News & Updates – January 2012: Issue 160

Tricare May Soon Cover MAT for Opioid Addiction

military uniformThe Defense Department is proposing to allow Tricare to pay for medical treatment and therapy programs using drug substitution therapy.

“For many, pain related to injuries must be treated for many months and such long-term use of pain medications has put our service members using those medicines at risk for dependence,” according to a DoD notice published in the Dec. 29 Federal Register.

Methadone and Suboxone are proven medications for treating opiate addicts, serving as lesser-of-evils substitutes for heroin and prescription painkillers like Vicodin and OxyContin. But medical substitution therapy, while covered by most private insurers, isn’t available to Tricare beneficiaries.

The comment period on the proposed change ends Feb. 27.

http://www.airforcetimes.com/news/2012/01/military-methadone-suboxone-tricare-substance-treatments-010512w/

Source: Air Force Times.com – January 5, 2012

New Prison Drug Test for Suboxone Has Smugglers Scrambling

drug testInmates in the county correctional facility in Doylestown, Pennsylvania have always been subject to random drug tests, especially inmates with work release privileges who leave the jail to go to their jobs. But those tests didn’t pick up every illicit substance, including Suboxone.

Prisoners knew the drug was undetectable, said Director of Corrections William Plantier, and were cashing in, charging $20 to $30 a dose on the prison black market. Beginning in January, the facility will start using a new test that screens for 13 drugs, including Suboxone.

http://www.phillyburbs.com/news/local/courier_times_news/new-prison-drug-test-has-smugglers-scrambling/article_1f4bb717-8119-569a-86e4-b5a97deaac34.html

Source: www.PhillyBurbs.com – December 15, 2011

What Vietnam Taught Us About Breaking Bad Heroin Habits

One theory about why the rates of heroin relapse were so low on return to the U.S. has to do with the fact that the soldiers, after being treated for their physical addiction in Vietnam, returned to a place radically different from the environment where their addiction took hold of them.

“I think that most people accept that the change in the environment, and the fact that the addiction occurred in this exotic environment, you know, makes it plausible that the addiction rate would be that much lower,” Nixon appointee Jerome Jaffe says.

http://www.npr.org/blogs/health/2012/01/02/144431794/what-vietnam-taught-us-about-breaking-bad-habits

For additional coverage of this topic see the two-part blog The “Lee Robins Study” and Its Legacy available at: http://pointsadhsblog.wordpress.com/2012/01/16/the-lee-robins-study-and-its-legacy-part-one/ and http://pointsadhsblog.wordpress.com/2012/01/18/the-lee-robins-study-and-its-legacy-part-two/

Source: National Public Radio – January 2, 2012

Medication-Assisted Recovery Essay Contest Winners

essay contestThe Addiction Technology Transfer Center (ATTC) National Office, in partnership with Faces & Voices of Recovery and the National Alliance for Medication-Assisted Recovery (NAMA Recovery), announced the top three winners of the 4th annual “In My Own Words…” essay contest focusing on recovery from addiction using medication. Almost 130 individuals from across the U.S. and the United Kingdom participated in the contest.

Contestants described, in their own words, how medication-assisted treatment supported their recovery from addiction and why they continue to be committed to recovery.

Darlene DeMore (Pennsylvania) won 1st place writing about her experiences on methadone maintenance treatment.

The essays can be accessed at: http://www.attcnetwork.org/MATessaycontest.asp

Source: Addiction Technology Transfer Center – December 15, 2011

Insomnia in Methadone Maintenance Patients Does Not Respond to Trazodone – Research Abstract

massage sleepA recent study sought to learn if trazodone (marketed as Desyrel and Oleptro) could help recovering drug abusers sleep better. The study concluded that the trazodone did not help this population of patients.

BACKGROUND: To test whether trazodone, one of the most commonly prescribed medications for treatment of insomnia, improves subjective and/or objective sleep among methadone-maintained persons with sleep complaints, a randomized, double-blind, placebo-controlled trial with 6-month follow-up was performed.

