HUSKY Pain Management ProgramPAGE

Provider Toolkits

The Centers for Disease Control and Prevention (CDC), in determining when to initiate or continue opioids for chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing), recommend the following:

  • Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred first line treatments for chronic pain, with opioid therapy being considered only after a risk benefit analysis shows that expected benefits for both pain and function are anticipated to outweigh risks to the patient. If used, opioids should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.
  • Before starting opioid therapy, clinicians should establish treatment goals with all patients, including realistic goals for pain and function. Discontinuing opioid therapy if benefits do not outweigh risks should also be considered. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
  • Before starting and periodically during opioid therapy, clinicians should discuss with patients the known risks and realistic benefits of opioid therapy, and patient and clinician responsibilities for managing therapy.

The full CDC Guideline for Prescribing Opioids for Chronic Pain is available here.

Additional guidance on the safe and effective use of opioids for the treatment of chronic pain is available through the Provider’s Clinical Support System for Opioid Therapies (PCSS-O)*. PCSS-O is a national training and mentoring project developed in response to the prescription opioid overdose epidemic.

*Funding for this initiative was made possible (in part) by Providers' Clinical Support System for Opioid Therapies from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Tapering Toolkit

While there is limited evidence to support the use of long-term opioid therapy for chronic pain (outside of end-of-life care), there is evidence that shows a high risk for serious harms associated with opioid use including:

  • Overdose and death
  • Respiratory depression
  • Worsening obstructive sleep apnea
  • Hypogonadism
  • Sedation
  • Abdominal pain and nausea
  • Constipation
  • Addiction

The HUSKY Health program is committed to supporting Connecticut Medical Assistance Program (CMAP) providers with decreasing the use of high-dose opioid medications. This tapering toolkit is designed to assist providers with engaging and managing their patients on high-dose opioids using a step-wise tapering method, and to provide guidance on the management of complications.

The steps described in this toolkit are:

  1. Identifying candidates for tapering
  2. Engaging the patient
  3. Assessing readiness to change
  4. Evaluating comorbid behavioral health and substance use conditions
  5. Developing a tapering plan
  6. Managing withdrawal symptoms

Document Downloads

  • Tapering Toolkit To download a pdf version of this Toolkit, click here.

Identifying Candidates for Tapering

It is important to first determine if a patient is an appropriate candidate for tapering. Tapering can be initiated for patients on any dose of opioids.

Tapering of long-term opioid therapy should be considered when the patient:

  • Has resolution of underlying condition or decreased pain
  • Requests a dosage reduction
  • Displays no clinically meaningful improvement in pain and function
  • Experiences complications from high-dose opioids
  • Experiences an overdose or other serious adverse event
  • Displays early warning signs of overdose risk such as confusion, sedation, or slurred speech
  • Is on dosages greater than or equal to 50 MME/day without benefit
  • Takes a benzodiazepine in addition to opioid medication
  • Shows signs of opioid use disorder
  • Is not adhering to a patient treatment agreement:
    • Inappropriate use of opioid medication
    • Failure to comply with monitoring
    • Selling prescription drugs
    • Forging prescriptions
    • Stealing or borrowing drugs
    • Aggressive demand for opioids
    • Unsanctioned dose escalation
    • Concurrent use of alcohol or illicit drugs
    • Obtaining opioids from multiple prescribers and/or pharmacies
    • Recurring emergency department visits for chronic pain management

Engaging the Patient

A successful tapering program requires the active involvement of the patient. It is important that providers engage patients in a non-threatening manner in order to establish a therapeutic alliance.

Motivational interviewing strategies offer techniques to elicit the patient’s motivations and potential obstacles to success in a non-threatening fashion. Motivational interviewing is an approach that can help patients with behavioral health conditions, substance use disorders, and chronic medical conditions make positive behavioral changes to improve their overall health.

Motivational interviewing is based on the following four principles:

  • Express Empathy: to enhance self-esteem and facilitate change – reflective listening is essential
  • Develop Discrepancy: help the patient to see that their current situation does not fit into their values and goals for the future
  • Roll with Resistance: to prevent a breakdown in the therapeutic alliance – avoid arguing and do not directly oppose resistance - offer new perspectives but do not insist
  • Support Self-efficacy: if a patient holds the belief that they have the ability to change, the likelihood of success is increased

Motivational Interviewing Techniques

Make affirmative statements

Affirmations are statements made in response to what a person has said. They are used to recognize strengths, successes, and efforts and to enhance self-confidence.

Examples of affirmative statements:

  • “I can see that you are really trying to stick to the tapering plan that we developed.”
  • “You showed a lot of strength when you told your friend that you wouldn’t get high with them.”
  • “In spite of what happened last week, the fact that you came back today shows that you are really committed to making this change.”

Be careful to avoid statements that could sound insincere such as “Wow, that’s incredible,” or “That’s great, good job.”

Providing advice/feedback/asking permission

Patients may have either too little or incorrect information about their behavior. Telling patients what to do does not work well. Presenting information in a nonjudgmental manner can empower patients to make informed decisions. Ask permission to give feedback. Patients are more likely to discuss change when respected and asked as opposed to being told that change is needed.

  • Have relevant informational handouts available
  • Whenever possible, focus on the benefits of change
  • Avoid using scare tactics, lectures, or severe warnings

Example:

  • Example: “Do you mind if we spend some time discussing…” followed by, “What do you know about the risks of taking opioid medication?” followed by, “Are you interested in learning more about these risks?”

Normalizing

Normalizing reassures the patient that ambivalence to change is not uncommon.

Example:

“A lot of people are concerned about reducing the amount of opioid medication they are taking.”

Using open-ended questions

Open-ended questions allow the patient to more fully describe their current situation. Providers can then reflect back or summarize in a way that communicates empathy.

Examples:

  • “What brought you here today?”
  • “What makes you think that it might be time for a change?”
  • “What was that like for you?”

Avoid closed-ended questions which can make it seem like you are interrogating the patient.

Reflective listening

Reflective listening allows the provider to carefully listen and then paraphrase what the patient has said. The goals of reflective listening are to build empathy, encourage the patient to identify their own reasons for change, and show that the provider understands what the patient is feeling.

