Program in Addiction Medicine Policy Work

In 2016, under the charge of Governor Dannel P. Malloy, several Program faculty members joined the Connecticut Opioid REsponse Initiative (CORE) to support development of a state-wide strategic plan to address the overdose crisis. This plan presented evidence-based, measurable methods for immediate implementation to address overdose deaths in the state. Long-term outcomes of the development and implementation of this strategic plan have included:

• Increased access to X-waiver trainings for providers seeking to prescribe buprenorphine
• Increased the number of mentors in the state who are available to help clinicians provide buprenorphine through a SAMHSA-funded program
• Increased trainings of CT clinicians in accordance with FDA blueprint for opioid prescribing
• Embedding the Prescription Drug Monitoring Programs into several large Connecticut (CT) health systems electronic medical records
• Increased distribution of naloxone to CT emergency departments
• Increased data-sharing between state agencies regarding opioid misuse and overdose deaths, with passage in 2017 of House Bill 7052, An Act Preventing Prescription Opioid Diversion and Abuse and FDA-funded research
  • Read more: Merging Statewide Data in a Public/University Collaboration to Address Opioid Use Disorder and Overdose (Becker WC., Heimer R., Dormitzer CM et al. Addiction Sci Clin Pract (2021))
• Increased tracking and reporting of overdoses events and use of naloxone
• Launch of CT campaign to improve public understanding of opioid use disorder and decrease addiction-related stigma.

The Connecticut Harm Reduction Working Group is an informal network of harm reduction practitioners, advocates, and scholars who organize around myriad issues affecting people who use substances in the state. Coordinated by faculty members of the Yale Schools of Medicine and Public Health in collaboration with the Global Health Justice Partnership, the group bridges resources and expertise available through Yale University with that of community-based service providers, advocates, and people with lived experience.

Read more about this group’s efforts during the COVID-19 pandemic in, A Community Responds to the COVID-19 Pandemic: a Case Study in Protecting the Health and Human Rights of People Who Use Drugs (Heimer R., McNeil R., Vlahov D. J Urban Health (2020)).

Pursuant to Connecticut PA 18-166 (SB 483) “An Act Concerning the Prevention and Treatment of Opioid Dependency and Opioid Overdoses in the State,” the Yale Program in Addiction Medicine was contracted by the Connecticut Department of Correction to inform the process of expanding medications for Opioid Use Disorder into all Connecticut prisons and jails. A Strategic Plan for Expansion of Medications for Opioid Use Disorder (MOUD) in the Connecticut Department of Correction, and accompanying cost analysis, were produced in 2020.

Several Program faculty members participate in activities of the Connecticut Alcohol and Drug Policy Council (ADPC), with particular representation on the Treatment sub-committee. The ADPC is a legislatively mandated body comprised of representatives from all three branches of State government, consumer and advocacy groups, private service providers, individuals in recovery from addictions, and other stakeholders in a coordinated statewide response to alcohol, tobacco and other drug (ATOD) use in Connecticut. ADPC is charged with developing recommendations to address substance-use related priorities in the state.

Program faculty have served in leadership and advisory positions with several federal entities and national associations, including but not limited to

• Office of National Drug Control
• Centers for Disease Control and Prevention
• American Society for Addiction Medicine
• American College of Academic Addiction Medicine
• American College for Emergency Physicians
• SAMHSA Providers Clinical Support System
• Association for Multidisciplinary Education and Research in Substance Use and Addiction

Faculty members’ work with these entities informs national policy around prescribing guidelines, treatment standards, and training and education in addiction medicine. Research conducted by Program faculty has been particularly instrumental in advancing evidence-based policy and practice for emergency department-initiated buprenorphine for the treatment of Opioid Use Disorder, and in describing and informing national policy around tobacco and vaping products. Read more:

• Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department (Hawk K., Hoppe J., Ketcham E et al. Annals of Emergency Medicine (2021))
• Emergency: Hospitals Are Violating Federal Law by Denying Required Care for Substance Use Disorders in Emergency Departments (Yeboah-Sampong S., Weber E., Friedman S. Legal Action Center (2021))
• Tobacco Control Policy Tool (Cancer Intervention and Surveillance Modeling Network (CISNET) (2020)).
• A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California (Friedman A., JAMA Pediatrics (2021)).

In 2020, the Program achieved national recognition for clinician- and patient-facing guidance on outpatient and hospital-based addiction treatment and harm reduction during the COVID-19 pandemic.

As several legal cases brought against the pharmaceutical industry and other entities amidst the overdose crisis move towards settlement, the Program is working with a broad coalition of institutional and community partners, led by Johns Hopkins Bloomberg School of Public Health, to advise state and local governments around principles for effective and equitable allocation of settlement funds to save lives. A special webinar held on this topic in June 2021 is viewable here.

Program faculty have worked extensively abroad to advance the Program’s mission globally, learn from and inform other models and systems of addiction care. Faculty collaborations have spanned Europe, the Middle East, the Americas, Africa, and Asia encompassing clinical, administrative, research and policy-based work. Several program faculty members have received funding, honors and awards, and collaborated with reputable international organizations such as the Centers for Disease Control and Prevention, the World Health Organization, and the United Nations and its specialized agencies. The Program is presently partnered with the Yale Institute for Global Health (YIGH) and the Department of Psychiatry to form the YIGH Global Addiction Network. This multidisciplinary group focuses on international research, clinical care, education, and policy in addiction treatment and prevention.

The following entities at Yale work with and alongside the Yale Program in Addiction Medicine to advance key policies and practices impacting addiction treatment and the wellbeing of people who use substances.

Child Study Center
Global Health Justice Partnership
Health Justice Lab
SEICHE Center for Health and Justice
Solomon Center for Health Law and Policy