AT Forum NEWS NOTES & UPDATES #151
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: March 2011
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
An analysis of national prescribing patterns shows that more than half of patients who received an opioid prescription in 2009 had filled another opioid prescription within the previous 30 days. This report also suggested potential opportunities for intervention aimed at reducing abuse of prescription opioids.
Researchers from the National Institute on Drug Abuse (NIDA), published results of this analysis in the April 6, issue of Journal of the American Medical Association (JAMA).
This study used data from SDI's Vector One National database, a privately owned national-level prescription and patient tracking service. The sample included 79.5 million prescriptions dispensed in the United States during 2009, which represent almost 40 percent of all the opioid prescriptions filled nationwide.
The records show that approximately 56 percent of painkiller prescriptions were given to patients who had filled another prescription for pain from the same or different providers within the past month. In addition, nearly 12 percent of opioids prescribed were to young people aged 10-29. Most of these were hydrocodone- and oxycodone-containing products, like Vicodin and Oxycontin. Dentists were the main prescribers for youth aged 10-19 years old. Nearly 46 percent of opioid prescriptions were given to patients between ages 40 and 59, and most of those were from primary care providers.
The April 6th issue of JAMA also includes an accompanying commentary from Dr. Volkow and Dr. Thomas McLellan of the University of Pennsylvania School of Medicine. They point out that according to the Centers for Disease Control and Prevention, prescription opioid overdose is now the second leading cause of accidental death in the United States, killing more people than heroin and cocaine combined. They also state that this is compelling evidence for the need to develop smart strategies to curtail abuse of opioid analgesics, without jeopardizing pain treatment.
The article abstract is available online at: http://jama.ama-assn.org/content/305/13/1315.abstract
Source: National Institute on Drug Abuse Press Release — April 5, 2011
< Back to top >
A team of Boston University researchers has found that the majority of individuals with substance dependence problems report having poor oral health. They also found that opioid users, in particular, showed a decline in oral health over the period of one year. These findings appeared online April 6, in the Journal of Substance Abuse Treatment.
Public health, dental medicine and internal medicine faculty from Boston University investigated the affects of different substances on oral health among a sample of substance-dependent individuals. Alcohol, stimulant, opioid and marijuana users were included. The subjects were asked to self-report their oral health status on a five-point scale ranging from poor to excellent.
Statistical analysis of the patients' reports found no significant associations between the types of substances used and oral health status. The results did show, however, that 60 percent of all subjects reported fair or poor oral health. Opioid users in the sample also exhibited worse oral health compared to one year ago.
The researchers hope that their findings prompt more oral health interventions targeted toward individuals with substance dependence in the future. They also suggest that engaging addicts in medical care discussions may be facilitated by addressing oral health concerns.
Source: Boston University Medical Center — April 14, 2011
< Back to top >
Lisa Mojer-Torres, JD, passionate advocate for medication-assisted treatment and recovery, and recent co-author with William L. White, MA, of a ground-breaking monograph, Recovery Oriented Methadone Maintenance (ROMM), died April 4 of ovarian cancer. The 54-year-old civil rights attorney was a board member of the National Alliance for Methadone Advocates, founding member and first board chair of Faces and Voices of Recovery, and recipient of many awards, including the 2010 Richard Lane/Robert Holden Patient Advocacy Award from the American Association for the Treatment of Opioid Dependence. She was also the recovery advocate for the New Jersey Division of Addiction Services.
"Lisa was a true pioneer for those seeking recovery, especially those in medication-assisted recovery," said Michael T. Flaherty, PhD, executive director of the Institute for Research, Education and Training in Addictions (IRETA). "While many fled from advocating for those needing medications to achieve and sustain their personal recovery, Lisa told her story. She brought reality to recovery for those individuals and their families."
The Faces and Voices of Recovery website has a tribute "Remembering Lisa Mojer-Torres" available at: http://facesandvoicesofrecovery.org/about/Lisa-Mojer-Torres.php
For the interview with Lisa Mojer-Torres and William White published in the Winter 2011 issue of AT Forum, go to http://www.atforum.com/newsletters/2011winter.php#recovery
< Back to top >
The Military's Bad Medicine - The Military's Outdated View on Drug-Addiction Treatment Leaves Soldiers and Their Families Suffering
"In many areas, TRICARE does an excellent job caring for active-duty and retired military personnel and their families. Yet for no valid reason, it continues to reject the most effective, evidence-based maintenance treatments for opiate addiction."
