AT Forum NEWS NOTES & UPDATES #152
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: April 2011
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
Benzodiazepines (BZD) misuse is a serious public health problem, especially among opiate-dependent patients with anxiety enrolled in methadone programs because it puts patients at higher risk of life-threatening multiple drug overdoses. Both elevated anxiety and BZD misuse increase the risk for ex-addicts to relapse.
However, there is no recent study to assess how serious the problem is and what factors are associated with BZD misuse. This study estimates the prevalence of BZD misuse in a methadone program, and provides information on the characteristics of BZD users compared to non-users.
Method: An anonymous survey was carried out at a methadone program in Baltimore, MD, and all patients were invited to participate through group meetings and fliers around the clinic on a voluntary basis. Of the 205 returned questionnaires, 194 were complete and entered into final data analysis. Those who completed the questionnaire were offered a $5 gift card as an appreciation.
Results: 47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program. Compared to the non-users, BZD users were more likely to be White, have prescribed medication for mental problems, have preexistent anxiety problems before opiate use, and had anxiety problems before entering methadone program. They reported more mental health problems in the past month, and had higher scores in anxiety state, depression and perceived stress (p <.05).
Conclusions: Important information on epidemiology of BZD misuse among methadone-maintenance patients suggests that most methadone programs do not address co-occurring anxiety problems, and methadone treatment may trigger onset or worsening of BZD misuse. Further study is needed to explore how to curb misuse and abuse of BZD in the addiction population, and provide effective treatments targeting simultaneously addiction symptoms, anxiety disorders and BZD misuse.
A provisional PDF file is available at: http://www.biomedcentral.com/1471-244X/11/90/abstract
Source: BMC Psychiatry — May 19, 3011
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Methadone therapy can help opiate-addicted inmates recover, and many countries have embraced it. But the U.S. hasn't.
Considering the high rates of opiate dependency among American prisoners (heroin and OxyContin), short-term jails seem like an ideal place for methadone programs. But few correctional facilities have taken the bold step of opening methadone maintenance treatment (MMT) programs, and very few plan to. Why?
The article can be accessed at: http://www.theatlantic.com/life/archive/2011/04/giving-prisoners-addictive-drugs-sometimes-a-good-idea/237823/
Source: The Atlantic — April 25, 2011
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According to an article in the June edition of Health Affairs, increasing access to rogue online pharmacies — those which dispense medications without a doctor's prescription — may be an important factor behind the rapid increase in the abuse of prescription drugs.
Investigators from Massachusetts General Hospital (MGH) and the University of Southern California (USC) found that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.
In their report, Goldman and lead author Anupam B. Jena, MD, PhD, of the MGH Department of Medicine, note that the recent marked rise in the abuse of prescription narcotic painkillers — drugs like Percocet and Oxycontin — corresponds with an increase in the presence of online pharmacies, many of which do not adhere to regulations requiring a physician's prescription. Drugs that are frequently abused — painkillers, stimulants, sedatives and tranquilizers — often can be purchased from rogue sites that may be located outside the U.S. The current study was designed to examine the potential link between online availability and prescription drug abuse, an association that has been suspected but not investigated in depth.
Using data available from the Federal Communications Commission, the researchers first compiled statistics on access to high-speed Internet service in each state during the years studied. Since actual rates of prescription drug abuse would be difficult if not impossible to calculate, they used information on admissions to substance abuse treatment facilities from a database maintained by the U.S. Substance Abuse and Mental Health Administration. Changes in both measures over the seven years were analyzed on a per-state basis, and treatment admissions were categorized by the particular types of abused substances involved.
The analysis indicated that each 10 percent increase in the availability of high-speed Internet service in a state was accompanied by an approximately 1 percent increase in admissions for prescription drug abuse. The increases were strongest for narcotic painkillers, followed by anti-anxiety drugs, stimulants and sedatives. During the same period admissions to treat abuse of alcohol, heroin or cocaine, substances not available online, showed minimal growth or actually decreased.
