AT Forum NEWS NOTES & UPDATES #114
November – December 2007
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: September/October 2007
Contents
MMT
Methadone Maintenance Results in Earlier Improvement in Quality of Life than Buprenorphine for Heroin Users
Do Mortality Rates Differ by Type of Pharmacotherapy for Opioid Dependence?
Menopause Symptoms in Midlife Women in MMT Mimic Those of Inadequate Methadone Dosing or Withdrawal
NALOXONE IN THE NEWS
Massachusetts to Distribute Overdose Medication to Addicts
HIV/AIDS
HAART and Drug Treatment May Improve Survival in People With HIV Who Inject Drugs
Injection-Room Plan Gets Mixed Reaction in San Francisco
WHAT IS RECOVERY?
Defining Recovery From Substance Abuse
GOVERNMENT
NIDA Issues Updated InfoFacts on Drugged Driving
New Codes to Enhance Screening and Intervention for Substance Abuse
SAMHSA Pilot Program Provides Consumer Information to Help Prevent Abuse of Prescription Drugs
Research Roundup
MMT
Methadone Maintenance Results in Earlier Improvement in Quality of Life than Buprenorphine for Heroin Users
This study used the Quality of Life Enjoyment and Satisfaction Questionnaire to assess the responses of heroin users receiving buprenorphine versus methadone in non-experimental programs at outpatient centers. Responses to the questionnaires were gathered at the start of treatment (304 patients) and at 4 and 8 months later (180 and 129 retained patients, respectively). Statistically significant improvements in Quality of Life (QoL) were seen in patients in both groups at 4 and 8 months, but the improvement occurred earlier in the methadone group—during the first month of treatment—and remained stable until the end of the program. The authors noted that additional studies are necessary to identify the factors related to the benefits and to explain the differential timeline.
Source: Ponizovsky AM, Grinshpoon A. Quality of life among heroin users on buprenorphine versus methadone maintenance. Am J Drug Alcohol Abuse. 2007;33(5):631-642.
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Do Mortality Rates Differ by Type of Pharmacotherapy for Opioid Dependence?
The risk of death from overdose associated with induction, maintenance, or discontinuation of an opioid pharmacotherapy may depend on the opioid’s mechanism of action. For example, methadone (full agonist) treatment may pose the greatest risk during treatment induction, whereas oral naltrexone (an antagonist) may be riskiest immediately after treatment is discontinued, because of diminished opioid tolerance.
In this study, Australian researchers analyzed coroners’ reports and various prescription data sources to estimate mortality rates possibly associated with these pharmacotherapies.
- From 2000 to 2003, drug-related deaths occurred as follows: buprenorphine, 1*; oral naltrexone, 32; and methadone, 282.
- The overall mortality rate associated with methadone was significantly lower than the rate associated with oral naltrexone (2.7 vs. 10.1 per 1000 treatment episodes).
- The mortality rate associated with methadone treatment was 3.0 per 100 person-years during the first week of treatment versus 0.34 per 100 person-years during the remainder of treatment.
- The mortality rate associated with oral naltrexone treatment was 1 per 100 person-years during treatment, versus 22.1 per 100 person-years in the 2 weeks after treatment was discontinued.
Author Comments: Although the methods used permit only crude estimates, and specific causes of death were not addressed, these findings heighten concerns about the possible increased risk of opioid overdose shortly after oral naltrexone treatment is discontinued. More rigorous studies are needed to refine the estimates presented here, to define risks and benefits of other (eg, depot) preparations of naltrexone in treating opioid dependence, and to develop treatment protocols to further enhance the safety profiles of specific opioid pharmacotherapies.
*The low number of buprenorphine-associated deaths precluded meaningful analysis.
Published in: Alcohol, Other Drugs, and Health: Current Evidence
Boston University School of Medicine/ Boston Medical Center
September/October 2007 issue. Article accessed 11/7/07
Marc N. Gourevitch, MD, MPH
Original Source: Gibson AE, Degenhardt LJ. Mortality related to pharmacotherapies for opioid dependence: a comparative analysis of coronial records. Drug Alcohol Rev. 2007;26(4):405–410.
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Menopause Symptoms in Midlife Women in MMT Mimic Those of Inadequate Methadone Dosing or Withdrawal
Women in MMT face special problems during menopause. Conditions common in MMT, such as hepatitis C infection, HIV/AIDS, psychological distress, and underlying irritability and depression, can intensify menopausal symptoms and can lead to a relapse into illicit drug use.
A study published in August in Social Work in Health Care investigated menopausal status in 135 methadone-maintained urban women aged 40 to 55 years. Subjects reported an average of about six menopause symptoms, the most common being irritability (69%) and depression (64%), followed by several estrogen-related symptoms.
The author commented on the similarity between many menopause symptoms and those of opioid withdrawal, or inadequate methadone dosing. Symptoms common to both groups include sweats, insomnia, anxiety, depression, poor concentration, fatigue, decreased libido, weight gain, and aching joints. Health care workers may attribute these symptoms in menopausal women in MMT to insufficient methadone dosing, when actually menopausal changes are the cause, and vice-versa. As a result, the author noted, women in this group may be erroneously under-treated or over-treated with methadone—and thus may be at high risk for relapse into illicit drug use.
