News & Updates – July 18, 2014; Issue 203

New AATOD Policy Statement: Increasing Access to Medication to Treat Opioid Addiction

AATODEarlier this month AATOD issued a policy paper “Increasing Access to Medication to Treat Opioid Addiction – Increasing Access for the Treatment of Opioid Addiction with Medications.” AATOD noted that “this paper raises a number of questions in order to stimulate a thoughtful policy discussion given the urgency of the public health crisis of untreated opioid addiction”.

The statement provides a discussion of: the value of providing comprehensive treatment services to treat a complicated illness, current policy debates on OTPs, DATA 2000 practices, reports of medication diversion, and future policy considerations

http://www.aatod.org/wp-content/uploads/2014/07/MAT-Policy-Paper-FINAL-070214-2.pdf

Source: The American Association of the Treatment of Opioid Dependence – July 2, 2014

 

Opioid Painkiller Prescribing Varies Widely Among States

Capsule and Pills“Health care providers wrote 259 million prescriptions for opioid painkillers in 2012 – many more in some states than in others – according to a Vital Signs report released this month by the Centers for Disease Control and Prevention that highlights the danger of overdose. The report also has an example of a state that reversed its overdose trend.

Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population.

“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, M.D., M.P.H. “Overdose rates are higher where these drugs are prescribed more frequently. States and practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”

The report suggested that states consider ways to increase use of prescription drug monitoring programs, and  consider policy options (including laws and regulation) relating to pain clinics (facilities that specialize in pain treatment) to reduce prescribing practices that are risky to patients.

http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html

Source: Centers for Disease Control and Prevention – July 2014

 

Overdose Deaths from Opioids, Heroin on the Rise

News Update 7-18-14“Overdose deaths from both prescription opioids and heroin increased in 2011, the most recent year available, according to new data from the U.S. Centers for Disease Control and Prevention.

While prescription opioid deaths followed a more than decade long trend and increased by about 2% from 2010 to 2011, to 16,917; heroin deaths jumped by about 44% in the same span of time to 4,397.

Officials with the CDC said the increase in heroin deaths may be partly due to users having less access to prescription opioids and switching to the illicit drug.

Leonard Paulozzi, a physician and researcher with the CDC, said about 75% of heroin users say they started out by using prescription opioids.

Paulozzi said doctors need to do a better of job of screening for opioid abusers by checking prescription drug monitoring programs in their states for patients who are doctor shopping and using urine screens to detect if they are using illicit drugs.”

http://www.jsonline.com/watchdog/watchdogreports/overdose-deaths-from-opioids-heroin-on-the-rise-b99302962z1-265452991.html

Source: Milwaukee Journal Sentinel – July 2, 2014

Treat Patients with Addiction During, After Hospitalization, Researchers Say

hospital sign purchasedshutterstock_33280960The results of a new study demonstrate that starting hospitalized patients who have an opioid (heroin) addiction on buprenorphine treatment in the hospital and seamlessly connecting them with an outpatient office based treatment program can greatly reduce whether they relapse after they are discharged.

Led by researchers at Boston Medical Center (BMC), the study shows the important role that providers play in offering these patients addiction treatment both while in the hospital and after – even if their primary reason for being in the hospital is not for their addiction.

In this study, 139 hospitalized individuals with opioid addiction who were not already in treatment were randomized into two groups. One group received a tapered dose treatment of buprenorphine for withdrawal and referral information about community treatment programs and the other were initiated on buprenorphine, an opioid substitute proven to treat opioid addiction, along with referral to a primary care office-based buprenorphine treatment program.

Of those in the buprenorphine maintenance group, more than one third (37 percent) reported no illicit opioid/drug use for the month after they left the hospital compared to less than one in ten (nine percent) among the control group. These patients also reported, on average, fewer days of illicit drug use and continued to use less over the following six months. This effect was evident despite the fact that these patients did not initially come to the hospital seeking treatment for their addiction.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” said Jane Liebschutz, MD, MPH, a physician in general internal medicine at BMC and associate professor of medicine at Boston University School of Medicine, who served as the study’s corresponding author. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

This study is published in JAMA Internal Medicine.

http://medicalxpress.com/news/2014-06-patients-addiction-hospitalization.html

Source: Boston Medical University –  June 30, 2014

Blog by Jana Burson on Split Dosing

“Split dosing, when used in reference to the medication-assisted treatment of opioid addiction, means instead of once daily dosing, the total medication dose is divided, or split, into two doses.

Methadone and buprenorphine (Suboxone, Zubsolv, etc.) are long-acting opioids.

