NEWS NOTES & UPDATES #130
April 2009
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: March 2009
Contents
MEDICATION-ASSISTED TREATMENT
New GAO Report Issued On Methadone-Associated Overdose Deaths
New Bipartisan Bill Targets Deaths Related to Methadone
Concern in Wisconsin over Suboxone-Related Deaths
West Virginia Backs Off on Proposed State Tax on Methadone
GOVERNMENT NEWS & RESOURCES
McLellan Announced as Deputy Drug Czar
SAMHSA Issues TIP 48: Managing Depressive Symptoms in Substance Abuse Clients
DRUG REFORM & COURTS
New York Leaders Agree to Drug-Reform Plan
Drug Courts Celebrate 20th Anniversary -
New Report: Drug Courts - A Review of the Evidence Now Available Online
MEDICATION-ASSISTED TREATMENT (MAT)
New GAO Report Issued On Methadone-Associated Overdose Deaths
At the end of March, the U.S. Government Accountability Office (GAO) issued a new report on factors contributing to increased methadone deaths and effort to prevent them.
The GAO reviewed documents, laws and regulations, data, and research from the Drug Enforcement Agency (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Interviews were also conducted with federal officials, officials in five selected states, officials from professional associations and advocacy groups, and experts in pain management, addiction treatment, and forensic sciences.
Highlights of the report include:
- Although information on methadone-associated overdose deaths is limited, available data suggest that methadone’s growing use for pain management has made more of the drug available, thus contributing to the rise in methadone-associated overdose deaths. Methadone prescriptions for pain management grew from about 531,000 in 1998 to about 4.1 million in 2006—nearly eightfold.
- Methadone has unique pharmacological properties that make it different from other opioids, and as a result, a lack of knowledge about methadone among practitioners and patients has been identified as a factor contributing to these deaths. GAO noted that particular vigilance is needed when starting treatment and increasing dosages, regardless of whether methadone is being used for addiction treatment or pain management.
- DEA data suggest that abuse of methadone diverted from its intended purpose has also contributed to the rise in overdose deaths as the number of methadone drug items seized by law enforcement and analyzed in forensic laboratories increased 262 percent, from 2,865 in 2001 to 10,361 in 2007.
- Data and research from five states GAO reviewed suggest that the specific circumstances of these deaths are variable because of drug combinations and unknown sources of methadone.
The 55-page report can be accessed at: http://atforum.com/addiction-resources/documents/GAOReport.pdf
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New Bipartisan Bill Targets Deaths Related to Methadone
In response to the GAO Report on methadone-associated deaths, U.S. Senators John D. (Jay) Rockefeller IV (D-WV), and Bob Corker (R-TN), introduced the Methadone Treatment and Protection Act of 2009 legislation to reduce the number of methadone and other opioid-related deaths by improving federal oversight, requiring both practitioner and patient education, and creating a uniform reporting system for opioid-related deaths. The proposed legislation identifies four problem areas and suggested solutions.
LACK OF EDUCATION
Provider Education
- Proposed Change: Require the Department of Health and Human Services (HHS) to establish a mandatory and comprehensive practitioner education program for methadone and other opioids. Completion of this education program will be required as part of the Drug Enforcement Administration’s (DEA) current registration process used to authorize practitioners to prescribe, dispense and administer controlled substances.
Consumer Education
- Proposed Change: Provide competitive grants to states and non-profit community organizations to distribute culturally sensitive educational materials about proper methadone usage. Priority will be given to applicants with a high incidence of methadone abuse and methadone-related deaths in their state.
INADEQUATE FEDERAL OVERSIGHT
Controlled Substances Clinical Standards Commission
- Proposed Change: Create the Controlled Substances Clinical Standards Commission to establish patient education standards, appropriate and safe dosing standards for all forms of methadone, benchmark standards for the reduction of methadone abuse, appropriate conversion factors for transition patients from one opioid to another, and guidelines for the initiation of methadone for pain management.
National All Schedules Prescription Electronic Reporting Act (NASPER)
- Proposed Change: This legislation would appropriate $25 million a year for NASPER to establish interoperable prescription drug monitoring programs within each state.
NO UNIFORM REPORTING SYSTEM FOR METHADONE-RELATED DEATHS
National Opioid Death Registry
- Proposed Change: Create a National Opioid Death Registry to track all opioid-related deaths and related information. Also, establish a standard form for medical examiners to fill out which would include information for the National Opioid Death Registry.
MISCELLANEOUS PROVISIONS
- Improving Patient Safety: Opioid treatment programs will be required by law to make acceptable alternative arrangements for the safe distribution of methadone for patients who are not permitted take home doses on days where the clinic is closed.
- Moratorium on 40-mg Methadone Diskettes: For two years, no provider may prescribe and no pharmacy or opioid treatment clinic may distribute 40-mg methadone diskettes unless the prescription or dispensation is consistent with DEA policy. Absolutely no 40-mg methadone diskettes can be distributed as a take-home dose.
