ADP

 

 

In This Issue

 



DIRECTOR'S COLUMN

Colleagues:

Governor Brown’s proposed elimination of ADP on July 1, 2012, was put on hold for a year after the Legislature approved and the Governor signed a budget trailer bill requiring a more detailed plan for reorganizing and transferring administrative and programmatic functions performed by ADP.

The Legislature’s intent in AB 1474 (Section 81) is to transfer ADP’s functions to other state departments effective July 1, 2013, and requires the California Health and Human Services Agency (CHHS)—in consultation with stakeholders and affected departments—to map out a plan that ensures the transfer can achieve the following goals:

  • Improve access to alcohol and drug treatment services for consumers, including a focus on recovery and rehabilitative services.
  • Effectively integrate the implementation and financing of services.
  • Ensure appropriate state and county accountability through oversight and outcome measurement strategies.
  • Provide focused, high-level leadership within state government for alcohol and drug treatment services.

The detailed plan from CHHS will include a number of components that involve stakeholders who will play an important role in developing the plan. Consumers, family members, providers, counties, and legislators will be invited to provide input for the plan. The plan will also include an ongoing process for stakeholder participation to assess and make recommendations for the delivery of alcohol and drug treatment services in California.

One major change at ADP is the transfer of Drug Medi-Cal (DMC) functions and 59 associated staff that will become part of the Department of Health Care Services effective July 1, 2012. This transfer of DMC functions and staff was part of the 2011-2012 Budget Act. For the time being, however, the DMC staff will remain housed in ADP’s office building.

Now that the Governor has signed the 2012-2013 Budget Act, ADP will move forward this coming fiscal year addressing a number of strategic initiatives and operational improvements that have been delayed due to both the fiscal crisis and reorganization planning.

This week saw another decision that may significantly impact the substance use disorder (SUD) field. The U.S. Supreme Court upheld President Barack Obama’s historic health care overhaul—the Patient Protection and Affordable Care Act (ACA). The ACA’s public and private insurance expansion presents several opportunities to serve new clients with untreated SUDs. With these opportunities, however, come challenges. The field must prepare for key elements of the ACA that become effective in 2014. These challenges include accommodating insurance industry changes, the increase in demand for SUD services brought on by expanded coverage, the implementation of electronic health records, and the delivery and financing of these services.

As ADP moves into a new fiscal year, we remain committed to serving you—the AOD and problem gambling fields—and helping you to prepare for changes on the horizon.


Acting Director

 


FEATURE ARTICLES

Medication-Assisted Treatment: Alcohol

Alcohol use disorders are common in Americans.  The 2009 National Survey on Drug Use and Health reported that 23.7 percent of people (59.6 million) reported binge drinking, and 6.8 percent (17.1 million) reported regular, heavy drinking of alcohol, 1 making alcoholism one of the most common diseases in the United States. Despite the prevalence of alcohol problems, most will not be prescribed medicines already U.S. FDA-approved and available for treatment of alcohol dependence—even those individuals who have failed psychosocial interventions in the past are usually not offered medication assisted treatment. Why those with alcohol use disorders are unlikely to be offered medication treatments specifically to help with reducing alcohol use and initiating abstinence probably has many underlying reasons. However, one reason is a lack of familiarity on the part of clinicians and those they serve about the available treatments and how those treatments work.

This article will briefly describe treatments specifically developed for maintenance treatment of alcohol dependence (i.e., preventing relapse/reducing alcohol use), which are currently approved by the U.S. Food and Drug Administration.

When someone develops an alcohol disorder, it is common, particularly for the first treatment, to send that person to a specialized substance abuse treatment program where he can receive education about the disease and learn coping skills to help him maintain sobriety in a safe and supportive environment. These programs vary in length and may be residential, outpatient, or a combination of residential/outpatient. Some will obtain long-term sobriety with such interventions, but many will not. Those who relapse after drug-free treatment should be evaluated to determine if they would benefit from addition of an alcohol pharmacotherapy to help them maintain sobriety.