When we use these medications for opioid addiction, we prefer to dose once per day.

Before I can order split dosing, I need to get permission from the state and federal authorities, just like I would for extra take homes doses for patient emergencies. In my state, methadone peak and trough levels are usually requested before they grant permission for split dosing. We draw the patient’s blood three hours after their dose, which is the peak. That’s the highest blood level the patient will have on that dose. On the next day, right before they take the next day’s dose, we draw another methadone blood level, called the trough, which is the lowest level the patient ever has on that dose.

Then we compare the peak to the trough. If the peak is more than twice the trough level, the patient is probably a fast metabolizer who will feel better taking part of their dose in the morning and part in the evening.”

http://janaburson.wordpress.com/2014/07/06/split-dosing/ 

Source: JanaBurson.com – July 6, 2014

Opinion by Maia Szalavitz : We Try More Drugs than Anyone Else, and 9 Other Ways Addiction Is Different in America

“We Americans like to think of ourselves as exceptional, the land of the free and the home of the brave, the City on the Hill and all that. When it comes to the politics and culture of drugs, we are indeed special—or at least dramatically different from the rest of the Western world. Too often, however, we are special for the wrong reasons.”

  1. We Try More Drugs Than Anyone Else
  2. We Incarcerate More People Than Anyone Else
  3. We Use More Opioids Medically (But Not for the Reasons You Might Think)
  4. We’re in the Middle of the Road on Alcohol
  5. We Have the World’s Highest Legal Drinking Age
  6. Our Treatment System Is Dominated by 12-Step Programs
  7. Coercion Is a Common Route to Treatment
  8. We Spend the Most Money on Addiction Research
  9. We Determine What Is and What Isn’t Legal Worldwide (But for No Rational Reason)
  10. We’re Not Very Good at Measuring Addiction

http://www.psmag.com/navigation/health-and-behavior/try-drugs-anyone-else-9-ways-addiction-different-america-85093/

Source:Pacific Standard – July 4, 2014

 

How Heroin Baggies are Marketed Like iPhones

“Nine years ago, when Graham MacIndoe was living in New York City and addicted to heroin, he started collecting the small glassine bags that held the drugs he bought. MacIndoe was a commercial photographer, and even in the grip of a years-long addiction that would ultimately leave him broke, imprisoned on Riker’s Island, and facing deportation, he became interested in the baggies on a visual level.

“There was just something about the design, the typography, the branding,” MacIndoe tells Quartz. “And just being around the drug trade myself, the promises that were in the bags—of good times and money, and this elusive lifestyle that you thought drugs would bring you.

MacIndoe found that marketing in the underground economy mirrored the corporate one in other ways. Special offers often accompanied a new drug’s introduction. Popular brands quickly attracted imitators, who adopted the visual look of the packaging but filled it with a lower-quality product. A kind of built-in obsolescence was common too, with suppliers “cutting” (i.e., adulterating) initially potent brands to maximize profits—a pressure to upgrade that MacIndoe compares to Apple’s strategy with the iPhone. “They’re giving you a product that seems really great at the time,” he says, “and then after a little while you realize you’ve got to move on, because they’re telling you something else is better—and they’re making it better intentionally so you’ll move on to a different brand.”

http://qz.com/229470/how-heroin-baggies-are-marketed-like-iphones/

Source: Quartz – July 7, 2014

FDA Designates Opioid Overdose Treatment for Fast Track Development Program

FDA“A Kentucky company headed by a recognized expert in nasal delivery of medication says its intranasal naloxone spray, a drug designed to treat opioid overdoses, has received Fast Track designation from the Food and Drug Administration (FDA).

The Fast Track program of the FDA is designed to expedite the development and review of new drugs that are intended to treat serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs. Fast Track-designated drugs ordinarily qualify for priority review, thereby expediting the FDA review process. AntiOp and the FDA may also be able to employ additional tools to expedite the FDA review process such as “rolling submission,” whereby AntiOp may submit portions of the new drug application (NDA) in a staged NDA submission process.”

http://www.marketwatch.com/story/fda-designates-opioid-overdose-treatment-for-fast-track-development-program-2014-07-15 

Source: MarketWatch.com – July 15, 2014

 

 

Obama Drug Strategy Aims to Change How Americans See Drug Abuse

White HousePresident Obama’s annual drug control strategy, released July 7, targets the rise of heroin but also seeks to portray drug abuse as a disease, not a moral failure.

