AT Forum NEWS NOTES & UPDATES #154
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: June 2011
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
Research Article - Distance Traveled and Cross-State Commuting to Opioid Treatment Programs in the United States
This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs) in the United States during 2005 - 2009. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60%) the patients traveled <10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n = 17, 792), factors significantly (P < .05) associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient’s ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use.
The authors suggested, to reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients’ commuting patterns and to factors associated with them.
The PDF article is available for download at: http://www.atforum.com/addiction-resources/documents/Cross-StateCommutingtoOTPsintheUS.pdf
Source: Journal of Environmental and Public Health Volume 2011, Article ID 948789, 10 pagesdoi:10.1155/2011/948789
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Dr. Andrew Byrne is a general medical practitioner from Sydney Australia who has been prescribing methadone for opioid addiction since 1986 and has published numerous research articles, letters, and commentaries in medical journals. Three of his recent blog posts include:
Is levo-methadone the answer to so-called cardiac complications? June 17, 2011
Buprenorphine wafer/film inductions confusing 6/15/11
German hep C study reports excellent results. 5/17/11
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U.S. Retail Distribution of Buprenorphine Approaches 1.5 Million Grams – 6/20/11
Number of Law Enforcement-Seized Buprenorphine Items Analyzed by U.S. Labs Increases Dramatically – 6/27/11
Number of U.S. Emergency Department Visits Related to the Nonmedical Use of Buprenorphine More Than Triples Since 2006 – 7/5/11
61% of Buprenorphine-Related Emergency Department Visits for Nonmedical Use – 7/11/11
Nearly All Emergency Department Visits for the Accidental Ingestion of Buprenorphine Occur in Children Under the Age of Six – 7/18/11
Source: Cesar Fax – www.cesar.umd.edu
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In the July issue of the Journal of the American Dental Association, a group of nine dentists, pharmacists, and addiction experts provides new research and recommendations to help dentists combat, rather than contribute to, abuse of addictive painkillers.
Many dentists really haven’t even perceived there to be a problem,” said George Kenna, an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, an addiction psychologist at the Center for Alcohol and Addiction Studies, and the corresponding author of the article. “Dentists write the third-most prescriptions for immediate release opioids in the United States, but they often don’t know the appropriate number of doses to prescribe, how many doses a patient uses, or most importantly what patients do with the leftover tablets they have.
As outlined by the administration’s policy, facilitating ways to reduce the number of leftover painkillers that can become a supply of drugs in the home for those who would abuse them, dentists and other prescribers would be taking a significant step, said Kenna who is also a pharmacist.
Last year Kenna helped lead a meeting of dentists and fellow addiction experts and pharmacists at the Tufts Health Care Institute Program on Opioid Risk Management, where he serves as a scientific adviser. The group offered several recommendations for dentists, including:
- Discuss with patients whether they need an opioid for their pain and how likely they are to use what you prescribe.
- Consider writing small quantities and limit refills.
- Do not prescribe drugs to patients you do not know; be suspicious of those who claim their drugs were lost or stolen.
- Use prescription monitoring programs (i.e., state databases), if available, to verify drug-use history.
- Advise patients either to destroy or lockup any excess medication.
- Keep prescription pads locked up.
In the article, the authors also call for more research to make the most effective use of opioid and non-opioid painkillers, for instance to determine how much painkiller and which kind patients really need. Without enough evidence to guide them, dentists have often felt obliged to prescribe opioids too often and in too great a quantity, Kenna said.
The press release can be accessed at: http://news.brown.edu/pressreleases/2011/07/dentists
Source: Brown University – July 1, 2011
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Injection drug users are in greater need of substance abuse treatment compared to non-injecting drug users, according to a new study by researchers at RTI International.
"Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders," said Scott Novak, PhD, a senior behavioral health epidemiologist at RTI International and the study's lead author. "These problems appear to characterize a treatment-resistant population in need of specialized treatments."