METHODS: From eight methadone maintenance programs in the northeastern U.S., 137 persons receiving methadone for at least 1 month who reported a Pittsburgh Sleep Quality Index (PSQI) score of six or higher were recruited. Two-night home polysomnography (PSG) was completed at baseline and 1 month later, with morning surveys and urine drug toxicologies. Interviews assessed sleep over the past 30 days at baseline and 1-, 3-, and 6-month follow-ups.

RESULTS: Participants averaged 38 years of age, were 47% male, and had a mean PSQI total score of 12.9 (±3.1). At baseline, intervention groups did not significantly differ on 10 PSG-derived objective sleep measures and 11 self-reported measures. Over 88% (n=121) of participants completed the PSG at 1-month. Without adjusting p-values for multiple comparisons, only 1 of 21 sleep measure comparisons was statistically significant (p<.05). The effect of trazodone on mean PSQI scores during the 6-month follow-up was not statistically significant (p=.10). Trazodone neither significantly increased nor decreased illicit drug use relative to placebo.

CONCLUSIONS: Trazodone did not improve subjective or objective sleep in methadone-maintained persons with sleep disturbance. Other pharmacologic and non-pharmacologic treatments should be investigated for this population with high rates of insomnia.

The article abstract is available at: http://www.ncbi.nlm.nih.gov/pubmed/21798674

The article was published in the January 1, 2012 issue of Alcohol and Drug Dependence.

New Schneiderman Rx Report Reveals Need for Real-Time Database to Address New York Prescription Drug Crisis

prescription drug crisisPrescription drug abuse is the country’s second most prevalent illegal drug problem, and recent reports and studies have documented corresponding data in New York State. For example:

  • Statewide prescriptions for hydrocodone have increased 16.7 percent, while those for oxycodone have increased an astonishing 82 percent;
  • In New York City, the rate of prescription pain medication misuse among those age 12 or older increased by 40 percent from 2002 to 2009, with nearly 900,000 oxycodone prescriptions and more than 825,000 hydrocodone prescriptions filled in 2009;
  • In Buffalo, New York’s largest methadone clinic outside of New York City, Catholic Health System, has begun to reorganize its service to accommodate an increase in care needed to treat the number of opiate-addicted expectant mothers and newborns;
  • On Long Island, both crisis and non-crisis admissions to drug treatment that involve opiates other than heroin and have increased at alarming rates. Between 2004 and 2009, the number of deaths due to the toxic effects of prescription opioids more than tripled in Nassau County; and
  • In the North Country, health care facilities have experienced a staggering increase in the percentage of non-crisis admissions for substance abuse involving prescription narcotics, eclipsing cocaine and heroin in Clinton and Franklin Counties, and surpassing even marijuana in St. Lawrence County.

The press release can be accessed at: http://www.ag.ny.gov/media_center/2012/jan/jan11a_12.html

Source: New York State Office of the Attorney General – January 11, 2012

Commentary Calls for Awareness of Internet Pharmacies’ Role in Prescription Drug Abuse

internet pharmaciesEfforts to halt the growing abuse of prescription drugs must include addressing the availability of these drugs on the Internet and increasing physician awareness of the dangers posed by Internet pharmacies. In a commentary in the December 20 Annals of Internal Medicine, investigators from Massachusetts General Hospital (MGH), the Schaeffer Center for Health Policy and Economics at the University of Southern California (USC), and The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) describe the probable contribution of Internet pharmacies to the problem and outline potential strategies for addressing the problem.

“Controlled prescription drugs like Oxycontin, Xanax, and Ritalin are easily purchased over the Internet without a prescription, yet physician awareness of this problem is low,” says Anupam B. Jena, MD, PhD, of the MGH Department of Medicine, lead author of the article. “Abuse of medications purchased from websites can pose unique challenges to physicians because patients who abuse these medications may not fit clinical stereotypes of drug abusers.”

Some illegitimate online pharmacies sell drugs with no prescription or medical information at all while others ask for completion of a questionnaire before a prescription is issued by a physician who has never seen the patient. Studies from CASA Columbia have found that 85 percent of websites offering controlled prescription drugs do not require a prescription, and many that do allow the prescription to be faxed, increasing the risk of forgery or fraud.

