Addiction Treatment Forum reports on substance abuse news of interest to opioid treatment programs and patients in methadone maintenance treatment.

NEWS NOTES & UPDATES #127

newsJanuary 2009

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: December 2008

List of all News/Updates

 

Contents

MEDICATION-ASSISTED TREATMENT (MAT)

EUROPAD Journal – Heroin Addiction and Related Clinical Problems. 2008(December), Vol. 10, No.4 - Now Available Online

Buprenorphine for Opioid Dependence: Why Is It Underprescribed?

IN THE NEWS

NASADAD Urges Congress to Include Block Grant in Stimulus Package

States Demand More Evidence that Treatment Works

New York Trains Counselors to Treat Dual Diagnosis

NIDA Releases New Report on Comorbidity of Addiction and Other Mental Illnesses

RESEARCH

Provider Discussions May Improve Substance Abuse Treatment in HIV-infected Persons

Less Than One in Five Inmates Needing Addiction Treatment Gets Help, NIDA Reports

NEW BOOKS FOR MAT PATIENTS & THEIR FAMILIES

Overcoming Prescription Drug Addiction – A Guide to Coping & Understanding

Overcoming Addiction: Paths toward recovery


MEDICATION-ASSISTED TREATMENT

EUROPAD Journal – Heroin Addiction and Related Clinical Problems. 2008(December), Vol. 10, No.4 Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction.

Articles in this issue include:

The PDF file can be downloaded from ATForum.com at: <HeroinAdd10-4.pdf>

< Back to top >


Buprenorphine for Opioid Dependence: Why Is It Underprescribed?

Overwhelming evidence has demonstrated that opioid agonist treatment reduces adverse consequences of opioid dependence. To improve access to pharmacotherapy, the Food and Drug Administration approved buprenorphine, a partial μ-opioid agonist, to treat patients with opioid dependence in 2002. To date, however, there has been limited uptake of buprenorphine by physicians, particularly in general practices. In this study, investigators asked 172 physicians involved in 1 of 2 buprenorphine initiatives to complete surveys assessing factors likely to affect their willingness to prescribe buprenorphine. Respondents included 49 trained nonprescribers, 45 novice prescribers (prescribed buprenorphine to 30 or fewer patients), and 78 experienced prescribers.

Factors rated by all respondents as strongly affecting their willingness to prescribe buprenorphine included:

Experienced prescribers were less concerned than novice or nonprescribers about most factors, particularly induction logistics, access to consultation with a buprenorphine expert, and access to clinical guidelines.

Experienced prescribers were more concerned than novice or nonprescribers about reimbursement.

Comments: These data indicate that experience prescribing buprenorphine alleviates many associated concerns. Similarities in responses between novice and nonprescribers suggest that substantial experience is required before these concerns are significantly reduced. The desire for guidelines, expert support, and expanded training in this area is not surprising given the limited attention paid to drug addiction and treatment in medical school and residency training curricula.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2008. Access checked 1/29/09.
Julia H. Arnsten, MD, MPH

Original Source: Netherland J, Botsko M, Egan J, et al. Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2008 [Epub ahead of print].

< Back to top >

IN THE NEWS

governmentNASADAD Urges Congress to Include Block Grant in Stimulus Package

The economic stimulus package being considered by Congress should include an increase of at least $100 million for the federal Substance Abuse Prevention and Treatment (SAPT) Block Grant as well as more funding for addiction services under the Medicaid program, according to a letter sent to Congressional leaders by the National Association of State Alcohol and Drug Abuse Directors (NASADAD).

The letter, sent on December 18th to the House and Senate leadership as well as members of the House and Senate Appropriations Committees, noted that states are facing major fiscal challenges and said that investing in the block grant and Medicaid treatment would foster economic growth.

NASADAD reported that nearly 70 percent of state substance-abuse agencies are facing either a hiring freeze or laying off staff, about half have cut services, and 42 percent expect budget cuts in the future.

"An investment in the SAPT Block Grant ensures that resources will reach all states and territories in an effective and efficient manner," said Rob Morrison, interim executive director of NASADAD. "[I]ndividuals receiving services from SAPT Block Grant funded programs demonstrated high abstinence rates at discharge from both illegal drug (68.3 percent) and alcohol (73.7 percent) use. The SAPT Block Grant also ensures accountability given that providers, counties and States work together to report how services affect people's lives -- including the impact services have on alcohol and other drug use; employment; criminal justice activity; housing; and more. Thus, strong investments in federal-State programs, like the SAPT Block Grant, are a valuable way to foster economic growth and help those most in need of services

Source: JoinTogether.org – January 16, 2009

< Back to top >


States Demand More Evidence That Treatment Works

Spending on addiction treatment now tops $20 billion annually and could grow with the passage of the federal parity law, but more funders are pressing treatment programs to move beyond shaky claims of success and prove that they work.

