Aleksandra Zgierska, MD

Approximately 65 people from Wisconsin attended the American Society of Addiction Medicine's Annual Conference in San Diego. Many of them were WISAM members but quite a few were not, and we welcome them to consider membership.Approximately 30 people attended the Wisconsin Chapter annual business meeting, which took place during the ASAM conference.

ASAM has developed a toolkit that offers suggestions on how you can make most out of Addiction Treatment Week. Please spread the word through social media, as well as engagement with the community and the media. See below for more information!

WISAM President Matt Felgus, MD and Immediate Past President Aleksandra Zgierska, MD holding the certificate signed by Governor Walker proclaiming the week of Apr 23-29 as Addiction Treatment Week.

In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), Wisconsin law enforcement agencies will again hold Prescription Drug Take Back Day on Saturday, April 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the event. 

The goal of Prescription Drug Take Back Day is to provide a safe, convenient and responsible method of disposal for unused or expired prescription drugs. The events also educate the community about potential abuse and consequences of improper storage and disposal of these medications. 

Drug take back days are held each spring across the country. The October 2017 Drug Take Back events in Wisconsin collected 63,941 pounds of unused medications, the largest fall drug take back collection to date. Wisconsin also had more law enforcement agencies participate than any other state in the country with 266 police and sheriffs’ departments hosting 130 events. Since October 2015, the Drug Take Back Day program has successfully collected and disposed of nearly 360,000 pounds of unused medications in Wisconsin alone. 

In addition to the semiannual Take Back Day, there are 349 permanent drug disposal drop boxes throughout Wisconsin, providing citizens a convenient, environmentally friendly and anonymous way to dispose of unused medications all year. 

For more information, including a list of accepted medications, visit the “Dose of Reality” website, which also features an interactive map to find a drug take-back location.

March 19, 2018

Governor Walker recently signed a proclamation declaring April 23-29th as the 2018 Addiction Treatment Awareness Week throughout the state of Wisconsin.  This was at the request and in partnership with the American Society of Addiction Medicine and the Wisconsin Society of Addiction Medicine.

National Addiction Treatment Week is an ASAM initiative that generates awareness that addiction is a disease, not a moral failing, promotes quality and evidence-based treatments for addiction, and focuses on the need for all medical professionals to treat addiction and save lives. A series of online events are scheduled for the week, including a webinar with ABPM and SAMHSA discussing the importance (and pathways) for physicians to enter the field of addiction medicine and Treat Addiction to Save Lives. 

A copy of the Governor’s proclamation is attached (link).  For more information on addiction treatment, please visit the ASAM website (link).

MD Magazine
The U.S. Food and Drug Administration has classified kratom, a botanical substance widely used as a painkiller despite agency approval, as an opioid. FDA Commissioner Scott Gottlieb released a statement referencing the FDA's concerns about the plant substance and its health consequences, which they said include death. Since they've been keeping tally, there have been 44 deaths reported that are considered associated with kratom, an increase from the 36 that had been reported in a November 2017 FDA advisory document. 

Wisconsin Health News The Legislature’s budget-writing committee is set to consider two bills Thursday that would support efforts to fight the opioid epidemic. The bills include recommendations proposed in a January report by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch, co-chairs of the Governor’s Task Force on Opioid Abuse. “It’s important that we get treatment to those who need it and punish those who are facilitating the flow of illegal drugs into Wisconsin,” Nygren told members of the Joint Finance Committee during a public hearing Wednesday. One of the proposals would create grant programs to combat drug trafficking, support substance abuse prevention and establish juvenile and family treatment courts. The proposal would also fund grants to provide medication-assisted treatment to inmates leaving jail and create two attorney positions in the Department of Justice to help with drug prosecutions. It would allocate $2.75 million in general purpose revenue and $500,000 in federal funding during the biennium. It also allows courts to order those guilty of drug violations to attend a victim impact panel or a similar program that shows how substance abuse affects an individual and their family. An additional bill makes a series of changes to boost substance use disorder treatment and prevention. The task force has been working with Pew Charitable Trusts, which recommended parts of the proposal. Other parts of Pew’s recommendations were enacted through two executive orders Gov. Scott Walker signed in January. “Wisconsin is a leader nationally on this issue, and these reforms will continue to push the state ahead,” Andrew Whitacre, senior associate for the Substance Use Prevention and Treatment Initiative at Pew, told lawmakers. The bill would require prescribers to submit proof of completion of continuing education requirements on best practices in prescribing controlled substances when renewing their licenses. It would also allow nurse practitioners and physician assistants who receive federal approval to dispense buprenorphine, a drug used to treat opioid addiction, even if their supervising doctor doesn’t have the same approval. The bill also prohibits the Department of Health Services from requiring prior authorization for buprenorphine combination products in Medicaid. The bill would expand pathways for people to become substance abuse counselors and require school boards to incorporate drug abuse awareness and prevention into its health instructional programs. It also aims to boost enrollment in the psychiatric mental health nursing program at the University of Wisconsin-Madison, expand the program’s capacity and provide fellowships for students to participate in clinical rotations in rural communities or areas with shortages of mental health professionals.  The bill would provide $50,000 to the Department of Children and Families to develop and maintain resources for social services workers who deal with cases related to substance abuse.