Currently, there are three medications that are FDA-approved to treat alcohol dependence in the United States. Those medications are disulfiram (also known by the trade name Antabuse) 2, naltrexone (available as tablets or as a once-monthly injection), and acamprosate 3 (see Table 1). Disulfiram given at a clinical dose of 250 mg once daily is a deterrent to alcohol use because it inhibits the enzymes responsible for the breakdown of alcohol leading to the buildup of acetaldehyde in the blood. Those taking disulfiram who drink alcohol will experience flushing, headache, palpitations, nausea, and hypotension (low blood pressure). The severity of the reaction is proportional to the amount of alcohol consumed. Rarely, deaths have been reported in those taking disulfiram and drinking alcohol, so it is important to discuss the need not to drink alcohol or use any alcohol-containing products while taking this medication. Naltrexone blocks mu opioid receptors (it is useful for treating opioid addiction as well), which are thought to affect craving for alcohol in some. Naltrexone can be given as tablets once a day and, therefore, could be adapted to clinician/counselor administration within a clinical program. The advantage to naltrexone tablets is the low cost of the medication. The disadvantage is that many people do not take their medications regularly, and in the case of alcohol mis-users, they may be ambivalent about stopping their use. The injectable form of naltrexone makes it possible to give the medication on a once monthly basis eliminating the need for daily medication. A person’s primary doctor could give the injection, or the injection could be administered at a substance abuse treatment program (if approved to provide medical care; check to determine the requirements in your program). The injectable form of naltrexone does not require one to remember to take the medication every day and many find this a significant advantage. Acamprosate is also an anti-craving drug and it must be administered as two pills given three times a day. Adherence can be a problem with this medication because we know that the more times a day people must take a medicine, the more likely they are to forget to take their medicine. However, for those who experience decreased craving and are able to abstain from alcohol, the multiple daily doses are not a source of complaint.

Table 1: Characteristics of FDA-Approved Pharmacotherapies for Alcohol Dependence

Alcohol Dependence Pharmacotherapy

Dose

Route of Admin

Common Side Effects 4

Common Contraindications 4

Disulfiram

250 mg daily

Oral

Drowsiness
Metallic taste
Headache
Impotence
Acne
Less common, but more serious: liver toxicity, peripheral neuropathy, psychosis, delirium

Psychosis
Significant liver disease
Esophageal varices
Pregnancy
Impulsivity

Naltrexone

50 mg daily
380 mg/month

Oral
Injection (into muscle)
Note: only facilities approved for providing medical treatment can administer

Nausea
Headache
Dizziness
Nervousness, anxiety
Drowsiness
Insomnia
Less common, but more serious: potential liver toxicity (especially at high doses) and suicidal ideation

Need for opioid pain medications
Acute hepatitis
Liver failure
Cannot take this drug if taking opioid medications as opiate withdrawal will occur

Acamprosate

Two 333 mg tablets
3 times daily

Oral

Diarrhea
Intestinal cramps
Itchiness
Dizziness
Muscle weakness
Headache
Flatulence
Nausea
Anxiety
Insomnia
Less common, but more serious: depression and suicide risk

Significant renal disease (creat cl <70 ml/min)

How do we match alcohol pharmacotherapies to those in need? One approach follows:

  1. For the individual who commits to stop drinking and/or has heavy consequences of relapse: Consider disulfiram.
  2. For the individual who wants to cut back or get help for craving: Consider naltrexone.
  3. If naltrexone doesn’t work or is contraindicated (e.g., if the person has severe liver disease -- see Table 1); if the person needs opioid analgesia; or if disulfiram is not an option: Consider acamprosate.

  4. Note: The information above assumes a medical evaluation and no contraindications to use of the medication under consideration.

Role of the Counselor and Other Substance Abuse Treatment Staff
Counselors and other substance abuse treatment professionals will play a critical role in assisting those who are in need of or who are receiving medication assisted therapy for alcohol use disorders. Counseling staff often have the best knowledge of individuals in substance abuse treatment because they spend the most time with clients in individual or group therapy. Counselors have an opportunity to learn the details of an individual’s struggle with alcohol, including whether he or she has been unsuccessful in treatment settings without access to medication treatment. A counselor may be the member of the treatment team to suggest consideration of medication treatment. The counselor and other clinic staff will likely be the first staff that an individual on medication sees at a clinic visit. If the individual is experiencing side effects or has questions about the medication, the counseling staff may be the ones to assure that these concerns are addressed by the medical staff. In addition, counselors have a very important role to play in supporting the treatment and helping the client to remain motivated to continue the treatment and to work all aspects of their recovery. Knowledge of medication treatments can give counseling staff and other substance abuse treatment professionals another tool to assist those seeking effective treatment of their alcohol use disorder.

Conclusion
Pharmacotherapies for alcohol dependence are important and useful tools for those struggling with alcoholism. For those with alcohol dependence who have not fully benefitted from drug-free treatment, a trial of pharmacotherapy is an important treatment option that needs to be considered. These medications do not require specialized treatment programs, but can be prescribed by the primary care clinician or by a physician or clinician specializing in treatment of substance use disorders. Collaboration between substance abuse treatment providers and primary care physicians and clinicians on behalf of alcohol-dependent individuals is key to obtaining the best treatment outcomes for this chronic, relapsing disease.

References

  1. Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings(Office ofApplied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586Findings). Rockville, MD.
  2. Barth, K. S., & Malcolm, R. J. (2010). Disulfiram: An old therapeutic with new applications. CNS & Neurological Disorders-Drug Targets, 9(1): 5-12.

