AT Forum NEWS NOTES & UPDATES #150
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: February 2011
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
GOVERNMENT & FUNDING NEWS
METHADONE AND MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
On March 8, West Virginia Senator Jay Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care, introduced the Prescription Drug Abuse Prevention and Treatment Act of 2011. The bill aims to prevent the unsafe use of prescription drugs and reduce the number of deaths from prescription drugs by promoting both physician and patient education and creating a uniform reporting system for painkiller-related deaths. It would also significantly increase federal funding to help states create and maintain prescription drug monitoring programs that all states can access.Rockefeller's bill aims to combat prescription drug related deaths and overdoes by:
- Requiring that health care professionals receive specialized training on safe pain management in order to be licensed to prescribe these drugs.
- Funding a competitive grant program to states to educate consumers on the proper use of prescription drugs and how to prevent abuse.
- Creating a commission to establish appropriate and safe guidelines for all dosing of prescription drugs, benchmarks to reduce abuse, and patient education guidelines.
- Providing $25 million per year to establish prescription drug monitoring programs within each state where states can share information with each other.
- Forming a comprehensive national database of drug-related deaths in the U.S., and establishing a standard form for medical examiners to fill out.
For more information on the Prescription Drug Abuse Prevention and Treatment Act of 2011 go to: http://rockefeller.senate.gov/press/record.cfm?id=331730 and http://www.theorator.com/bills/text/s507.html
Source: United States Senator Jay Rockefeller — March 8, 2011
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Pennsylvania State Sen. Kim Ward (R-39) announced March 21, that she is introducing two bills that would place limits on taxpayer-funded methadone treatment services and increase program accountability.
The first bill would require that the Department of Public Welfare (DPW) limit Medicaid payments to 30 months for clients receiving methadone treatment. The limit is based on a recent Legislative Budget and Finance Committee (LBFC) Report which found that clients are in treatment an average of 27.3 months.
The legislation would also require DPW to establish stringent regulations for the inspection of methadone clinics. The regulations would include compliance with the federal requirements that clients receive a minimum of 2.5 hours of counseling per month while in treatment.
The second bill would restrict methadone clients who participate in the Medical Assistance Transportation Program to four weeks of transportation -- including both mileage reimbursement and para-transit services -- to the clinic closest to their residence. The LBFC found that that methadone maintenance transportation services cost taxpayers more than $32 million in 2009-10.
"At a time when our state government is cutting programs across the board, that are important to many Pennsylvanians, there is no place for an open-ended taxi service paid for with scarce state tax dollars," said Ward. "Four weeks is a reasonable amount of time for individuals to get settled into their treatment schedules where other travel arrangements can be made at their own expense. Without limits, there is no incentive," stated Ward.
The press release can be accessed at: http://senatorward.com/press/2011/0311/032111.htm
Source: Pennsylvania State Senator Kim Ward — March 21, 2011
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Doctors Lax in Monitoring Potentially Addicting Drugs — Study: Missed Opportunity to Reduce Opioid-Related Abuse, Addiction and Overdose
Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a new study by researchers at Albert Einstein College of Medicine of Yeshiva University.
The study, published in the March 2 online edition of the Journal of General Internal Medicine, found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence.
"Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings," said lead author Joanna Starrels, M.D., M.S., assistant professor of medicine at Einstein. "The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring."
The researchers studied administrative and medical records of more than 1,600 primary care patients for an average of two years while they received regular prescription opioids for chronic, non-cancer pain. They looked at whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills.
Only a small minority (8 percent) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24 percent). Only half of patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk. Although fewer than one-quarter (23 percent) of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills.
Source: Albert Einstein College of Medicine of Yeshiva University — March 3, 2011
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EUROPAD Journal Heroin Addiction and Related Clinical Problems. 2011 (March), Vol. 13, 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 the March issue include:
- Tobacco smoking prevalence in a large sample of heroin users accessing rehabilitation
- Housing and employment situation, body mass index and dietary habits of heroin addicts in methadone maintenance treatment
- Effect of valproate on benzodiazepine withdrawal severity in opioid-dependent subjects
- Opioid addiction complicated by alcoholism (in young men)
- Dual Diagnosis (Comorbidity): A growing diagnostic and treatment issue in psychiatric and substance use programmes
- Does cannabis have therapeutic benefits for withdrawing opioid addicts?
- Is it time for new studies on the level of insight in heroin addicts to promote compliance with methadone treatment?
The PDF file can be downloaded from ATForum.com at: http://atforum.com/documents/HeroinAddict13-1.pdf
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Botulism is a rare disease and recurrent botulism even more rare. However, in California, recurrent wound botulism among injection drug users has been on the rise and makes up three-quarters of reported cases in the U.S.. A new study published in Clinical Infectious Diseases examines this problem.