“The Internet serves as an open channel for distribution of controlled prescription drugs with no mechanisms to even block sales to children. This is particularly dangerous given that addiction is a disease that, in most cases, originates with substance use in adolescence,” says Susan Foster, MSW, vice president and director of Policy Research and Analysis at CASA Columbia.

Additional investigations by U.S. agencies have verified the ease with which controlled drugs can be purchased online, but little information is available on how drugs acquired that way are used. While some surveys suggest that as many as 10 percent of prescription drug abusers obtain their drugs online, the authors stress that such surveys probably underestimate the situation and would not reach individuals most likely to abuse prescription drugs purchased over the Internet. They also note that surveys in drug treatment centers would totally miss local drug dealers, who are increasingly likely to access their supplies online.

Earlier this year Jena and Dana Goldman, PhD, director of the Schaeffer Center at USC and also a co-author of the current article, published a study finding that 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. They estimated that for every 10 percent increase in high-speed Internet use during those years, admissions for prescription drug abuse increased 1 percent. “Prescription use starts with the physician,” says Goldman, “and we need to more actively engage them to control illicit use. Access to universal, electronic prescription records would be of great assistance in this regard.”

Both federal and private agencies have taken measures to reduce the impact of illicit Internet pharmacies, including the 2008 passage of the Ryan Height Online Pharmacy Consumer Protection Act, which specifically prohibits delivery of controlled substances prescribed by a physician who had never examined the patient. But the success of that law and related efforts, such as FDA warning letters to Internet pharmacies and their service providers, is unknown. The authors note that regulatory efforts also are “stymied by these pharmacies’ ability to appear, disappear, and reappear constantly,” and the reluctance of search engines to stop running ads for rogue online pharmacies. The increasing online availability of prescription drugs may entice individuals believed to be at low risk for drug abuse to overuse controlled medications.

The authors note that, while physicians and other health care providers should play a major part in addressing the challenges posed by Internet pharmacies, their awareness of the problem and ability to recognize and treat substance abuse of any kind is usually limited. “Physicians need to educate patients about the risks of purchasing any medications over the Internet and should consider brief but routine questioning about Internet-based medication use,” says Jena, who is also a senior fellow at the Schaeffer Center at USC. “Given the ability of illegal online pharmacies to evade law enforcement efforts, physician awareness and involvement will be crucial to reducing this problem.”

Source: Massachusetts General Hospital – December 19, 2011

SAMHSA Announces Working Definition and Guiding Principles of Recovery

A new working definition of recovery from mental disorders and substance use disorders was announced Dec 22 by the Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.

The new working definition of Recovery for Mental Disorders and Substance Use Disorders is as follows:

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that support a life in recovery:

  • 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;
  • 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.

The press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

For more on the Guiding Principles of Recovery go to: http://blog.samhsa.gov/2011/12/22/samhsa%E2%80%99s-definition-and-guiding-principles-of-recovery-%E2%80%93-answering-the-call-for-feedback/

Source: The Substance Abuse and Mental Health Services Administration – December 22, 2011

Centers for Disease Control and Prevention (CDC) Policy Impact Report: Prescription Painkiller Overdoses

This new report provides an excellent overview of the scope of prescription painkiller abuse in the U.S. The report provides an overview of:

  • The role of prescription painkillers in prescription painkiller overdoses and deaths
  • How prescription painkiller deaths occur
  • Where the drugs come from and who is most at risk
  • Where overdose deaths are the highest
  • CDC recommendations to prevent prescription drug overdose including the role of:
    • Prescription Drug Monitoring Programs
    • Patient review and restriction programs
    • Health care provider accountability
    • Laws to prevent prescription drug abuse and diversion
    • Better access to substance abuse treatment

Key statistics include:

  • The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was 4 times larger in 2010 than in 1999.
  • Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month.
  • Most prescription painkillers are prescribed by primary care and internal medicine doctors and dentists, not specialists. Roughly 20% of prescribers prescribe 80% of all prescription painkillers.
  • The drug overdose epidemic is most severe in the Southwest and Appalachian region, and rates vary substantially between states. The highest drug overdose death rates in 2008 were found in New Mexico and West Virginia, which had rates nearly five times that of the state with the lowest rate, Nebraska.