 


CURES: An Intervention to Improve Client Safety

California’s  prescription drug monitoring program, called CURES (Controlled Substance Utilization Review and Evaluation System), was established to assist the safe treatment of those taking opioid medications, specifically, prescription opioid pain medications.

How Does CURES Work?
The CURES program requires pharmacies that fill and dispense opioid prescriptions to enter prescription information for controlled substances into the CURES computer database. The data can then be accessed by any clinician who registers to use the database and is also registered with the Drug Enforcement Agency (DEA) to prescribe controlled substances in Schedules II-IV.

A clinician who is registered to prescribe controlled substances may register for CURES by completing registration materials available online at  https://pmp.doj.ca.gov/pmpreg/RegistrationType_input.action.

To complete electronic registration, clinicians must submit a signed copy of their application and notarized copies of required validating documentation, which include Drug Enforcement Administration Registration, State Medical License or State Pharmacy License, and government issued identification. Competed applications and notarized documents should be  mailed to:

Bureau of Criminal Identification & Investigative Services
Attn: PDMP Registration
P.O. Box 160447
Sacramento, CA 95816

Why is CURES Helpful?
California’s CURES is part of a 48-state program of controlled substance prescription monitoring. Although the state programs are currently not linked, there are initiatives currently in development that will allow clinicians to determine not only what prescriptions for controlled substances their patients have received, but also whether those patients are obtaining prescriptions in other states for controlled substances. Checking CURES before prescribing to any new patient, and checking periodically thereafter, can help to increase the margin of safety in the treatment of those who have problems with substance misuse.
The United States has an epidemic of prescription pain medication abuse. The Centers for Disease Control reports that the United States has seen a 300 percent increase in sales of powerful opioid pain medications since 1999. Coincident with the greater availability of these drugs, there has been a surge in deaths from overdoses with 14,800 deaths in 2008—more than for heroin and cocaine combined—and in 2009, approximately 475,000 emergency department visits for adverse events related to misuse of opioid pain medications—a 100 percent increase over 5 years. In 2010, more than 12 million Americans (1 in 20 aged 12 years or older) reported non-medical use of prescription pain medications [1].  Treatment admissions for addiction to pain medicines have quadrupled between 1998 and 2008.[2] 

Another dangerous trend is the combined use of prescription pain medications and other substances including illicit drugs and alcohol. Further, some patients will have toxicities when taking opioid pain medications as prescribed while taking other medications also prescribed by their doctors for other mental or physical disorders. Many medications, illicit drugs and alcohol can have adverse drug interactions when taken together, which can result in serious medical consequences or even death. The CDC states that mixing of drugs was found in half of prescription opioid-related deaths. Drugs commonly identified with opioids included benzodiazepines, heroin, cocaine, and alcohol [1]. These findings underscore the risks for those entering substance abuse treatment, an especially vulnerable time for many because they have not had the opportunity to benefit from therapeutic modalities offered in treatment. Therefore, it is even more important that clinicians check for possible toxicities that might occur in clients seeking substance abuse treatment, particularly those seeking methadone treatment.

What the CURES System Is and Is Not
As previously stated, the CURES system is in place to help make prescribing controlled substances safer for individuals who may be at risk either because of substance use disorders or other conditions for which they have been prescribed medications that may be similar. CURES also helps identify “doctor shoppers”—individuals who visit multiple clinicians seeking controlled substances either for personal use, financial gain, or both. Clinicians who request a Patient Activity Report through CURES for every new client will help prevent adverse events resulting from the conditions just described.
Checking CURES is not a requirement for any form of substance abuse treatment. However, it is an easy and important intervention that can be completed rapidly, in real time, with an electronic report generated by a web-based request.  It assists clinicians in providing the best and safest treatment to clients.
CURES is not set up as a means of bringing law enforcement to treatment. There is no requirement to report people found to be obtaining multiple controlled substance prescriptions to law enforcement. However, such knowledge can be essential to providing safe and effective care to those seeking treatment and will help clinicians to make decisions in the best interest of those they serve.

References

  1. Centers for Disease Control and Prevention: Injury Prevention and Control Policy Impact: Prescription Painkiller Overdoses. 2011; http://www.cdc.gov/HomeandRecreationalSafety/rxbrief Accessed April 21, 2012
  2. Morbidity and Mortality Report Weekly. Vital signs: overdoses of prescription opioid pain relievers --- United States, 1999—2008. 2011; 60 (43);1487-1492.

 


REPORTS FROM THE FIELD

Increasing Accessibility: Developing a 'Safe Party' Mobile Website

The Safe Party Initiative, a collaboration between UC Davis and the City of Davis, rolled out a new responsive, low-cost and low-maintenance website that anchors the local campus and community-based alcohol risk reduction initiative. The site offers college “party throwers” and “party goers” strategies to keep the party going, help a friend in an emergency, and make it home safely after a night out. Safeparty.ucdavis.edu is the first responsive web design published within the University of California (UC) system and offers users mobile, tablet and desktop formats.

