Disorder: What Support Do Pharmacists Need?

African American woman pharmacist in white lab coat reviewing notes standing in front of shelf fully stocked of medicine

What’s the Question?

More than 90% of Americans live within 5 miles of a community pharmacy, making pharmacists a natural source for opioid-related preventive services, like screening patients for problem use, educating patients about safe medication practices, providing naloxone rescue kits, delivering brief interventions, and making referrals to treatment.

However, little is known about pharmacists’ concerns about opioid-related problems, what prevention-related practices they already engage in, and their commitment or willingness to provide services to people with opioid or other drug use problems. The studies that have been done to date have identified training/education as a primary factor influencing pharmacists’ attitudes toward and skills related to providing opioid-related prevention services. But what other factors might be involved?

How Was This Study Conducted?

For this study, part of the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN-0105), researchers surveyed pharmacists to better understand their concerns about opioid-related problems and preventive services; examine whether their demographics, pharmacy characteristics, and opioid-related education/training played any role in those concerns, and explore other barriers to delivering preventive services.

Who Were the Study Participants?

1146 respondents were recruited from 47 states and DC (AK, ME, and RI were not represented). Approximately 54% of respondents were female, 49% were aged 35-54, 96% were not Hispanic/Latino, 75% were white, 13% were Asian, and 5% were Black. In addition, 32% resided in the Midwest region (South, 30%, Northeast, 20%, West, 17%), 38% practiced in an urban setting (suburban 33%, rural 29%), 64% worked at an independent pharmacy (chain 17%, hospital/clinic 9%, supermarket 7%, other 2%), approximately 53% had more than 10 years of pharmacy experience, and 55% were pharmacy managers/owners.

What Did Researchers Find Out?

Overall, 75.48% of respondents reported having concerns about opioid use problems at their pharmacy practice sites, with 62.04% also reporting concerns about non-opioid drug use problems (illicit and non-opioid drugs).

Pharmacists who asked patients about their opioid use were more likely to report concerns about opioid misuse in their community, suggesting that these conversations might be ideal times for screening or brief intervention. Pharmacists in rural areas also indicated relatively high concerns about opioid and illicit drug misuse and were more likely that pharmacists in urban areas to deliver intervention services, which may be related to the severity of the opioid epidemic in rural areas, as well as the shortage of treatment options in those regions. These findings suggest that rural pharmacists may be more willing than those in urban areas to receive training and deliver services.

As with other studies, education played a key role in pharmacists’ preventive practices and their willingness to engage in such practices. Pharmacists who received 3+ hours of education in the past year were also less likely than pharmacists with no education in the past year to perceive concerns about opioid and illicit drug misuse in their practices, possibly because pharmacists with training are more confident talking to patients about opioids and thus have fewer concerns.

The main barrier to delivering preventive services was time constraints due to high workloads, burnout, or staff shortages. Pharmacists also had concerns about awkward or negative experiences when talking to people about their opioid use, suggesting that communication strategies might be a good component of any training, as well as resources for screening tools, opioid use disorder treatment options, and contacts for addiction treatment programs. Arming pharmacists with accurate information and teaching them how to have these conversations could increase their confidence in delivering these services, making it more likely that they will.

What Are the Implications for the Workforce?

Pharmacists are on the frontlines of the opioid epidemic and could play an extremely important role in keeping people safe and connecting them to services. Having received opioid-related training on screening, intervention, and referral to treatment in the past year was one of the key indicators of willingness to deliver preventive services, something that educators/trainers in the addiction workforce might be able to play a role in.

Additionally, pharmacists noted as a barrier their lack of awareness of local drug treatment programs and a desire to have pamphlets on hand to share with their patients, another way addiction workforce members might be able to get involved.

With the passage of the Mainstream Addiction Treatment (MAT) Act in December 2022, removing the federal legal barrier to pharmacist buprenorphine prescribing, over 10 states are now allowing pharmacists to prescribe controlled substances like buprenorphine under collaborative practice agreements with healthcare providers. Working with pharmacists to increase their willingness to provide such a service and arming them with information and other supports could help make a difference in rates of opioid use disorder and other illicit drug use disorders as well.

Improving First Responders’ Perceptions of Overdose Events and Survivors Through Training Co-Facilitated by Overdose Survivors

CTN Dissemination Library & Northwest ATTC

What’s the Question?

First responders like police, EMTs, and firefighters frequently interact with people who use drugs (PWUD), and, based on how these interactions go, they can either help or harm. First responders have reported negative views toward PWUD and also misinformation related to ways to help them, such as believing that distributing naloxone leads to riskier drug use behaviors (not true). Identifying ways to improve negative beliefs about PWUD and interventions to support them is key to improving interactions between first responders and these communities, which could in turn help reduce rates of both addiction and overdose.

How Was This Study Conducted?

