News and Updates – March 23, 2012 Issue 163

Veterans of Iraq, Afghanistan Wars with Mental Health Diagnoses More Likely to Receive Prescription Opioids for Pain

Iraq and Afghanistan war veterans with mental health diagnoses, particularly posttraumatic stress disorder, are more likely to receive prescription opioid medications for pain-related conditions, have higher-risk opioid use patterns and increased adverse clinical outcomes associated with opioid use than veterans with no mental health diagnoses, according to a study in the March 7 issue of the Journal of the American Medical Association (JAMA).

Greater exposure to combat coupled with improvements in battlefield medicine and protective gear have resulted in large numbers of veterans of Iraq and Afghanistan surviving injuries that would have been fatal in prior wars. Veterans are returning home with co-existing mental and physical health problems, and posttraumatic stress disorder (PTSD) is the most prevalent mental health disorder. “Nationwide, the prescription of opioid analgesics has nearly doubled since 1994 because of a greater recognition of the importance of treating pain. At the same time, rates of prescription opioid misuse and overdose have increased sharply, and prescription opioids are now a leading cause of death in the United States. Iraq and Afghanistan veterans with pain- and PTSD-prescribed opioids may be at particularly high risk of prescription opioid misuse given the high co-occurrence of substance use disorders among veterans with PTSD,” according to background information in the article.

Karen H. Seal, MD, MPH, of the San Francisco Veterans Affairs Medical Center, and colleagues examined the association between mental health disorders and patterns of opioid prescription use, related risks, and adverse clinical outcomes, such as accidents and overdose, among a national sample of 141,029 Iraq and Afghanistan veterans. The study included veterans who received at least one non-cancer-related pain diagnosis within one year of entering the Department of Veterans Affairs (VA) health care system from October 2005 through December 2010.

Additional information on the study is available at:

Journal of the American Medical Association – March 6, 2012

Retention in Opioid Agonist Treatment after Prison Release Reduces Re-incarceration

Opioid agonist treatment (OAT) in prison and after release might influence the risk of re-incarceration. This prospective cohort study linked data on OAT and incarceration among 375 men with heroin use originally recruited in 1996–1997 for a randomized controlled trial of OAT in prison in New South Wales, Australia. Participants were followed through 2006.

  • During 9+ years of observation, 331 participants engaged in OAT 1081 times, with a median of 2 episodes per participant (mean length of engagement, 156 days); 58% started OAT in prison.
  • Ninety percent of participants were re-incarcerated after the first incarceration.
  • Engagement in OAT at the time of release had no effect on re-incarceration.
  • Post-release retention in OAT was associated with a one-fifth reduction in the number of re-incarcerations.

Comments: This study affirms that retention in OAT following release is associated with reduced re-incarceration among former prisoners with opioid dependence. Although other investigations have shown that initiating OAT prior to release maximizes post-release treatment retention, the current study suggests active linkage to ongoing treatment is an essential component. Continuing or initiating OAT during incarceration is necessary but not sufficient to optimize post-release outcomes among opioid-dependent inmates; correctional systems and treatment providers must also provide transitional assistance to ensure that former inmates reach OAT programs after release.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue January/February 2012. Access checked 3/12/12. Peter D. Friedmann, MD, MPH

Original Source: Larney S, Toson B, Burns L, et al. Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of reincarceration. Addiction. 2012;107 (2):372–380.

Opioid Abuse Linked by Researchers to Mood and Anxiety Disorders

Individuals suffering from mood and anxiety disorders such as bipolar, panic and major depressive disorders may be more likely to abuse opioids, according to a new study led by researchers from the Johns Hopkins Bloomberg School of Public Health, who found that such disorders are highly associated with nonmedical prescription opioid use. The results are featured in a recent issue of the Journal of Psychological Medicine.

For the study, researchers examined individuals with mood and anxiety disorders and their association with nonmedical prescription opioid use and opioid disorder.

“Lifetime nonmedical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders. Nonmedical opioid-use disorder due to nonmedical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders,” said Silvia Martins, lead author of the study and an associate scientist in the Bloomberg School’s Department of Mental Health.

“However, there is also evidence that the association works the other way, too,” she said. “Increased risk of incident opioid disorder due to nonmedical use occurred among study participants with baseline mood disorders, major depressive disorder, dysthymia and panic disorder, reinforcing our finding that participants with mood disorders might use opioids nonmedically to alleviate their mood symptoms. Early identification and treatment of mood and anxiety disorders might reduce the risk for self-medication with prescription opioids and the risk of future development of an opioid-use disorder.”

Using data from the National Epidemiologic Study on Alcohol and Related Conditions, a longitudinal face-to-face survey of individuals ages 18 years and older between 2001–2002 and 2004–2005, researchers assessed participants for a history of psychiatric disorders.