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

Source: Centers for Disease Control and Prevention – December 19, 2011

New Report: Illicit Drug-Related Emergency Department Visits in Metropolitan Areas of the United States: 2009

hospital signMajor metropolitan areas show significant variation in the rates of emergency department (ED) visits involving illicit drugs. In terms of overall illicit drug-related emergency room visits, Boston has the highest rate (571 per 100,000 population), followed by New York City (555 per 100,000 population), Chicago (507 per 100,000 population), and Detroit (462 per 100,000 population). By comparison the national average was 317 per 100,000 population.

This new report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) was drawn from the agency’s Drug Abuse Warning Network (DAWN), a public health surveillance system that monitors drug-related emergency department visits throughout the nation. This information was collected from eleven metropolitan areas including Boston, Chicago, Denver, Detroit, Miami (Dade County and Fort Lauderdale Division), Minneapolis, New York (Five Boroughs Division), Phoenix, San Francisco, and Seattle.

“When friends, family members and health professionals miss the signs and symptoms of substance abuse the results can be devastating,” said SAMHSA Administrator Pamela S. Hyde. “One consequence is the costly and inefficient use of emergency rooms as a first step to treatment. Substance abuse prevention and early intervention can keep people off drugs in the first place and clear the path to healthier lifestyles.”

The emergency department findings were similar to the overall trend regarding visits related specifically to heroin use. Again Boston had the highest rate (251 per 100,000 population, followed by Chicago (216 per 100,000 population), New York City (153 per 100,000 population), Detroit (150 per 100,000 population) and Seattle (118 per 100,000 population). The national average was 69 per 100,000.

The report can be accessed at: http://www.samhsa.gov/data/2k11/WEB_DAWN_023/DAWN_023_IllicitDrugEDVisits_plain.pdf

Source: Substance Abuse and Mental Health Services Administration – December 15, 2011

Adult Drug Courts Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts

Scales of JusticeThe National Association of Drug Court Professionals announced that the U.S. Government Accountability Office (GAO) released its fourth report on Drug Courts in December, concluding that Drug Courts reduce recidivism and save money. The report validated existing Drug Court research by examining over 30 scientifically rigorous studies involving more than 50 Drug Courts throughout the country. The GAO was established to support Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government. The scope of this report was mandated by the Fair Sentencing Act of 2010.

Of the 32 Drug Court programs reviewed, 31 showed reductions in recidivism. Of those that performed statistical comparisons, the large majority (72%) reported statistically significant reductions in crime for the Drug Court participants. In the GAO analysis, Drug Court participants were found to have up to a 26 percent lower rate of recidivism than comparison groups. Re-arrest rates for Drug Court graduates were found to be up to 58 percent below comparison groups.

The GAO reviewed 11 cost-benefit studies published between 2004 through 2011. These studies provided information to determine net-benefit, defined as the monetary benefit of reduced recidivism accrued to society from the Drug Court program through reduced future victimization and justice system expenditures, less the net costs of the Drug Court program. Drug Courts were found to have a cost-benefit as high as $47,852 per participant.

The GAO included in its review the National Institute of Justice’s Multi-Site Adult Drug Court Evaluation (MADCE), which it called “the most comprehensive study on Drug Courts to date.” This five-year study published in July also confirmed that Drug Courts significantly reduce recidivism and drug use. Additional benefits were found to include increases in employment, education, family functioning and financial stability. The MADCE cost-benefit analysis determined benefits of $6,208 to society per participant. The GAO concluded, “This is the broadest and most ambitious study of Drug Courts to date; it is well done analytically, and the results, as they relate to the impact of Drug Courts, are transparent and well described.”