Examples:

  • “It sounds like you are really concerned about the amount of Percocet you are taking.”
  • “I get the sense that you are feeling a lot of pressure from your family to stop using the fentanyl patches and Xanax but you are afraid that you can’t do it because of the difficulties you have had in the past.”
  • “I get the sense that you are very concerned about going into withdrawal while we are tapering the Dilaudid.”

Summaries

Summaries require that providers listen carefully to what the patient is saying. Summaries are a great way to wrap up a discussion and transition to the next topic.

Examples:

  • “It sounds like you are very concerned about how much Oxycontin you are taking but you are also concerned that without it your pain will get worse and the withdrawal will be unbearable.”
  • “Over the past few months you have been talking about decreasing the amount of morphine you are taking. It sounds like you have experienced some of the negative effects of taking this medication long term. It makes sense that you are ready to make a change.”

Change talk

Getting patients to state their reasons for wanting to change as opposed to lecturing the patient on why they must change has been proven to be more effective.

Examples:

  • “How can I help you get past some of the problems you are experiencing?”
  • “What would be the good things about decreasing the amount of opioids you are taking?”
  • “If you do make this change, how would your life be different?”

Decisional balancing (pros and cons)

Asking patients to look at both the positive and negative effects of their current behavior helps the patient to better understand their own ambivalence. The patient sees that while there are benefits to taking opioid medication, there are negative consequences if they decide to continue using.

Examples:

  • “What are some of the good things about taking opioid medication?”
  • “Looking at the other side, what are some of the not so good things?”

Supporting confidence to change

Making comments and asking the patient about changes they have made can improve self-confidence.

Examples:

  • “It seems that you have been sticking to the tapering plan. That is different than before. How have you been able to do it?”
  • “How do you feel about the changes you have made?”

Dealing with discrepancies

Addressing discrepancies between what the patient is saying and what they are doing in a nonjudgmental manner encourages the patient to recognize and resolve discrepancies. This is a more effective approach than simply telling the patient that what they are doing does not make sense.

Example:

  • “You say you want to see your daughter get married next year, but you are continuing to say you don’t need to decrease the amount of Oxycontin you are taking, and your sister had to give you Narcan twice in the last month. How can you be sure that you will live to see her get married?”

Motivational Interviewing - Points to Keep in Mind

  • Listen more than you talk
  • Remain sensitive and open to the patient’s issues
  • Invite the patient to talk about and explore their own ideas for change
  • Encourage the patient to talk about their reasons for not changing
  • Help the patient identify successes and challenges from their past and relate them to their present efforts
  • Seek to understand the patient
  • Summarize for the patient what you heard, not what you think
  • Value the patient’s opinion more than your own
  • Remind yourself that the patient is capable of making their own choices

Assessing Readiness to Change

Assessing the patient’s motivation to decrease or eliminate their opioid medication is crucial. If providers know where the patient is in terms of readiness to change they will be better prepared to work with them. Depending on where the patient is, the discussion may go in a different direction.

The Change Readiness Model suggests that patients who are potential candidates for a significant health change, including decreasing the use of opioids, typically go through the following stages:

Stage 1 - Precontemplation
In this stage, patients on high-dose opioids do not consider that their opioid use could be a problem or is no longer indicated. This may be due to the fact that they have not yet experienced negative consequences from their opioid use or they may be in denial about the severity of the consequences they have experienced.

Provider Intervention - establish trust and rapport

Stage 2 - Contemplation
In this stage, the patient begins to think about changing, decreasing, or ending their opioid use. They are more aware of negative consequences or lack of indication for ongoing treatment. The patient is weighing the pros and cons of decreasing or ending their opioid use. Patients in this stage may be more open to receiving information about possible negative consequences.

Provider Intervention - give information in a non-judgmental manner

Stage 3 - Preparation
In this stage, the patient is aware of the need for change. They are gathering information and seeking strategies to decrease or stop their opioid use.

Provider Intervention - discuss options

Stage 4 - Action
In this stage, patients believe they have the ability to change their behavior and are actively engaged with strategies to decrease or stop their opioid use. Patients in this stage are open to receiving help and are also likely to seek support from others.

Provider Intervention - taper opioid, manage complications, and offer support

Stage 5 - Maintenance and Relapse Prevention
In this stage, the patient has successfully decreased or stopped their opioid use. They are learning to use strategies to manage pain other than opioid medication.

Provider Intervention - assess and support

Stage 6 - Relapse
Patients may not be able to immediately sustain the changes they have made. Resuming opioid medication use after a period without it is common early on in the process. Resumption of use should not be interpreted as treatment failure or as lack of commitment. Resumption of use can provide new information and opportunities to enhance the patient’s plan of care.

Provider Intervention - help the patient reenter the change cycle, remain nonjudgmental, and assist the patient in developing alternative coping skills

Evaluation of Comorbid Behavioral Health and Substance Use Conditions

Evaluating for potential comorbid behavioral health or substance use conditions that may complicate or prevent a successful opioid taper is crucial.

Available screening tools include but are not limited to:

Patient Health Questionnaire (PHQ-9)
The Patient Health Questionnaire (PHQ-9) is an instrument for screening, diagnosing, monitoring, and measuring the severity of depression.

Generalized Anxiety Disorder 7-item (GAD-7)
The Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and measuring the severity of generalized anxiety disorder.

Primary Care PTSD Screen (PC-PTSD)
The PC-PTSD is a 4-item screen designed for use in primary care settings and is currently used to screen for veterans for PTSD.

The Connecticut Behavioral Health Partnership (CT BHP) offers a toolkit to assist Primary Care Providers (PCPs) with the identification of behavioral health conditions. The PCP toolkit is available at: pcptoolkit.beaconhealthoptions.com.

Opioid Use Disorder

Opioid Use Disorder is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5.

The diagnosis of Opioid Use Disorder can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12-month period:

  • Taking more opioid drugs than intended or over longer periods of time than intended
  • Wanting or trying to control opioid drug use without success
  • Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs
  • Craving, or a strong desire or urge to use opioids
  • Failing to carry out important roles at home, work, or school because of opioid use
  • Continuing to use opioids, despite use of the drug causing relationship or social problems
  • Giving up or decreasing participation in other activities because of opioid use
  • Using opioids even when it is physically unsafe
  • Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway
  • Tolerance for opioids as defined by either of the following:
    • A need for increased amount of opioids to achieve desired effects
    • Markedly diminished effect with the continued use of the same of amount of an opioid
  • Withdrawal as manifested by either of the following:

If a patient is found to have a comorbid condition, treatment should be initiated for both disorders and should occur concurrently. Providers and patients can contact CT BHP for guidance and information on counseling and adjunctive treatment options, including Medication Assisted Treatment (MAT) by calling 1.877.552.8247, Monday through Friday, 9:00 a.m. - 7:00 p.m. or visiting their website at www.ctbhp.com. CT BHP members and providers can also do a referral search for behavioral providers via www.ctbhp.com/members/mbr-findprv.html.