Source: Massachusetts General Hospital — May 12, 2011
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During the Drug Enforcement Agency's second National Prescription Drug Take-Back event on April 30th more than 376,593 pounds (188 tons) of unwanted or expired medications for safe and proper disposal were turned in at 5,361 take-back sites in all 50 states. This is 55 percent more than the 242,000 pounds (121 tons) collected during last September's event. Four days after last fall's Take-Back Day, Congress passed legislation amending the Controlled Substances Act which will allow the DEA to develop a process that will soon allow Americans to safely dispose of their prescription drugs all year round.
Source: Drug Enforcement Agency - May 20, 2011
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Mr. Barrett and other prison officials nationwide are searching their facilities, mail and visitors for Suboxone, a drug used as a treatment for opiate addiction that has become coveted as contraband.
The article can be accessed at: http://www.nytimes.com/2011/05/27/us/27smuggle.html?_r=2&hp=&pagewanted=all
Source: NewYorkTimes.com — May 26, 2011
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Under the Influence of Methadone - There's a Better, Cheaper Option For Opioid Addicts. So Why Isn't it Widely Used?
A lively debate of methadone versus Suboxone that generated many comments in the Boston Globe.
The article can be accessed at: http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2011/05/15/under_the_influence_of_methadone/
Source: Boston.com — May 15, 2011
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Illicit drug use in the US is estimated to have cost the US economy more than $193 billion in 2007, according to a study produced and released on May 26 by the National Drug Intelligence Center.
The Economic Impact of Illicit Drug Use on American Society, produced on behalf of the Office of National Drug Control Policy, estimates the economic impact of illicit drugs for calendar year 2007 — the most recent year for which data are available. "This study shows the economic cost of illicit drug use is significant," said NDIC Director Michael F. Walther. "The study's finding that the economic cost of illicit drug abuse totaled $193 billion reveals that this nation's drug problem is on par with other health problems."
According to a 2008 study by the National Institute of Diabetes and Digestive and Kidney Diseases, diabetes costs the United States more than $174 billion each year. The Centers for Disease Control and Prevention report that from 1995 to 1999, smoking accounted for at least $157 billion annually in health-related economic costs.
The study is the first comprehensive assessment of costs associated with drug use in almost a decade. The statistical findings presented in the study integrate economic costs in three principal areas: crime, health, and productivity. Costs considered in each of these areas include:
- Crime: This includes criminal justice costs, crime victim costs, and other federal costs for activities including intelligence production, interdiction, source nation assistance, and research and development.
- Health: Specialty drug treatment costs, hospital and emergency room costs for non-homicide and homicide cases, insurance administration costs, and other health costs.
- Productivity: Labor participation costs (for those who are employed but are not as productive as they might be due to illicit drug use) and incapacitation costs attributable to specialty treatment, hospitalization, incarceration, premature mortality (non-homicide related),and premature mortality (homicide-related).
The 123 page PDF file can be accessed at: http://www.justice.gov/ndic/pubs44/44731/44731p.pdf
Source: US Department of Justice National Drug Intelligence Center (April 2011) — May 26, 2011
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In August 2010, leaders in the behavioral health field, including people in recovery from mental health and addiction problems and the Substance Abuse Mental Health Services Administration (SAMHSA) met to explore the development of a common, unified definition of recovery. After many conversations and hard work with SAMHSA's partners in the field, a working unified definition and set of principles for recovery has been developed. The development of a standard, unified working definition of recovery will help assure access to recovery-oriented services for those who need it, as well as reimbursement to providers.Working Definition of Recovery
Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.Principles of Recovery
- Occurs via many pathways;
- Is holistic;
- Is supported by peers;
- Is supported through relationships;
- Is culturally-based and influenced;
- Is supported by addressing trauma;
- Involves individual, family, and community strengths and responsibility;
- Is based on respect; and
- Emerges from hope.
- Health: overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way;
- Home: a stable and safe place to live that supports recovery;
- Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
- Community: relationships and social networks that provide support, friendship, love, and hope.
