WSU CEI will host its next Community of Practice session for Social Workers and Care Coordinators in May. Watch your inbox registration information. For the full calendar of events in 2023, contact Vanessa Lohf.
In April, OCK providers and members of the State and MCO Coordination Team participated in the OneCare Kansas Learning Collaborative to learn more about a recent study conducted by the Lawrence/Douglas County Health Department and their partners. The study focused on tobacco treatment services and tobacco-free environments in the OneCare Kansas network. Participants also heard from the OneCare Kansas program at the Mental Health Association of Southcentral Kansas about their efforts to make tobacco treatment more accessible for the people they serve. For resources related to tobacco cessation and treatment, visit the Tobacco Cessation Information page located under the OCK section of the KanCare website.
Lawrence-Douglas County Public Health conducted an OCK Program Tobacco Study on a sample of 10 OCK programs. The aim of this study was to investigate OCK program tobacco treatment services in behavioral health settings. The information that follows provides a summary of the tobacco study report shared with OCK Partners (OCKPs), including some of the survey’s findings and some recommendations for providers to consider.
Between 34-57% of OCK members smoke tobacco, which is more than double the average among adult Kansans. Individuals with mental health and addiction-related conditions frequently struggle with tobacco dependence. Smoking is the leading cause of death among this population, accounting for 50% of deaths in individuals with schizophrenia, depression and bipolar disorder. Up to 80% of those receiving treatment for substance use disorders have indicated a desire to quit smoking. Although tobacco use disorder is a DSM diagnosis, it is the only substance use disorder that is rarely diagnosed or treated. Those who attempt to quit smoking without the assistance of a treatment program succeed only 3-5% of the time. Individuals who participate in assisted tobacco dependence treatment may experience better mental health outcomes, reduced risk of relapse for substance use disorders and improved well-being and quality of life.
As part of the Health Action Plan (HAP), OCK programs screen members for tobacco and willingness to quit. The OCK programs who were surveyed have been effective at advising members who are tobacco users to quit. However, willingness to quit smoking is a factor that determines how successful a quit attempt will be. To best address tobacco dependence, clinical practice guidelines recommend interventions for all tobacco users, not just those who are ready to quit. Providers can develop and implement different tobacco care pathways for those who are ready to quit now, those interested in quitting but not right now, and those who say they are not interested in quitting. For those who are not interested in quitting, motivational counseling is the recommended treatment method to incorporate into their care pathway.
OCK members have access to tobacco cessation services through KanCare. KanCare provides members with coverage for evidence-based tobacco treatment, including individual and group counseling and tobacco cessation medications for up to four quit attempts per year. Providing counseling and medication to members can more than double their chance of quitting tobacco. The best outcomes are achieved when these two treatment methods are utilized simultaneously. Some of the OCK programs surveyed indicated they are referring their members to other organizations for these services instead of treating the members in-house. OCK programs can consider offering more of these services in-house, as many programs have providers within their facility who can provide counseling and write prescriptions. These OCK programs can bill KanCare for providing tobacco-dependence treatment to members.
One of the main barriers to treating tobacco dependence is inadequate training. Most OCK Programs surveyed indicated they had staff members who had received training in treating tobacco dependence. Although, the survey findings also identified gaps in training as a barrier to treating tobacco dependence. Providers can build staff capacity and fill these gaps in training by participating in more tobacco training programs and continuing education. Tobacco training programs targeted to behavioral health settings could be beneficial to these OCK Programs. Some training programs available to providers include the University of Kansas Tobacco Treatment Education Program and Kansas Tobacco Cessation Help (KaTCH) Training Program. Other training resources are available on the Tobacco Cessation Information webpage under the OCK section of the KanCare website.
Providing a tobacco-free environment is another critical component of treating tobacco dependence. About half of OCK programs surveyed have tobacco-free policies that prohibit tobacco use indoors and on all grounds. Other agencies without policies in place can consider implementing comprehensive tobacco-free policies to help improve treatment outcomes for those with tobacco dependencies. In addition, some OCK programs have staff who use tobacco, which can affect the culture around treating tobacco. Helping these staff members access evidence-based tobacco treatment as a covered benefit on their health insurance plans may be beneficial.