Tuchman E. Exploring the prevalence of menopause symptoms in midlife women in methadone maintenance treatment. Soc Work Health Care.2007;45(4):43-62.
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NALOXONE IN THE NEWS
Massachusetts to Distribute Overdose Medication to Addicts
The Massachusetts Department of Public Health will distribute kits containing the anti-overdose drug naloxone (Narcan) to opiate addicts statewide, mirroring a project piloted in Boston last year, the Boston Globe reported Nov. 2. In this controversial plan, State Public Health Commissioner John Auerbach noted the many deaths in Massachusetts resulting from heroin overdose. He said that there are people who are not ready for treatment, “and we want to prevent them from dying from a fatal overdose before we have an opportunity to convince them to get into treatment,” he said.
Critics, on the other hand, believe that giving naloxone to users will remove the motivation to change their behavior. Michael Gimbel, a recovering heroin addict who has directed substance abuse programs in Maryland, commented that the addict “is going to say, ‘I just overdosed and I got another lease on life—great.’” The federal Office of National Drug Control Policy also objected to the plan, saying that naloxone should be administered only under medical supervision. For the complete story, see the Source below:
Source: JoinTogether.org – November 5, 2007
Each of the kits to be distributed contains two prepackaged doses of naloxone. Each dose comes in a syringe, and a wedge device is attached to create a mist. A dose is sprayed into the nose of the overdose victim, and the naloxone is absorbed by the nasal membranes. The overdose victim need not be conscious to be treated.
Source: http://psychology.wikia.com/wiki/Naloxone
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HIV/AIDS
HAART and Drug Treatment May Improve Survival in People With HIV Who Inject Drugs
Highly active antiretroviral therapy (HAART) and methadone treatment have significantly improved length of survival in people with HIV and opioid dependence, respectively. It is not clear, however, whether HIV infection and HAART influence the length of survival among people with injection drug use (IDU) who receive methadone treatment.
This observational study from Spain examined survival data among 1181 people with IDU (59% with HIV) who had been admitted to a substance-abuse treatment program before or after 1997 (the era of established methadone programs and HAART). One-third of subjects with HIV had received HAART.
- Survival was shortest in people with IDU and HIV admitted to drug treatment before 1997.
- But length of survival has improved substantially since 1997, when HAART was introduced.
- Since 1997, length of survival in people with IDU and HIV was similar to that in people with IDU, but not HIV.
Comments: This study supports the benefit of both HAART and methadone treatment on survival in people with IDU and HIV. The longer survival in patients who did not receive HAART may be partially attributable to access to drug treatment, prophylaxis for opportunistic infections, and ongoing clinical care. The increase in survival, even in patients with HIV who did not receive HAART, is encouraging. Yet it reminds us of the challenge in providing state-of-the-art care to patients with substance-use disorders and HIV.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue September/October 2007. Article accessed 11/7/07/07.
David A. Fiellin, MD.
Original Source: Muga R, Langohr K, Tor J, et al. Survival of HIV-infected injection drug users (IDUs) in the highly active antiretroviral therapy era, relative to sex- and age-specific survival of HIV-uninfected IDUs. CID. 2007;45(3):370–376.
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Injection-Room Plan Gets Mixed Reaction in San Francisco
Some San Francisco drug-reform advocates and health officials say that allowing addicts to shoot up in a government-sponsored and medically supervised setting will prevent overdoses and the spread of HIV. But the idea has been met with some skepticism even in this liberal city, the San Francisco Chronicle reported Oct. 19.
The Alliance for Saving Lives is calling on the city to "create a legal Safer Injection Facility staffed with trained medical professionals." But Mayor Gavin Newsom said that he doubts any neighborhood in the city would be willing to host the program, not even the notorious Tenderloin. Vancouver has the only safe-injection facility in North America, but many such facilities exist in Europe. Read the full story at either of the links in this summary.
Source: JoinTogether.org – October 25, 2007
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WHAT IS RECOVERY?
Defining Recovery From Substance Abuse
(November 2, 2007) Abstinence from alcohol and drugs is just the starting point in defining "recovery" for people with substance abuse disorders, according to a paper in the October issue of the Journal of Substance Abuse Treatment (JSAT).
An initial definition developed by a panel of experts from the Betty Ford Institute defines recovery as “a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship." The panel's report appears as part of a special section of JSAT devoted to Defining and Measuring Recovery.
The full article may be accessed by clicking on the link below:
Article adapted by Medical News Today from original press release.
The articles appear in the Journal of Substance Abuse Treatment, October 2007, published by Elsevier.
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Government
NIDA Issues Updated InfoFacts on Drugged Driving
In October, the National Institute of Drug Abuse updated the InfoFacts report on Drugged Driving. Highlights include:
What is Drugged Driving?