WI Health News

The Dane County Board of Supervisors voted last week to give the OK for the county to pursue a lawsuit against opioid manufacturers.

More than 80 percent of Wisconsin counties have sued drugmakers alleging that their marketing contributed to the opioid epidemic. The companies involved have denied wrongdoing.

“This is a crisis that must be addressed," Supervisor Mary Kolar said at a meeting last Thursday. 

Dane County’s resolution authorizes the county’s Office of Corporation Counsel to select outside counsel to pursue the lawsuit. The county would enter into a contingency fee arrangement, so the outside counsel wouldn’t receive compensation unless the county receives financial benefit.

Marcia MacKenzie, Dane County’s Corporation Counsel, said they’ll talk with the firms being used by the Wisconsin Counties Association. But she wants to “see if the county could get a better deal elsewhere” than the arrangement other counties have pursued.

“It may not be possible because they’ve already cornered the market,” she said. “But we owe it to the citizens and the taxpayers to look into it.” 

En Español

By Alan Mozes
HealthDay Reporter

TUESDAY, Jan. 30, 2018 (HealthDay News) -- There's a well-known crisis going on with opioid painkiller abuse, but new research reveals a sizeable chunk of Americans are popping far too many over-the-counter pain relievers, too.

Among those surveyed who take over-the-counter ibuprofen (Motrin, Advil), 15 percent admitted to exceeding daily maximum dosage when taking either ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs), the study found.

NSAIDs include popular medications such as aspirin, Advil, Motrin, Aleve (naproxen) and Celebrex, a prescription pain reliever.

The researchers tracked week-long NSAID "diaries" from about 1,300 adults, completed between 2015 and 2016. All had taken an ibuprofen medication at some point in the month before completing their diaries.

Many users said they'd either exceeded the prescribed daily limit of a single NSAID; taken two different NSAIDs together; or had popped a second dose earlier than indicated.

Study author David Kaufman, director of Boston University's Slone Epidemiology Center, noted that ibuprofen and other NSAIDs are among "the most-used medicines in the U.S.

"[But] most NSAID use is over-the-counter," he added, "with users deciding what to take without involvement by health care providers."

Kaufman believes NSAID misuse has the potential for serious side effects, including both gastrointestinal bleeding and/or a raised risk for heart attack.

His team's findings "can help guide programs that will lead to safer NSAID use," he said.

In the study, participants were 45, on average. Three-quarters were white, and about 60 percent were women.

About 87 percent said they took OTC ibuprofen during the week they recorded their usage habits. But about 37 percent also took other types of NSAIDs, with aspirin being the most popular, followed by naproxen.

That said, less than 40 percent actually understood that the NSAID medications they were taking were, in fact, NSAIDs.

What's more, 11 percent of ibuprofen users reported exceeded daily dosage instructions at least once during the week. That figure hit 23 percent among naproxen users.

Overall, 15 percent of participants were found to have exceeded dosing recommendations for at least one NSAID on one or more days throughout the week.

The team further observed that the risk for excessive NSAID use appeared to be higher among those respondents who were in poor physical condition while also struggling with chronic pain. Having a relatively poor knowledge about proper dosing also upped risk.

The findings were published online Jan.26 in the journal Pharmacoepidemiology and Drug Safety.

Kaufman downplayed the notion that users might be popping too many NSAIDs to avoid using addictive opioid painkillers.

"My guess," he said, "is that while avoidance of opioids may influence prescribing decisions by doctors, it may not affect consumer behavior very much."