The Safe Party project managers upgraded safeparty.ucdavis.edu by designing a “mobile first” platform so the website can respond based on the device that is being used. This mobile-friendly format provides information using new technology features such as one-touch dialing to call resources directly from the site. After a party, students can easily access the website on their mobile device and call a local cab or Tipsy Taxi to get home safely. If there is a medical emergency, they can get immediate directions on the site to the local emergency room or call 9-1-1 using one touch dialing. The upgraded site is iOS and Android optimized, which exponentially increases student accessibility to this potentially life-saving Safe Party information.

Students can also access tips to keep their party fun and safe. “Party goers” and “party throwers” can find quick checklists of what to do before, on the day of, and after the party to ensure that everyone has a good time. The site also has the latest laws that affect party hosts and guests. The premise of the website is based on the notion that instant access to cues to action, information and relevant resources will reduce the negative consequences that can result from risks related to drinking alcohol.

Partners in the Safe Party Initiative continue to focus on creating safer party environments by building a closer sense of community between students and neighbors, promoting safety at parties, and enhancing enforcement of alcohol-related laws and policies. This initiative was initially funded by the Safer California Universities grant, sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

The lead project managers, Mandy Li and Adam Napolitan, will be presenting a workshop at the 2012 Alcohol and Drug Programs Training Conference. The workshop, “Increasing Accessibility: Developing a Safe Party Mobile Website,” will focus on the process of identifying the human, time and fiscal resources to successfully create and roll out an alcohol risk reduction website. It is slated on Wednesday, August 22, from 3:15 – 4:45 p.m.

‘Lock It Up Project’ targets teen prescription drug abuse

More than 70 percent of teens who abuse prescription painkillers say they get them from family, relatives and friends. The Fresno County Department of Behavioral Health Substance Abuse Services is sponsoring the “Lock It Up Project” to tackle the problem by raising awareness of the danger of the illicit use of prescription painkillers. 

The California Health Collaborative is in the second year of a five-year contract with the Fresno County to deliver the “Lock It Up Project,” targeting communities with a high rate of prescription drug abuse use among teens, according to Rolando Valero, program manager of the “Lock It Up Project.”

The “Lock It Up Project” is a community-based substance abuse prevention program designed to increase awareness of the risks and consequences associated with illicit use of prescription painkillers by teens and young adults in Fresno County. The project includes informational and educational presentations, in-service trainings for school and professional personnel, community-based outreach, Train-the-Trainer programs, town hall meetings, and media campaigns.

According to the 2008-09 California Healthy Kids Survey, Fresno County high school youth abuse prescription drugs more than any illicit street drug. The survey showed that 12 percent of 9th grade students and 16 percent of 11th grade students in Fresno County reported using prescription painkillers in their lifetime.

ONDCP’S National Drug Control Strategy Goals for 2012

In its National Drug Control Strategy 2012 (NDCS), the White House Office of National Drug Control Policy (ONDCP) said that preventing drug use is the “most cost-effective, common-sense approach to promoting safe and healthy communities.” In the Strategy, the Administration committed to fostering community-based prevention infrastructure and to working to achieve the following goals by 2015:

Goal 1: Curtail illicit drug consumption in America

  • Decrease the 30-day prevalence of drug use among 12- to17-year-olds by 15%
  • Decrease the lifetime prevalence of 8th graders who have used drugs, alcohol, or tobacco by 15%
  • Decrease the 30-day prevalence of drug use among young adults aged 18–25 by 10%
  • Reduce the number of chronic drug users by 15%

Goal 2: Improve the public health and public safety of the American people by reducing the consequences of drug abuse

  • Reduce drug-induced deaths by 15%
  • Reduce drug-related morbidity by 15%
  • Reduce the prevalence of drugged driving by 10%

To achieve these goals, the Strategy focuses on seven core areas:

  1. Strengthen Efforts to Prevent Drug Use in Our Communities
  2. Seek Early Intervention Opportunities in Health Care
  3. Integrate Treatment for Substance Use Disorders into Health Care and Expand Support for Recovery
  4. Break the Cycle of Drug Use, Crime, Delinquency, and Incarceration
  5. Disrupt Domestic Drug Trafficking and Production
  6. Strengthen International Partnerships
  7. Improve Information Systems for Analysis, Assessment, and Local Management

In addition to the two overarching goals, the NDCS establishes two key policy focus areas:

Reduce drugged driving – Younger drivers appear to be particularly affected by the danger of drugged driving; one in four fatally injured drivers testing positive for drugs were between the ages of 15 and 24. Actions that are in the works to address drugged driving include encouraging states to adopt Per Se (zero tolerance) drug impairment laws; educating communities and professionals how to prevent drugged driving; and increasing training for law enforcement to help them identify drugged drivers.