- Annual Report on Effectiveness: No later than September 30, 2010 the Secretary will report to Congress the effectiveness and evaluate the success of efforts to reduce opioid addiction and methadone-related deaths including the impact of health care provider and patient education.
A detailed summary of the Methadone Treatment and Protection Act of 2009 can be accessed at: http://corker.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id=bfdff477-2b11-471c-99e9-07367c1a5bbf
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Concern in Wisconsin over Suboxone-Related Deaths
The recent Suboxone-related deaths of two Milwaukee-area residents has drawn negative attention to federal rules that allow patients to use the buprenorphine-based drug at home, the Milwaukee-Wisconsin Journal Sentinel reported April 2.
Some local officials blame wider availability of the drug for increasing the risk of abuse by recreational users. Milwaukee police said they saw evidence of illicit trafficking of Suboxone even before it was linked to the overdose deaths of teenager Madison Kiefer and college student Luke David Murphy.
Chuck Wood of the Waukesha County Sheriff's Department said informants noted that a street market for the drug has developed because recreational users have found a way to use Suboxone to get high. Suboxone was specifically designed to limit abuse potential by including the opiate antagonist naloxone in the formulation. "It was going to be so controlled," Wood said. "Now we're seeing it out in the community."
An official with the federal Substance Abuse & Mental Health Services Administration (SAMHSA) said the overdose deaths seem to be the tragic results of abuse rather than any inherent danger in Suboxone. "Suboxone is a very safe drug," said Robert Lubran, SAMHSA's director of pharmacologic therapies. "There's a reason why they're controlled substances -- because they're abusable."
"It really does its job well," said Jim Aker, a counselor at ProHealth Care, a program in Waukesha that has used Suboxone to treat 140 recovering addicts during the past two years.
Police believe that the two overdose deaths were the result of ingesting Suboxone along with other substances; some users incorrectly believe that Suboxone mitigates the effects of other drugs. Tim Baxter, medical director of Reckitt Benckiser Pharmaceuticals Inc., said Suboxone alone cannot trigger a fatal overdose. But he said it has been linked to 15 deaths nationally when combined with alcohol or other drugs.
Baxter said abuse has been tapering off, as drug users discover Suboxone's limited potential for intoxication. "Some kids will decide, 'Oh, this sounds like fun, we'll have a go,'" Baxter said. "They may try it once, but they go on to something else."
Source: JoinTogether.org - April 7, 2009
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EUROPAD Journal – Heroin Addiction and Related Clinical Problems. 2009(March), Vol. 11, No. 1 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:
- Treatment of Opioid Dependence and ADHD/ADD with Opioid Maintenance and Central Stimulants
- Unintentional and Intentional Injuries Due to Opiate Abuse
- Use and Abuse of High-Dose Buprenorphine (HDB) Obtained Without a Prescription: a French Survey
- A 10-Year Evaluation of Chronic Pain Patients Treated with Opioids
- Psychotherapeutic Experiences with Methadone Maintained Patients in the Framework of Multidisciplinary Clinical Institution
- Coordinating Methadone Treatment Providers and Policymakers: Lessons Learned Over 30 Years…Mark Parrino
- And others…
The PDF file can be downloaded from ATForum.com at: <HeroinAdd11-1pdf>
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West Virginia Backs Off on Proposed State Tax on Methadone
In our March 2009 news update we reported that there was a proposed bill introduced during February in the West Virginia House of Delegates that would tax nine Opioid Treatment Programs (OTPs) $1 for each dose of methadone that they dispense. Projected yearly tax revenues are estimated at $1.5 million. The tax revenues would fund prevention, early intervention, and recovery programs for opioid-dependent people. The original article can be accessed at: http://wvgazette.com/News/200903210417
On April 2 the Charleston Gazette reported that the bill died in the committee process. House Health and Human Resources Chairman Don Perdue said ”procedural problems” and time constraints doomed the bill. Delegate Ralph Rodighiero, said that some delegates “backed off” the plan after it became clear patients would ultimately pay for the tax.
Some state lawmakers want to conduct a study to determine how a tax on methadone would impact OTP business operations and patient care. It was reported that an interim study could start in June if the legislature approves it. “Perdue wants to know how many people return time and again to the clinics, and how carefully doctors follow with patients.”
The article can be accessed at: http://sundaygazettemail.com/News/200904022593
Source: West Virginia Gazette – April 2, 2009
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GOVERNMENT NEWS & REPORTS
McLellan Announced as Deputy Drug Czar
A. Thomas McLellan, a noted addiction researcher, has been nominated as deputy director of the Obama administration's Office of National Drug Control Policy (ONDCP), the Chicago Tribune reported April 10.
If confirmed, McLellan will serve as the chief deputy to presumptive drug czar Gil Kerlikowske, who also must be confirmed by the Senate.
McLellan, 59, has been involved in some of the most important addiction research in recent decades, including the development of the Addiction Severity Index and studies comparing addiction with other chronic health conditions. Most recently, he headed the Treatment Research Institute at the University of Pennsylvania.
