AT Forum NEWS NOTES & UPDATES #131
May 2009
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: April 2009
Contents
MEDICATION-ASSISTED TREATMENT
SAMHSA and FDA Introduce Public Education Safety Campaign on Methadone
2009 AATOD QTc Session Recap by Andrew Byrne, MD
NIATx Announces Opioid Treatment Provider Process Improvement Project
A First – New York Nursing Home Hopes to Open Satellite Methadone Clinic
SAMHSA Issues Clarification Letter on Buprenorphine Prescribing in OTPs
GOVERNMENT
New Drug Czar Disavows Drug 'War'
Obama Retains Ban on Federal Funding of Needle Exchange
New Report Issued on Prescription Drug Threat Assessment
NIDA Updates Principles Of Drug Addiction Treatment Guide
NIDA Releases April Issue of Addiction Science & Clinical Practice
RESEARCH
Pain and the Nonmedical Use of Prescription Opioids
Stigma Increases Likelihood That Female Drug Users Reoffend
MEDICATION-ASSISTED TREATMENT
SAMHSA and FDA Introduce Public Education Safety Campaign on Methadone
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Food and Drug Administration (FDA) launched an initiative on April 28 to help ensure the safe use of methadone. The campaign responds to concerns about an escalating number of poisoning deaths linked to the improper use of this medication.
The public outreach effort, Follow Directions: How to Use Methadone Safely, is designed to inform consumers, health care professionals and treatment clinics about the safe use and misuse of the drug for both pain relief and drug addiction treatment.
Outreach materials about methadone for the public and health care professionals include a brochure, a poster and a fact sheet, available in English and Spanish. A point-of-sale information sheet will also be distributed in pharmacies where methadone is dispensed to pain management patients.
To learn more information about the campaign, visit www.dpt.samhsa.gov/methadonesafety
Source: SAMHSA – April 28, 2009
< Back to top >
2009 AATOD QTc Session Recap by Andrew Byrne, MD
On May 20, Andrew Byrne, MD posted an informal recap of the April AATOD Conference that was held in New York City on his website. Of particular interest, is his coverage of the much anticipated session on QTc. Dr. Byrne was one of four speakers and panelists on a workshop/panel discussion on cardiac issues related to patients on methadone maintenance. You can access his AATOD meeting recap at:
http://www.redfernclinic.com/c/2009/05/new-york-addiction-conference-april.php4
< Back to top >
NIATx Announces Opioid Treatment Provider Process Improvement Project
Up to 30 opioid treatment providers will be selected to learn the NIATx model of process improvement. NIATx helps providers improve access to and retention in treatment for their patients by using process improvement methods to achieve the four NIATx aims:
- Reduce waiting times
- Reduce no-shows
- Increase admissions
- Increase continuation in treatment
Funded by CSAT, this year-long project begins in August 2009. The application deadline is June 12, 2009.
To learn more information about this project visit: https://www.niatx.net/Content/ContentPage.aspx?NID=445
< Back to top >
A First – New York Nursing Home Hopes to Open Satellite Methadone Clinic
The Riverdale Press reported on May 20, that a Westchester New York hospital and Kingsbridge nursing home hope to partner to open a satellite methadone clinic at the nursing home this Fall. The satellite clinic would initially serve 45 people who currently have to travel from the nursing home to the hospital to obtain their weekly doses.
Mary O’Mara, a vice president at St. Joseph’s hospital said that Medicaid spends $50,000 a year annually to shuttle the patients between the nursing home and hospital. The proposed satellite clinic would have a registered nurse on site seven days/week, counselors would be available five days/week, and there would be a part-time clerical staff member.
The article can be accessed at: http://riverdalepress.com/full.php?sid=8663¤t_edition=2009-05-21
Source: The Riverdale Press – May 20, 2009
< Back to top >
SAMHSA Issues Clarification Letter on Buprenorphine Prescribing by Physicians in OTPs
The Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) issued a Dear Colleague letter on April 27, in response to requests for clarification regarding a physician's prescribing authority for buprenorphine in an Opioid Treatment Program (OTP). Key points of the clarification letter include:
- A DATA 2000-qualified physician, who is employed by an OTP can issue buprenorphine prescriptions to patients enrolled in the OTP, and the patient can take the prescription to a local pharmacy to be filled. This would not be considered part of the OTP’s medication inventory since the prescription would be filled at a pharmacy, as opposed to having the medication dispensed through OTP staff. The 30 or100-patient limit depending on qualifications would apply.
- OTPs may also admit patients and administer or dispense (but not prescribe) buprenorphine. In these cases, the OTP administers or dispenses the buprenorphine from the OTP inventory directly to the patient as directed by the physician. In this instance, the 30 or 100-patient limit, does not apply.