Nonmedical use of prescription opioids was defined to participants as using a prescription opioid without a prescription or in greater amounts more often or longer than prescribed or for a reason other than a doctor’s instruction to use them. Logistic regression was used to determine whether lifetime nonmedical prescription opioid use and opioid disorders due to this use predicted incident mood and anxiety disorders and the reverse. Researchers say they believe that these findings provide support for a bidirectional pathway between nonmedical prescription opioid use and opioid-use disorder due to nonmedical use and several mood and anxiety disorders.

Carla Storr, author of the study and an adjunct professor in the Bloomberg School’s Department of Mental Health, said, “With the current increased use of nonmedical prescription drugs, especially among adolescents, the association with future psychopathology is of great concern. Using opioids, or even withdrawal from opioids, might precipitate anxiety disorders, suggesting that there is a subgroup of people who are vulnerable to future development of anxiety disorders.” Individuals using prescription opioids need to be closely monitored not only for the possibility of engaging in nonmedical use but also for the development of co-morbid psychiatric disorders, she said.

Added Martins, “Additional studies are needed to examine the relationship between nonmedical prescription opioid use and prescription opioid-use disorder with mood and anxiety disorders since they could co-occur due to shared genetic or environmental risk factors.”

The study was written by Martins, M.C. Fenton, K.M. Keyes, C. Blanco, H. Zhu and Storr.

Source: John Hopkins Bloomberg School of Public Health – March 5, 2012

First Guidelines Issued for Getting People Newly Diagnosed with HIV Disease into Care

Leading AIDS experts at Johns Hopkins and other institutions around the world have issued new guidelines to promote entry into and retention in HIV care, as well as adherence to HIV treatment, drawn from the results of 325 studies conducted with tens of thousands of people infected with HIV, the virus that causes AIDS.

The guidelines are believed to be the first ever to focus exclusively on how best to get those newly diagnosed with HIV into treatment plans and to help them adhere to lifelong drug and check-up regimens.

Some 50,000 Americans each year are diagnosed with the potentially deadly, but now-treatable infection, and more than a million Americans already are known to be HIV positive.

However, experts worry that barely two-thirds of Americans with HIV disease, some 69 percent, have ever used potent antiretroviral drug therapy, or ART, to keep viral levels in the blood low. Still fewer, they say, 59 percent, continue their drug therapy, and less than a third, or 28 percent, have achieved near total viral suppression to keep the disease in check by carefully complying with treatment regimens and getting regular tests for viral load.

The need is urgent, he says, because other research has shown that patients who miss follow-up medical visits within the first year after they begin outpatient drug treatment for HIV infection tend to be out of compliance with regimens, and, over the long term, die at twice the rate of those who keep their appointments.

Chang, an assistant professor at the Johns Hopkins University School of Medicine, was one of 31 experts worldwide, including three faculty members at Johns Hopkins, who drafted the guidelines on behalf of the International Association of Physician in AIDS Care, or IAPAC.

The guidelines were published online earlier this month in the Annals of Internal Medicine and the publication was timed to coincide with the 19th annual Conference on Retroviruses and Opportunistic Infections in Seattle.

Funding support for the guidelines, which took over a year to complete, was provided by the National Institutes of Health’s Office of AIDS Research.

Source: John Hopkins Medicine – March 5, 2012


Q&A: What You Need to Know About Hepatitis C – Hepatitis C Kills More Americans Than HIV. How Does the Virus Spread?

The Centers for Disease Control and Prevention (CDC) reported I February that the hepatitis C virus (HCV) now kills more Americans annually than HIV, the virus that causes AIDS. Most of the deaths occur in middle-aged adults — 3% of baby boomers are infected — and about half of people infected don’t know they have the virus.

Healthland spoke with Dr. John Ward, who heads the CDC’s effort to fight hepatitis C, about who is at risk of infection, how the disease is really spread and why it’s important to know your hepatitis C status now.

Source: – February 23, 2012



Florida goes from “Oxy-Express” to anti-prescription drug abuse leader – 3/14/12

One year after Florida launched its pill mill strike force teams, state leaders say Florida has gone from being known as the “Oxy-Express” to a role model for the nation on how to crack down on prescription drug abuse.

On Wednesday, Gov. Rick Scott reported that prescription drug strike force teams have removed about a half million pills from the streets and made more than 2,000 arrests, including 34 doctors in the past year.

New York

Law Would Force New York City to Alert Neighbors on Methadone Clinic Openings – 3/13/12

New legislation has been proposed that would require the city to notify local community boards of plans to open methadone clinics in the wake of a failed attempt to bring a clinic to lower Manhattan last year.

The bill Councilwoman Margaret Chin is set to introduce would force the city’s Health Department to contact community boards and the City Council about any plans to open methadone clinics when the department is first contacted by the state Office of Alcohol and Substance Abuse Services for certification.


Addiction costs Oklahoma more than annual budget – 3/10/12

  • Addiction costs Oklahoma and its residents an estimated $7.2 billion a year.
  • That’s more than the state government’s budget of $6.7 billion.
  • That’s roughly $1,900 for every man, woman and child in the state. Enough to create about 273,000 median-wage jobs. Enough to build nine skyscrapers like Oklahoma City’s Devon tower.

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