Instead, Kaufman believes some consumers may simply decide to take an excessive number of pills -- regardless of label instructions. But that behavior is "potentially modifiable with better education of users," he added.

But another expert does think there could be a link between excessive OTC painkiller abuse and the current opioid epidemic.

Dr. David Katz directs the Yale University Prevention Research Center in New Haven, Conn. He said that "the nation's highly publicized opioid crisis is really just a window to a less-publicized crisis of chronic, inadequately managed pain" among an unhealthy portion of the American public.

"When narcotics are not being used to manage such pain, NSAIDs often are," said Katz, who wasn't involved in the study. "That a substantial subset of those relying on NSAIDs are using them ill-advisedly or excessively is rather to be expected under these circumstances."

One solution, according to Katz, is to boost "health literacy," so that patients know the risks of taking any medicine.

But a longer-term solution to all painkiller abuse requires refocusing attention on the benefits of a healthy lifestyle, Katz said, with the goal being "the prevention and management of chronic pain by means other than medication."

More information

There's more on NSAID safety concerns at U.S. Food and Drug Administration.

SOURCES: David Kaufman, Sc.D., director, Slone Epidemiology Center, Boston University, and professor, epidemiology, Boston University School of Public Health; David Katz, M.D., director, Yale University Prevention Research Center, New Haven, Conn.; Jan. 26, 2017, Pharmacoepidemiology and Drug Safety

Last Updated: Jan 30, 2018

Copyright © 2018 HealthDay. All rights reserved.

Jan 19, 2018, 5:00am

The opioid epidemic has become a serious problem in the United States, impacting every demographic segment of the population. Employers are on the front line of this problem, both because of the impact employees with opioid addiction can have on workplace safety and because these addictions can begin with prescriptions for work-related injuries. The Milwaukee Business Journal recently assembled a panel of experts to explore what companies – large and small – need to know about the opioid epidemic and the role they can play in mitigating its impact.

LAURIE GREENLEES (Moderator): How serious of a challenge for society is opioid addiction, and how does it compare to other addiction challenges the nation has faced or currently faces?

MICHAEL MILLER: Addiction has been affecting workers and workplaces for a very long time. Alcohol has been a perennial problem. There were methamphetamines in the 1970s and the cocaine epidemic of the late 1980s and 1990s. The opioid epidemic is grabbing everyone’s attention today because of the overdose deaths. Alcohol kills, too, but it’s not as sudden – it can take decades.

KEVIN HILDEBRANDT: That is a very good point. Opioids are definitely a concern, but alcohol and other types of addictions are very prevalent.

JIM MUELLER: Drug addiction is costing us $80 billion annually in medical care, addiction treatment and lost productivity. There were 63,632 drug overdose deaths in 2016, with two thirds of those deaths opioid-related. To put that in context, the Foxconn deal was $3 billion and that was considered a really big deal and the 9/11 terrorist attacks killed about 3,000 people. We’re losing 63,000 Americans to drug overdoses every year. If those were war casualties, it would be front-page news and on all of the networks daily. It’s a very serious problem.

GREENLEES: How is it impacting employers?

HILDEBRANDT: It directly affects employers in terms of safety issues, productivity and lost work time. It can also have an indirect impact if the addiction is in the employee’s family. They’re distracted because their mind is on their loved one. I don’t know how big an issue it is nationally, but I know what I see and it’s frightening. There’s a young guy at work whose sister is addicted and there’s an older person whose son is addicted. It is hard for me to believe, but it’s true.

MILLER: Another problem is presenteesim, which is when an employee shows up to work, but is not productive. They may be hung over, in withdrawal or under the influence. They may be distracted because of a family member’s addiction. That impacts productivity, and can lead to workplace errors and injuries.

HILDEBRANDT: It can be very difficult for an employer to help when it is an employee’s family member who is addicted. You can tell something is wrong because the employee is distracted, but it is very difficult to understand how you can help.

MILLER: That’s why employee assistance programs (EAPs) are so important. They let people get help confidentially.

MUELLER: Drug problems are an especially big problem for employees right now because there is such a supply and demand issue for workers. Employers’ priorities change over time. Ten years ago it was health care. Right now it is hiring and retention. I also think opioid addiction is a big workplace safety issue. Not only for the worker, but for the people around them. I think the impact of drug problems on workplace safety is going to be fertile ground for legal liability in the future, especially for employers who are not proactive in this space.