“When Michael Botticelli, President Obama’s acting “drug czar,” unveiled the administration’s annual drug control strategy on Wednesday morning, he emphasized that “we cannot arrest or incarcerate our way out of the drug problem.”

The 98-page strategy follows the template of Obama’s previous drug policy statements, but it also raises the alarm on the nation’s growing middle-class problem of opioid addictions, as heroin and painkillers become a suburban and middle-America scourge.”

http://www.csmonitor.com/USA/Politics/2014/0709/Obama-drug-strategy-aims-to-change-how-Americans-see-drug-abuse

The White House press release on the 2014 strategy can be accessed at: http://www.whitehouse.gov/ondcp/news-releases/2014-national-drug-control-strategy

The strategy can be accessed at: http://www.whitehouse.gov/sites/default/files/ndcs_2014.pdf

See related article – ASAM Applauds ONDCP’s 2014 National Drug Control Strategy: Applauds Focus on Opioid Epidemic available at: http://www.asam.org/magazine/read/article/2014/07/15/asam-applauds-ondcp’s-2014-national-drug-control-strategy-applauds-focus-on-opioid-epidemic

Source: The Christian Science Monitor – July 9, 3024, American Society of Addiction Medicine – July 15, 2014

APA Archived Webinar: Managing Pain in Patients with an Addiction History

pain collagePCCS-MAT has a new webinar archived on their website made available from the American Psychiatric Association on “Managing Pain in Patients with an Addiction History”. The webinar can be accessed at: http://pcssmat.org/education-training/archived-webinars/apa-archived-webinar-managing-pain-in-patients-with-an-addiction-history/.

The 1 hour webinar is presented by Jan Kauffman, RN, Vice President, Addiction Treatment Services North Charles Foundation, Inc., and Assistant Professor of Psychiatry, Harvard Medical School. One CME credit is available.

The goal of the presentation is to familiarize clinicians with the tools to identify chronic pain patients at risk for misuse of opioids, and provide strategies for managing chronic pain patients with addictive disorders. Guidelines for risk stratification, safe prescribing, and assessing, monitoring and managing errant behavior will be discussed.

Source: PCSS – MAT Training – May 13, 2014

Online Training Module From PCSS MAT – American Academy of Addiction Psychiatry (AAAP) – Utilizing Innovative Strategies and Community Resources for Methadone Treatment

webThis module is free of charge and provides techniques and strategies that clinicians and program administrators can use to enhance methadone and buprenorphine maintenance treatment.  This affirmative approach aims to improve the experience of both the patients and the staff by encouraging positive interactions between staff and patients and among the patients in an effort to develop a recovery community.  Methadone patients often feel isolated and have limited opportunities for sober social support.  This presentation directly addresses some of the limitations of the modality and provides ideas and options to clinicians to combat the stigma long associated with maintenance treatment by integrating peer services into treatment.

The presenter is Sarah H. Church, PhD, Executive Director, Division of Substance Abuse Albert Einstein College of Medicine.

http://pcssmat.org/event/aaap-online-module-posted-utilizing-innovative-strategies-and-community-resources-for-methadone-treatment/

A listing of upcoming PCSS-MAT webinars is available at: http://pcssmat.org/education-training/webinars/

Source: PCSS – MAT Training – July 1, 2014

A New Edition of Slaying the Dragon: The History Of Addiction Treatment And Recovery In America By William L. White

Slaying the Dragon“A new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America has just rolled off the presses. The first edition (1998) went through multiple printings and has been used as a text in collegiate addictions studies programs. Of even greater import has been how this history helped many people in recovery see themselves as “a people” and contributed to the rise of a new recovery advocacy movement in the U.S.

Multiple circumstances created the need for a new edition of Slaying the Dragon–recent seminal research on earlier periods of history, the accumulation of more than 16 years of new addiction and recovery research and, of course, events of enormous significance that have transpired since 1998. That addiction treatment has gone through significant challenges and changes in the past 16 years is self-evident, but readers may not appreciate some of the momentous and unprecedented events that have occurred within the larger history of addiction recovery. Such events include the growth and diversification of recovery mutual aid societies, the cultural and political mobilization of people in recovery, the emergence of new grassroots recovery support institutions, the rise of recovery as a potentially new organizing paradigm for national drug policy, key breakthroughs in recovery research, and rising efforts to fundamentally redesign addiction treatment.”

http://www.williamwhitepapers.com/blog/2014/06/year-of-the-dragon.html

Source: WilliamWhitePaper.com – June 29, 2014

STATE NEWS OF INTEREST

News & Updates – June 30, 2014; Issue 202

Feds Seek Ways to Expand Use of Addiction Drug

White House“The government’s top drug abuse experts are struggling to find ways to expand use of a medicine that is considered the best therapy for treating heroin and painkiller addiction.