Behavioral Health Services

Under the CT BHP, the following services are covered:

  • Medication Assisted Treatment (MAT) including methadone maintenance, buprenorphine, and naltrexone
  • Ambulatory Detoxification
  • Inpatient Detoxification Outpatient Counseling
  • Intensive Outpatient Treatment
  • Partial Hospitalization
  • Residential Substance Abuse Rehabilitation
    • Covered by CT BHP, available to certain HUSKY Health members (contact CT BHP for details)
    • HUSKY D has services for Residential Substance Abuse Rehab covered by Advanced Behavioral Health, which can be reached at 1.800.606.3677, Monday through Friday, 8:30 a.m. - 5:00 p.m.

Medication Assisted Treatment

To date, Medication Assisted Treatment (MAT) is the most effective treatment for patients with opioid use disorder. MAT combines medications and behavioral therapy to provide a holistic approach to the treatment of opioid use disorder. The HUSKY Health program covers a number of medications used in the treatment of opioid use disorders.

The following medications are currently covered without Prior Authorization (PA):

  • Buprenorphine HCL tablet (sublingual)
  • Methadone
  • Naltrexone oral
  • Suboxone film (sublingual)
  • Vivitrol (extended release naltrexone injectable) – covered without PA effective 7/1/18

The following medications are currently covered with PA:

  • Buprenorphine/naloxone tablet (sublingual)
  • Bunavail buccal strip*
  • Zubsolv tablet (sublingual)*
  • Probuphine subdermal*
  • Sublocade (extended-release buprenorphine injection)

*These medications are not covered for HUSKY B members

MAT providers can be located here.

To learn more about MAT, providers and patients can contact the CT BHP at 1.877.552.8247, Monday through Friday, 9:00 a.m. - 7:00 p.m. or access the CT BHP MAT Resources page.

Developing a Tapering Plan

Tapering plans should be person-centered and should minimize the symptoms of opioid withdrawal while ensuring adequate pain treatment through the use of non-pharmacologic treatments and non-opioid medications.

How to Taper

There are multiple strategies for tapering opioid medications that range from slow tapers to more rapid regimens. Patients on high-dose opioids require special attention as a rapid taper may trigger withdrawal symptoms. Tapering plans should take a person-centered approach and should minimize the symptoms of opioid withdrawal while providing adequate pain control with non-pharmacologic therapies and non-opioid medications.

Non-pharmacologic Therapies for Chronic Pain

Under the HUSKY Health program medical benefit, the following services are covered:

  • Physical and occupational therapy
  • Naturopath services
  • Transcutaneous Electrical Nerve Stimulation (TENS) units
  • Chiropractic manipulation
  • Acupuncture

Non-opioid Medications for Chronic Pain

The following is a list of non-opioid medications suggested by the Centers for Disease Control and Prevention (CDC) as possible first-line pharmacologic treatment:

  • Acetaminophen
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  • Gabapentin/pregabalin
  • Tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors
  • Topical agents (lidocaine, capsaicin, NSAIDs)

Recommendations

  1. Consider sequential tapers for patients who are on chronic benzodiazepines and opioids. Co-manage care with other prescribers.
  2. Do not use ultra-rapid detoxification or antagonist-induced withdrawal under heavy sedation or anesthesia. The effectiveness of this treatment has not been established and potential risks are high.
  3. Base the rate of taper on patient safety:
    1. Institute a more rapid taper if the patient has had a severe negative outcome e.g., overdose, is diverting, or is using street drugs
    2. Taper slowly if no acute safety concerns. Start with a taper of ≤ 10% of the original dose per week and assess the patient’s functional and pain status at each visit.
    3. Use extra caution during pregnancy – coordinate with specialists
  4. Discuss the increased risk for overdose if patients quickly return to a higher dose.
  5. Adjust the rate, intensity, and duration of the taper based on the patient’s response (e.g. emergence of opioid withdrawal symptoms.)
  6. Take the following into consideration when making a decision to continue, pause, or discontinue the taper:
    1. Assess for aberrant behaviors that may be suggestive of addiction
    2. Address pain with the use of non-pharmacologic and non-opioid medications
    3. Evaluate for symptoms of behavioral health disorders (i.e., anxiety, depression and opioid use disorder). Ensure patients are receiving adequate psychosocial support.
  7. Do not reverse the taper. The rate may be slowed or paused while managing withdrawal symptoms.
  8. Once the smallest available dose is reached, the interval between doses can be extended and opioids may be stopped when taken less than once a day.
  9. Use non-benzodiazepine medications to treat withdrawal if needed.
  10. Consider inpatient withdrawal management if the taper is poorly tolerated.

Opiod Dose Calculator

Managing Withdrawal Symptoms

Opioid withdrawal syndrome is characterized by the signs and symptoms of sympathetic stimulation including: anxiety, restlessness, diaphoresis, tremor, nausea, abdominal cramps, diarrhea, myalgia or arthralgia, and insomnia.

The Clinical Opiate Withdrawal Scale can be used to rate common signs and symptoms of opiate withdrawal and monitor these symptoms over time.

Consider using non-opioid and non-benzodiazepine medications during the taper to reduce withdrawal symptoms if needed.