The study, published in the July issue of Journal of Addictive Diseases, used data from the National Survey on Drug use and Health, to compare past-year injection drug users and non-injection drug users' routes of administration of those who use heroin, methamphetamine, and cocaine.
The researchers also found that injection was the most highly preferred route of administration among those living in rural areas compared to those living in either urban or suburban locations.
The study showed that injection drug users were also more likely than those using drugs via other routes to be aged 35 and older, unemployed, and possess less than a high school education.
"This study confirms a longstanding belief that injection drug users are a unique population with their own treatment needs, regardless of what drug they inject," Novak said.
Additionally, injection drug users exhibited higher rates of abuse and dependence, perceived need for substance abuse treatment, and co-occurring physical and psychological problems than non-injection drug users.
"By learning more about how routes of administration are related to user characteristics, we could improve our ability to tailor substance abuse treatment and prevention strategies to individual users," Novak said. "Because injection drug users are disproportionately engaged in the criminal justice system, criminal justice diversion programs, such as Drug Courts, and treatment for incarcerated offenders should also consider the unique needs of injection drug users."
The press release can be accessed at: http://www.rti.org/news.cfm?objectid=1FDAC33F-5056-B100-3145C837ECC036BF
Source: RTI International – July 12, 2011
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Researchers at The Scripps Research Institute have developed a vaccine against a heroin high and have proven its therapeutic potential in animal models.
The new study, published recently online by the American Chemical Society's Journal of Medicinal Chemistry, demonstrates how a novel vaccine produces antibodies (a kind of immune molecule) that stop not only heroin but also other psychoactive compounds metabolized from heroin from reaching the brain to produce euphoric effects.
“We saw a very robust and specific response from this heroin vaccine,” said George F. Koob, chair of the Scripps Research Committee on the Neurobiology of Addictive Disorders and a co-author of the new study. “I think a humanized version could be of real help to those who need and want it.”
Attempts by other researchers over the past four decades to create a clinically viable heroin vaccine, however, have fallen short, in part due to the fact that heroin is an elusive target metabolized into multiple substances each producing psychoactive effects.
The study was funded by the National Institute of Drug Abuse of the National Institutes of Health and the Skaggs Institute for Chemical Biology at Scripps Research.
For further information the press release can be accessed at: http://www.scripps.edu/news/press_releases/20110720janda.html
Source: The Scripps Research Institute – July 20, 2011
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A new study by researchers at Drexel University’s School of Public Health suggests that abuse of prescription painkillers may be an important gateway to the use of injected drugs such as heroin, among people with a history of using both types of drugs. The study, published in the International Journal of Drug Policy, explores factors surrounding young injection drug users’ initiation into the misuse of opioid drugs. Common factors identified in this group included a family history of drug misuse and receiving prescriptions for opioid drugs in the past. The results support a need for efforts to prevent misuse of prescription drugs, particularly during adolescence.
“Participants were commonly raised in households where misuse of prescription drugs, illegal drugs, or alcohol, was normalized,” explains Dr. Stephen Lankenau, an associate professor in the School of Public Health and principal investigator of the study. “Access to prescription medications – either from a participant’s own source, a family member, or a friend – was a key feature of initiation into prescription drug misuse.”
In numerous cases, the desire to experiment with a prescription opioid drug, combined with financial incentives or pressures from friends to sell available quantities, resulted in escalated patterns of opioid misuse, according to the study.
Lankenau and colleagues also describe two key findings as evidence of an emerging dynamic among misuse of opioid drugs and the use of injection drugs. First, four of five IDUs misused an opioid before injecting heroin, in contrast to more conventional patterns of using opioids as a substitute drug after initiating heroin use.
Second, in nearly one out of four young IDUs in this study, a prescription opioid was the first type of drug they injected. Prescription opioids are rarely reported at initiation into injection drug use amongst young IDUs. All but two of these participants later transitioned into injecting heroin.
