AT Forum NEWS NOTES & UPDATES #148
December 2010 / January 2011
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: November 2010
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
METHADONE AND MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
The long-awaited MOTHER Maternal Opioid Treatment: Human Experimental Research study was published in the New England Journal of Medicine on December 9.
To view the abstract or to purchase the article go to: http://www.nejm.org/doi/full/10.1056/NEJMoa1005359?query=TOC
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Twice as many young people are getting prescriptions for controlled substances than had been 15 years ago, Reuters reported Nov. 29.
Investigators led by Robert J. Fortuna, MD, of the University of Rochester's Strong Children's Research Center in New York, assessed U.S. prescription trends for 15- to 29-year-olds based on 2007 survey data from more than 8,000 physicians, clinics, and emergency departments. They then compared results with similar data from 1994.
Analysis revealed that more than 11 percent of teenagers received prescriptions for controlled medications (including Oxycontin, Vicodin, Ritalin, and sedatives) in 2007, up from 6 percent in 1994. A similar trend was seen for young adults, where the prescription rate for such drugs rose from 8 to 16 percent over the same time period.
As noted by Fortuna, the rise does not necessarily mean the drugs are being diverted or abused. However, teenagers and college students are much more likely than adults to use prescription drugs recreationally and to pass them on to others.
"The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana," concluded the authors. "This trend and its relationship to misuse of medications warrants further study."
The article was published online Nov. 29 in the journal Pediatrics.
Source: JoinTogether.org - December 7, 2010
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In October, the National Institutes of Health (NIH) updated several of their Fact Sheets related to drug addiction. The Fact Sheets provide a review of research discovery, current treatment status, and future expectations for the prevention and treatment of diseases and conditions affecting the nation's health. Three of interest to opioid treatment programs (OTPs) and their patients include:Heroin
Future expectations for heroin include a broader acceptance that heroin addiction is a chronic brain disease that will help erase stigma, permit a more accurate assessment of disease prevalence, identify those with increased vulnerability, and improve the rate of treatment seeking. By moving forward with this multi-pronged approach, we will close the heroin treatment gap: currently, only about 20 percent of the estimated 810,000 heroin addicts seek or receive any form of treatment for their addiction.Drug Abuse and Addiction
Future expectations for drug abuse and addiction recognize that the scientific knowledge we have accumulated will be used to transform the way we treat addiction and how we prevent drug abuse in the first place, or its escalation to addiction.
- Genes account for about 50 percent of a person's risk of becoming addicted, and environmental factors influence the effect of these genes — an area of research called epigenetics. Progress in genetics/ epigenetics research will lead to more refined prevention and treatment interventions targeted to individual risk or to modifiable environmental influences.
- Emerging medication targets and treatment approaches will capitalize on our expanded knowledge of underlying neurobiology and brain circuitry involved in addiction. Of critical importance to the development of future addiction therapies is the notion of brain plasticity as a two- edged sword: the same malleability that can bring about deleterious brain changes also holds promise for effective and enduring treatments.
- Immunotherapy (e.g., "vaccines"), will be available to sustain abstinence, even prevent addiction. Studies are underway to develop or improve vaccines that use antibodies to bind the drug while it is still in the bloodstream, preventing it from entering the brain.
Getting proven treatments into the criminal justice system will promote abstinence, help identify and mitigate related diseases like HIV, and foster productive reintegration back into the community.
- Working together, public health and criminal justice systems will make evidence-based treatments, including medications, available to the offender population—an effort being promoted through a NIDA-led multisite, interagency research initiative known as CJ-DATS — Criminal Justice Drug Abuse Treatment Studies. CJ-DATS seeks to test proven treatments and implementation strategies within the criminal justice system and remove the barriers to their adoption.
- The overrepresentation of both drug abuse and HIV within criminal justice populations demands better strategies to integrate services and improve outcomes for both. An approach known as "seek, test, treat" aims to reach out to high-risk, hard-to-reach groups who have not been recently tested, test them for HIV, and initiate and maintain HAART (highly active antiretroviral therapy) for those testing positive.
The Fact Sheets can be accessed at: http://report.nih.gov/NIHfactsheets/
Source: National Institutes of Health -Yesterday, Today, and Tomorrow Research Timelines
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Under a new program started by Fairfield County Sheriff Dave Phalen in Lancaster, Pennsylvania, television for the inmates will be replaced with videos dealing with drug and alcohol education and recovery, along with anger management, tips on finding a job and making life choices.