Symptoms Treatment
Restlessness, diaphoresis, tremors Clonidine
Nausea Anti-emetics such as ondansetron, prochlorperazine
Diarrhea Loperamide or anti-spasmodics such as dicyclomine
Myalgia, arthralgia, neuropathic pain, or myoclonus NSAIDs, gabapentin or muscle relaxants such as cyclobenzaprine, tizanidine, or methocarbamol
Insomnia Sedating antidepressants (e.g. nortriptyline, mirtazapine, trazodone). Do not use benzodiazepines or sedative-hypnotics

References

Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain – United States, 2016:
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

CDC Pocket Guide: Tapering Opioids for Chronic Pain:
https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf

Enhancing Motivation for Change in Substance Abuse Treatment – Treatment Improvement Protocol (TIP) 35:
https://store.samhsa.gov/shin/content//SMA13-4212/SMA13-4212.pdf

Interagency Guideline on Prescribing Opioids for Pain:
http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf

Mayo Clinic Review of Opioid Tapering:
http://www.mayoclinicproceedings.org/article/S0025-6196(15)00303-1/pdf

Motivational Interviewing:
https://www.integration.samhsa.gov/clinical-practice/motivational-interviewing

Motivational Interviewing Assessment:
https://www.drugabuse.gov/sites/default/files/files/MIA-STEP_Factsheet.pdf

Motivational Techniques and Skills for Health and Mental Health Coaching/Counseling:
http://www.nova.edu/gsc/forms/mi-techniques-skills.pdf

Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders:
https://www.samhsa.gov/sites/default/files/topics/mental_substance_disorders/pharmacologic-guidelines.pdf

Stages of Change and Treatment: Comparing Models:
http://www.ct.gov/dmhas/lib/dmhas/publications/CSP-StagesChangeTx.pdf

U.S Department of Veterans Affairs Pain Management Opioid Taper Decision Tool:
https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf

Primary Care Provider (PCP) Pain Management Toolkit

The PCP Pain Management Toolkit is a comprehensive guide for Primary Care Providers (PCPs) supporting the safe and effective treatment of chronic pain in the primary care setting. The toolkit provides recommendations and outlines the available services for members with chronic pain conditions. This toolkit was developed through a collaboration between the Connecticut Department of Social Services (DSS), Community Health Network of Connecticut, Inc., the Connecticut Behavioral Health Partnership (CT BHP), the Connecticut Dental Health Partnership (CTDHP), and the Connecticut Department of Mental Health and Addiction Services (DMHAS).

Document Downloads

  • PCP Pain Management Toolkit To download a pdf version of this Toolkit, click here.
  • Pain Management Quick Guide To download the quick guide to covered pain management services and a checklist for prescribing opioids, click here.

Non-opioid Services & Treatments for Chronic Pain

The HUSKY Health program covers non-pharmacologic treatments for chronic pain. Reference the medical, behavioral, and dental services provided below in addition to covered non-opioid treatments for chronic pain.

Medical Services

Under the HUSKY Health program medical benefit, the following services are covered:

  • Physical and occupational therapy
  • Naturopath services
  • Transcutaneous Electrical Nerve Stimulation (TENS) units
  • Chiropractic manipulation
  • Acupuncture

HUSKY Health Member Engagement and Escalation Unit

For further clarification of covered medical benefits or for assistance with locating a Connecticut Medical Assistance Program (CMAP) enrolled medical provider offering one or more of the above services, you may contact the HUSKY Health Member Engagement Services and Escalation Unit. The representatives are available to ease the coordination of care for patients with chronic pain by locating and providing appointment assistance and assisting with referrals to pain management specialists. Providers can “Reach for Escalation” by calling 1.800.440.5071, Monday through Friday 8:00 a.m. - 6:00 p.m. or completing the Reach for Escalation form and fax to 203.265.3197 or e-mail to reachforescalation@chnct.org.

HUSKY Health Intensive Care Management Program

The HUSKY Health Intensive Care Management (ICM) program can assist you with coordinating care for your patients with chronic pain by assessing the patient’s health status, barriers, and strengths; developing a patient centered care plan; identifying gaps in care; coordinating with specialists; coordinating with the CT Behavioral Health Partnership (CT BHP); conducting patient visits, coordinating transportation; and providing appointment reminders. To refer patients to the ICM program, providers can call 1.800.440.5071, Monday through Friday 8:00 a.m. - 6:00 p.m. and select the prompt for Intensive Care Management or complete the ICM Referral Form and fax to 866.361.7242.

Behavioral Health Services

Under the CT BHP the following services are covered:

  • Medication Assisted Treatment (MAT) including methadone maintenance, buprenorphine, and naltrexone
  • Ambulatory Detoxification
  • Inpatient Detoxification
  • Outpatient Detoxification
  • Outpatient Counseling
  • Intensive Outpatient Treatment
  • Partial Hospitalization
  • Residential Substance Abuse Rehabilitation, covered by CT BHP, available to certain HUSKY members (contact CT BHP for details)

HUSKY D has services for Residential Substance Abuse Rehab covered by Advanced Behavioral Health, which can be reached at 1.800.606.3677, Monday through Friday 8:30 a.m. - 5:00 p.m.

CT BHP offers a toolkit to assist Primary Care Providers (PCPs) with the identification of behavioral health conditions. The PCP toolkit is available here.

For further clarification of covered benefits or assistance with locating a CMAP enrolled behavioral health provider offering one or more of the above services, including locating a provider certified to treat with buprenorphine, you may contact the CT BHP at 1.877.552.8247, Monday through Friday from 9:00 a.m. - 7:00 p.m.

CT BHP Behavioral Health Peer and Intensive Care Management Programs

CT BHP has a number of programs for members including Peer and Intensive Care Management (ICM) programs. Peer Specialists are individuals who, because of their personal journey or the journey of a loved one through the mental health and substance use system, are very knowledgeable and effective in mitigating the impact of mental health and substance use on individuals and families. This lived experience can help others. Community Peer Specialists generally work with Adults and Family Peer Specialists who usually focus their work on the family. Intensive Care Managers are licensed clinicians who are available in the emergency department of five local hospitals to work with members who have been identified as frequent visitors. In addition, two of the five hospitals also have specialized programs where a team works with members who are receiving medical treatment for detoxification from substances. The Peer/ICM program is designed to help assist members with utilizing services as an alternative to hospitalization and link the member to services in the community that meet their needs.

Behavioral Health Member Resources

The following are available to members on the CT BHP website at www.ctbhp.com:

  • Achieve Solutions: a library of behavioral health related topics
  • A listing of Enhanced Care Clinics, mental health and substance abuse outpatient treatment programs
  • A calendar of upcoming events and trainings
  • Referral Connect: an online tool to locate behavioral health providers
  • Information on recovery and wellness

For further clarification of covered benefits or assistance with locating a CMAP enrolled behavioral health provider offering one or more of the above services, contact the CT BHP at 1.877.552.8247, Monday through Friday, 9:00 a.m. - 7:00 p.m.