Prevent prescription drug abuse – The Centers for Disease Control and Prevention designated prescription drug abuse an epidemic, and the public health and public safety consequences of it continue to mount. In 2010, one in four people using drugs for the first time began by using a prescription drug non-medically. Proactive approaches that are under way include increasing the number of prescription drug monitoring programs and improving their effectiveness; encouraging and providing the proper disposal of prescription drugs; and increasing enforcement against illicit pill mills.

The NDCS also provides progress updates on implementation of the 2010 and 2011 NDCS. According to the administration,further progress implementing the Strategy will require “a comprehensive effort that includes Federal, state, local, tribal, and territorial government agencies, international institutions and partner nations, nongovernmental organizations, academia, private industry, and American citizens from all walks of life.”

 


ANNOUNCEMENTS

SAMHSA Grants Available

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications until July 20, 2012, for the Targeted Capacity Expansion Program: Substance Abuse Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS grants totaling up to $130.5 million over the course of a five year period.

The purpose of this program is to facilitate the development and expansion of culturally competent and effective community-based treatment systems for substance use and co-occurring mental disorders within racial and ethnic minority communities in states with the highest HIV prevalence rates (at or above 270 per 100,000).

The expected outcomes for the program include reducing the impact of behavioral health problems, reducing HIV risk and incidence, and increasing access to treatment for individuals with co-existing behavioral health, HIV, and hepatitis conditions. This program will help ensure those individuals who are at high risk for or have a substance use or co-occurring mental disorder and who are most at-risk for or are living with HIV/AIDS have access to and receive appropriate behavioral health services.

SAMHSA expects that up to $26.1 million will be available annually to provide up to 52 grants at up to $500,000 per grantee, over the five year grant period. The actual award amounts may vary, depending on the availability of funds.

WHO CAN APPLY: Eligible applicants are domestic public and private nonprofit, community-based organizations in States and Territories with HIV prevalence rates of 270/100,000. See Section III-1 of this RFA for complete eligibility information.

HOW TO APPLY: You may request a complete application package from SAMHSA for TI-12-007 at 1-877-SAMHSA7 (726-4727) [TDD: 1-800-487-4889]. You also may download the required documents from the SAMHSA website at http://www.samhsa.gov/grants/apply.aspx . Applicants are encouraged to apply online using www.grants.gov .

APPLICATION DUE DATE:  July 20, 2012. Applications must be received by the due date and time to be considered for review. Please review carefully Section IV-3 of the application announcement for submission requirements.

ADDITIONAL INFORMATION: Applicants with questions about program issues should contact David C. Thompson at (240)-276-1623 or David.Thompson@samhsa.hhs.gov . They may also contact Kirk James at (240)-276-1617 or Kirk.James@samhsa.hhs.gov . For questions on grants management issues contact Eileen Bermudez at (240)-276-1407 or Eileen.Bermudez@samhsa.hhs.gov .

Drug Medi-Cal Administrative Functions Moved to DHCS

Assembly Bill 106 (Chapter 32, Statutes of 2011) approved the transfer of California’s Drug Medi-Cal (DMC) program from the Department of Alcohol and Drug Programs to the Department of Health Care Services (DHCS), effective July 1, 2012. 

For the past 12 months, ADP staff has been working in concert with DHCS staff and stakeholders in the alcohol and other drug field to implement a successful transfer of the information technology and administrative processes.  A major plus in the transition is the fact that many of ADP’s knowledgeable DMC employees will continue with their DMC functions, thus spreading the institutional knowledge of alcohol and other drug treatment services  to DHCS, too.  The DMC personnel will remain at 1700 K Street in the ADP building for the immediate future. 

DMC information and resources have been moved to the DHCS website (www.dhcs.ca.gov), but a link will be accessible on the ADP website (www.adp.ca.gov) for the next several months. Links to all information on the ADP website will redirect the web visitor to the DHCS site.

ADP Training Conference

In the next few years, health care reform will affect alcohol, drug and problem gambling services and practitioners across the state. With the coming reform in mind, ADP’s 2012  statewide training conference will focus on ideas for integrating addiction prevention, treatment and recovery services with primary care and mental health services—the current direction of reform initiatives. This year’s conference, “Journey to Integration: Opportunities and Challenges, will bring together people and ideas that will help shape the future of the field, and promote universal understanding and use of prevention, public health, chronic care and recovery support frameworks.

Register now and join your peers on August 21-23, 2012, at the Woodlake Hotel Sacramento (the former Radisson Hotel Sacramento) for powerful presentations and compelling speakers.