There is no set time requirement for recovery as it is recognized that this is an individualized process whereby each person's journey of recovery is unique and whereby each person in recovery chooses supports, ranging from clinical treatment to peer services that facilitate recovery.
The blog on SAMHSA's definition of recovery can be accessed at: http://blog.samhsa.gov/2011/05/20/recovery-defined-a-unified-working-definition-and-set-of-principles/
Source: Substance Abuse Mental Health Services Administration - May 20, 2011
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New Study Shows 49 Percent Rise in Emergency Department Visits For Drug Related Suicide Attempts By Females Aged 50 and Older From 2005 to 2009
A new national study shows that from 2005 to 2009 (the most recent year with available figures) there was a 49 percent increase in emergency department visits for drug-related suicide attempts by women aged 50 and older — from 11,235 visits in 2005 to 16,757 in 2009. This increase reflects the overall population growth of women aged 50 and older.
The report by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows that, while overall rates for these types of hospital emergency department visits by women of all ages remained relatively stable throughout this period, visits involving particular pharmaceuticals increased. For example, among females, emergency department visits for suicide attempts involving drugs to treat anxiety and insomnia increased 56 percent during this period — from 32,426 in 2005 to 50,548 in 2009.
Similarly, emergency department visits for suicide attempts among females involving pain relievers rose more than 30 percent from 36,563 in 2005 to 47,838 in 2009. The rise in the number of cases involving the misuse of two narcotic pain relievers, hydrocodone and oxycodone was particularly steep. There was a 67 percent increase in the number of cases involving hydrocodone (from 4,613 in 2005 to 7,715 in 2009), and a 210 percent increase in the number of these cases involving oxycodone (from 1,895 in 2005 to 5,875 in 2009).
"The steep rise in abuse of narcotic pain relievers by women is extremely dangerous and we are now seeing the result of this public health crisis in our emergency rooms," said SAMHSA Administrator Pamela S. Hyde, J.D. "Emergency rooms should not be the frontline in our efforts to intervene. Friends, family and all members of the community must do everything possible to help identify women who may be in crisis and do everything possible to reach out and get them needed help."
The full report is available at: http://www.oas.samhsa.gov/2k11/DAWN011/DrugRelatedSuicide_HTML.pdf
Source: Substance Abuse and Mental Health Services Administration — May 18, 2011
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U. S. Senator Brown Announces Plan to Combat Prescription Drug Abuse By Targeting Doc-Shopping and Pharmacy-Hopping
On May 4, U.S. Sen. Sherrod Brown (D-OH) announced a plan to combat prescription drug abuse by targeting doctor-shopping and pharmacy-hopping. Brown unveiled new legislation that would crack down on the fraudulent use of Medicaid cards to obtain and fill prescriptions for addictive pain medications.
During a news conference call, Brown outlined how a Medicaid lock-in program would prevent prescription drug abusers from acquiring excess prescription drugs—which they may abuse or illegally-resell—by barring them from visiting multiple doctors and pharmacies.
An investigation by the nonpartisan Government Accountability Office (GAO), which audited the Medicaid programs of the five largest states, found 65,000 cases in which Medicaid beneficiaries visited six or more doctors and up to 46 different pharmacies to acquire prescriptions. This same GAO report found approximately 1,800 prescriptions written for dead patients and 1,200 prescriptions "written" by dead physicians.
Senator Brown announced the introduction of the Stop Trafficking of Pills Act (STOP Act). This bill would require national adoption of Medicaid Lock-In programs, which are already used in nearly 20 states. South Carolina's Medicaid lock-in pilot program targeted high-use beneficiaries and spurred a 43 percent decrease in the total number of prescription pain medications. Medicaid lock-in programs can be effective by limiting the doctors from which a high-risk patient can receive prescriptions, as well as the pharmacies from which the patient can obtain medicines. This enables the kind of close monitoring needed to prevent high-risk patients from personally abusing or selling opioids.