Dental Health Services

Pain management remains a significant consideration in dental care.

For assistance with locating a dental provider, contact the Connecticut Dental Health Partnership (CTDHP), at 1.855.CTDENTAL, 1.855.283.3682, Monday through Friday, 8:00 a.m. - 5:00 p.m. Representatives can assist you with locating a dental provider or dental specialist, obtaining dental care coordination and case management, and obtaining other resources. Additional information is available on the CTDHP website at www.ctdhp.com.

Dental Health Member Resources

The following services are available to members on the CTDHP website at www.ctdhp.com:

  • Summary of dental benefits
  • Rights, privacy, and responsibilities
  • Dental Assistance Self Help (DASH) library of topics related
    to oral health
  • Forms and materials
  • News and updates
  • Websites and links
  • Member dental history and provider locator (available after creation of a member account)

Non-opioid Treatments for Chronic Pain

If you are considering pharmacologic treatment for chronic pain, the CDC recommends non-opioid therapies to the extent possible. The following is a list of non-opioid medications suggested by the CDC as possible first-line pharmacologic treatment:

  • Acetaminophen
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  • Gabapentin/pregabalin
  • Tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors
  • Topical agents (lidocaine, capsaicin, NSAIDs)

Opioid Treatment for Chronic Pain

When Considering Opioid Treatments for Chronic Pain

If you are considering prescribing opioids for your patient, it is important to perform a full evaluation of benefits and risk factors (i.e. history of drug use, history of mental health conditions, presence of sleep-disordered breathing, concurrent benzodiazepine use). The CDC offers a checklist for prescribing opioids for chronic pain and standard risk assessment tools.

In addition, the CDC recommends the use of urine drug testing to confirm the presence of prescribed medications or for undisclosed prescription drug or illicit substance use.

The CDC also recommends that providers check for both opioids and benzodiazepines from other sources, as concurrent use of benzodiazepines increases the risk for opioid overdose. To provide comprehensive prescription information for Schedule II through Schedule V drugs, the Connecticut Prescription Monitoring and Reporting System (CPMRS), a web-based tool, is available to all providers with a Connecticut Controlled Substance Registration.

Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation

The CDC recommends the following in terms of opioid selection, dosage, duration, follow-up, and discontinuation of opioid treatment:

  • When initiating opioid therapy for chronic pain, immediate-release opioids are recommended over extended-release/long-acting (ER/LA) opioids.
  • Providers should prescribe the lowest effective dosage, use caution when prescribing opioids at any dosage, carefully reassess evidence of individual benefits and risks when increasing dosage to > 50 morphine milligram equivalents (MME)/day, and avoid increasing the dosage to > 90 MME/day.
  • When opioids are used for acute pain, providers should prescribe the lowest effective dose of immediate-release opioids and prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
  • Providers should evaluate the benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Providers should evaluate the benefits and harms of continued therapy with patients every 3 months or more frequently. If the benefits do not outweigh the harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.

For additional information, the full CDC Guideline for Prescribing Opioids for Chronic Pain is available here.

Providers may access information on calculating the total daily dosage in MME of opioids, in this CDC document.

Re-assessing Risk and Addressing Harms of Opioid Use

Periodically the provider should re-evaluate the risk of ongoing opioid use and should consider offering naloxone when factors that increase the risk of opioid overdose are present. Naloxone, an opioid antagonist, is used to block or reverse the effects of opioid medication if an overdose has occurred.

The HUSKY Health program covers both Narcan nasal spray and naloxone syringes without prior authorization. Evizio, a non-preferred drug, requires prior authorization through the DSS Pharmacy program. You may contact the DSS Pharmacy Prior Authorization Assistance Center at 1.866.409.8386, Monday through Friday, 8:30 a.m. - 4:30 p.m. for more details.

In addition, certified pharmacists are allowed to prescribe and dispense select naloxone products.

Providers should review the patient’s history of controlled substance prescriptions through use of the Connecticut Prescription Monitoring and Reporting System (CPMRS) and utilize urine drug testing at least annually. Furthermore, providers should avoid prescribing opioid medications concurrently with benzodiazepines and should offer or arrange for evidence-based treatment such as MAT in combination with behavioral therapies for patients showing signs of opioid use disorder.

Symptoms of Opioid Use disorder

Opioid Use Disorder is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. The diagnosis of Opioid Use Disorder can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12-month period:

  • Taking more opioid drugs than intended or over longer periods of time than intended
  • Wanting or trying to control opioid drug use without success
  • Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs
  • Craving opioids
  • Failing to carry out important roles at home, work or school because of opioid use
  • Continuing to use opioids, despite use of the drug causing relationship or social problems
  • Giving up or reducing other activities because of opioid use
  • Using opioids even when it is physically unsafe
  • Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyways
  • Tolerance for opioids as defined by either of the following:
    • A need for increased amount of opioids to achieve desired effects
    • Markedly diminished effect with the continued use of the same of amount of an opioid
  • Withdrawal as manifested by either of the following:

Are you concerned that your patient is showing signs of opioid use disorder?

Help is available via the CT BHP Provider Connect. Call 1.877.552.8247, Monday through Friday 9:00 a.m. - 7:00 p.m. for guidance and information on counseling and adjunctive treatment options including MAT. CT BHP staff members are also available to assist you with understanding benefits, level of care guidelines, and referrals, as well as precertification and authorization as appropriate. CT BHP staff members are also available 24 hours a day, 7 days a week to assist your patients with referrals to treatment. Patients may contact the CT BHP at 1.877.552.8247.

Medication Assisted Treatment (MAT)

View the full MAT page on the CT BHP website.

Medications in combination with counseling and behavioral therapies can provide a holistic, patient approach to the treatment of opioid dependency. The HUSKY Health program covers a number of medications used in the treatment of opioid use disorders. The following medications are currently covered:

  • Buprenorphine HCL Tablet (Sublingual)
  • Methadone
  • Naltrexone oral
  • Suboxone film (sublingual)
  • Vivitrol (extended release naltrexone injectable)

To learn more about MAT contact the CT BHP at 1.877.552.8247, Monday through Friday 9:00 a.m. - 7:00 p.m. or visit the CT BHP website. Providers may also visit the Beacon Health Options website for additional information on available behavioral health services.

Interested in Becoming Certified to Prescribe Buprenorphine?