Conference plenary sessions and workshops will inspire and energize with new perspectives and ideas for collaboration and integration. Some will address the needs of specific populations in California:  Native Americans, military veterans, women, and youth.  Others will focus on ways of integrating substance use disorder prevention and treatment into local health clinics and Federally Qualified Health Centers; community colleges; and local community programs. Additionally, we will address innovative and evidence-based practices for alcohol and other drug prevention, treatment and recovery support.

Keynote speakers bring knowledge, experience and valuable messages from many perspectives.  From the federal level, we will hear from David K. Mineta, Deputy Director at the White House Office of National Drug Control Policy; Jon Perez, Regional Administrator, Region IX, Substance Abuse and Mental Health Services Administration; and Alejandro Arias, Team Leader and Public Health Advisor, CSAT.  The Honorable Rogelio R. Flores, Superior Court Judge in Santa Barbara County, will be back for a return engagement to educate and inform on integration with the criminal justice system. Susan Blacksher, Executive Director, California Association of Addiction and Recovery Services, will bring her considerable experience to bear on the future of the field in her keynote address.
The four conference goals focus on the continuum of services with the coming changes associated with health care reform. The goals are to:

  1. Share the Best to Promote Change. Attendees will share new technologies, promising practices, proven approaches and successes for instituting systemic, programmatic and individual change to improve services.
  2. View the Landscape. Participants will discuss California’s current environment of diverse service needs, interdependency and trends and the affect on the substance use disorder field.
  3. Promote Gender and Cultural Responsiveness. The conference will offer perspective on current knowledge, skills and resources to address disparities, build alliances, and promote culturally responsive services and systems for California’s diverse population.
  4. Explore Alternative Resources. Attendees and speakers will share knowledge and skills to enlighten others on ways to develop new—and leverage existing—funding and other resources.

For registration information and a more complete description of conference emphasis areas, go to the conference website at http://www.cce.csus.edu/conferences/adp/12/index.htm

Launch of Privacy Webpage: Privacy 360

On March 15, 2012, the California Health & Human Services Agency, Office of Health Information Integrity (CalOHII) launched a webpage dedicated to better informing Californians of their rights and responsibilities when it comes to their health information, as well as the role of electronic health information exchanges in transmitting patients health information. 

This webpage offers patients and providers information, frequently asked questions, links to informative video clips, news items, and state and federal laws on the privacy and security of health information.

CalOHII is aiming for Privacy 360to be a useful and beneficial site for all Californians who want to learn more about the exchange of health information in the age of electronics.

CADPAAC Presents Awards for Achievements

The annual awards banquet for the County Alcohol and Drug Program Administrators Association of California (CADPAAC) was held in May during its quarterly meeting. The following individuals were honored for their achievements:

Treatment / Recovery: Community Recovery Resources, Nevada County

Prevention: Larry Silveira, Santa Clara County DADS

Collaborative Leadership:  Cally A. Bright, Deputy District Attorney, San Diego County

Friend of the FieldJudge Debra Givens, Yuba County Drug Court

State LeadershipMichael Cunningham, ADP Acting Director

Lifetime Achievement:  Robert Garner, Santa Clara County; Linda Murdock, Mariposa County; David Reiten, Shasta County

 


ADP BULLETINS

Editor’s Note: This section of FOCUS will highlight recent ADP Bulletins to the field that contain important messages on specific programs and service issues. To read the full text of the bulletin, click on the bulletin number.

Bulletin 12-04 State Fiscal Year 2012-13 Governor’s Budget (Preliminary) Allocation, 1.0

Issue date: February 23, 2012 - Expiration Date: None

This bulletin transmits the Fiscal Year (FY) 2012-13 Governor’s Budget (Preliminary) Allocation, contingent upon enactment of the FY 2012-13 Budget Act and federal appropriations, to counties for informational and planning purposes. After the FY 2012-13 Budget is enacted, a final bulletin will be sent to reflect any adjustments. This Bulletin includes five exhibits: (A) Overview of Programs, Funding, and Allocation Methodologies; (B) Statewide Allocation Summary; (C) Substance Abuse Prevention and Treatment (SAPT) Block Grant (BG) Exchange Program; (D) Funding Periods for SAPT BG; and (E) Individual County Allocation Summary (for county administrators only).

Bulletin 12-05 Substance Abuse Prevention and Treatment Block Grant Allowable HIV Early Intervention Services

Issue Date: March 2, 2012 - Expiration Date: Not applicable
This bulletin contains new guidelines on the expenditures of Substance Abuse Prevention and Treatment (SAPT) Block Grant HIV Early Intervention Services (EIS). The Substance Abuse and Mental Health Services Administration recently expanded the allowable use of HIV EIS funds to include infectious disease testing, such as Hepatitis C, and outreach services for intravenous drug users who are not currently in a substance use disorder treatment program. 