The Dear Colleague letter can be accessed at: http://buprenorphine.samhsa.gov/DrClg-SubRx-0409.pdf
Source: SAMHSA – April 27, 2009
< Back to top >
GOVERNMENT
New Drug Czar Disavows Drug 'War'
The Obama administration's new 'drug czar' says he is open to a fundamental rethinking of the nation's approach to preventing illicit-drug use and wants to cast aside the language of war in describing the effort, the Wall Street Journal reported May 14.
"Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them," said Gil Kerlikowske, recently confirmed as the director of the Office of National Drug Control Policy (ONDCP). "We're not at war with people in this country."
Kerlikowske said that the Obama administration wants to focus on drug use as a public-health problem, with an increased emphasis on providing addiction treatment as an alternative to incarceration.
"While I don't necessarily disagree with Gil's focus on treatment and demand reduction, I don't want to see it at the expense of law enforcement," said James Pasco, executive director of the Fraternal Order of Police. "People need to understand that when they violate the law there are consequences."
Kerlikowske said he doesn't support legalization but is in favor of needle-exchange programs, which he said were "part of a complete public-health model for dealing with addiction."
Source: JoinTogether.org - May 14, 2009
< Back to top >
Obama Retains Ban on Federal Funding of Needle Exchange
Failing to keep a campaign promise, President Barack Obama has decided to keep in place a ban on using federal money to support needle-exchange programs, the Huffington Post reported May 7.
Obama's budget plan, released last week, still includes language prohibiting federal funding for needle exchanges, even though the White House website stated until very recently that, "The President ... supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users."
That statement has been removed from the White House website; an Obama spokesperson cast the issue as one of timing, not intent. "We have not removed the ban in our budget proposal because we want to work with Congress and the American public to build support for this change," said spokesperson Ben LaBolt. "We are committed to doing this as part of a National HIV/AIDS strategy and are confident that we can build support for these scientifically based programs."
However, Tom Angell, a spokesperson for the group Law Enforcement Against Prohibition, said it was "hard to imagine how removing mention of support for a proven lifesaving program from the White House website is part of a grand strategy to 'build support' for syringe exchange."
Source: JoinTogether.org - May 12, 2009
See related Time magazine article “Why Obama Isn't Funding Needle-Exchange Programs” by Maia Szalavitz from May 16: http://www.time.com/time/nation/article/0,8599,1898073,00.html?xid=rss-topstories
< Back to top >
New Report Issued on Prescription Drug Threat Assessment
The Office of National Drug Control Policy (ONDCP), released a report on the diversion and abuse of prescription drugs on May 20. The report shows unintentional deaths involving prescription opioids increased 114 percent from 2001 to 2005, and treatment admissions increased 74 percent in a similar four-year period.
The National Prescription Drug Threat Assessment (NPDTA) was prepared by the National Drug Intelligence Center (NDIC) in conjunction with the Drug Enforcement Administration (DEA). It synthesizes reports and data from law enforcement and public health officials to evaluate the threat posed by the distribution, diversion, and abuse of controlled prescription drugs in the U.S.
Key Findings
- Non-medical use of prescription drugs (pain relievers, stimulants, tranquilizers, and sedatives) is most prevalent among young adults—individuals aged 18 to 25. From 2003-2007, approximately six percent of this age group reported non-medical prescription drug use in the past month.
- Among the general population, nonmedical use of controlled prescription drugs was stable from 2003-2007, with 7 million Americans, aged 12 and older, reporting past month nonmedical use of prescription drugs.
- Pain relievers are the most widely diverted and abused, with one in five new drug abusers initiating with potent narcotics such as oxycodone, hydrocodone, and methadone.
- Diversion and abuse of controlled prescription drugs cost public and private medical insurers an estimated $72.5 billion per year.
- Diverted controlled prescription drugs are often more readily available than heroin in all drug markets. Opioid pain relievers are the most commonly diverted. Diversion methods include prescription drug fraud, theft, rogue Internet pharmacies, and friends and relatives—the primary sources of controlled prescription drugs for most abusers.
- Although diversion and abuse of controlled prescription drugs is highest in eastern states, violent and property crimes associated with prescription drug diversion and abuse have increased in all regions of the United States over the past 5 years.
The full press release can be accessed at: http://www.whitehousedrugpolicy.gov/news/press09/052009.html
The National Prescription Drug Threat Assessment 2009 can be accessed at: http://www.usdoj.gov/ndic/pubs33/33775/index.htm
Source: Office of National Drug Control Policy - May 20, 2009
< Back to top >
NIDA Updates Principles Of Drug Addiction Treatment Guide
The National Institute on Drug Abuse (NIDA) released an updated edition of their popular 80-page guide on drug addiction. Principles of Drug Addiction Treatment (2nd Edition) is intended to address addiction to a wide variety of drugs, including nicotine, alcohol, and illicit and prescription drugs. It is designed to serve as a resource for health care providers, family members, and other stakeholders trying to address the myriad of problems faced by patients in need of treatment for drug abuse or addiction. The guide addresses frequently asked questions and evidence-based approaches to addiction treatment.