GREENLEES: From an employment perspective, is opioid addiction more or less of a problem than other addictions?

HILDEBRANDT: I would go back to some of the comments Dr. Miller made. The addiction problem is probably more pronounced when you look at alcohol or tobacco, but opioid addiction is more impactful from a perception standpoint.

MILLER: One of the challenges with opioid addiction is that there is such a significant overlap with the chronic pain population. It is very difficult to get those suffering from chronic pain back to work at a functional level after an injury. It really requires two different approaches. One is effective pain management and the other is addiction treatment, if necessary.

HILDEBRANDT: When someone who has an addiction problem is injured, the time it takes to get them back to work is extended. It’s even more challenging if it is an opioid addiction. It definitely extends the recovery time.

MUELLER: I would make two points here. The first point is that when it comes to addictions involving alcohol or tobacco, the solution is to eliminate the person’s need for those substances. When it comes to opioids, however, there is often an underlying issue related to pain. The cure needs to focus on returning the person to functionality, not eliminating the pain, and that requires a different type of treatment. The second point is that, unlike other addictions, opioid addiction often starts in the medicine cabinet. One study found that 54 percent of the time, the drug comes from a friend or relative. I have pain, you have medication. And, 82 percent of the time, that friend or relative obtained it from a physician.

MILLER: The pills may be given to them by a friend or relative or they may be stolen from the medicine cabinet. People with a 30-day supply of opioids for acute pain typically use three to five days’ worth, which means they have up to 27 days’ worth of supply sitting in the medicine cabinet. That’s why there’s been a major public health strategy to focus on safe medication storage and disposal. You shouldn’t keep extra prescription pills around. You need to take them to a designated medication drop location.

MUELLER: I agree. There are a lot of people who don’t realize that there are drug drops in Walgreens and most other pharmacies where you can dispose of your unused prescriptions.

GREENLEES: Many employers think they are inoculated from the opioid problem because they have drug screening programs in place. Is that an accurate assessment?

HILDEBRANDT: There are ways to beat drug tests so it is a question of what type of drug testing program you have, how effective it is and how representative it is of what is going on in your workplace. And the goal should not be to “catch” people, but to identify and help people so that you can have a safe and healthy workforce.

MILLER: There’s a tremendous misunderstanding when it comes to drug testing, which is that employment-based drug testing will detect people who are taking pain pills. Often, it won’t. The test looks for opiates – codeine, morphine, heroin and other substances that come from opium itself. Pain pills like OxyContin, hydrocodone and methadone are synthetic drugs. They are opioids, not opiates, and they are not detected by the common, commercially available drug-screening tests.

GREENLEES: What are the most effective treatment options for opioid addiction?

MILLER: The treatment for opioid addiction is unique in that medications play a key role. The medications are extremely important for improving outcomes because they block the opioid receptors, making it difficult for the drug to work. That creates a new issue, however, because the counselors who are on the front line of therapy cannot prescribe medications. You need to have licensed prescribers, which is why we are working to get primary care physicians more involved in treating opioid addiction.

MUELLER: An important issue is early identification, which can be a problem in our current, production-based health system where primary care physicians need to see 38 or so patients per day. You need to spend time with patients to identify this issue.

MILLER: Early identification is critical, and the best places are often in the workplace or schools. You want to get the problem identified – whether it is alcohol, cocaine, opioids or methamphetamines – before physical health and functionality are impaired.

GREENLEES: What role can employers play in reducing the opioid challenge? What programs and/or policies do you think we should have in place?

HILDEBRANDT: There are three or four different things. First, they have to be open to the concept that the addiction problem exists and that it is counterproductive to their organization. That starts the conversation. Reasonable suspicion training, which helps supervisors detect signs and symptoms of alcohol and drug abuse, can have a significant impact on early identification. The next component is having a robust drug testing program. Without that, you are not doing anything. The final component is being committed to helping employees by pointing them in the right direction and being accommodating to that EAP process. You do those things and you will have an impact. The worst thing an employer can do is nothing, because they will just be letting their problems compound.

MUELLER: The best practice I know of is QuadGraphics. They have an education program that involves all of their members – all of their employees, their families and their other dependents. You have to reach out to everyone.

GREENLEES: What would you say to employers who forego drug testing due to their concerns about finding a sufficient number of drug-free workers in a highly competitive job market?