Buprenorphine is an FDA approved opioid addiction treatment. Individuals taking buprenorphine may be able to discontinue other opioid medication with minimal withdrawal symptoms. In order to prescribe buprenorphine, providers must apply for a waiver under the Drug Addiction Treatment Act of 2000 (DATA 2000). To receive a waiver, providers must first notify the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) of their intent to practice this form of MAT. The notification of intent to prescribe must be submitted to CSAT before dispensing and prescribing opioid treatment. Providers may either complete the online Waiver Notification Form SMA or may download the form, complete, and fax it to 240.238.9858.

Along with the form, providers are required to submit their training certificates showing that they have completed the required training to prescribe and dispense buprenorphine. Information about available 8-hour buprenorphine waiver training courses is available on the SAMHSA website.

Additional information on the physician waiver process is available here.

Additional guidance on the safe and effective use of MAT is available through the Provider’s Clinical Support System for Medication Assisted Treatment (PCSS-MAT)*. PCSS-MAT is a national training and mentoring project developed in response to the prescription opioid overdose epidemic and the availability of pharmacotherapies to address opioid use disorder.

*Funding for this initiative was made possible (in part) by Providers' Clinical Support System for Medication Assisted Treatment (grant nos. 5U79TI024697 and 1U79TI026556) from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Emergency Department Practitioner Pain Management Toolkit

Pain is one of the most common complaints among patients visiting the Emergency Department (ED). As the frequency of opioid use for the treatment of pain has increased there has been a significant increase in the non-medicinal use of opioids, addiction, drug-related emergency department visits, and deaths. These guidelines were developed to provide emergency department providers with recommendations for the safe and effective management of pain in the emergency department setting and are not meant to replace the clinical judgement of the treating provider.

These guidelines were adapted from the American Academy of Emergency Medicine, the Connecticut Hospital Association (CHA), and the Massachusetts Hospital Association (MHA) and are in-line with the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain. Recommendations from other states were reviewed as part of the development of these guidelines.

Document Downloads

  • Emergency Department Practitioner Pain Management Toolkit To download a pdf version of this Toolkit, click here.
  • Emergency Department Practitioner Pain Management Quick Guide To download a pdf version of this Quick Guide, click here.

Emergency Department Opioid Prescribing Guidelines for the Treatment of Non-Cancer Related Pain

The CDC recommends the following in terms of opioid selection, dosage, duration, follow-up, and discontinuation of opioid treatment:

  1. Consider short-acting opioids for the treatment of acute pain only as a second-line treatment to other analgesics unless there is a clear indication for the use of opioid medication (e.g. patients with an acute abdomen or long bone fracture).
  2. Start with the lowest possible effective dose for the management of pain. Higher doses increase the risk of adverse events such as respiratory depression and overdose. These risks are especially pronounced in opioid-naïve patients.
  3. When prescribing opioids for acute pain, prescribe a short course of opioid medication. Most patients require no more than 3 days of pain control for most acute pain conditions. Excessive quantities increase the risk of misuse, abuse or diversion and may lead to long-term use.
  4. Consider high dose NSAIDs for acute dental pain along with referral to the Connecticut Dental Health Partnership (CTDHP). Providers can contact CTDHP at 1.855.283.3682.
  5. Address exacerbation of chronic pain conditions with non-opioid pharmacologic treatment, non-pharmacologic therapies. Coordinate with the patient’s Primary Care Provider (PCP) for follow-up care.
  6. Consult the Connecticut Prescription Monitoring Program (CTPMP) database before writing opioid prescriptions.
  7. Ask about a history of current substance abuse prior to prescribing opioids for acute pain. Opioids should be prescribed with great caution in the context of a substance abuse history. Consider assessing for opioid misuse or addiction using a validated screening tool.
  8. Consider risk factors for respiratory depression when prescribing opioids. Use caution when prescribing opioid medications to patients currently taking benzodiazepines and/or other opioids. Opioid medications, when combined with other central nervous system depressants or given to patients with underlying medical conditions such as obstructive sleep apnea, can increase the risk for overdose. In addition, patients taking higher doses of opioids, including cumulative doses from more than one source, are at higher risk for respiratory depression.
  9. Use extra caution when considering prescribing opioids to patients who do not have proper identification.
  10. Provide safety information about opioid medication to patients. Patients should be informed of the risks of taking opioid medication which include: overdose that can lead to death, fractures from falls, drowsiness leading to injury, tolerance, dependence and addiction. Patients should be informed that respiratory depression is more common with the use of alcohol, benzodiazepines, antihistamines and barbiturates. In addition, they should be provided with information on the safe storage and proper disposal of unused medications. Consider adding safety information to standard discharge instructions for all patients prescribed opioids as part of an ED visit.
  1. Refrain from initiating treatment with long-acting, or controlled release opioids. These medications can cause death from respiratory depression even when taken as directed and some are appropriate only for patients who have become tolerant to opioids. Often, community-based providers require patients to agree to and sign a medication contract. In addition, these medications require close monitoring and follow-up care. Due to the nature of the care provided in an emergency department setting, close monitoring on an ongoing basis is generally not possible.
  2. Refrain from ordering IV or IM opioids for acute exacerbations of chronic pain. Use of parenteral opioids should be avoided for an acute exacerbation of chronic pain due to their short duration and potential for addictive euphoria. In general, oral opioids are superior to parenteral opioids in duration of action.
  3. Avoid replacing prescriptions for lost, stolen, or destroyed opioid prescriptions or for those finished prematurely. Patients misusing controlled substances frequently report their opioid medications as having been lost or stolen. Most written agreements between chronic pain patients and pain management physicians state that prescriptions for opioids will not be replaced.
  4. Avoid providing replacement doses for Methadone or Suboxone for patients participating in a Medication Assisted Treatment (MAT) program.
  5. Understand Emergency Medical Treatment and Active Labor Act (EMTALA) and its requirements for the treatment of pain. The emergency clinician is required under the EMTALA to evaluate an ED patient reporting pain. However, the law allows the emergency clinician to use clinical judgment when treating pain and does not require the use of opioids.
  6. Utilize the HUSKY Health Intensive Care Management (ICM) program to assist you with care coordination. ICM team members will assess a patient’s health status, barriers, and strengths; develop a patient centered care plan; identify gaps in care; coordinate with specialists; coordinate with the CT Behavioral Health Partnership (CT BHP); conduct patient visits, coordinate transportation; and provide appointment reminders. To refer patients to the ICM program, providers can call 1.800.440.5071, Monday through Friday 8:00 a.m. - 6:00 p.m. and select the prompt for Intensive Care Management or complete the ICM Referral Form and fax to 866.361.7242.
  7. Maintain a list of local primary care and MH clinics that provide follow-up care for patients.