In this study, researchers interviewed 50 young IDUs aged 16 and 25 years old in New York and Los Angeles, who had misused a prescription drug at least three times in the past three months, to study contextual factors leading to their use of opioid drugs. Participants were recruited in natural settings, such as parks, streets, and college campuses, during 2008 and 2009. A mixed-methods research design was utilized that collected both quantitative and qualitative data.
Additional findings and descriptors of the study population include:
- Most were white, heterosexual males in their early 20s
- Many did not complete high school, were expelled from school, or held back a grade
- Nearly all were homeless at some point, most were currently homeless, and most regarded themselves as “travelers,” (i.e., moving from city to city in search of work, housing, or adventure)
- Most had received a psychological diagnosis, such as depression, anxiety, or Attention Deficit Hyperactivity Disorder (ADHD), and many had a history of drug treatment
- Most generally regarded prescription opioids as readily accessible, valued commodities that could be traded or sold
- Nearly three-quarters had been prescribed an opioid in their lifetime, which occurred on average at 14.6 years old, often for common ailments such as dental procedures or sports injuries
- Most witnessed family members misuse one or more substances during childhood and adolescence, ranging from alcoholism to injecting heroin
Source: Drexel University’s School of Public Health – July 22, 2011
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A new study by Geisinger Health System researchers found a high prevalence of prescription pain medication addiction among chronic pain patients. In addition, they found that the American Psychiatric Association’s (APA) new definition of addiction, which was expected to reduce the number of people considered addicts who take these medicines, actually resulted in the same percentage of people meeting the criteria of addiction.
Published in the Journal of Addictive Diseases, the study found that 35 percent of patients undergoing long-term pain therapy with opioids like morphine, OxyContin, Percocet and Vicodin, meet the criteria for addiction.
Using electronic health records, a random sample of outpatients undergoing long-term opioid therapy for non-cancer pain was identified and 705 participants completed telephone interviews from August 2007 through November 2008.
When comparing the APA’s newly revised criteria for addiction with the old criteria, researchers were surprised to find the prevalence of and risk factors for addiction to be virtually the same. It was determined that different symptoms now qualify the same patients for inclusion who would have been excluded under the previous classification system.
The study states that pain medication addiction often happens in people under 65, with a history of opioid abuse, withdrawal symptoms and substance abuse treatment. Risk factors for severe pain medication addiction also include a history of anti-social personality disorder.
“Ultimately, we hope our research will aid the development of newer classes of medications that don’t negatively impact the brain and therefore avoid addiction entirely,” Boscarino said.
The press release can be accessed at: http://www.newswise.com/articles/prescription-pain-medication-addiction-prevalent-among-chronic-pain-patients
Source: Geisinger Health System – July 21, 2011
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On July 11, Gil Kerlikowske Director of National Drug Control Policy released the Obama administration's 2011 National Drug Control Strategy. The Administration's new Strategy continues to expand upon a balanced approach to drug control that emphasizes community-based drug prevention, integration of drug treatment into the mainstream health care system, innovations in the criminal justice system to break the cycle of drug use and crime, and international partnerships to disrupt transnational drug trafficking organizations.
For the first time, the 2011 Strategy outlines specific actions designed to improve the health and safety of three special populations affected by high rates of substance use: active duty military and veterans; college students; and women and their dependent children.
Goal 1: Curtail illicit drug consumption in America
- Decrease the 30-day prevalence of drug use among 12– to 17- year- olds by 15%
- Decrease the lifetime prevalence of 8th graders who have used drugs, alcohol, or tobacco by 15%
- Decrease the 30-day prevalence of drug use among young adults aged 18–25 by 10%
- Reduce the number of chronic drug users by 15%
Goal 2: Improve the public health and public safety of the American people by reducing the consequences of drug abuse
- Reduce drug-induced deaths by 15%
- Reduce drug-related morbidity by 15%
- Reduce the prevalence of drugged driving by 10%
To support a public health approach to drug control outlined in the Strategy, the Obama Administration has committed over $10 billion for drug education programs and support for expanding access to drug treatment for addicts.