The press release can be accessed at: http://www.prweb.com/releases/2011/12/prweb9053242.htm

The GAO Report can be accessed at: http://www.gao.gov/new.items/d05219.pdf

Source: The National Association of Drug Court Professionals – December 19, 2011

Centers for Disease Control and Prevention (CDC) Drug Poisoning Deaths in the U.S,, 1980–2008

Key findings of a new report issued by the CDC on drug poisoning deaths include:

  • In 2008, poisoning became the leading cause of injury death in the U.S. and nearly 9 out of 10 poisoning deaths are caused by drugs.
  • During the past three decades, the number of drug poisoning deaths increased sixfold from about 6,100 in 1980 to 36,500 in 2008.
  • During the most recent decade, the number of drug poisoning deaths involving opioid analgesics more than tripled from about 4,000 in 1999 to 14,800 in 2008.
  • Opioid analgesics were involved in more than 40% of all drug poisoning deaths in 2008, up from about 25% in 1999.

The 8-page report can be accessed at: http://www.cdc.gov/nchs/data/databriefs/db81.htm

Source: National Center for Health Statistics (NCHS) Data Brief Number 81 – December 2011

RI Hospital Study Analyzes Link Between HIV Infection and Overdose Risk

A study from Rhode Island Hospital, published ahead of print in the journal AIDS, is the first to systematically review and analyze the literature on the association between HIV infection and overdose risk. The findings show a 74 percent greater risk of overdose among drug users if they are HIV-infected. The researchers found that reasons for the increased risk are biological and behavioral, but may also include environmental and structural factors.

Drug overdose is a common cause of non-AIDS death among people with HIV and is the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medication as part of their treatment, while others may continue to use illicit opioids despite their disease status. Both scenarios present a heightened risk for fatal and non-fatal overdose. While the association between HIV infection and injection drug use has been well documented, the potential association between HIV and overdose has received less attention.

With this in mind, Traci Green, PhD, MSc, a researcher with Rhode Island Hospital and the Lifespan/Tufts/Brown Center for AIDS Research, led a study to systematically review the literature on the putative association of HIV infection with overdose, meta-analyze the results and explore the causes.

“It is not entirely clear why the risk is greater, and few studies have endeavored to figure out why this might be happening,” Green points out. Biological explanations for the association could include clinical status, immunosuppression, opportunistic infections and poorer physical health in this population, while several studies posit that conditions that affect body’s ability to metabolize, like hepatitis C infection, may also increase the risk of overdose. Behavioral factors include high-risk lifestyles and psychiatric comorbidities that might be greater among HIV-infected than HIV-uninfected drug users.

Green further explains that other reasons for the association may include factors such as poor access to medication-assisted therapy to treat opioid dependence, homelessness and poverty, which may contribute to a higher risk of overdose.

Through their research, Green reports that there are ways to reduce the increased risk of overdose among this population. Green comments, “The good news is that we already have several cost-effective overdose prevention tools to call upon. The first is access to highly active antiretroviral therapy (HAART) medications, prescribed by providers prepared to prevent and manage potential interactions between antiretrovirals and drugs with abuse potential. The second is medication-assisted therapy, and in particular, methadone and buprenorphine therapies, which have been shown to protect against fatal overdose. The third tool is distribution of Naloxone (Narcan), a prescription medication with no abuse potential that reverses an opioid overdose, to people who are HIV positive and use opiates.

Green adds, “Bringing overdose awareness and prevention into the HIV care setting is critical to reducing overdose deaths. Health care providers who treat HIV-infected patients with a history of substance abuse or who are taking opioid medications should consider counseling patients on how to reduce their risk of overdose. They may also consider prescribing Naloxone to patients, or offering a referral to MAT to reduce the risk of overdose.”

The study was funded through grants from the Centers for Disease Control and Prevention, the National Institutes of Health (NIH), National Institute on Drug Abuse and the NIH Center for AIDS Research.

http://www.lifespan.org/news/2011/12/12/ri-hospital-study-analyzes-link-between-hiv-infection-and-overdose-risk/

The abstract is available at: http://journals.lww.com/aidsonline/Abstract/publishahead/HIV_infection_and_risk_of_overdose___a_systematic.99042.aspx

Source: Lifespan News – December 12, 2011

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