MILLER: I can’t imagine a more misguided decision than to forego pre-employment drug testing. All you are doing is hiring people you don’t know anything about.

HILDEBRANDT: Drug testing can play a critical role in both weeding out job applicants and in helping employees. If you have a good employee who has an addiction problem, imagine how great they could be if they had a clear mind. Unions also play an important role. They can have just as much impact as employers on educating and influencing employees. Unfortunately, some people in union leadership do not want to address the issue.

MUELLER: A lot depends on the size of the employer. Small employers are at a significant disadvantage due to the time and financial commitment of a drug program. They do not have the ability to hire someone like Kevin with his expertise and focus. Drug testing alone can be a burden. For larger employers, it is a matter of priority and culture. When it comes to drug programs, about 20 percent of large employers are proactive, 20 percent are reactive and 60 percent are passive. Action is recommended, obviously. You have to know who you are hiring and you want to be able to identify and help your existing employees with robust EAP programs that provide counseling and treatment. Those programs that can really make a difference. Unfortunately, too many employers look at their EAP programs as a checkbox, something they have as part of their long-term disability coverage. It offers three consultations, period.

MILLER: I agree. EAPs can be a major part of solution, but they have to be high quality. They cannot be window dressing.

GREENLEES: What steps can employers take to increase awareness of EAP benefits?

HILDEBRANDT: You can treat it the same way you treat your retirement planning. Make them aware of it. You can also encourage employees to guide employees to an EAP instead of turning a blind eye.

GREENLEES: The Legislature is reportedly looking at the opioid challenge as part of a broader look at workers compensation issues in the state. What role can employers have in minimizing opioid prescriptions as a form of pain management for workers compensation claims?

HILDEBRANDT: One thing that I think can be done is for the employer to work with health care providers, workers and insurers. The communication has to be very effective and open. Employers can also do a better job of early detection using reasonable suspicion training programs and by working with insurers and providers to identify individuals who may be going from emergency room to emergency room in search of prescription drugs.

MUELLER: You have to look at the problem holistically and comprehensively. You need to have drug testing for opioids, which is beyond the regular five panel tests. You need to have education at the supervisor level, the employee level and the dependent level. You need to have good communication with your workers comp carrier. You also need to have access to treatment and to EAPs that have some depth to them.

MILLER: A lot of this work falls on the health care system. Educating and training doctors, nurse practitioners and physician assistants to prescribe differently is really key. Benefit structures are also important. Current benefit designs incentivize the use of injections, nerve blocks and other types of interventional pain management. Unfortunately many insurers won’t pay for comprehensive pain treatment that uses counselors, physical therapists, massage therapists and alternative medicine. The same is true for pharmacy benefits, which incentivize the 30-day supplies that can be problematic when it comes to opioids. What if you had a plan design that had no copay for a five-day supply and the usual copay for a 30-day supply? That change would incentivize a safer prescribing process for opioids.

MUELLER: I agree. Acupuncture and alternative pain treatments are becoming more popular, but are still not frequently prescribed. We need to be trying different methods of treatments beyond prescriptions.

HILDEBRANDT: You need an aggressive post-injury, return-to-work policy where the person is not allowed to fall out of the work cycle. You need to get them back to work as soon as you can. When people stay away from work, they go backward. The sooner they get back to work, the better they are for themselves and society.

TABLE OF EXPERTS

Moderator

Laurie Greenlees, MBA, PHR, SHRM-CP

Human Resource Business Advisor Manager and HR Hotline, MRA

Laurie is a certified Professional Human Resources manager with expertise in talent management, employee relations and engagement, compliance and best practices in FMLA and ADA administration and leadership development. As manager of MRA’s 24/7 HR Hotline, Laurie and her team of professional HR Advisors answer questions regarding the opioid crisis and its impact on area workplaces.

Kevin Hildebrandt

Director of Risk Management, Miron Construction Co., Inc.

Kevin provides support for Miron’s field operations, enhancing production while controlling risk for employees as well as customers, their facilities and equipment, and the public. He supervises the safe operation of all Miron equipment, and serves as the lead instructor for Miron’s professional crane operator development program.