The New York Times reported Dec. 23 that few treatment programs have evidence to prove their effectiveness: private programs generally don't allow outside evaluation, while publicly funded programs spend their money on providing services, not conducting studies. Moreover, the addiction treatment field lacks standard measures of success.

"What we have in this country is a washing-machine model of addiction treatment," said A. Thomas McClellan, CEO of the Treatment Research Institute. "You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you're discharged and everyone's crying and hugging and feeling proud -- and you're supposed to be cured ... It doesn't really matter if you're a movie star going to some resort by the sea or a homeless person. The system doesn't work well for what for many people is a chronic, recurring problem."

However, states like Oregon, Delaware, and North Carolina are beginning to demand that grantees use evidence-based practices and increase accountability. A 2003 Oregon law, for example, sought to increase use of interventions like naltrexone for alcohol dependence, buprenorphine for opiate addiction, motivational interviewing for incoming treatment patients, and cognitive behavior therapy.

More than half of Oregon's treatment budget now goes to programs that use evidence-based practices. "Before the mandate, most programs had some evidence-based practices, and since then there has been a lot more interest and awareness of them," said researcher Traci Rieckmann of Oregon Health and Science University.

However, Rieckmann said that some programs that claim to use evidence-based treatment may not be doing so, or implementing programs correctly. Many smaller programs, for example, don't have an M.D. on staff, so they can't prescribe medications like naltrexone. True reform will only come when patients are tracked throughout the treatment process to ensure that goals -- clearly defined beforehand -- are met, experts said.

The Oregon experience also has resulted in a culture clash between researchers and other backers of standardized interventions and counselors used to doing things their own way. Some experts say that there needs to be a place for "practice-based evidence" as the treatment system is reformed.

"I'm a counselor, and I'd be defensive, too: 'What do you mean, all this stuff I've been doing my entire life is wrong?' " said Brian Serna, director of outpatient services at the Adapt treatment program. "So the challenge is to build a bridge between what the science says is effective and what people are already doing."

Source: JoinTogether.org - December 23, 2008

< Back to top >


New YorkNew York Trains Counselors to Treat Dual Diagnosis

New York's Medicaid program has long hindered comprehensive treatment for people with co-occurring addiction and mental-health problems, but now the state is training more counselors to provide services to dually diagnosed patients, the Associated Press reported January 11, 2009.

The state's Office of Alcohol and Substance Abuse Services and the Office of Mental Health are working together to address a problem that affects 90 percent of individuals with both addiction and mental illness. Medicaid won't pay for both types of treatment simultaneously, so a $3.2-million grant from the National Development and Research Institutes is being used to train addiction counselors to address mental illness, and vice-versa.

"It is finally taking a person-centered approach to care, and saying emphatically, 'If you need treatment for a dual diagnosis, you will get it,'" said Karen Carpenter-Palumbo, commissioner of the state Office of Alcohol and Substance Abuse Services.

New York's addiction and mental-health screening, assessment, rehabilitation, discharge and aftercare programs also are being overhauled. Services will be integrated at 1,223 licensed addiction and mental-health outpatient programs statewide.

The full press release can be accessed at: http://www.nyshealthfoundation.org/content/article/detail/1466

Source: JoinTogether.org – January 14, 2009

< Back to top >


NIDA reportNIDA Releases New Report on Comorbidity of Addiction and Other Mental Illnesses

The National Institute on Drug Abuse (NIDA) recently released a research report, Comorbidity: Addiction and Other Mental Illnesses, summarizing the state of the science regarding the complex relationship between substance abuse and other mental disorders.

For the past 20 years, national surveys have documented the high prevalence of drug abuse among individuals diagnosed with other mental illnesses and vice versa. For example, studies show that people diagnosed with mood or anxiety disorders are about twice as likely to also suffer from a drug use disorder, and the inverse is also true. "We do not know enough yet to predict precisely whether one disorder will lead to the other(s) or how to prevent comorbidity," said NIDA Director Nora D. Volkow, M.D. "We do know, however, that the high rate of comorbidity means that we need a comprehensive approach to intervention that identifies, evaluates, and treats each disorder concurrently."

The report describes common factors that can lead to comorbidity, including genetic and gender vulnerabilities, involvement of similar brain regions, and the influence of developmental factors; and discusses how comorbidity can be diagnosed and treated. Several examples of behavioral therapies tested in patients with comorbid conditions--as well as potential medications--are outlined in the research report. The comorbidity research report also highlights some of the challenges of treating these conditions concurrently.