The press release can be accessed at: http://brown.senate.gov/newsroom/press_releases/release/?id=6509e42e-9f89-455f-8dd9-e3b6a6f605b3
Source: Sherrod Brown U.S. Senator Ohio — May 4, 2011
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On May 17, US Rep. Nick J. Rahall (D-WV) Tuesday pointed to H.R. 1925, the Prescription Drug Abuse Prevention and Treatment Act of 2011, which he introduced, as a good starting point for discussing options to address the widespread problem.
"This new legislation, along with the drug summit that I am convening, are part of a coordinated strategy to attack the epidemic of prescription drug abuse that has infiltrated our communities," said Rahall. "The bill would implement many of the national recommendations put forward by experts — focusing on education and training, monitoring, evaluation and enforcement — and provides a good guideline for tomorrow's discussion about coordinating federal, state, and local efforts to fight the prescription drug epidemic. I commend Senator Rockefeller for his insight and efforts in drafting this legislation, and his continued leadership in health care. I am pleased to serve as the chief sponsor of his bill in the House."
Rahall is promoting the legislation as one prong of the four-part strategy he is pursuing on prescription drug abuse — a strategy that tracks the recommendations of the Office of National Drug Control Policy (ONDCP). The four major areas of that strategy are: education, tracking and monitoring, proper medical disposal, and enforcement.
Rahall's bill, the House companion measure to the Senate bill authored by Rockefeller (D-WV), would promote both physician and consumer education, as well as authorize federal funding to help states create and maintain prescription drug monitoring programs that all states can access. The bill would also set up a uniform system for tracking pain killer-related deaths, helping states and law enforcement manage and report data.
H.R. 1925 compliments other legislation Rahall has cosponsored to strengthen law enforcement and crackdown on "pill mills," a term used by law enforcement to describe a doctor or clinic that is prescribing or dispersing powerful narcotics inappropriately or for non-medical uses. He has also called upon the ONDCP Director to support the petition from the Appalachia High Intensity Drug Trafficking Area (HIDTA) and the West Virginia State Police and local law enforcement to include Mercer County in the Appalachia HIDTA. With such a designation, southern West Virginia would have increased access to federal resources and information-sharing among federal, state, and local law enforcement personnel to help reduce illicit drug trafficking within the area.
The full press release can be accessed at: http://www.rahall.house.gov/index.cfm?sectionid=10§iontree=5,10&itemid=1858
Source: Congressman Nick Rahall — May 17, 2011
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Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines when their immune systems were relatively healthy, according to findings from a large-scale clinical study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
The clinical trial, known as HPTN 052, was slated to end in 2015 but the findings are being released early as the result of a scheduled interim review of the study data by an independent data and safety monitoring board (DSMB). The DSMB concluded that it was clear that use of antiretrovirals by HIV-infected individuals with relatively healthier immune systems substantially reduced transmission to their partners. The results are the first from a major randomized clinical trial to indicate that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner.
"Previous data about the potential value of antiretrovirals in making HIV-infected individuals less infectious to their sexual partners came largely from observational and epidemiological studies," said NIAID Director Anthony S. Fauci, MD "This new finding convincingly demonstrates that treating the infected individual — and doing so sooner rather than later — can have a major impact on reducing HIV transmission."
The NIH press release can be accessed at: http://www.nih.gov/news/health/may2011/niaid-12.htm
Source: National Institutes of Health — May 12, 2011
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Known more commonly as Narcan, Naloxone is a drug that, once injected into the body, blocks the opiate receptors in the brain. In short, it reverses the effects of an opiate-related, or heroin, overdose. An update on the Chicago Recovery Alliance.http://news.medill.northwestern.edu/chicago/news.aspx?id=186855
Cash-strapped states are scaling back efforts to provide life-saving medicines to HIV patients.http://www.washingtonpost.com/national/health/states-cut-back-efforts-to-provide-drugs-for-hiv-aids/2011/05/20/AFYGRK9G_story.html
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