There will be a major emphasis on fighting heroin, opiate and prescription drug addiction, which are major contributors to the drug problems in Fairfield County, said Phalen.
Phalen said he hopes by piping in the programming, particularly a series of drug and alcohol recovery and treatment videos, the inmates will get valuable information on how to get treatment and turn their lives around.
Source: LancasterEagleGazette.com — December 11, 2010
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New SAMHSA Study Shows Dramatic Shifts in Substance Abuse Treatment Admissions Among the States Between 1998 And 2008
Although the overall rate of admissions to substance abuse treatment in the U.S. remained stable between 1998 and 2008, a new study shows striking changes and variations in admission rates by region.
As indicated in an earlier SAMHSA report, Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008, the treatment admission rate for opiates other than heroin (mainly narcotic pain relievers) rose 345 percent nationwide during these 11 years. The new study shows that increased admissions for pain reliever abuse occurred in every region of the nation and were highest in the New England (Conn., Mass., Maine, N.H., R.I. and Vt.) and the East South Central states (Ala., Ky., Miss. and Tenn.).
The new study provided mixed news concerning heroin -- nationwide the rate of heroin admissions dropped by 3 percent from 1998 to 2008, but this drop was not uniform and in many states the levels have actually risen. Heroin treatment admission rates were consistently highest in the New England and Middle Atlantic states.
"Drug addiction is a disease that requires the same kind of evidence-based, public health remedies called for with any chronic disease," said Gil Kerlikowske, Director of National Drug Control Policy. "This substantial rise in drug treatment admissions for illicit drugs, particularly for marijuana and misuse of prescription drugs, shines a necessary spotlight on these problems and the need for early intervention, treatment, and recovery support services for those affected by these disorders. That is why the Obama Administration has requested an increase of $137 million for FY 2011 to expand access for drug treatment programs across the United States."
The full report is available at: http://wwwdasis.samhsa.gov/teds08/teds2k8sweb.pdf
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) — December 22, 2010
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Results from the 2010 Monitoring the Future study were released on December 14. The study is conducted by a team of social scientists at the University of Michigan's Institute for Social Research, and is funded by a grant from the National Institute on Drug Abuse. In 2010, more than 46,000 8th, 10th, and 12th graders, enrolled in nearly 400 secondary public and private schools, participated in the study.
The proportion of young people using any illicit drug has been rising over the past three years, due largely to increased use of marijuana—the most widely used of all the illicit drugs.
Taking heroin using a needle did show a small but statistically significant increase in 2010, but only among 12th graders and without any concurrent changes in perceived risk, disapproval, or availability. "Because the prevalence rates for heroin use are so low in this population, it doesn't take a lot of cases to yield a significant change," said Lloyd Johnston, principal investigator of the study, "so we are not yet ready to say that this is a real change. If it is real, it would be important; but we will want to see another year's data before being confident that it is."
The use of a class of drugs consisting of narcotics other than heroin nearly tripled from 1992 through 2004, from an annual prevalence of 3.3% in 1992 among 12th graders (the only ones for whom these drugs are reported) to 9.5% in 2004. Use then remained level through 2009, showing a non-significant drop of 0.5 percentage points in 2010. Most of the drugs in this important class of addictive substances are analgesics (taken for pain), and two of the most important are Vicodin and OxyContin.
Where students acquire these prescription drugs is a matter of some interest. By asking those who used each drug in the past year where they got them, the investigators learned that the most common source was a friend giving the drug to the respondent, followed by a friend selling the drug to the respondent. In some cases the drugs were left over from a prescription the respondent previously had, and in some cases the drugs were taken from a relative without their permission; but these were less common sources. Only a modest proportion of the users (between 20% and 30%, depending on the drug) said they had bought them from a drug dealer or stranger. Almost none said that they had bought them on the Internet.
The press release can be accessed at: http://ns.umich.edu/htdocs/releases/story.php?id=8174
Data from the study can be accessed at: http://www.monitoringthefuture.org/data/10data.html#2010data-drugs
Source: Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (December 14, 2010). "Marijuana use is rising; ecstasy use is beginning to rise; and alcohol use is declining among U.S. teens." University of Michigan News Service: Ann Arbor, MI. Retrieved 12/14/10 from http://www.monitoringthefuture.org
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Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug Related Emergency Department (ED) Visits
In 2009, there were nearly 4.6 million drug-related ED visits of which about one half (49.8 percent, or 2.3 million) were attributed to adverse reactions to pharmaceuticals and almost one half (45.1 percent, or 2.1 million) were attributed to drug misuse or abuse (Table 1).