The OCK Tobacco Study report recommends that providers take action to address tobacco dependence among members with mental health and addiction issues. Providers can do this by continuing training in tobacco dependence treatment and using integrated models to treat tobacco dependence. OCK members have coverage for evidence-based tobacco treatment and many OCK programs can provide this treatment within their organization by utilizing staff who are qualified to provide these services. Providers can work to create a tobacco-free environment and be proficient in motivational counseling to help members consider treatment for tobacco dependence. Providers can complete the Kansas Tobacco Guideline for Behavioral Health Care Self-Assessment each year to help them recognize their program's strengths and areas for quality improvement. For more information, please refer to the full report and the Kansas Tobacco Guideline for Behavioral Health Care. Additional resources specific to OCK can be viewed on Tobacco Cessation Information webpage under the OCK section of KanCare website.
Dee Kinard, PhD (Lawrence-Douglas County Public Health Department) is the lead investigator for the project. Johanna Jeyaraj, a medical student at UMKC completed the data collection and analysis. Kimber Richter, PhD (University of Kansas School of Medicine) and Rick Cagan, (NAMI Kansas Behavioral Health Tobacco Project) provided key support for the project. Project funding was provided by NAMI Kansas, based on a grant from the Kansas Health Foundation.
The Biden administration announced that fentanyl mixed with the animal tranquilizer xylazine is an emerging threat, marking the first time a substance was classified as a threat in the United States. The United States Drug Enforcement Administration issued a public advisory, reporting the drug has spread to 48 states. Congress is looking to classify xylazine as a controlled substance, and a bipartisan bill has been introduced to assist law enforcement in reducing xylazine distribution.
In 1972, the Food and Drug Administration approved xylazine for veterinary use. This substance was recently discovered to be used widely in illicit drugs for human consumption. As a street drug, xylazine is often referred to as “tranq”, “tranq dope” or “zombie heroin.” Human consumption of xylazine can lead to dangerous consequences. The harmful side effects of xylazine use in humans include breathing difficulties, long-lasting skin sores and ulcers, the potential for amputation of limbs, and an increased risk of sepsis, a life-threatening condition that requires hospitalization.
Xylazine is a contributing factor to the nations escalating overdose crisis. In 2020, xylazine played a role in 800 drug-related deaths in the United States, predominantly in the Northeast. By 2021, the drug had been linked to approximately 3,000 deaths, primarily in the South. The number of overdose deaths associated with xylazine in the southern and western regions of the United States has increased by more than 1,000% and 750%, respectively.
In the United States, xylazine combined with other substances, such as fentanyl, has become an increasingly lethal threat. Legislators are currently working on strategies to combat the dangers of xylazine use in the United States. More information can be found in xylazine article on the USA Today website.
Asthma is a chronic respiratory condition that can cause inflammation and narrowing of the airways, leading to breathing difficulties. Allergies occur when the immune system overreacts to a substance, such as pollen, pet dander and dust mites, which can induce allergic rhinitis symptoms. Some individuals develop allergic asthma or allergy-induced asthma due to skin or food allergies. Asthma and allergic asthma can often occur together, with allergens being a common trigger for asthma symptoms.
Asthma symptoms can be caused by allergic responses. An allergic response occurs when the immune system misidentifies a harmless substance, such as tree pollen, as an invader. To defend the body, antibodies bind to the allergen. The chemicals that are released can cause nasal congestion, a runny nose, itchy eyes and skin responses. Some individuals may experience an allergic response that affects their lungs and airways, resulting in asthma symptoms.
While both asthma and allergic rhinitis have specific therapies, there are also medications that are effective for treating both conditions. These medications include:
- Leukotriene Modifier is a daily medication that works to regulate the immune system and relieve symptoms.
- Immunotherapy, often known as allergy shots, is used to treat asthma by decreasing the immune response to specific allergy triggers with low dose injections of the allergen that causes the symptoms.
- Omalizumab (Xolair) is an anti-immunoglobulin E (IgE) therapy used to treat severe allergic asthma. It helps the body detect allergens and signals the immune system to release histamine, which prevents the allergic reaction that causes asthma symptoms.
Asthmatic allergic reactions are more common among those with a family history of allergies. Individuals prone to hay fever or other allergies are also more likely to develop asthma. Although allergic asthma is most common, other types of asthma have different triggers. Asthma attacks in some individuals may be triggered by exposure to cold air, stress, exercise, infections and gastroesophageal reflux disease. Many individuals can be affected by several types of asthma triggers.
Allergies and asthma are closely related and can often occur together. Identifying the triggers and avoiding allergens can help reduce asthma symptoms. It is important that individuals work with their healthcare provider to develop a treatment plan. With the proper management, individuals with allergies and asthma can lead healthy lives. For more information, please reference the Mayo Clinic's article on Allergies and Asthma.
|