In this project, funded by SAMHSA -- the Connecting the DOTS (Drug Overdose Trust and Safety) Project -- the authors sought to build on the foundation of a prior training project (MO-HOPE) by partnering with the SHIELD (Safety & Health Integration in the Enforcement of Laws on Drugs) Training Initiative to develop an intervention incorporating components based on participant feedback, guidance from subject matter experts, and the emerging success of an occupational wellness approach to professional training.

The curriculum used three core modules: Responder Resilience (reviewing responder stress, burnout, trauma, and mental health), Responder Safety (reviewing bloodborne diseases, overdose recognition, and naloxone administration, as well as fentanyl contact concerns) and empathic communication strategies when responding to an overdose, and Public Safety, reviewing evidence-based treatments and local support services for people with SUD and how first responders can refer to them.

Importantly, the training was delivering using a co-facilitator model, with one trainer being a peer first responder (paramedic for EMS, police officer for law enforcement) and the other a working behavioral health specialist with lived experience of being revived from an overdose by a first responder. This approach was used to model collaboration across sectors, humanize addiction and overdose rescue, and offer insights on how PWUD experience interactions with first responders.

A pre- and post-training survey was used to evaluate this new approach and see if first responders’ beliefs and attitudes toward PWUD and naloxone changed after they attended the training and, if so, did training-associated changes differ by professional population (law enforcement vs. EMS/firefighters).

Who Were the Study Participants?

There were 1,407 participants from 43 agencies within 36 Missouri counties who attended 151 of the trainings between December 2020 and May 2023 who completed the surveys. 53.9% were law enforcement and 46.1% were EMS/firefighters. Most participants identified as white (87%) and men (83%), with the average age 36.31 years. Participants had been in their current field for an average of 11.99 years.

What Did Researchers Find Out?

Though attitudes and beliefs among law enforcement were more negative than among EMS/firefighters both before and after the training, attending the training was associated with improvements in those attitudes and beliefs in both sectors, indicating promise with this new approach. Outside of that, the DOTS/SHIELD training yielded no interaction by profession, with both groups reporting similar improvements. This is likely the result of including profession-specific customization, as well as profession-specific peer trainers.

Including a behavioral health specialist with lived experience helped humanize those on the receiving end of responders’ care and provided a rare glimpse into the positive downstream outcomes of their work.

Using customized training components tailored with local substance use resource information also helped equip first responders with the mechanisms needed to improve survival outcomes, which can not only help the people they serve, but also improve their own attitudes toward PWUD by increasing confidence they would truly be able to help. Connecting people to services can also reduce future overdose events, which can in turn reduce demand on first responders, helping to address compassion fatigue and burnout.

Training components that addressed common misinformation about needlestick injuries and fentanyl exposure also helped officers perceive less risk of threat of potential harm during encounters with PWUD, which in turn could make them more likely to issue referrals to services rather than make arrests.

What Are the Implications for the Workforce?

This study provides great insight into what components make training effective for first responders, and also highlights the value of including both peers and people with lived experience as training facilitators. Tailoring trainings to better inform audiences about resources in their own communities can also increase effectiveness and improve outcomes for attendees. Given the frequency with which first responders encounter people with opioid use disorder or in overdose situations, providing effective training to these groups to reduce stigma and improve interactions with PWUD could make a real difference in the number of overdoses in a given community. Many of the lessons learned by this study may apply to training for other types of service providers as well.

Danielle Eakins-sq

Danielle Eakins

Mandi Nugent

Mandi Nugent

Winter 2025 CLAS Trainings for Peers and Workforce Professionals

CLAS: Culturally and linguistically appropriate services

NOTE: THE CLAS TRAINING FOR PEERS HAS BEEN RESCHEDULED FOR FEBRUARY 18. Register for the new date here! (If you had registered for the original date, please forward your registration confirmation email to [email protected] to reserve a seat in the new class!)

Join us this winter to learn about CLAS (Culturally and Linguistically Appropriate Services)!

The Northwest ATTC is offering two trainings in early 2025 -- one for peers and one for workforce professionals.

Marginalized communities including, but not limited to, Black, Indigenous, and LGBTQIA are adversely affected by substance use disorders and recent data proves those same communities have more barriers to treatment. So how do we as providers use a person-centered approach that embraces cultural humility ensuring that folks from all walks of life get the SUD recovery support they so richly deserve?

In this conversational workshop, led by peer Sean Mahoney, PWS, CRM, we will dive deeper into those inequities and discuss how CLAS (Culturally and Linguistically Appropriate Services) standards can help us infuse our practice and organizations with cultural humility.

Find out more about: CLAS for Peers (February 18) | CLAS for Workforce Professionals (February 11)

Free to register. Certificate of Attendance available upon completion of this virtual training. (These trainings will also be offered in Spring 2025 if you can't make it this winter!)