From 1993 through 2006, 17 injection drug users were identified within the surveillance system of the California Department of Public Health for having recurrent wound botulism. Clinical symptoms ranged from acute paralysis to slurred speech to difficulty swallowing, and at least one case of wound botulism for each patient was laboratory confirmed. Of those, 14 had one recurrence and three had two recurrent episodes. All of the patients reported heroin use, with 88 percent specifically reporting black tar heroin use.
"Recurrent cases suggest that exposure to botulism due to injection drug use does not result in protective immunity," according to study author Duc Vugia, MD, of the California Department of Public Health. "As a result, both clinicians and injection drug users should be aware of the potential for wound botulism to recur with continued injection drug use to allow for timely diagnosis and early administration of appropriate treatment."
Dr. Vugia added, "If these near death experiences do not change behavior among these injection drug users and if severe disease from exposure to botulism does not confer immunity, recurrent wound botulism will continue to occur and add to the health care burden. Continued efforts to reduce injection drug use and educate current users on the infectious risks associated with illicit drug use are crucial to improving the health of the injection drug use population."
Source: Infectious Diseases Society of America (IDSA) — February 25, 2011
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For several decades now, states have taken a "nail 'em-and-jail 'em" approach to drug offenders. Their prisons have filled up -- drug arrests nearly tripled between 1980 and 2009, rising from 580,000 to 1.6 million, according to the FBI -- even as costs have mounted and evidence has grown that community treatment is more effective than prison for many low-level offenders.
Add shrinking budgets to the mix, and it's no wonder that the Wall Street Journal could report on March 5 that many states are now rolling back their punitive drug laws and investing in treatment instead of prison.
States that have already passed legislation of this kind include Colorado, Kentucky, New York, and South Carolina. Similar bills are under consideration in Delaware, Florida, Indiana, Massachusetts and Pennsylvania. (Serious drug crimes still carry harsh penalties.)
Kentucky just passed a new law lowering penalties for many drug offenses and beefing up spending on rehabilitation and drug testing. Republican state senator Tom Jensen said, "If you just throw everyone in jail, it's terribly expensive and they get out and they are in the same boat." Jensen said he had "bought into the tough-on-crime concept" for many years, according to the Wall Street Journal, and that coming around to rehabilitation and treatment instead was "an education process."
Scott Burns, executive director for the National District Attorneys Association disagrees with the change in state policy. "You need to have serious consequences or repercussions in place if people use heroin, Oxycontin," he said.
His colleague Aaron Negangard, who chairs the Indiana Prosecuting Attorneys Council, agreed, saying that "too many people" were being released from prison. "Crime will go up in five to 10 years and people will wonder why," he said.
Source: JoinTogether.org — March 8, 2011
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The Drug Enforcement Administration announced that their second nationwide prescription drug take back day will be on Saturday, April 30th from 10 a.m. to 2 p.m. local time.
The public can find a nearby collection site by visiting www.dea.gov, clicking on the "Got Drugs?" icon, and following the links to a database, where they enter their zip code.
Source: Drug Enforcement Administration — March 8, 2011
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- Behavioral Health and Social Media - Increasing Outreach, Feedback, and Virtual Communities
- President's Budget
- Administrator's Message
- Ask SAMHSA!
- Behavioral Health Spending Down... and more
The PDF file can be accessed at: http://www.samhsa.gov/samhsaNewsletter/Volume_19_Number_1/JanuaryFebruary2011.pdf
Source: Substance Abuse Mental Health Services Administration — March 14, 2011
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A special issue of the journal Neuron, published on February 24th by Cell Press, provides new insight into to the most recent advances in addiction research and highlights the complexities associated with the neurobiological and societal impacts of addiction, as well as strategies for the prevention and treatment of substance abuse.
The February issue contains review articles written by leaders in the field of addiction research that shed light on genetic vulnerability to addiction, the impact of addictive drugs on neuronal transmission, the effects of addictive drugs on reward, risk and decision making, behavioral and pharmacological treatments for addiction and reward mechanisms in obesity.
"Substance abuse disorders profoundly affect our society," writes Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), on the societal impacts of addiction. "Though costs are usually translated in economic terms — approximately half a trillion dollars in the USA — their impact is much more insidious, eroding the foundation of human relationships and the established social contract." New insight into the science of addiction may eventually lead to better strategies that empower families and individuals who are living with this chronic, relapsing brain disease and its associated compulsive and destructive behaviors.