The 12-page report can be accessed at: http://www.nida.nih.gov/researchreports/comorbidity/index.html

Source: National Institute on Drug Abuse – January 6, 2009

< Back to top >


RESEARCH

Provider Discussions May Improve Substance Abuse Treatment in HIV-infected Persons

Substance abuse treatment (SAT) is a critical component in preventing the spread of HIV infection and is associated with improved HIV outcomes. This study examined factors associated with SAT, including patient–provider discussions of substance abuse, among people with HIV. Researchers conducted interviews with 951 HIV-infected adults receiving care at 14 sites in the HIV Research Network, a consortium of HIV research centers. Seventy-one percent of respondents reported current (past 6- month) (36%) or lifetime (35%) drug use.

Comments: These findings reinforce the need to increase the opportunities for linkage between substance abuse treatment and HIV primary care. Although HIV primary care providers are faced with many demands, they should be encouraged to screen for and counsel patients about substance use.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2008. Access checked 1/1/09.
Julia H. Arnsten, MD, MPH

Original Source: Korthuis PT, Josephs JS, Fleishman JA, et al. Substance abuse treatment in human immunodeficiency virus: the role of patient-provider discussions. J Subst Abuse Treat. 2008;35 (3):294–303.

< Back to top >



inmates needing treatmentLess Than One in Five Inmates Needing Addiction Treatment Gets Help, NIDA Reports

Half of all prison inmates are dependent on drugs -- including many incarcerated on non drug-related offenses -- but less than 20 percent get the treatment they need, according to a new report from the National Institute on Drug Abuse (NIDA).

The authors of the report suggest that the criminal justice system is in a unique position to encourage drug abusers to enter and remain in treatment, thereby disrupting the vicious cycle of drug use and crime. In fact, most studies indicate that outcomes for those who are legally pressured to enter treatment are as good as or better than outcomes for those who enter treatment without legal pressure, the researchers note.

"Addiction is a stigmatized disease that the criminal justice system often fails to view as a medical condition; as a consequence, its treatment is not as available as it is for other medical conditions," said Redonna K. Chandler, principal author of the report and chief of NIDA's Services Research Branch.

There are several ways in which drug abuse treatment can be incorporated into the criminal justice system. These include therapeutic alternatives to incarceration, treatment merged with judicial oversight in drug courts, treatments provided in prison and jail, and reentry programs to help offenders transition from incarceration back into the community.
NIDA researchers stressed that the criminal-justice system is ideal for getting people into treatment and applying pressure to complete therapy. They noted that a dollar spent on drug courts, for example, saves $4 in healthcare costs, while a dollar spent on prison-based treatment saves $2-$6.

The NIDA press release can be accessed at: http://www.nida.nih.gov/newsroom/09/NR1-13.html

The study appears in the January 14, 2009 issue of the Journal of the American Medical Association.

Sources: JoinTogether.org and National Institute of Drug Abuse - January 13, 2009

< Back to top >


NEW BOOKS FOR MAT PATIENTS & THEIR FAMILIES

overcoming addiction bookOvercoming Prescription Drug Addiction – A Guide to Coping and Understanding

Prescription drug overdose is now the second leading cause of accidental death in the U.S.. Motor vehicle deaths are first. In 2005, 33,000 Americans died from prescription drug overdoses. That’s a 60 percent increase from deaths in 2000. "Addiction is taking a dramatic toll on individuals and their families," according to Rod Colvin, author of Overcoming Prescription Drug Addiction (Third Edition, Addicus Books, September 2008).

What are the messages of Colvin's book? The main theme of the book is education. "The public needs to be aware of the use of narcotics and the risk of addiction. They also need to understand that treatment is available. All to often, shame and guilt stop people from getting help to overcome addiction." The book also offers compelling anecdotes of recovery from former addicts, along with insights from addiction medicine specialists.

This easy-to-read 203-page book would be a helpful to both persons who are addicted to prescription opioid drugs as well as their families.

Overcoming Prescription Drug Addiction is available to purchase as a paperback or as an e-book for $19.95 at:
http://www.addicusbooks.com/show_title.cfm?isbn=9781886039889

< Back to top >


Overcoming Addiction: Paths toward recovery

This report describes a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs. It also includes targeted advice on specific types of addiction, as well as information about coping with a loved one’s addiction. Chapters include:

Prepared by the editors of Harvard Health Publications in collaboration with Howard J. Shaffer, Ph.D., Director, Division on Addictions, Cambridge Health Alliance, Associate Professor of Psychology, Department of Psychiatry, Harvard Medical School. 49 pages. (2008)

The report can be purchased online for $18.00 at: http://www.health.harvard.edu/special_health_reports/Overcoming-Addiction.htm


Notice:

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 unrestricted educational grant from Covidien Mallinckrodt a manufacturer 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.