News & Updates – March 16 2012: Issue 162

SAMHSA Announces Winners of the 2012 Science to Service Awards

SAMHSA Announces Winners of the 2012 Science to Service Awards

On February 23 the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the winners of the 2012 Science and Service Awards. Three opioid treatment programs (OTPs) and five office-based opioid treatment (OBOT) practitioners were selected for their commitment to excellence in the treatment of individuals with opioid-related conditions.

The purpose of these awards is to promote excellence in the treatment of opioid addiction by recognizing OTPs and OBOT practitioners who use pharmacotherapy as part of their treatment protocol and who have demonstrated implementation of exemplary innovative services, practices, and/or strategies, resulting in improved patient outcomes.

Applications for the award were reviewed by a panel of experts in the field of addiction medicine using five specific criteria: (1) treatment population(s)/ subpopulation(s) served, (2) evidence-based practices and treatment, (3) improved patient outcomes, (4) innovativeness, and (5) management and staff capabilities.  Each application received three independent reviews by panel members who then nominated the program or individual practitioner for the award.

The three OTP winners are:

  • The Addiction Institute of New York at St. Luke’s and Roosevelt Hospitals – New York, New York
  • CODA – Portland, Oregon
  • Connecticut Counseling Centers, Inc. – Norwalk, Connecticut

The OTP awardees will be honored at the awards banquet on April 24, 2012 at the 2012 national conference of the American Association for the Treatment of Opioid Dependence (AATOD).

http://blog.samhsa.gov/2012/02/23/announcing-the-winners-of-the-2012-science-to-service-awards/

Source: The Substance Abuse and Mental Health Services Administration – February 23, 2012

Research Abstract: Link Between Prescription and Illicit Drug Misuse in High-Risk Populations

Background. Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles and New York, which represent different local markets for illicit and prescription drugs.

Design and Methods. Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and poly drug users.

Results. In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available.

Conclusion. Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs.

Free access to the article is available at: http://www.jphres.org/index.php/jphres/article/view/jphr.2012.e6/html

Source: Journal of Public Health Research – Volume 1, #1 (2012)

CESAR FAX Publishes Report Warning of Emerging Epidemic of Buprenorphine Misuse

Prior research has shown that criminal offenders’ drug test results can help identify emerging drug epidemics well before they become evident in surveys and other community indicators. CESAR staff recently pilot tested the Adult Offender Population Urine Screening (OPUS) Program in Maryland as a rapid, low-cost tool for detecting and assessing emerging local drug trends.

In 2008, 1,061 urine specimens* originally collected and screened for 5 or fewer drugs by Maryland Division of Parole and Probation (DPP) agents were systematically sampled and sent to an independent laboratory for expanded testing for 31 drugs. The results showed an increase in the percentage of persons testing positive for buprenorphine since a smaller 2005 pilot study, and that these specimens often contained other drugs, suggesting possible misuse. Of the 98 specimens that tested positive for buprenorphine, 45% also contained two or more additional drugs and more than 60% contained other opioids (data not shown).

The drugs most frequently found were morphine (45%), cocaine (27%), marijuana (19%), and benzodiazepines (19%; see figure below).  Both other opioids and benzodiazepines could have lethal consequences if used with buprenorphine1.

A unique benefit of OPUS is that it enables the identification of local areas where drug misuse may be emerging. Once specific hot spots are identified, follow-up interviews can provide concrete details about substance use that can be used to guide criminal justice and public health efforts. CESAR staff conducted interviews in 2010 with 15 supervisees in one of the six probation offices close to Baltimore that submitted a high percentage of buprenorphine- positive specimens. The supervisees reported wide-spread availability of buprenorphine in the street and in prisons. While the most frequently mentioned reason for using buprenorphine was for self-medication to manage withdrawal symptoms, several participants mentioned that buprenorphine could be used to get high or to enhance the effects of other drugs. Additional reports of the smuggling of buprenorphine into jails and diversion of the drug to the street have also been reported across the country2.

The Maryland Adult OPUS findings, combined with national indicators of increased buprenorphine availability, diversion, and nonmedical use, suggest that there may be an epidemic of buprenorphine misuse emerging across the U.S. Unfortunately, “current testing protocols do not routinely include buprenorphine and cannot inform us of the magnitude and scope of buprenorphine misuse. Thus, offenders smuggle the drug into jails and prisons because its use will go undetected and buprenorphine-related deaths cannot be tracked because medical examiners and coroners do not routinely test for the drug in most states” (p. 6).

The authors recommend that “buprenorphine be added to all relevant drug testing regimens, if only to gauge the extent of diversion and misuse” (p. 6). In addition, the authors suggest that physician education programs “redouble their efforts to teach strategies to deter diversion and misuse of the drug” (p. 3) and that doctors closely monitor dosing “to ensure that the appropriate amount is prescribed, thereby reducing the likelihood of diversion” (p. 6). The OPUS model could be easily replicated in other states interested in tracking emerging prescription and other drug problems.