Michael Miller, MD, DFASAM, DLFAPA

Medical Director, Herrington Recovery Center at Rogers Behavioral Health

Dr. Miller is a board-certified general psychiatrist and addiction psychiatrist. He has practiced for more than 30 years, and is a Distinguished Life Fellow of the APA and ASAM, as well as at-large director of the ABAM. He serves as a faculty member for the Addiction Psychiatry Fellowship and the Addiction Medicine Fellowship at the University of Wisconsin School of Medicine and Public Health.

Jim Mueller

Owner, Mueller QAAS

Jim has more than 30 years of employee benefit experience serving as president of Frank F. Haack & Associates and Zywave, one of the largest technology companies in the metro Milwaukee area. Jim helped Frank F. Haack & Associates grow into the largest benefit broker/consultant in Wisconsin and a top 70 brokerage firm nationally. He is now committed to providing employers objective advice on their employee benefit programs through Mueller QAAS.

WI Health News

Gov. Scott Walker signed two executive orders that are part of a series of new recommendations offered by his task force charged with tackling the opioid epidemic.

One of Walker’s orders creates the Governor’s Commission on Substance Abuse Treatment Delivery, which will study whether Wisconsin should adopt a “hub-and-spoke” delivery model for substance abuse disorder treatment.

The model involves regional “hubs” that serve as resource centers for addiction treatment and “spokes” in the community that provide recovery support for patients as well as referrals to more intensive services.

“Too many Wisconsin families feel the painful effects of this crisis every day,” Walker said in a Friday statement. “Through the guidance and recommendations of the task force, we've created reforms that will open the door to the best treatment outcomes for patients and their families.”

An additional order signed by Walker directs the Department of Health Services to convene a faith-based summit on opioids for pastors, priests and those involved in faith-based organizations.

Under the order, DHS will work with the Law Enforcement Standards Board to develop best practices around how law enforcement and first responder should treat situations involving opioids.

The order directs DHS to apply for a federal grant to develop software that tracks treatment capacity for substance abuse services, create uniform statewide standards on data submission for people seeking treatment, work with the Department of Corrections to facilitate continuity of care for offenders reentering the community and review Medicaid prior authorization rules to ease access to buprenorphine, an opioid-addiction treatment drug.

The Department of Children and Families will also have to revise some of its programs and standards to better document and track substance abuse problems in child welfare cases. And the state patrol and Capitol Police will have to use software aiming to ensure accuracy and timely reporting for overdoses.

The order calls on the Governor’s Task Force on Opioid Abuse to continue its work. Both executive orders come from recommendations in a Friday report by task force co-chairs Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette. The recommendations build on previous actions by the Legislature and Walker's administration.

“Wisconsin is leading the way,” the co-chairs wrote in their Friday report. “Our kids and communities deserve nothing less.”

The report recommends that the state:

·     Expand Department of Children and Families programs that help at-risk youth.

·     Clarify state law so that schools have to teach students about prescription drug abuse.

·     Create a fund to provide grants to state and local agencies to expand efforts to fight against illegal drugs.

·     Add two regional drug resource prosecutors to Department of Justice field offices in Wausau and Green Bay.

·     Support the use of victim impact panels, a sentencing tool for judges in drunken driving cases, that involve people in recovery or family members of overdose victims.

·     Encourage the adoption of software allowing police departments to participate in a nationwide database that tracks overdose data.

·     Analyze the use of technology in Milwaukee County that aims to help law enforcement and medical examiners process overdose cases faster.

·     Require all prescribing professionals to have continuing education requirements specific to controlled substances.

·     Provide one-time funding to the Department of Children and Families to develop internet-based training resources on the opioid epidemic for county-based social services and veterans service staff.

·     Look into reciprocity for mental health and substance abuse professionals with other states.

·     Fund graduate nursing education to reduce wait lists and increase class sizes at the University of Wisconsin's mental health nursing program.

·     Incorporate recommendations from the agreed-upon bill from the Worker’s Compensation Advisory Council that help expand coverage for addiction treatment.

·     Clarify state law so that nurse practitioners and physician assistants can prescribe buprenorphine even if their supervising physician can't.

·     Provide $1 million to launch a pilot project providing Vivitrol, which targets drug abuse, to individuals with substance use disorder whom are leaving jail.

·     Revise Wisconsin law that targets pregnant mothers with substance abuse disorder.

·     Pass a bill expanding drug courts to juvenile courts and create a fund to support such efforts.

·     Pass a bill clarifying standards around people with drug convictions seeking occupational licensures.

Read the report.