The article can be accessed at: http://prospect.org/cs/articles?article=bad_medicine2
Source: The American Prospect — April 14, 2011
< Back to top >
Illicit drug overdose deaths declined dramatically after the establishment of North America's first supervised injection facility located in Vancouver, Canada, according to the findings of a new study published in the April 11, issue of The Lancet.
In the first peer-reviewed study to assess the impact of supervised injection sites on overdose mortality, researchers observed a 35% reduction in overdose deaths in the immediate vicinity of a pilot injection facility called Insite located in Vancouver, Canada, following its opening in September 2003. By contrast, overdose deaths in the rest of Vancouver declined only 9% over the same period. No overdose deaths have been recorded at Insite since the facility's opening.
Insite supervises over 500 injections on an average day with only 12 injection seats. It is estimated that the neighborhood in Vancouver has an estimated 5000 injection drug users.
The researchers reviewed nearly 300 case reports from the British Columbia Coroners Service documenting all illicit drug overdose deaths in Vancouver between January 1, 2001 and December 31, 2005. Deaths were sorted geographically into two categories: those occurring within approximately a third of a mile from the facility and those occurring elsewhere in the city. Overdose mortality rates were then calculated for each category in the periods before and after Insite's opening.
Established in 2003 in response to an HIV epidemic and escalating overdose death rates in this downtown Vancouver neighborhood, Insite enables injection drug users to consume pre-obtained drugs under the supervision of nurses. Counselors are also available onsite to provide support and referrals to programs, including addiction treatment. An extensive scientific evaluation by UHRI researchers has previously demonstrated the facility's ability to reduce HIV risk behavior, increase access to addiction treatment and primary health care services, and reduce healthcare costs in the long term.
Despite its success, INSITE has come under legal attack from political opponents. On January 15, 2010, the British Columbia Court of Appeal upheld a decision by the BC Supreme Court, now under appeal to the Supreme Court of Canada, that allowed Insite to continue to operate based on its demonstrated health benefits. Several groups and organizations, including the Canadian Medical Association, the Canadian Public Health Association, and the Canadian Nurses Association are calling for the continued operation of Insite.
The article summary can be accessed at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62353-7/fulltext#article_upsell
Source: Columbia University's Mailman School of Public Health — April 21, 2011
< Back to top >
Obama Administration Releases Action Plan to Address National Prescription Drug Abuse Epidemic; Announces FDA Action Requiring Drug Makers to Develop Education Program For Prescribers
On April 19, Gil Kerlikowske, White House Director of National Drug Control Policy; Assistant Secretary for Health and Human Services, Howard Koh, M.D.; Food and Drug Administration Commissioner, Margaret A. Hamburg, M.D.; and DEA Administrator, Michele M. Leonhart released the Obama Administration's comprehensive action plan to address the national prescription drug abuse epidemic and announced new Federal requirements aimed at educating the medical community about proper prescribing practices.Key elements of the plan — called Epidemic: Responding to America's Prescription Drug Abuse Crisis — include:
- Expansion of state-based prescription drug monitoring programs
- Recommending convenient and environmentally responsible ways to remove unused medications from homes
- Supporting education for patients and health care providers
- Reducing the number of "pill mills" and doctor-shopping through law enforcement
The plan is the culmination of six months of collaboration across the Federal government, with agencies including the Departments of Justice, Health and Human Services, Veterans Affairs, the Department of Defense, and others.
In support of the action plan, the Food and Drug Administration (FDA) announced that it is requiring an Opioids Risk Evaluation and Mitigation Strategy (REMS). The new program will require manufacturers of long-acting and extended-release opioids to provide educational programs to prescribers of these medications, as well as materials prescribers can use when counseling patients about the risks and benefits of opioid use.
"The toll our Nation's prescription drug abuse epidemic has taken in communities nationwide is devastating," said Director Kerlikowske. "We share a responsibility to protect our communities from the damage done by prescription drug abuse. This plan will build upon our already unprecedented efforts to coordinate a national response to this public health crisis by addressing the threat at the Federal, state, and local level."
ONDCP is coordinating an unprecedented government-wide public health approach to reduce drug use and its consequences in the United States . This effort includes requesting an increase in funding for drug prevention by $123 million and treatment programs by $99 million dollars for Fiscal Year 2012, to train and engage primary health care to intervene in emerging cases of drug abuse, expand and improve specialty care for addiction — including care for families and veterans, and to better manage drug-related offenders in community corrections.
