Dr. Westley Clark on Overdose – Prevention of Prescription Drug Abuse Can Start With Education about the Risk of Overdose Death

ClarkOn January 16, the ATTC Network hosted a free webinar, “SAMHSA’s Opioid Overdose Prevention Toolkit & Prescription Drug Abuse,” led by the Director of the Center for Substance Abuse Treatment at SAMHSA, Dr. H. Westley Clark.

In addition to an overview of the toolkit itself, Clark’s presentation included epidemiological details about the current overdose epidemic, federal-level efforts to address overdose, and the importance of access to evidence-based treatment (including medications).

The recorded webinar is available online for on-demand viewing.  You can also download the slides for an overview of the talk.

Here are two salient points:

  • The exchange of prescription pain relievers is happening at a person-to-person level.
  • Prevention of prescription drug abuse can start with education about the risk of overdose death. 

The risk of death from an overdose, said Clark, is a good jumping off place for a larger conversation about substance use.  Not only is pill-popping not harmless, it can actually kill you or someone you love. “We can use overdose as a starting point to get people to be aware of some of the consequences of the misuse of prescription opioids or heroin, for that matter,” he said. “We’ve got friends and relatives who are handing people very powerful drugs with the assumption that if they can take it, then anybody can take it.  And that is not the case.”

Emphasizing the long-term consequences of a behavior–like the possibility of becoming addicted as a result of recreational painkiller use–doesn’t always get through to people.  But the possibility of dying from a drug overdose today or tomorrow?  No kindly neighbor wants to bear responsibility for that.

The Institute for Research, Education & Training in Addictions (IRETA) blog also provides a list of currently available and forthcoming resources to help individuals and communities prevent prescription drug abuse and overdose.

http://iretablog.org/author/iretablog/

Source:  Institute for Research, Education & Training in Addictions – January 27, 2014

Navigating the Gap: A Compelling Method for Working in the Space Between Addiction Research and Practice

“There’s a lot of work to do in MAT. Although MAT is an evidence-based practice, more and more questions are surfacing around how to deliver it in the real world to improve outcomes. Questions like:

  • How can we offer MAT to a broader population?
  • Which patients are best suited to which medications?
  • Which patients are best suited to which treatment settings?
  • What are the best guidelines to use around dose, duration, monitoring, and concurrent psychosocial treatment?

Research and practice in this area are both moving and changing quickly. Buprenorphine (Suboxone, Subutex) for opioid dependence has exploded onto the market (half a million people now use it) and has been joined by naltrexone for opioid and alcohol dependence.  Other addiction medications are right on their tails. Human testing for a cocaine vaccine is expected to begin within a year.

Amid this flurry, in the last two years, IRETA has created treatment practice guidelines in two areas—how to use buprenorphine for opioid dependence treatment and how to manage patient benzodiazepine use in MAT. We’ve been able to do that using the RAM.”

http://iretablog.org/2013/05/31/navigating-the-gap/

Source: IRETA.org – May 31, 2013

Medication-Assisted Treatment for Substance Use Disorders: Research and Practice Training Session

SAMHSAThis full-day training session will precede the 75th Annual Meeting of the College on Problems of Drug Dependence, which will be held June 15–20, 2013 at the Hilton Bayfront Hotel in San Diego from 8:30 AM to 4:30 AM. Registration and CEUs are free.

Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA), the training will provide practitioners, clinicians, clinical supervisors, healthcare providers, researchers, and other participants the opportunity to learn the latest information and best practices on medication-assisted treatment (MAT) for substance use disorders (SUDs). Nationally renowned researchers and experts will present on topics such as:

  • Pain management and prescription opioid addiction.
  • Agonist and antagonist medications to treat opioid dependence.
  • Adolescents and young adults—treatment for opioid abuse.
  • Veterans and MAT.
  • Smoking cessation with SUD patients.
  • Integrating MAT and primary care.
  • A state’s response to prescription drug abuse.
  • A county’s approach to MAT.
  • Integrating MAT into a 12-step program.

