Compiled & Edited by Sue Emerson – Publisher
Prior Edition: August 2010
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
- Risk Factors for Painkiller Addiction Identified
- New Philadelphia Mural Celebrates Recovery From Addiction
- National Survey Reveals Increases in Substance Use From 2008 To 2009
- SAMHSA Announces New Online Continuing Education Courses for Substance Abuse Treatment Professionals
- Advisory Group Recommends New Addictions Institute Replace NIAAA, NIDA
- New Data Show Millions of Americans with Alcohol and Drug Addiction Could Benefit from Health Care Reform
DRUG USE AND OLDER ADULTS
- Emergency Department (ED) Visits Involving Illicit Drug Use by Older Adults: 2008
- Aging Drug Users are Increasing and Facing Chronic Physical and Mental Health Problems
- The Addiction Files: How Do We Define Recovery? — An Interview With William White
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
Risk Factors for Painkiller Addiction Identified
Researchers have found four common risk factors among study participants addicted to opioid painkillers, and found evidence that genes could play a part in the addiction, Medical News Today reported Aug. 28.
Investigators from Geisinger Health System interviewed 705 patients suffering from chronic pain who had been prescribed opioid painkillers for over 90 days, and examined their DNA. Researchers found that patients 65 years old or younger, using psychiatric medications, or with histories of drug abuse or depression were more likely to be addicted to the painkillers. Over one in four participants who were currently addicted had all four risk factors.
“By assessing patients in chronic pain for these risk factors before prescribing painkillers, doctors will be better able to treat their patients’ pain without the potential for future drug addiction,” said Joseph Boscarino, Ph.D., an epidemiologist and senior investigator at Geisinger’s Center for Health Research.
The study also looked at chromosome 15 where a gene had previously been linked to dependency on alcohol, nicotine, and cocaine. Researchers found evidence suggesting that genetic mutations on the same chromosome may be linked to opioid addiction.
The findings were published online in the journal Addiction.
Source: JoinTogether.org – September 7, 2010
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New Philadelphia Mural Celebrates Recovery From Addiction
On Sept 22 a mural was unveiled on the walls of the JEVS methadone clinic in North Philadelphia. They tell stories of struggle and new beginnings, and were painted with the help of recovering patients.
The patients worked on the mural in sections In the basement of JEVS as part of their ongoing therapy. During several poetry workshops, participants wrote about their experiences and hopes for the future, their poems became part of the mural.
The mural is part of a partnership between the city’s Mural Arts program and the department of Behavioral Health. One of the goals is to connect people in recovery to the healing power of art, as well as re-connect them with family members and their communities.
Additional information and photos of the mural can be accessed at: http://whyy.org/cms/news/health-science/behavioral-health-health-science/2010/09/22/new-philadelphia-mural-celebrates-recovery-from-addiction/46346
Source: WHYY Philadelphia—September 22, 2010
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National Survey Reveals Increases in Substance Use From 2008 To 2009
The use of illicit drugs among Americans increased between 2008 and 2009 according to a national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). The National Survey on Drug Use and Health (NSDUH) shows the overall rate of current illicit drug use in the United States rose from 8.0 percent of the population aged 12 and older in 2008 to 8.7 percent in 2009. This rise in overall drug use was driven in large part by increases in marijuana use.
The annual NSDUH survey also shows that the nonmedical use of prescription drugs rose from 2.5 percent of the population in 2008 to 2.8 percent in 2009.
“Today’s findings are disappointing, but not surprising, because eroding attitudes and perceptions of harm about drug use over the past two years have served as warning signs for exactly what we see today.” said Director of National Drug Control Policy, Gil Kerlikowske. “Fortunately, this Administration’s National Drug Control Strategy, with its focus on prevention, treatment, smart law enforcement, and support for those in recovery, highlights the right tools to reduce drug use and its consequences.”
As in previous years, the 2009 NSDUH shows a vast disparity between the number of people needing specialized treatment for a substance abuse problem and the number who actually receive it. According to the survey, 23.5 million Americans aged 12 or older (9.3 percent of this population) need specialized treatment for a substance abuse problem, but only 2.6 million (or roughly 11.2 percent of them) receive it.
NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older.
The complete survey findings are available on the SAMHSA website at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf
Source: Substance Abuse and Mental Health Services Administration — September 16, 2010
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SAMHSA Announces New Online Continuing Education Courses for Substance Abuse Professionals
SAMHSA has five new online courses for substance abuse treatment professionals including two on prescription opioid misuse, abuse, dependence and addiction:
- Prescription Medication (Part 1): Misuse, Abuse, and Dependence — Instructs substance abuse treatment professionals about prescription medication use, abuse, misuse, and dependence. It presents trends in the use of prescription medications and compares medication classes: opioid analgesics (pain relievers), sedative-hypnotics (benzodiazepines and barbiturates), and stimulants.
- Prescription Medication (Part 2): Addressing Addiction — Provides information for substance abuse treatment professionals about treating patients who are addicted to prescription medications. It includes information about screening, assessment, and treatment planning for their patients.