The full press release can be accessed at: http://www.whitehousedrugpolicy.gov/news/press11/041911.html
The full Action Plan can be accessed at: http://www.whitehousedrugpolicy.gov/publications/pdf/rx_abuse_plan.pdf
The FDA's Opioids Risk Evaluation and Mitigation Strategies (REMS) can be accessed at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm163647.htm
Source: Office of National Drug Control Policy — April 19, 2011
< Back to top >
SAMHSA Introduces Guidance Changing Its Block Grant Programs to Reflect New Opportunities Provided by Parity, Health Reform and Emerging Science
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced a new approach for the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community Mental Health Services Block Grant (MHBG) in the Federal Register on April 11.
"Changes in healthcare delivery structures, rapid adoption of health information technology, scientific advances in prevention and treatment services, growing understanding of recovery, and implementation of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act will greatly enhance access to prevention, treatment and recovery support services nationwide," said SAMHSA Administrator Pamela S. Hyde, J. D. "These changes also present opportunities to establish the role of the block grants as critical underpinnings of the public substance abuse and mental health service systems, drivers of quality and innovation, and essential resources for transforming health care in America, especially in difficult economic times."Under this new approach states and territories will have the opportunity to use block grant dollars for prevention, treatment, recovery supports and other services that supplement services covered by Medicaid, Medicare and private insurance. The Block Grant funds will be directed to four purposes:
- Fund priority treatment and support services for individuals without insurance or for whom coverage is terminated for short periods of time
- Fund those priority treatment and support services not covered by Medicaid, Medicare or private insurance for low income individuals and that demonstrate success in improving outcomes and/or supporting recovery
- Fund primary prevention - universal, selective and indicated prevention activities and services for persons not yet identified as needing treatment
- Collect performance and outcome data to determine the ongoing effectiveness of behavioral health promotion, treatment and recovery support services and plan the implementation of new services on a nationwide basis
Currently the two SAMHSA block grant programs have been administered somewhat differently by separate SAMHSA centers, and states have had idiosyncratic structures and timing for accepting, planning and accounting for these grants. In an effort to streamline application and funding procedures, SAMHSA is now issuing guidance promoting consistent application, assurance and reporting dates across both block grants and offering states and territories the option to submit one coordinated plan for both grants.
For detailed information about proposed changes to the block grant programs, including their application policies, go to http://samhsa.gov/grants/blockgrant/ or to the Federal register notice at: http://www.gpo.gov/fdsys/pkg/FR-2011-04-11/pdf/2011-8520.pdf.
Source: The Substance Abuse and Mental Health Services Administration — April 11, 2011
< Back to top >
On March 30, the Substance Abuse and Mental Health Services Administration (SAMHSA) published its strategic initiatives paper -- an overview of SAMHSA's goals, priorities and action steps for accomplishing its mission of reducing the impact of substance abuse and mental illness on America's communities.The eight strategic initiatives set forth in the paper address how SAMHSA will maximize its resources in an environment that promises improvements in the nation's behavioral health care system over the next few years as a result of a variety of forces -- most notably the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act. The strategic initiatives include:
- Prevention of Substance Abuse and Mental Illness
- Trauma and Justice
- Military Families
- Recovery Support
- Health Reform
- Health Information Technology
- Data, Outcomes, and Quality
- Public Awareness and Support
SAMHSA's strategic initiatives paper, Leading Change: A Plan for SAMHSA's Roles and Actions 2011-2014, is available at http://store.samhsa.gov/product/SMA11-4629
Source: The Substance Abuse and Mental Health Services Administration — March 30, 2011
< Back to top >
Buchanan "Pill Mill" Crackdown Draws Bipartisan Support - National Anti-Drug Coalition Urges Swift Passage
U.S. Rep.Vern Buchanan's bill to combat prescription drug abuse and crack down on Florida's sprawling pill mill industry was introduced March 14, with broad bipartisan support from senior members in both parties.
Buchanan's bill, "The Pill Mill Crackdown Act of 2011," includes provisions to: support state-based prescription drug monitoring programs; use the money from seized illicit operations for drug treatment; strengthen prescription standards for certain addictive pain drugs; and toughen prison terms and fines for pill mill operators.
"Today, we take a crucial step toward putting these pill mills out of business," said Buchanan. "Many of these so-called pain clinics are nothing more than illegal drug distribution networks that bring untold misery to our children, our families, and our communities."