Of the 2.1 million ED visits involving drug misuse or abuse, 1.2 million visits involved the misuse or abuse of pharmaceuticals, and almost 1.0 million were related to illicit drugs.
|Table 1. Drug-Related Emergency Department (ED) Visits, by Type of Visit: 2009|
|Type of Drug-Related ED Visit||Number of ED Visits*||Percent*|
|Total Drug-Related ED Visits||4,595,263||100.0%|
|Drug Misuse or Abuse||2,070,439||45.1%|
|Misuse or Abuse of Pharmaceuticals||1,244,679||27.1%|
|Illicit Drug Use||973,591||21.2%|
|Alcohol Involvement with Drug Use||519,650||11.3%|
* Because each visit may represent multiple types of visits and multiple types of drugs, the estimates add to more than the total number of visits and the percentages add to more than 100.
** Alcohol involvement includes use of alcohol in combination with other drugs for patients of all ages and use of alcohol only for persons aged 20 or younger. Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for persons aged 20 or younger.
ED visits resulting from the misuse or abuse of pharmaceuticals occurred at a rate of 405.4 visits per 100,000 population compared with a rate of 317.1 per 100,000 population for illicit drugs (Table 2). About one half of ED visits for misuse or abuse of pharmaceuticals involved pain relievers (194.0 visits per 100,000 population), which were most commonly narcotic pain relievers (e.g., oxycodone and hydrocodone products; 129.4 visits per 100,000 population).
|Table 2. Misused or Abused Drugs Most Commonly Involved in Emergency Department (ED) Visits: 2009|
|Drugs||Number of ED Visits||Number of ED Visits per 100,000 Population|
|Narcotic Pain Relievers||397,160||129.4|
|Drugs to Treat Insomnia and Anxiety||433,600||141.2|
* Use of alcohol in combination with other drugs is recorded by DAWN for patients of all ages.
** Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for persons aged 20 or younger.
The findings in this report demonstrate the increasing importance of pharmaceuticals to total drug-related ED visits. Pharmaceuticals, even those that are sometimes abused, can have very positive effects when used as prescribed or directed. However, when misused or abused, they can lead to serious negative side effects. Between 2004 and 2009, the number of ED visits involving the misuse or abuse of pharmaceuticals increased substantially. About twice as many people experienced ED visits caused by the misuse or abuse of pharmaceuticals in 2009 than in 2004, and this pattern was consistent across age groups.
The 8-page report can be accessed at: http://oas.samhsa.gov/2k10/DAWN034/EDHighlightsHTML.pdf
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 28, 2010). The DAWN Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD.
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The United States government is cracking down on the sale of drugs over the internet without prescriptions, the BBC reported Dec. 17.
Researchers estimate that about one in every six Americans, or 36 million people, have used unlicensed online pharmacies to buy drugs. The initiative—said to be part of an Obama administration plan to address counterfeit medicines—aims to shut down illegal online pharmacies and raise awareness that their products are not safe.
"Those who sell prescription drugs online without a valid prescription are operating illegally, undercutting the laws that were put in place to protect patients, and are thereby endangering the public health," said Victoria Espinel, an intellectual property enforcement coordinator.
Partners in the initiative include Google; online-payment processors like Visa and PayPal; and online hosting companies like Network Solutions. The companies will target illegal web pharmacies by shutting down web sites, blocking ads and payments. They will also work with law enforcement and underwrite public awareness campaigns to educate the public about the risks of buying prescription drugs online.
Two organizations — The Partnership at Drugfree.org and the Alliance for Safe Online Pharmacies — will research why so many Americans have used online drug stores, what they purchase, and why some perceptions of the risk involved vary so widely.
Source: JoinTogether.org — January 3, 2011
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The number of adults tested for HIV reached a record high in 2009, according to an analysis of national survey data released today in a CDC Vital Signs report. Last year 82.9 million adults between 18 and 64 reported having been tested for HIV. This number represents an increase of 11.4 million people since 2006, when CDC recommended that HIV testing become a routine part of medical care for adults and adolescents, and that people at high risk of infection be tested at least once a year. Despite this progress, 55 percent of adults—and 28.3 percent of adults with a risk factor for HIV—have not been tested.