This training will provide information on how MAT is being used to improve opioid dependence treatment outcomes, across a variety of settings and populations.

Register at: http://www.seiservices.com/samhsa/cpdd2013/Registration.aspx
Source: The Substance Abuse Mental Health Services Administration and the National Institute on Drug Abuse – May 2013

Many Medical Residents Give Poor Marks to Addiction Training: Survey

“More than half of internal medicine residents at Massachusetts General Hospital in Boston say they were not adequately trained in addiction and other substance use disorders, according to a new survey.

The survey, conducted last year, found residents rated their training in these areas as fair or poor, Health Canal reports. Many said they were not prepared to diagnose or treat addiction or substance use disorders.

“Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes,” lead author Sarah Wakeman, MD said in a news release. “Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training.”

http://www.drugfree.org/join-together/addiction/many-medical-residents-give-poor-marks-to-addiction-training-survey?utm_source=Join%20Together%20Daily&utm_campaign=db0c98e29b-JT_Daily_News_Many_Medical_Residents&utm_medium=email&utm_term=0_97f4d27738-db0c98e29b-221281549

Source: DrugFree.org – May 23, 2013

MMT Patients Need Physical Activity; Brief Interventions Could Help

Physical activity is so important for patients in methadone maintenance treatment (MMT). They’re already at increased risk of physical and mental health disorders, including chronic pain and sleep problems. Lack of enough physical activity carries additional risks: cardiovascular disease, various psychiatric disorders, high blood pressure, diabetes, osteoporosis, obesity, and colon cancer.

Given the importance of physical activity to their patients, how can MMT programs help?

A study in the Journal of Substance Abuse Treatment (in press) offers some suggestions. The study assessed the levels of physical activity in 305 MMT patients, cited patients’ perceptions of the benefits of and barriers to exercise, and provided recommendations.

Study Group Characteristics

Participants were recruited between December 2008 and May 2011 at nine MMT sites in New England. All were taking part in a smoking cessation intervention trial, and had been enrolled in MMT for at least four weeks.

Additional characteristics of the group:

  • Average age: 40 years
  • 50% men
  • 243 (80%) non-Hispanic white
  • 113 obese; 103 overweight; 18 refused to be weighed
  • Cigarette use: at least 10 per day (inclusion criterion); average, 19.7
  • Average methadone dose: 109 mg/day

Almost 45 percent considered themselves in fair or poor physical health.

Physical Activity Guidelines

The American Heart Association recommends a healthy adult have at least 30 minutes of moderate-intensity aerobic physical activity five days a week, or at least 20 minutes of vigorous activity three days a week.

Study Results

Only 38 percent of participants met or exceeded recommended guidelines, and almost 25 percent reported no physical activity. In contrast, about 49 percent of adults in the U.S. meet guidelines, and almost 14 percent are inactive (less than 10 minutes of activity of moderate intensity per week).

In general, study participants highly endorsed (rated favorably) the benefits of exercise. More than 75 percent credited exercise with giving a sense of accomplishment, improving health, increasing energy level, feeling stronger, improving cardiovascular fitness, becoming physically fit, increasing confidence to stay clean and sober, and maintaining or losing weight in order to look better. Interestingly, those who met activity guidelines were significantly more likely than the others to report relapse prevention and reduced anxiety as benefits.

Motivation: The Key for MMT Patients

The most frequently perceived barrier to exercise was lack of motivation (103 participants). This is consistent with findings from previous studies in substance users. The authors cite an earier study showing that, “encouragingly, motivation to exercise was the best predictor of physical activity.” Among other barriers cited were not having enough energy, having an injury or disability, and health problems.

Noting that brief interventions or counseling sessions have helped increase physical activity in a variety of populations, the authors suggest this approach for MMT patients. Measures could include “brief, counselor administered physical activity or exercise intervention” based on adaptations of the widely used five A’s for smoking cessation intervention—ask, advise, assess, assist, arrange—to provide “a standardized framework for a clinic based brief intervention.” They add that the potential benefits in mental health and relapse prevention, highly endorsed by participants, should be covered during the “advise” part of the exercise.