Bulletin 12-06 Drug Medi-Cal State General Fund Recoupment

Issue Date:  March 13, 2012 - Expiration Date: Not applicable
This bulletin informs all counties that the Department of Alcohol and Drug Programs (ADP) will begin recouping the State General Funds that were paid for Drug Medi-Cal (DMC) services in state Fiscal Year 2011-12. This is the result of the realignment of the DMC non-federal funding to the counties effective July 1, 2011.

Bulletin 12-07 Use of Substance Abuse Prevention and Treatment (SAPT) Block Grant Funds for Syringe Exchange Services

Issue Date: May 8, 2012 – Expiration Date: Not applicable
This bulletin clarifies the use of the Substance Abuse Prevention and Treatment (SAPT) Block Grant for Syringe Exchange Programs (SEPs). Currently, SAPT Block Grant funds may not be used for syringe exchange programs.

Bulletin 12-08 California Outcomes Measurement System - Treatment: Edit to Zip Code for Homeless Population

Issue Date: May 16, 2012 – Expiration Date: Not applicable
This bulletin provides information regarding an edit to the California Outcomes Measurement System-Treatment (CalOMS Tx) data collection system. Effective May 18, 2012, CalOMS Tx will be modified to allow ‘00000’ or any five-digit Zip Code at Current Residence (CID-8) field when Current Living Arrangements (SOC-2) is “1”- Homeless (preferred method is to use the billing provider zip code).

Bulletin 12-09 Proposed Drug Medi-Cal Rates for Fiscal Year 2012-2013

Issue Date: May 21, 2012 – Expiration Date: Not applicable
This bulletin transmits the proposed Fiscal Year (FY) 2012-2013 reimbursement rates for Drug Medi-Cal (DMC) services. The proposed rates and subsequent claim payments are contingent upon Legislative action and approval of the FY 2012-2013 Budget Act. The rates will be effective July 1, 2012 through June 30, 2013. Counties and direct contract providers may submit DMC claims based on the proposed rates, however, the Department of Health Care Services may not be able to issue payments for any services provided in FY 2012-2013 until the Budget Act is signed.

Bulletin 12-10 Narcotic Treatment Program Exceptions to Take-Home Medications

Issue Date: June 6, 2012 – Expiration Date: Not applicable
The purpose of this bulletin is to notify all Narcotic Treatment Programs (NTP) of a change in the Department of Alcohol and Drug Programs’ (ADP) policy for the following:

1. Exception to the number of take-homes for patient step levels, Title 9, California Code of Regulations (CCR), Chapter 4, Section (§)10375(a)(1-6).

2. Elimination of the physicians’ authority to grant exceptions for take-home medication for patients with medical or exceptional circumstances making daily attendance a hardship, Title 9, CCR, Chapter 4, §10385(a)(1,2).

3. Elimination of the ADP 8045 – Physician Request for a Temporary Exception to Regulations. ADP will use the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment’s (CSAT) electronic Exception Request and Record of Justification SMA 168 form (Exhibit 1) via the SAMHSA/CSAT Opioid Treatment Program Extranet.

Bulletin 12-11 Drug Medi-Cal Program Administration

Issue Date: June 6, 2012 – Expiration Date: Not applicable
This bulletin informs County Alcohol and Drug (AOD) Program Administrators and direct contract service providers that the Department of Alcohol and Drug Program (ADP) is reviewing California Code of Regulations, Title 22, to ensure its Drug Medi-Cal (DMC) program oversight system conforms with regulatory requirements. ADP shall provide technical assistance and training to agencies interested in education on the regulatory requirements associated with the DMC program.

Bulletin 12-12 The DMC Transition from ADP to DHCS - Related to DMC Claims and CalOMS Tx Reporting

Issue Date: June 20, 2012 – Expiration Date: Not applicable
The purpose of this bulletin is to notify all stakeholders of the information technology (IT) changes that will take place as a result of the transfer of the Drug Medi-Cal (DMC) Program from the Department of Alcohol and Drug Programs (ADP) to the Department of Health Care Services (DHCS).

 


ADP DIVISION UPDATES

Information Management Services Division

SMART—ADP successfully updated the SMART Drug Medi-Cal (DMC) Claims system from version 4010 electronic health transaction standards to the 5010 standards to comply with federal HIPAA requirements. In addition, to prepare for the transfer of DMC to the Departmental of Health Care Services (DHCS), ADP modified the SMART system to comply with the DHCS cash management method. All changes have been successfully tested and are ready for implementation upon the transfer of the DMC program.

PRIME—It has been six months since the debut of the Provider Registry Information Management Enterprise (PRIME), a system for collection and storage of provider information. Since the launch of PRIME at ADP, provider data is easier to update and to query.  Before the new system was developed, a query of ADP’s provider database would only show one match at a time; PRIME allows users to view an entire list of entries matching the query criteria. The type of information that can be stored is enhanced to include email addresses, identifying numbers related to the provider, and categorical listings.  PRIME allows ADP to provide faster service with the ability to easily view current and historic data for providers and process provider data.