Percentage of Buprenorphine-Positive Specimens Testing Positive for Other Drugs, 2008 (N=98)

 

*To enhance the likelihood of detecting less commonly used drugs, we targeted random samples of 15 drug-positive specimens and 5 drug-negative specimens submitted by each DPP office.

1) Reckitt Benckiser Pharmaceuticals Inc., Suboxone Tablet Product Information, 2012. Available online at: http://www.suboxone.com/pdfs/SuboxonePI_tablet.pdf.  2) CESAR FAX, Volume 20, Issue 33 and CESAR FAX Buprenorphine Series, 2012. Available online at http://www.cesar.umd.edu/cesar/cesarfax.asp.

Source: Adapted by CESAR from Wish, ED, Artigiani, E, Billing, A, Hauser, W, Hemberg, J, Shiplet, M, and DuPont, R, “The Emerging Buprenorphine Epidemic in the United States,” Journal of Addictive Diseases 31(1):3-7, 2012. Available online at: http://www.tandfonline.com/doi/abs/10.1080/10550887.2011.642757.

Addiction is Not Hopeless

Most of the public is unaware that relapse rates for all  substance use disorders are about the same as relapse rates for other chronic illnesses such as hypertension, asthma or diabetes, or that there are approximately 20 million individuals who are in stable, long-term (a year or more) recovery. These successes are not observable in part because those individuals wish to remain anonymous while they look and act exactly like the rest of us.

Addiction is not hopeless, intractable or untreatable. Millions of people are in recovery from it.

http://www.cnn.com/2012/02/22/opinion/brooks-addiction-problem/index.html?hpt=hp_t3

Source: CNN.com – February 22, 2012

How Prescription Drug Abuse Costs You Money

fundingHow Prescription Drug Abuse Costs You Money

One study puts the potential overall cost of painkiller abuse at more than $70 billion a year. Pill addicts who shop around for doctors to score prescriptions cost insurers $10,000 to $15,000 apiece. The toll in lost productivity: $42 billion. The criminal justice bill: $8.2 billion. It all adds up.

http://money.cnn.com/2012/02/22/news/economy/prescription_drug_abuse/

Source: CNN.com – February 24, 2012

Deadly Duo: Mixing Alcohol and Prescription Drugs Can Result in Addiction or Accidental Death

Prescription drugs and alcohol can be a dangerous combination, Nora Volkow of the National Institute on Drug Abuse says. Painkillers and booze are perhaps the worst to mix, because both slow breathing by different mechanisms and inhibit the coughing reflex, creating “a double-whammy effect,” she says, that can stop breathing altogether. Alcohol also interacts with anti-anxiety drugs (including Xanax), antipsychotics, antidepressants, sleep medications and muscle relaxants—intensifying the drugs’ sedative effects, causing drowsiness and dizziness, and making falls and accidents more likely.

http://www.scientificamerican.com/article.cfm?id=mixing-alcohol-prescription-drugs-result-addiction-accidental-death

Source: ScientificAmerican.com – February 24, 2012

Soldiers to be Tested for Prescription Drug Abuse

The Army will soon begin expanded testing of Soldiers for unauthorized prescription drugs, in addition to currently tested illegal substances.

“We’re starting with hydrocodone and hydromorphone as the first expansion” of testing said Lt. Col. Shaun Bailey, chief of the drug testing branch at the Army Center for Substance Abuse Programs. He explained that these two pain-killers are widely used, as they are found in Vicodin and other brand-named drugs.

“We will continue to expand and increase our prescription drug-testing capabilities in the months to come,” Bailey said. “We’re not limiting ourselves in this initial announcement.” The expanded testing of urinalysis samples will begin around May 1 and ramp up as more labs come online, Bailey said. The program will be fully implemented Army-wide by Oct. 1 as part of the Army’s crackdown on prescription drug abuse.

http://www.army.mil/article/74584/Soldiers_to_be_tested_for_prescription_drug_abuse/

Source: United States Army – February 27, 2012

EUROPAD Journal – Heroin Addiction and Related Clinical Problems March 2012 Issue Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. Articles in the March issue include:

  • How should methadone and buprenorphine treatment be organized and regulated? A comparison between two systems in the context of a EUROPAD Conference in Brussels
  • Heroin addicts’ psychopathological subtypes. Correlations with the natural history of illness
  • Profile of an addict, or, beyond the addiction mask
  • Factors associated with discharge against medical advice from an alcohol and drug inpatient detoxification unit in Barcelona between 1993 and 2006
  • A compartmental model for the pharmacokinetics of heroin and its metabolites in man
  • The state of the art regarding heroin addicts in prisons in Slovenia during the period from 1990 to 2008
  • Clinical assessment of opiate induction: The Opiate Dosage Adequacy Scale Induction Form (O.D.A.S.-IF)

http://atforum.com/documents/HeroinAddict1412012.pdf

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