Congressman Markey, dean of the Massachusetts congressional delegation, said "this legislation will help curb the growing epidemic of prescription drug abuse by cracking down on the healthcare providers who prescribe medically unnecessary painkillers and will support law enforcement in their efforts to identify and stop illegal activities."Specifically, Buchanan's Bill would:
- Toughen federal penalties for pill mill operators by doubling the prison sentence from 10 to 20 years and tripling the fine from $1 million to $3 million
- Stipulate that assets seized from violators be used to: fund drug monitoring databases in the states; fund DEA enforcement actions against Pill Mills; and, support drug treatment programs within the Substance Abuse and Mental Health Services Administration. The DEA last month seized an estimated $2.5 million in illicit assets owned by pill mill owners in South Florida
- Reclassify hydrocodone combination drugs (one of the most addictive and dangerous drug mixtures) to make them a Schedule II drug that is more difficult to prescribe and obtain
The press release can be accessed at: http://buchanan.house.gov/index.php?option=com_content&task=view&id=4250&Itemid=167
The text of the proposed legislation can be accessed at: http://www.govtrack.us/congress/billtext.xpd?bill=h112-1065
Source: U.S. Rep.Vern Buchanan Website — March 14, 2011
< Back to top >
2008 Treatment Episode Data Set (TEDS) Report on Discharges From Substance Abuse Facilities is Now Available
On April 19, The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the availability of its 2008 TEDS report on discharges from substance abuse treatment facilities located throughout the nation. The report provides information on treatment completion, length of stay, substances of abuse, demographic information and other statistical data about those aged 12 and older who were discharged from drug treatment facilities in 2008.Discharges From Medication-Assisted Treatment for Opioid Addition
Discharges aged 12 and older from outpatient medication-assisted opioid therapy included 93 percent from outpatient treatment and 7 percent from intensive outpatient treatment.Of the 62,328 discharges aged 12 and older from outpatient medication-assisted opioid therapy in 2008:
- 15 percent (n = 9,043) completed treatment
- 18 percent (n = 11,365) were transferred to further treatment
- 40 percent (n = 25,115) dropped out of treatment
- 12 percent (n = 7,626) had treatment terminated by the facility
- 15 percent (n = 9,179) failed to complete treatment for other reasons
Reason for discharge from outpatient medication-assisted opioid therapy: TEDS 2008
- 197 days among those who completed treatment
- 151 days among those who transferred to further treatment
- 120 days among those who dropped out of treatment
- 215 days among those whose treatment was terminated by the facility
- 185 days among those who failed to complete treatment for other reasons
Median length of stay in outpatient medication-assisted opioid therapy,
by reason for discharge: TEDS 2008
The report can be downloaded at http://wwwdasis.samhsa.gov/teds08/teds2k8dindex.htm or in PDF at: http://wwwdasis.samhsa.gov/teds08/teds2k8dweb.pdf
Source: The Substance Abuse and Mental Health Services Administration — April 19, 2011
< Back to top >
A free, nationwide service was launched April 8, to help primary care providers seeking to identify and advise substance-abusing patients. The service, Physician Clinical Support System for Primary Care (PCSS-P), offers peer-to-peer mentorship and resources on incorporating screening and follow-up into regular patient care. PCSS-P is a project of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the American Society of Addiction Medicine (ASAM).
NIDA also launched a quick screening tool to help health care providers identify these patients.
The warm line service — "warm" because the response is within 24 hours rather than an immediate response typical of a hotline — is available to physicians and other health care providers at no cost. Providers register with PCSS-P and receive the contact information of a mentor who is a specialist in screening, brief intervention, treatment and referral for patients with substance abuse problems. Mentors can then be contacted, via phone or email, with specific questions about clinical situations involving alcohol, drugs, and tobacco. To take advantage of the service, physicians can call PCSS-P at 877-630-8812, or register online at www.PCSSmentor.org.
NIDA's Quick Screen is an online interactive single-question screen that asks, "In the past year, how many times have you used the following: alcohol (more than 4 or 5 drinks in a day for women or men, respectively); tobacco products; prescription drugs for nonmedical reasons; and illegal drugs?" If a patient indicates past year use of illegal drugs, or prescription drugs for nonmedical reasons, the clinician has the option of conducting NIDA's full screening tool for the specific drugs abused.
Source: National Institute on Drug Abuse — April 8, 2011
< Back to top >