"Today's news shows that we have had progress increasing testing, and that more progress is both necessary and possible," said Thomas R. Frieden, M.D., M.P.H., CDC director. "With most adults and with nearly a third of high-risk people having never been tested for HIV, we need to do more to ensure that all Americans have access to voluntary, routine and early HIV testing in order to save lives and reduce the spread of this terrible disease."
CDC estimates that 1.1 million adults are living with HIV and that as many as one in five of these individuals (approximately 200,000 Americans) does not know that they are infected. Reducing the number of undiagnosed infections is a critical component of HIV prevention, as most sexually transmitted HIV infections in the United States are transmitted by people who are unaware of their infection. Research shows that once people learn they are infected, most take steps to protect their partners. Furthermore, people who are diagnosed earlier have longer life expectancies because they can benefit from HIV care and treatment.
The Vital Signs report also highlights surveillance data showing that many people with HIV are diagnosed too late in their infection to take full advantage of effective treatment options and protect their partners from infection. In the 37 states with long-standing, confidential, name-based HIV reporting systems, 32 percent of people diagnosed with HIV in 2007 progressed to AIDS within 12 months, indicating a late diagnosis and missed opportunities for treatment.
This summer, the White House announced the National HIV/AIDS Strategy, which includes the goal of increasing the proportion of HIV-infected individuals who are aware of their HIV status to 90 percent. Consistent with this goal, in 2010 CDC provided $60 million to support HIV testing efforts in 30 of America's jurisdictions most heavily impacted by HIV. The funding allows CDC and its partners to expand a successful three-year initiative to increase access to HIV testing among African-Americans, Latinos, men who have sex with men, and injection drug users.
The press release can be accessed at: http://www.cdc.gov/media/pressrel/2010/r101130.html
Source: Centers for Disease Control and Prevention — November 30, 2010
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The Centers for Disease Control and Prevention (CDC) estimates that 19 percent of the more than 1 million people who currently live with the human immunodeficiency virus (HIV) in the United States are injection drug users. Injection drug users also represent approximately 12 percent of the estimated 56,300 new HIV cases each year in the United States. The behaviors associated with injection drug use, such as sharing needles and other drug equipment, place injection drug users at risk for spreading or contracting HIV. Therefore, substance abuse treatment facilities that include HIV prevention/education as part of their treatment programs and perform HIV screenings and HIV risk assessments can play a vital role in the control, prevention, and treatment of HIV.
Facilities that operated OTPs were more likely than other treatment facilities to provide special programs or groups for persons with HIV/AIDS and more likely to provide early intervention for HIV or HIV/AIDS education, counseling, or support.
- Over one half of the approximately 1,240 facilities that operated an OTP provided HIV testing (63 percent) or HIV/AIDS education, counseling, or support (83 percent).
- Less than half of OTPs provided early intervention for HIV (48 percent) or special programs or groups for persons with HIV/AIDS (21 percent).
Despite advances in the treatment of HIV/AIDS since the 1980s, when HIV and AIDS first emerged in the United States, nearly 20,000 people with AIDS die each year. There is still no cure for HIV; however, advances in HIV treatment regimens extend the lives of the people infected with the virus once they are diagnosed.
The 6-page PDF report can be accessed at: http://oas.samhsa.gov/2k10/317/317HIV2k10Web.pdf
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 1, 2010). The N-SSATS Report: HIV Services Offered by Substance Abuse Treatment Facilities. Rockville, MD.
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A new resource is available from the State Associations for Addiction Services (SAAS) for providers preparing for systems transformation efforts as a result healthcare reform.
Implementing Healthcare Reform: First Steps to Transforming Your Organization, A Practical Guide for Leaders outlines, in an easy-to-follow format, several steps agencies can take to initiate systems transformation to take advantage of the many opportunities available under healthcare reform.
The 42-page guide can be accessed for no charge at: http://www.saasnet.org/drupal-6.6/
Source: State Associations for Addiction Services — November 29, 2010
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The Road to Recovery 2010, features footage, photos, and interviews of participants from 2010 National Alcohol and Drug Addiction Recovery Month events held around the country.
Available free-of-charge from the Substance Abuse Mental Health Services Administration on DVD or for download at: http://store.samhsa.gov/product/SMA10-4505
Source: Substance Abuse Mental Health Services Administration — November 2010
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