The updated guide can be accessed at : http://www.nida.nih.gov/PODAT/PODATIndex.html
Source: National Institute on Drug Abuse – April 17, 2009
< Back to top >
NIDA Releases April Issue of Addiction Science & Clinical Practice
This issue features three articles on drug abuse and the criminal justice system.
- Dr. Michael Prendergast describes how correctional drug treatment can improve outcomes for offenders upon release and stresses the importance of community aftercare for reducing relapse and recidivism.
- Dr. Carl Leukefeld and colleagues describe two projects for drug-abusing offenders re-entering the community after incarceration: the development of a set of re-entry guidelines through a Delphi process and an intervention to reduce post-release HIV risk in women offenders.
- Ms. Melody Heaps and her colleagues at Treatment Alternatives for Safe Communities (TASC) of Illinois put forward a recovery-oriented system of care for drug-abusing criminal offenders that exists outside of the justice system, co-manages offender treatment, and provides other services to promote successful outcomes as well as public health and safety.
The April 2009 issue can be accessed at: http://www.nida.nih.gov/ascp/index.html
< Back to top >
RESEARCH
Pain and the Nonmedical Use of Prescription Opioids
This population-based survey* collected demographic, psychiatric, and substance use data from 42,734 U.S. adults to determine whether nonmedical use of prescription opioids is driven by untreated pain. Respondents were questioned about past-year nonmedical use of prescription opioids and the extent to which pain interfered with their activities of daily living (i.e., low, moderate, high). Primary findings were as follows:
- The past-year rate of nonmedical use of prescription opioids was 1.8%. Twenty percent of these individuals met criteria for opioid abuse/ dependence.
- Pain was positively associated with an increased probability of nonmedical use and prescription opioid abuse/dependence.
- Within each level of pain, the odds of past-year nonmedical use and abuse /dependence were significantly higher for those with unhealthy alcohol use.
*The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
Comments by James Harrison, MHS, CADC: This study helps raise clinician awareness that individuals who meet criteria for opioid abuse/dependence may have untreated pain. Pain and unhealthy alcohol use should be assessed in patients reporting nonmedical use of prescription opioids. This study was limited to adults only; it is not known if link between physical pain and nonmedical prescription analgesic use exists among youth.
Reference: Novak SP, Herman-Stahl M, Flannery B, et al. Physical pain, common psychiatric and substance use disorders, and the non-medical use of prescription analgesics in the United States. Drug Alcohol Depend. 2009;100(1–2):63–70.
Source: JoinTogether.org – Treatment Practitioner’s Research Bulletin - March 2009
< Back to top >
Stigma Increases Likelihood That Female Drug Users Reoffend
Research published in the journal Substance Abuse Treatment, Prevention, and Policy reveals how legal punishment, withdrawal of services and social stigmatization encourage a return to drug use, increased criminal activity and ultimately re-incarceration.
Juliana van Olphen from San Francisco State University led a team of researchers who held focus groups and conducted semi-structured interviews with 17 women who had recently left jail. She said, "After carrying out this research, our conclusion was that punitive drug and social policies related to employment, housing, education, welfare, and mental health and substance abuse treatment make it extremely difficult for users and former users to live a normal life and reintegrate into society".
The kind of policies the authors refer to include the federal ban on food stamps for people convicted of a drug offense and the "one strike, you're out" policy by which first-time drug offenders are evicted from public housing. According to van Olphen, "These policies have adversely and disproportionately affected women, especially poor women, ruining their chances of finding employment, housing or education upon release".
The researchers found that a central theme throughout women's narratives revolved around the double stigma of being a drug user and having a history of incarceration. While the stigmas are created to act as a deterrent to drug use, they often actually promote it by limiting the options of the victims of the 'War on Drugs'. The authors conclude, "In the future, launching campaigns to reduce the intersecting stigmas of drug use and incarceration may enhance the effectiveness of reintegration services while also assisting women leaving jail to find the support they need for successful reintegration into their families and communities".
The article can be accessed at: http://www.substanceabusepolicy.com/content/pdf/1747-597x-4-10.pdf
Source: Nowhere to go: How stigma limits the options of female drug users after release from jail Juliana E van Olphen, Michele J Eliason, Nicholas Freudenberg and Marilyn Barnes Substance Abuse Treatment, Prevention, and Policy (in press)
< Back to top >
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.