An online podcast features an interview with Dr. Volkow. She explains how recent imaging studies have shown that drugs of abuse do not just disrupt reward pathways in the brain, but that deficits actually expand to an area of the brain called the prefrontal cortex. "This was very surprising because the prefrontal cortex, which has been recognized to be crucial for cognitive operations, was never thought to be of any relevance to the process of addiction," says Dr. Volkow. She goes on to explain how this damage to the prefrontal cortex is linked with compulsivity and impulsivity, pathological behaviors intimately intertwined with addiction, and that therapeutic strategies for addiction should be aimed at reversing these critical cognitive deficits.
The podcast is available at http://www.cell.com/neuron.
Source: Cell Press — February 23, 2011
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A strong link between victimization experiences and substance abuse has been discovered by researchers at the University of Illinois at Chicago.
The correlation is especially prevalent among gays, lesbians and bisexuals -- more so than in heterosexuals, says Tonda Hughes, professor and interim head of health systems science in the UIC College of Nursing. Hughes is lead author of the study, published in the journal Addiction.
Researchers compared victimization experiences of unwanted sexual activity, neglect, physical violence, and assault with a weapon, across four sexual-identity subgroups -- heterosexual, gay or lesbian, bisexual, or "not sure." The study used data collected nationally from 34,635 adults from the National Epidemiologic Survey on Alcohol and Related Conditions.
Hughes and her research team wondered if sexual-minority women and men are at a heightened risk for victimization. The results, Hughes said, showed that they are.
Lesbian and bisexual women were more than twice as likely as heterosexual women to report any victimization over their lifetime. Lesbians, gay men and bisexual women also reported a greater number of victimization experiences than did heterosexuals. Three times as many lesbians as heterosexual women reported childhood sexual abuse.
One possible explanation for this disproportionality, Hughes said, is that lesbians are more willing to acknowledge and report this experience.
"Gays and lesbians tend to be more self-reflective," she said. "This means they are more likely to think about and report negative or stigmatizing life experiences. Heterosexuals may not be inclined to do so."
Gay men also had high rates of victimization, with about half of them reporting any lifetime victimization. They reported significantly higher rates of childhood sexual abuse, childhood neglect, partner violence and assault with a weapon than heterosexual men.
Not only are there higher rates of violence and victimization among sexual minorities, but there is also a higher rate of substance abuse, Hughes said.
Regardless of sexual identity, women who reported two or more victimization experiences had two to four times the prevalence of alcohol dependence, drug abuse or drug dependence as women who reported no victimization, she said.
The research also concluded that gay, lesbian and bisexual youth may use substances to cope with adverse psychological and interpersonal effects of victimization, increasing the risk for further victimization from others, she said.
Source: University of Illinois at Chicago — February 24, 2011
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The National Conference of State Legislatures (NCSL) has launched a database to track the actions of state legislatures related to some of the major provisions in the Affordable Care Act. Topics in the database include Medicaid, Health Insurance Exchanges, Health Insurance Reform, Health Information Technology, Prevention and Wellness, and Providers and Workforce.
The database also includes bills that oppose, opt out or differ from elements of the federal provisions, under the topic Challenges and Alternatives.
"States are at different starting places to implement health reform; the roughly 600 bills included in the database vary so far, depending on the state," said Martha Saenz, a health policy analyst at NCSL. "Introduced bills deal primarily with some of the state flexibility, such as establishing health insurance exchanges."
The database includes 2011 legislation, including pending, failed and enacted bills and resolutions. Bills can be searched by state, topic, keyword, status, and/or primary sponsor. The database is available at: http://www.ncsl.org/?TabId=22122
Source: National Conference of State Legislatures — March 15, 2011
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The Obama administration has designated intravenous needle exchanges as a drug treatment program, allowing federal money set aside to treat addictions to be used to distribute syringes to narcotics users.http://washingtonexaminer.com/local/crime-punishment/2011/02/white-house-moves-fund-needle-exchanges-drug-treatment
On the Trail of Addiction - Researchers map drug users' moment-to-moment experiences as they travel the urban landscape — 3/1/11
Researchers in Baltimore are providing drug users with a Palm Pilot PDA and they are randomly prompted by the PDA to answer questions about their mood, their stress level, and cues in their environment that may lead to relapse.http://www.urbanitebaltimore.com/baltimore/on-the-tracks-of-addiction/Content?oid=1378874
Grimm (R-Staten Island/ Brooklyn) hopes to introduce a bill that makes the federal Drug Enforcement Administration set up a "secure Web portal" for physicians and pharmacists across the country to access, requiring them to report any prescriptions electronically.http://www.silive.com/news/index.ssf/2011/03/staten_islands_rep_grimm_calls_2.html