Exacerbation of Chronic Pain Conditions

Address exacerbation of chronic pain conditions with non-opioid pharmacologic treatment, non-pharmacologic therapies, or referral to pain specialists for follow-up. Opioid analgesics should not be considered the initial approach to pain management in patients being discharged from the ED. Alternative and effective interventions exist. Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred first line treatments for chronic pain. Alternative and effective interventions exist.

The HUSKY Health Pharmacy program covers the following non-opioid pharmacologic treatment:

  • Acetaminophen
  • Non Steroidal Anti Inflammatory Drugs (NSAIDs)
  • Gabapentin/Pregabalin
  • Tricyclic antidepressants and serotonin/norepinephrine reuptake inhibitors
  • Topical agents (lidocaine, capsaicin, NSAIDs)

The HUSKY Health program also covers the following non-pharmacologic therapies including:

  • Physical and occupational therapy
  • Naturopath services
  • Transcutaneous Electrical Nerve Stimulation (TENS) units
  • Chiropractic manipulation
  • Acupuncture

Connecticut Prescription Monitoring Program (CTPMP)

The Connecticut Prescription Monitoring Program collects prescription data for Schedule II through Schedule V drugs into a central database, the Connecticut Prescription Monitoring and Reporting System (CPMRS). Providers and pharmacists use the data from the (CPMRS) for the active treatment of their patients.

While most ED patients legitimately seek pain relief treatment occurring from injury or exacerbations of chronic pain conditions, some patients seek opioid medications for inappropriate use or diversion. The CTPMP is intended to collect and make available prescription histories so that Connecticut providers may treat and counsel patients appropriately.

When consulting the CTPMP, the following should raise concerns:

  • Obtaining medications from multiple providers, provider groups or hospital systems
  • Obtaining large numbers of pills that may not be warranted given the patient’s condition
  • Filling prescriptions at multiple pharmacies especially when prescriptions are filled in quick succession or on the same day
  • Filling prescriptions far from the patient’s home address or work address

NOTE: When methadone is dispensed from a methadone maintenance program it will not appear in the CTPMP database.

Opioid Risk Assessment

It is recommended that prior to prescribing opioid medications; providers screen for potential opioid misuse and consider the following features that may be associated with increased risk of addiction or abuse:

  • Use of multiple providers or pharmacies to obtain controlled substances
  • Preoccupation with opioids more so than underlying pain conditions
  • Anger, aggression, or threatening response to limiting opioid use
  • Insistence on specific or rapid onset formulation, or parenteral opioid administration
  • Requests for rapid dose escalation
  • Evidence of habituation and reported tolerance in patients without history of opioid use
  • Noncompliance with recommended non-opioid treatments or evaluations
  • Inability to restrict medications or take them on agreed upon schedule
  • History of alcohol or other controlled substance dependence or abuse

To learn more about MAT contact the CT BHP at 1.877.552.8247, Monday through Friday 9:00 a.m. - 7:00 p.m. or visit the CT BHP website. Providers may also visit the Beacon Health Options website for additional information on available behavioral health services.

Opioid Risk Assessment Tools

There are various standardized opioid risk assessment tools that can be used to evaluate a patient’s risk of aberrant drug-related behavior. HUSKY Health recommends the use of the following risk assessment tools.

DAST – 10
The DAST-10 is a 10-item brief screening tool that can be administered by a clinician or self-administered. This tool assesses drug use in the past 12 months.

Opioid Risk Tool (ORT)
The ORT is a brief, self-report screening tool designed for use with adults to assess for risk of future opioid abuse among individuals prescribed opioids for the treatment of chronic pain.


Morphine Equivalent Dose

The CDC recommends that when initiating opioid therapy for chronic pain outside of active cancer, palliative, and end-of-life care:

  • Clinicians should prescribe the lowest effective dosage
  • Clinicians should use caution when prescribing opioids at any dosage
  • Clinicians should carefully reassess evidence of individual benefits and risks when increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day

Risks for serious harm related to opioid therapy especially increase at higher opioid dosage, may increase motor vehicle accidents, opioid use disorder and overdose. Information on calculating total daily dose of opioids is available on the CDC website.

For additional information, the full CDC Guideline for Prescribing Opioids for Chronic Pain is available here.


Medication Assisted Treatment (MAT)

Medications in combination with counseling and behavioral therapies can provide a holistic, patient approach to the treatment of opioid dependency. The HUSKY Health program covers a number of medications used in the treatment of opioid use disorders.

The following medications are currently covered:

  • Buprenorphine HCL tablet (Sublingual)
  • Methadone
  • Naltrexone (oral)
  • Suboxone film (sublingual)
  • Vivitrol (extended release naltrexone injectable)

Additional information on MAT is available on the MAT page of the CT BHP website. The MAT page includes a variety of helpful resources including a search tool providers may use to locate CMAP providers offering MAT services. Providers may search by provider, town, or treatment modality.

Providers should be aware of the specific regulatory requirements for the administration of methadone and buprenorphine products for the treatment of opioid use disorder. ED clinicians should avoid providing replacement doses for Methadone or Suboxone for patients participating in a medication assisted treatment MAT program unless the dose is verified with the treatment program and the patient’s ED visit has prevented administering of their scheduled dose.