These courses provide one continuing education unit per module for maintaining certification or licensure.
The five e-learning courses are available at:
Knowledge Application Program (KAP) E-Learning Web site page
Source: The Substance Abuse and Mental Health Services Administration — August 27, 2010
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Advisory Group Recommends New Addictions Institute Replace NIAAA, NIDA
An expert working group recommended on Sept. 15 to replace the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) with a new Institute on Addictions within the National Institutes of Health (NIH), according to an e-mail sent to NIAAA liaison representatives.
The Substance Use, Abuse, and Addiction (SUAA) Working Group was created in 2009 by the Scientific Management Review Board (SMRB) to advise it on whether NIH should be reorganized to maximize its work on addictions. The question of whether NIH should combine NIAAA and NIDA — both founded in the early 1970s — has been a topic of debate for several decades.
The SUAA Working Group said in its report (PDF) that although its members agreed unanimously that the current NIH structure was not effective, they disagreed on how to address the problem.
After numerous meetings and gathering public input, the working group recommended two options for consideration: “(1) a single institute focused on addiction, in which all NIH addiction-related research would be relocated, or (2) a trans-NIH addiction program (like the Neuroscience Blueprint) with participation from all institutes and centers that fund addiction-related research.”
In other words, the first option was a structural merger of NIAAA, NIDA, and other addiction research portfolios located in other NIH centers. The second proposed option was a functional one, designed to support interdisciplinary work on addictions without changing the NIH’s organizational structure. Interestingly, the SUAA Working Group’s report noted that a NIDA advisory council had voted unanimously for the first option, while a NIAAA advisory council voted unanimously for the second option.
What happens next? NIH director Dr. Francis S. Collins, M.D., Ph.D. has to decide whether to accept the recommendations of the SMRB. If he does, the actual structure of the new institute would need to be hammered out.
Then the Secretary of the Department of Health and Human Services, of which NIH is a part, would need to sign off on the new institute, followed by a six-month review period for Congressional “notification” and public comment.
Source: JoinTogether.org – September 17, 2010
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New Data Show Millions of Americans with Alcohol and Drug Addiction Could Benefit from Health Care Reform
New government data released on Sept 16 demonstrate the continued, urgent need for more Americans to have access to drug and alcohol addiction treatment, according to an analysis by the Closing the Addiction Treatment Gap (CATG) initiative. If implemented properly, federal health care reform legislation could help remove financial barriers to treatment for millions of Americans.
According to Defining the Addiction Treatment Gap, a CATG review of the annual National Survey on Drug Use and Health released by the Substance Abuse and Mental Health Services Administration (SAMHSA) and other national data sources, addiction continues to impact every segment of American society.
“Our society and our health care system have been slow to recognize and respond to addiction as a chronic, but treatable, condition,” said Dr. Kima Joy Taylor, director of the CATG Initiative. “While change doesn’t happen overnight, if health care reform is implemented properly, millions of Americans will finally have insurance coverage for addiction treatment. This is an historic step toward a comprehensive, integrated approach to health care that includes treatment of addiction.”
Defining the Addiction Treatment Gap is intended to provide statistical context for efforts to close America’s addiction treatment gap, including the design of an addiction treatment benefit as part of health care reform implementation. According to CATG, a number of important factors should be considered:
- Twenty-three million Americans are currently addicted to alcohol and/or other drugs. Only one in 10 of them (2.6 million) receives the treatment they need. The result: a treatment gap of more than 20 million Americans.
- Cost and lack of insurance is the primary obstacle cited by Americans who say they need but are unable to receive treatment. Among those able to access treatment, nearly half (48.4 percent) reported using their own money to pay for their care.
In contrast to other chronic diseases, funding for addiction treatment disproportionately comes from government sources. More than three-quarters — 77 percent — of treatment costs are paid by federal, state and local governments, including Medicaid and Medicare. Private insurance covers only 10 percent of addiction treatment costs, with out-of-pocket expenditures and other private funding making up the remaining percentage. In contrast, private insurance pays for approximately 37 percent of general medical costs.
Screening and treatment is not integrated into the health care delivery system. Less than seven percent of those receiving treatment were referred by another health provider. In contrast, slightly more than two-thirds of those receiving treatment got there through self-referrals or the criminal justice system.
Citations for this data, along with a review of current data on addiction and treatment, are available at www.treatmentgap.org.
“Congress embraced addiction treatment as an essential part of health care reform,” said Gabrielle de la Gueronniere, JD, director for national policy at the Legal Action Center and a member of the CATG initiative. “But federal and state regulators are now tasked with translating and implementing that vision. This may be the single greatest opportunity in our lifetime to make a difference. The costs of untreated addiction are too great to not get this right.”