Sen. Carl Levin of Michigan on Wednesday pressed officials from the White House, the National Institute of Drug Abuse and other agencies to increase access to buprenorphine, a medication which helps control drug cravings and withdrawal symptoms. It remains underused a decade after its launch.

“As long as we have too few doctors certified to prescribe bupe, we will be missing a major weapon in the fight against the ravages of addiction,” Levin told the forum, which also included patients and non-government medical experts.”

http://bostonherald.com/business/business_markets/2014/06/feds_seek_ways_to_expand_use_of_addiction_drug

Source: BostonHerald.com – June 18, 2014

Across The US, An Explosion of Addiction

heroin and injection“Over the last 18 months, The Cincinnati Enquirer has used a team of reporters to cover the heroin problem locally. We joined with Gannett papers in Arizona, Delaware and Vermont for this series on heroin nationally.”

Part IThe Resurgence Of The Deadly Drug Has Sparked A Flurry Of Action From Governors’ Mansions And Statehouses Across New England And The Midwest To Small-Town Police Stations From Northern Kentucky To Wisconsin

Part II – Heroin’s Hidden Journey – Nearly All Heroin Fueling A U.S. Resurgence Enters Over the 1,933-Mile Mexico Border

Part III – Heroin addicts left trapped; families, heartbroken

Part IV – Scanning the battlefield in war on heroin

Part V – In Vermont, on the front lines of war on heroin

Source: USAToday.com – June 12, 2014

Heroin Users Are 90 Percent White, Living Outside Urban Areas

“The image of the heroin user is changing, according to researchers who say the great majority are now white men and women who mostly live outside the cities.

Their study published in JAMA Psychiatry, tracked data from almost 2,800 heroin users and found that first-time users are now generally older than those who began taking the drug in the 1960s. About 90 percent are white, according to the study, and 75 percent now live in non-urban areas.

The research also confirmed a link between the rise of opioid abuse and the growing use of heroin that had been noted in earlier studies. Heroin use has jumped 80 percent to 669,000 users from 2007 to 2012, according to the National Survey on Drug Use and Health, after being relatively stable since 2000.”

http://washpost.bloomberg.com/Story?docId=1376-N6AV3H6S972C01-71HUL1EQ4U5J4QKSAPSPOBBT5I

See related article  - Opioids leading to new class of heroin abusers, study finds at: http://www.jsonline.com/news/health/opioids-leading-to-new-class-of-heroin-abusers-study-finds-b99278535z1-260996001.html

Source: WashingtonPost.com – May 29, 2014

Drugs for Treating Heroin Users: A New Abuse Problem in the Making?

“Evidence is mounting that certain drugs used to treat heroin users are themselves being sold on the streets – and may even be a ‘gateway’ to heroin or opioid use. As some experts herald their value for treating addiction, others ask if the ‘cure’ is making things worse.

More than a decade ago, the FDA partnered with a British company to develop Suboxone, a new treatment for addiction to opioids. But that effort has had highs and lows, experts say. Lifesaving to some opioid abusers, Suboxone and generic drugs like it have not helped others to whom they have been prescribed – in part, these experts say, because of poor oversight of how the opioids are dispensed and used.

Those drugs have also ended up where the U.S .government hoped they wouldn’t: on the street, where they are sold in the same illicit subculture in which heroin and prescription painkillers are peddled.”

http://www.csmonitor.com/USA/Society/2014/0530/Drugs-for-treating-heroin-users-a-new-abuse-problem-in-the-making

Source: Christian Science Monitor – May 30, 2014

To Beat Heroin Addiction, A Turn To Coaches

“Recommendations out this week from a task force on opiate abuse include more peer support and home-based counseling. Health insurers and state Medicaid leaders say they will look at funding for recovery coaches, but there is no plan to do so right now.

Across the country, there’s growing interest in using recovery coaches to help heroin users stop, says Robert Lubran, director of the division of pharmacologic therapies at the federal Substance Abuse and Mental Health Services Administration. At least one state, New York, is paying for coaches to help treat addiction through its Medicaid program.

“This is an evolving field,” Lubran says. “[We are] learning more and more about the best ways to treat addiction and certainly the use of peer counselors, or peer coaches, has become more and more widespread.”

http://commonhealth.wbur.org/2014/06/heroin-recovery-coaches

Source: WBUR’s CommonHealth Reform and Community – June 13, 2014

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