Non-Opioid Services & Treatments For Chronic Pain

Care Coordination

To the extent possible, hospitals should develop a process to coordinate the care of patients who frequently visit the ED. Recommendations include the following:

  • Developing an internal process to identify and provide notice to the patient’s PCP that the patient was prescribed or sought opioid medications or was treated for an overdose. If appropriate, the ED should notify the PCP of a positive screening for opioid misuse or opioid use disorder as well as the information provided to the patient
  • Discussing follow up care with the patient that may include referrals to treatment, referrals to community support programs and/or follow-up appointments with appropriate providers
  • Maintaining a list of local primary care and mental health clinics that provide follow-up care for patients


HUSKY Health Emergency Department Care Management Program

The Emergency Department Care Managers (EDCM) receives instant notification for HUSKY members that go to the EDs with certain trigger diagnoses. Claims and Electronic Medical Records (EMR) are reviewed to identify utilization, ED care and medications. The EDCM will speak to the hospital Care Managers in the ED for members that are difficult to contact in the community. For members with identified behavioral health or substance abuse diagnoses, the EDCM will collaborate with CTBHP staff dedicated to 5 Connecticut EDs (Hartford, St Francis, Yale, Bristol and Backus). Members are asked to sign a release of information form for the Community Care Team (CCT). The members discussed at these meetings are provided strong support in the community from the behavioral health support team, providers, and peers.

If the member is able to speak to the EDCM, the engagement process is started while the member is in the ED. For members discharged from the ED a telephonic outreach call is made to members with numerous ED visits in a rolling 12 month period. The EDCM will complete a telephonic assessment and work with the member to schedule a follow-up appointment for their PCP post ED visit. If a member does not have a PCP, the EDCM will work with the member to locate a PCP and schedule an appointment. If the member needs a specialist or pain management provider they are referred to ICM. Members are also referred to ICM for further assistance with coordination of care and access to services. ICM will also provide education on medical conditions.

HUSKY Health Member Engagement Services and Escalation Unit

For further clarification of covered medical benefits or for assistance with locating a CMAP enrolled medical provider providers may contact the HUSKY Health Member Engagement Services and Escalation Unit. The representatives are available to ease the coordination of care for patients with chronic pain by locating and providing appointment assistance and helping with referrals to pain management specialists. Providers can “Reach for Escalation” by calling 1.800.440.5071, Monday through Friday, 8:00 a.m. - 6:00 p.m. or by completing the on line “Reach for Escalation” form available on the HUSKY Health website at www.ct.gov/husky. To download this form click here.

HUSKY Health Intensive Care Management Program

The HUSKY Health Intensive Care Management (ICM) Program can assist providers with coordinating care for patients with chronic pain by assessing the patient’s health status, barriers and strengths; developing a patient centered care plan; identifying gaps in care; coordinating with specialists; coordinating with the CT BHP; conducting patient visits, coordinating transportation; and providing appointment reminders. To refer patients to the ICM program, providers can call 1.800.440.5071, Monday through Friday, 8:00 a.m. – 6:00 p.m. and select the prompt for Intensive Care Management or complete the ICM Referral form available on the HUSKY Health website at www.ct.gov/husky and fax to: 866.361.7242. To download this form click here.

Behavioral Health Services

  • MAT including methadone maintenance, buprenorphine and naltrexone
  • Ambulatory Detoxification
  • Inpatient Detoxification
  • Outpatient Detoxification
  • Outpatient Counseling
  • Intensive Outpatient Treatment
  • Partial Hospitalization
  • HUSKY D has services for Residential Substance Abuse Rehab covered by Advanced Behavioral Health which can be reached at 1.800.606.3677, Monday through Friday, 8:30 a.m. – 5:00 p.m.

For further clarification of covered benefits or assistance in locating a CMAP enrolled behavioral health provider offering one or more of the above services, providers may contact the CT BHP at 1.877.552.8247, Monday - Friday, 9:00 a.m. – 7:00 p.m.

Dental Health Services

Pain management remains a significant consideration in dental care and patient management. For assistance with locating a dental provider, providers may contact the Connecticut Dental Health Partnership (CTDHP), at 1.855.283.3682, Monday through Friday, 8:00 a.m. - 5:00 p.m.

CTDHP representatives will:

  • Assist providers with locating a dental provider
  • Coordinate dental care
  • Provide case management
  • Assist with obtaining additional resources

Under the CTDHP the following services are covered:

  • Exams
  • Dentures
  • Cleanings
  • Crowns
  • Root Canals
  • X-rays
  • Fillings
  • Oral Surgery
  • Extractions
  • Orthodontia

Additional information is available at www.ctdhp.com.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

EDs are encouraged to develop a process to screen for patient substance misuse risk that includes services for brief intervention and referrals to treatment programs for patients who are at risk for developing or who actively have substance use disorders. Opioids should be prescribed with great caution in the context of a substance abuse history. All patients for whom ED providers are considering writing an opioid prescription should be screened.

Screening tools should be used to assess the patient’s risk of opioid misuse or use disorder. Screening will help providers make patient-specific treatment decisions and recommendations for follow-up care. The SBIRT process is used in a number of hospitals.

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.

The components of SBIRT are:

  • Screening to quickly assess the severity of substance use and to identify the appropriate level of treatment.
  • Brief Intervention which focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change and which includes non-judgmental conversations about an individual’s substance use
  • Referral to Treatment in order to provide those identified as needing more extensive treatment with access to specialty care

Providers may access additional information on SBIRT on the Substance Abuse and Mental Health Services Administration (SAMHSA) website at https://www.samhsa.gov/sbirt/about.

Connecticut Department of Social Services (DSS) Provider Bulletin PB 2015-79 “Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care”, published in October 2015, notifies providers of the availability of reimbursement for SBIRT services. Guidance related to coding, claims submission, and referral and supportive resources is included in the bulletin.

SBIRT App

The SBIRT App for Screening, Brief Intervention, and Referral to Treatment for substance use provides users with detailed steps to complete an SBIRT intervention with patients or clients. The app is designed for use by physicians, other health workers, and mental health professionals and can be used with patients and clients 12 years and older. The app provides evidence-based questions to screen for alcohol, drugs and tobacco use. If warranted, a screening tool is provided to further evaluate the specific substance use. The app also provides steps to complete a brief intervention and/or referral to treatment for the patient based on motivational interviewing.

Integrated within the app are three screening instruments for substance use: the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) assesses substance use in adolescents, the Alcohol Use Disorders Identification Test (AUDIT) assesses alcohol use in adults, and the Drug Abuse Screening Test (DAST) assesses drug use in the adults.

To download this app to your smartphone, visit your app store.

This portion of the HUSKY Health website is managed by Community Health Network of Connecticut, Inc., the State of Connecticut’s Medical Administrative Services Organization for the HUSKY Health Program. For the general HUSKY website gateway, please visit www.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services.

Copyright © 2002-2016 State of Connecticut.

Privacy Statement   Disclaimer