At the national level, Closing the Addiction Treatment Gap is focused on four key elements that are necessary to maximize the opportunity presented by health care reform:
- Developing a meaningful addiction treatment benefit that covers a full continuum of addiction services for both the patient and the patient’s family, as appropriate;
- Improving coordination and integration of available services, including wellness and prevention services, screening, intervention, treatment and other supports;
- Monitoring implementation to prevent new barriers to treatment, ensure full coverage for and access to appropriate care, including the utilization of strategies and interventions with demonstrated effectiveness; and
- Preserving federal and state safety nets to ensure treatment is still available to individuals not covered by health care reform, unable to afford insurance coverage even with subsidies, or with insufficient coverage. Unfortunately, systemic and societal obstacles continue to prevent many people from seeking addiction treatment. A number of current government policies result in discrimination—housing, education, health care and employment—against those who disclose a history of addiction. These barriers can hinder the long-term health of those seeking to address an addiction through treatment. Although there has been progress in reducing both the stigma and the discriminatory policies, many people with addiction histories are unable to fully exercise their rights and participation in society.
The 12-page report can be accessed at:
Source: Open Society Foundations—September 16, 2010
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DRUG USE AND OLDER ADULTS
Emergency Department (ED) Visits Involving Illicit Drug Use by Older Adults: 2008
In 2008, the majority of ED visits involving illicit drug use by older adults (71.2 percent) were made by males. More than half were made by adults aged 50 to 54 (58.2 percent) (Figure 1). More than half of visits were made by non-Hispanic blacks (58.2 percent), nearly one third were made by non-Hispanic whites (31.3 percent), and nearly one tenth were made by Hispanics (9.8 percent).
|Figure 1. Emergency Department (ED) Visits Involving Illicit Drugs by Adults Aged 50 or Older, by Age Group: 2008|
ED visits made by adults aged 50 to 64 were more likely to involve cocaine than visits made by those aged 65 or older (63.8 vs. 48.3 percent) (Figure 2). Involvement of heroin and illicit stimulants did not differ by age group.
Discharge from the ED
Less than half of ED visits involving illicit drug use by older adults (48.1 percent) resulted in evidence of follow-up care. This varied by drug, with follow-up care resulting from 54.3 percent of visits involving cocaine, 48.1 percent involving illicit stimulants, 43.6 percent involving heroin, and 39.3 percent involving marijuana (Figure 2).
|Figure 2. Follow-up Disposition of Emergency Department (ED) Visits Involving Selected Illicit Drugs by Adults Aged 50 or Older: 2008|
As Americans continue to live longer, researchers and health professionals are attempting to understand the effects of illicit drugs on older individuals. The impaired cognitive and motor functions resulting from the use of illicit drugs may exacerbate age-related physiologic changes. Falls, other accidents, and prescription medication interactions are of special concern.
Less than half of ED visits involving illicit drug use by older adults resulted in follow-up care; therefore, continued efforts to provide referrals in the ED may help older adults to receive appropriate treatment for substance abuse problems. ED visits involving heroin use in this population had an especially low rate of follow-up care and may represent missed opportunities for intervention.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, and illicit stimulants (e.g., amphetamines and methamphetamines).
The 4-page report can be accessed at:
Source: The Drug Abuse Warning Network (DAWN) Report — September 9, 2010
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Aging Drug Users are Increasing and Facing Chronic Physical and Mental Health Problems
Health and social services are facing a new challenge, as many illicit drug users get older and face chronic health problems and a reduced quality of life. That is one of the key findings of research published in the September issue of the Journal of Advanced Nursing.
UK researchers interviewed eleven people aged 49 to 61 in contact with voluntary sector drug treatment services. The nine men and two women who took part in the study had an average age of 57. All were currently single and their homes ranged from a caravan, hostel or care home to social housing.
Key findings from the study – by the Evidence-based Practice Research Centre at Edge Hill University and the Centre for Public Health at Liverpool John Moores University included:
- Most started taking drugs as adolescents or young adults, often citing recreational use, experimenting or being part of the hippy era. Child abuse and the death of a parent were also mentioned.
- Some started taking drugs late in life due to stressful life events like divorce or death. Meeting a drug using partner was another trigger. One man started taking drugs later in life to shock his drug taking partner into stopping and ended up developing a drug habit himself.
- Some increased their drug use over time, while others had periods when they tried to reduce or even abstain from drugs. All but two of the participants were taking methadone, either as maintenance or as part of a reduction strategy in order to give up drugs.
- Most recognized that their drug use was having detrimental and cumulative effects on their health, as they had developed a range of chronic and life-threatening conditions that required hospitalization and ongoing treatment.
- Physical health conditions included: circulatory problems such as deep vein thrombosis, injection site ulcers, stroke, respiratory problems, pneumonia, diabetes, hepatitis and liver cirrhosis. Malnutrition, weight loss and obesity also featured, as did accidental injuries due to falls and drug overdoses.
- Common mental health problems included memory loss, paranoia and changed mood states, with anxiety or anger also featuring.
The article can be accessed at no charge at:
Source: Wiley Online Library — September 9, 2010
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The Addiction Files: How Do We Define Recovery? — An Interview With William White