Licensing and Certification Division

Each year, ADP receives approximately 450 applications for licensing and certification. Since July 2011, the Department has streamlined the application process, resulting in shorter processing time. Currently, ADP has about 132 applications, averaging 61 days old, being reviewed. The Licensing and Certification Division is processing more than 85% of applications within 100 days. Five applications that are more than 100 days old are either in the process of being issued or awaiting information from providers. 

With the transfer of Drug Medi-Cal application processing from ADP to the Department of Healthcare Services effective July 1, 2012, ADP should be able to reduce the application processing time to within 90 days during the next fiscal year.

Office of Problem Gambling

More than 200 participants attended the 2012 Problem Gambling Training Summit on March 5-6, kicking off National Problem Gambling Awareness Week. The Office of Problem Gambling (OPG) and the UCLA Gambling Studies program hosted the event in San Diego.

Workshops covered topics such as youth and senior prevention; working with families of problem gamblers; motivational interviewing techniques; personal stories about the devastating effects of problem gambling; steps to recovery; and an open Gamblers Anonymous meeting. Keynote speakers included Dr. Deborah G. Haskins specializing in the African American and faith communities, and Mr. Michael Burke, author of Never Enough, a personal story of compulsive gambling and the road to recovery.

Awards for “Achieving Success One Step at a Time” were presented to individuals or agencies in the categories of problem gambling treatment, responsible gambling and government. The winners were:

Treatment
NICOS Chinese Health Coalition

Responsible Gambling
California Lottery

Government
California Department of Justice, Bureau of Gambling Control

The California Council on Problem Gambling presented the “Lifetime Achievement Award” to Marc Lefkowitz, recognizing his significant contribution to the field of problem gambling in California.

Program Services Division – Prevention Branch

Strategic Prevention Framework State Incentive Grant – The PSD - Prevention Branch continues to make progress rolling out the Strategic Prevention Framework State Incentive Grant (SPF SIG) project.  The breaking news is that 12 communities in 11 counties have been selected to participate in this pilot program to provide data-driven planning and research-based programming. The SPF SIG is an infrastructure grant program of the Substance Abuse and Mental Health Administration Agency (SAMHSA) and supports an array of activities to help grantees deliver and sustain effective prevention services.  The focus of this program is the prevention and reduction of underage and excessive drinking, targeting individuals between the ages of 12 – 25 years.  Because this is a five year grant, we expect to see measurable outcomes and look forward to tracking the results and successes of the programs.

An extensive community assessment process was conducted that included interviewing county AOD staff and evaluating community characteristics such as high alcohol consumption, alcohol-related crashes, and underage drinking. These communities were selected to receive funding:

    Livermore (Alameda County)
    Antioch (Contra Costa County)
    Walnut Creek (Contra Costa County)
    Santa Monica (Los Angeles County)
    San Rafael (Marin County)
    Merced (Merced County)
    Huntington Beach (Orange County)
    Folsom (Sacramento County)
    Redlands (San Bernardino County)
    Santa Barbara (Santa Barbara County)
    Santa Rose (Sonoma County)
    Ventura (Ventura County)

The ADP website will be updated to include a SPF SIG project page, where details and outcomes related to the project will be posted.

Prevention Regional Forums – ADP, through its Community Prevention Initiative (CPI), is hosting three regional trainings titled "Planning for Prevention Across Systems."  CPI is sponsored by the Center for Applied Research Solutions, ADP’s alcohol and drug prevention technical assistance contractor.  The agenda will focus on substance use prevention planning processes across different state agencies; areas for potential partnerships; and successes, challenges and learnings from other cross-system prevention initiatives.  The first training was held June 5-6 at the Hilton Arden in Sacramento.  Subsequent trainings will be held in Orange County at the Hyatt Regency Orange in Garden Grove on June 20 -21, and in Monterey County at the Portola Hotel and Spa on June 27-28. For more information, contact Laura Colson, manager in ADP’s Prevention Services Branch, at Laura.Colson@adp.ca.gov or (916)323-8336.

Town Hall Meetings – In recognition of Alcohol Awareness Month in April, communities throughout California hosted more than 90 Town Hall Meetings—with the theme “Getting to Outcomes”—to discuss how to prevent and reduce underage drinking. The Town Hall Meetings, sponsored by SAMHSA and the Governor’s Prevention Advisory Council (GPAC), work at the grassroots level to raise awareness of the public health dangers of underage drinking and to provide families and communities with practical steps for steering youth away from underage drinking.

Youth involvement in the planning and implementation of meetings on underage drinking can be directly attributed to the California Friday Night Live Partnership’s involvement. The effectiveness of the events will be reported after the communities are surveyed where town hall meetings were held. Survey results from the 2010 round of Town Hall Meetings are on the ADP website.