In 12 states (Arizona, Georgia, Indiana, Illinois, Iowa, Michigan, Minnesota, Nevada, Pennsylvania, Rhode Island, Utah, and Wisconsin), it is illegal for a driver to operate a motor vehicle if the driver’s blood contains any detectable level of a prohibited drug, or its metabolites. Other state laws define "drugged driving" as driving when a drug "renders the driver incapable of driving safely," or "causes the driver to be impaired."
How Many People Take Drugs and Drive?
The National Highway Traffic Safety Administration (NHTSA) reports that 17,000 people were killed in alcohol-related crashes in 2006. Studies have found that drugs are used by 10 to 22 percent of drivers involved in crashes, often in combination with alcohol.
According to the 2006 National Survey on Drug Use and Health (NSDUH), an estimated 9.5 million people age 12 and older reported driving under the influence of illicit drugs during the year prior to the survey.
Research indicates that marijuana is the illegal drug most often detected in impaired drivers, fatally injured drivers, and motor vehicle crash victims. A variety of other drugs, such as benzodiazepines, cocaine, opiates, and amphetamines, also have been reported in fatal and nonfatal motor vehicle crashes.
A number of studies have examined illicit drug use in drivers involved in motor vehicle crashes, reckless driving, or in fatal accidents. For example:
- While 34 percent of drivers admitted to a Maryland trauma center tested positive for drugs only, 16 percent tested positive for alcohol only; and 50 percent of those under 18 tested positive for alcohol and/or drugs. Although more people in this study tested positive for drugs alone, compared to alcohol alone, findings from a single geographic location cannot be generalized. In fact, many studies in similar populations have found higher prevalence rates of alcohol use than drug use.
- Of almost 3,400 fatally injured drivers from 3 Australian states (Victoria, New South Wales, and Western Australia) between 1990 and 1999, drugs other than alcohol were present in 26.7 percent of the cases. The drugs included cannabis (13.5 percent), opioids (4.9 percent), stimulants (4.1 percent), benzodiazepines (4.1 percent), and other psychotropic drugs (2.7 percent). Almost 10 percent of the cases involved both alcohol and drugs.
To access the complete fact sheet <click here… >
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New Codes to Enhance Screening and Intervention for Substance Abuse
Beginning January 1, 2008, health care professionals will be able to offer on-the-spot screening and intervention services to patients who abuse or are addicted to drugs or alcohol. The new service will enable health care workers to dedicate time and resources to assess patients’ risk by asking a series of specific questions, and, when appropriate, to offer immediate intervention.
The service is based on Current Procedural Terminology (CPT®) codes issued by the American Medical Association. The codes will streamline reporting and reimbursement procedures for doctors who perform structured screening and brief intervention services for alcohol or substance (excluding tobacco) abuse. The new codes will also give medical professionals a way to communicate with colleagues, patients, and insurers about screening and intervention procedures. Publication of the codes was announced by the White House Office of National Drug Control Policy (ONDCP).
For more information on the new codes (99408 and 99409) please visit: http://www.whitehousedrugpolicy.gov/
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SAMHSA Pilot Program Provides Consumer Information to Help Prevent Abuse of Prescription Drugs
Abuse of prescription drugs—particularly the nonmedical use of pain relievers—is growing, especially among teens and young adults. To help counteract this increase, the Substance Abuse and Mental Health Services Administration (SAMHSA) is launching a 26-week pilot program to provide point-of-sale information sheets on substance-abuse prevention to consumers of highly abused prescription drugs. These drugs include hydrocodone, certain sleep aids, and oxycontin.
According to SAMHSA Administrator Terry Cline, PhD: “Most prescription drug abusers say they get access to these drugs through a friend or relative. That’s why this program is so important—consumers need to understand that these beneficial prescription medications can pose serious potential health risks if abused, and if they fall into the wrong hands. Armed with this abuse prevention information and advice on how to properly store and dispose of these drugs, consumers can play a major role in helping eliminate this problem.”
Using the services of Catalina Marketing Corporation, SAMHSA is delivering the abuse-prevention information sheets through 6,300 pharmacies throughout the country participating in the pilot program. Themes covered include information on disposing of unused medication and on storing drugs (many teens and young adults report that they can easily obtain drugs from the family medicine cabinet).
For more information, go to http://www.samhsa.gov/rxsafety/
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All facts and opinions are those of the sources cited. News reports may have been edited for length and/or modified for clarity without altering essential data as originally published.
Addiction Treatment Forum and its associates do not endorse any medications, products, or treatments described, mentioned, or discussed in any of the sources referenced. Nor are any representations made concerning efficacy, appropriateness, or suitability of any such products or treatments. This News Update is made possible by an educational grant from Mallinckrodt Inc., distributors of methadone and naltrexone.
In view of the possibility of human error or advances in medical knowledge, Addiction Treatment Forum and its associates do not warrant the information contained in the above news updates is in every respect accurate or complete, and they are not responsible nor liable for any errors or omissions that may be found in such information or for results obtained from use of such information.