“Another potentially cost-effective intervention,” according to the authors, “could involve peer led exercise promotion groups run through methadone clinic programs.” Moreover, it would be useful to have a brief discussion of exercise and physical activity during monthly counseling sessions or doctors’ visits, the authors said. “Developing efficacious and low-cost physical activity adjuncts to this population at high risk for lifestyle-induced medical conditions may have important benefits for health and drug treatment outcomes.”

*     *     *

Caviness CM, Bird JL, Anderson BJ, et al. Minimum recommended physical activity, and perceived barriers and benefits of exercise in methadone maintained persons. J Subst Abuse Treat. 2012. http://dx.doi.org/10.1016/j.jsat.2012.10.002.

Link to the five As of smoking cessation: http://www.ahrq.gov/clinic/tobacco/tobaqrg.pdf

_________

Effective Risk Management Strategies in Outpatient Methadone Treatment – Trainer’s Manual and PowerPoint Slides

This one-day training program available from The Institute for Research, Education, and Training in Addictions (IRETA)  is designed to increase opioid treatment providers’ (both clinical and administrative staff) knowledge and skills on the most effective ways to conduct risk management strategies for opioid treatment centers.

Training materials include a Trainers Manual and nine PowerPoint presentations, one for each of the nine training modules.

The manual was created as a guide to facilitate the successful delivery of “Effective Risk Management Strategies in Outpatient Methadone Treatment”. It includes suggested scripts and activities for each module to help guide you through the entire training process.

The modules include:

  • Module 1: What’s Going On Out There? (Introduction, Methadone-Associated Mortality, Professional Liability)
  •  Module 2: Managing Risk
  •  Module 3: Risk Management and OTP Practice
  • Module 4: Impairment
  • Module 5: Take-Home Medication
  •  Module 6: Three Case Studies
  • Module 7: Recovery-Oriented Methadone Maintenance (ROMM)
  • Module 8: Pain Management Therapy
  • Module 9: Special Populations and Risk

Modules 1-6 provide information and content for a standalone training of approximately 7 hours – not including breaks and lunch. Modules 7-9 are supportive content to the topic of risk management and can be delivered in approximately three additional hours.

http://ireta.org/riskmanagementcurriculum

Source: The Institute for Research, Education, and Training in Addictions – January 2013

Scientific American: This is Our Society on Drugs: Top 5 Infographics


Infographics are graphic visual representations of information, data or knowledge that present complex information quickly and clearly. This compilation of infographics on addiction include:

  • This is Your Brain on Prescription Drugs
  • This is Your Body on Drugs
  • Prescription Drugs Go Figure
  • Medical Uses of Abused Drugs
  • Drug Use in Today’s Classroom

http://blogs.scientificamerican.com/white-noise/2012/04/20/this-is-our-society-on-drugs-top-5-infographics/

Source: ScientificAmerican.com  –  April 20, 2012

New Webcast From SAMHSA Now Available Online – Treatment and Recovery in Behavioral Health for Americans With Disabilities

Persons with disabilities in our society experience substance use and mental disorders at relatively high rates, yet special challenges exist for those who want to access and use treatment and recovery support services.  The Americans with Disabilities Act prohibits discrimination against persons with disabilities, but how does this protection apply in providing treatment and recovery services for individuals with substance use and mental disorders?  What are the barriers to access disabled persons face and how can these barriers be overcome?  This webinar will explore a range of issues associated with treatment and recovery in behavioral health for disabled persons, including barriers to access, differences in outcomes, and options to diminish the incidence of discrimination.

http://www.recoverymonth.gov/Resources-Catalog/2011/Webcast/08-Treatment-and-Recovery.aspx

Source: SAMHSA Recovery MonthOriginal Webcast August 3, 2011

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