A copy of the 2011 National Drug Control Strategy is available at: http://atforum.com/addiction-resources/documents/ndcs2011.pdf
Source: The Office of National Drug Control Policy – July 11, 2011
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Chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity.
The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. Acting through the National Institutes of Health (NIH), HHS asked the IOM to assess the state of the science regarding pain research, care, and education and to make recommendations to advance the field.
The report brief can be accessed at: http://iom.edu/~/media/Files/Report%20Files/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Pain%20Research%202011%20Report%20Brief.pdf
Source: Institute of Medicine of the National Academies Report Brief – June 2011
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New National Report Shows Many Differences in the Types and Levels of Substance Use and Mental Illness Problems Experienced Among the States
A new report providing state-by-state analyses of a wide range of behavioral health issues reveals that despite some wide variations among the states in the types and levels of problems they confront -- every state must deal with these issues. For example, among those aged 12 and older, Iowa had less than half the current illicit drug use rate of Alaska (5.3-percent versus 13.5-percent) – yet Iowa also was among the top 10 states with the highest levels of people age 12 and older currently participating in binge drinking (28.6-percent).
The report developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides valuable insight to state public health authorities and service providers on the scope and nature of behavioral health issues affecting their states.
Among the report’s other notable findings:
- Current illicit drug use dropped among adolescents aged 12 to 17 in 17 states between 2002-2003 and 2008-2009 -- no increases in current illicit drug use occurred in any state in this age group over this time period.
- All ten states that had the highest rates of past month illicit drug use among persons age 12 or older were also the top 10 states for past month marijuana use (in alphabetical order -- Alaska, Colorado, District of Columbia, Hawaii, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island and Vermont).
The report is based on the combined 2008 and 2009 National Surveys on Drug Use and Health (NSDUH). Using data drawn from interviews with 137,436 persons from throughout the country the report provides a state-by-state breakdown along 25 different measures of substance abuse and mental health problems including illicit drug use, binge drinking, alcohol and illicit drug dependence, tobacco use, serious mental illness, and major depressive episode.
The full report can be accessed at: http://store.samhsa.gov/shin/content//SMA11-4641/SMA11-4641.pdf
Source: The Substance Abuse and Mental Health Services Administration – July 21, 2011
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EVENTS TO NOTE
Free webinars to learn about various topics affecting the field of addictions treatment and recovery services.
Upcoming webinars include:
How Substance Use Disorders Affect Physical Health— August 24, 2011
This webinar will discuss physical health concerns as they relate to the use and misuse of alcohol and other drugs. We will examine the overwhelmingly negative effects of drug and alcohol abuse on the human body, including a discussion of how different categories of drugs affect physical health. Effects on pregnant women will be highlighted as a special concern. We will conclude with an explanation of how behavioral and primary healthcare workers can better intervene to address these issues.
"You Can't Fool The Bladder Police": Effective Use Of Urine Drug Screening – September 21, 2011
Urine drug testing is used by MH and AOD treatment providers to ensure and/or confirm drug use and /or abstinence of patients in treatment. While accurate, there are ways to "fool" a drug test, invalidate a drug test, and there are substances that create false positives. This training will aid the treatment provider in understanding how both "in-house" testing kits and laboratory tests work. Additionally, we will explore substances that interfere with the validity of these tests.
To sign up for the webinars go to: http://www.ireta.org/ireta_main/training_events.html
More than 125 physicians descended on Capitol Hill this week to demand some relief in their fight against prescription drug addiction. With nearly 30,000 Americans dying from overdose last year - roughly half from prescription drugs - they say it's time for the federal government to step in. Their solution: Require health care professionals who prescribe drugs to receive specialized training.
AstraZeneca is adding a new heart warning to the labels of Seroquel, a antipsychotic drug, at the request of the Food and Drug Administration. The revised label, posted on the Federal Food and Drug Administration website, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines (including methadone) linked to a heart arrhythmia that can cause sudden cardiac arrest.
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