"I think [McLellan's] long and rigorous examination of how drug-abuse treatment is delivered is pretty unique," said David Friedman, director of addiction studies at Wake Forest University's medical school. Friedman added that recent comments by Obama administration officials about the role that demand reduction needs to play in fighting Mexican drug cartels indicates that McLellan's job could become very high-profile.
Source: JoinTogether.org – April 13, 2009
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SAMHSA Issues TIP 48: Managing Depressive Symptoms in Substance Abuse Clients
On March 17 the Substance Abuse and Mental Health Services Administration (SAMHSA) released a new Treatment Improvement Protocol (TIP) 48, Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery. This manual provides the “what,” “why,” and “how-to” of working with clients with depressive symptoms and substance use disorders.
Beginning with TIP 48, there is a new approach and format for TIPS. Market research conducted on the TIP series over the past several years has indicated counselors, program administrators, and clinical supervisors want products that are short, concise, focused on how to perform relevant activities, and targeted to their particular needs. To those ends, this
TIP is organized into three parts:
- Part 1 for substance abuse counselors focuses on providing appropriate counseling methods and frameworks.
- Part 2 for program administrators focuses on providing administrative support to implement adoption of the counseling recommendations made in Part 1.
- Part 3 for clinical supervisors, program administrators, and interested counselors is an online literature review that provides an in-depth look at relevant published resources. Part 3 will be updated every 6 months for 5 years.
Part 1 and Part 2 can be accessed online at: http://www.kap.samhsa.gov/products/manuals/tips/pdf/TIP48.pdf
Part 3 can be accessed online at : http://www.kap.samhsa.gov/products/manuals/tips/pdf/TIP48_LitRev.pdf
Source: SAMHSA – March 17 and April 10, 2009
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DRUG LAW REFORM
New York Leaders Agree to Drug-Reform Plan
Legislators in New York have reached an agreement with Gov. David Paterson to strike down the state's punitive Rockefeller-era drug laws, repealing many mandatory-minimum prison sentences while allowing judges the option to send first-time nonviolent offenders to treatment, the New York Times reported March 25.
The plan, which includes an expansion of treatment programs and drug courts, comes with an estimated $50-million price tag. Marissa Shorenstein, a spokesperson for Paterson, said the deal was a personal victory for the governor, who has made drug reform a priority of his administration.
The legislation give judges the authority to send first-time nonviolent offenders to treatment in all but the most serious cases; offenders would have to plead guilty as a condition of avoiding incarceration. Failure to complete the treatment program would send the case back before a judge, who would retain the option of imposing a prison sentence.
Judges also would have the option of sending some repeat drug offenders to treatment. Repeat offenders accused of more serious drug crimes, however, could only go to treatment if an evaluation determined they were drug-dependent.
Some state district attorneys have expressed resistance to changing the laws. "The prison population is going down and public safety has improved, and I’d hate to do anything that would upset either of those trends," said Michael Green, the district attorney of Monroe County.
Negotiators said finding money to pay for more drug treatment programs will prove difficult. However, the changes are expected to save money since sending offenders to treatment is less expensive than spending $45,000 per inmate per year to keep them imprisoned.
New York has one of the most extensive drug-treatment networks in the country, and the new plan could give the state the sentencing policy it needs to fully utilize its treatment programs, drug-policy experts said.
"New York could actually become a national leader," said Gabriel Sayegh of the Drug Policy Alliance, a national group that promotes alternatives to current drug policies. "We’re going in a public-health direction here. We’re making that turn, and that’s what’s significant."
Source: JoinTogether.org - March 26, 2009
The press release issued by Governor Patterson can be accessed at: http://www.ny.gov/governor/press/press_0327091.html
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Drug Courts Celebrate 20th Anniversary -
New Report: Drug Courts - A Review of the Evidence Now Available Online
The Sentencing Project announced the publication of a new report, Drug Courts: A Review of the Evidence, that assesses the impact of the drug court movement.
Since their introduction in 1989, drug courts have received a significant amount of attention by practitioners, policymakers, and the general public. Originally conceived as an alternative to incarceration for persons convicted of low-level drug offenses, there are now more than 1,600 drug courts nationally, covering all 50 states. Many of these programs have broadened their eligibility requirements to grant more individuals access to treatment rather than incarceration. In the two decades since their launch, a substantial body of literature has been established evaluating drug court efficacy in regard to reducing recidivism and criminal justice costs.
To mark the 20-year anniversary of the modern drug court, The Sentencing Project surveyed a wide-range of research to outline general findings on the operation and efficacy of drug courts, and to highlight benefits and potential concerns. Overall, they found that:
- Drug courts have generally been demonstrated to have positive benefits in reducing recidivism.
- Evaluations of the cost-effectiveness of drug courts have generally found benefits through reduced costs of crime or incarceration.
- Concern remains regarding potential "net-widening" effects of drug courts by drawing in defendants who might not otherwise have been subject to arrest and prosecution.
The 22-page PDF file can be downloaded at: http://sentencingproject.org/Admin/Documents/publications/dp_drugcourts.pdf
Source: The Sentencing Project – April 2, 2009
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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.