News & Updates – August 10, 2012: Issue 171

Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010

According to a new report from the Centers for Disease Control and Prevention (CDC) prescription painkiller overdoses were responsible for more than 15,500 deaths in 2009. While all prescription painkillers have contributed to an increase in overdose deaths over the last decade, methadone has played a central role in the epidemic. More than 30% of prescription painkiller deaths involve methadone, even though only 2% of painkiller prescriptions are for this drug. Six times as many people died of methadone overdoses in 2009 than a decade before.

The report also acknowledged that methadone has been used safely and effectively to treat drug addiction for decades. It has been prescribed increasingly as a painkiller because it is a generic drug that can provide long-lasting pain relief. But as methadone’s use for pain has increased, so has nonmedical use of the drug and the number of overdoses.

Source: The Centers for Disease Control and Prevention - July 6, 2012

Abuse-Proof Prescription Painkillers May Spur Heroin Habit

The move by drug companies to make abuse-proof prescription painkillers may be inadvertently promoting heroin use, a new study found. The study of more than 2,500 people with opioid dependence found a 17 percent drop in OxyContin abuse with the 2010 arrival of a formula that’s harder to inhale or inject. During the same time period, heroin abuse doubled.

Unlike its predecessor, the abuse-deterring version of OxyContin turns to gel when crushed, making it harder for people to snort or inject for a rapid high. But nearly a quarter of study participants found a way around the formulation tweak, and 66 percent said they switched to another opioid – usually heroin.

Source: - July 11, 2012

Majority of Buprenorphine-Certified Physicians Think Buprenorphine Is Easier to Get Illegally Than Methadone

Physicians who are certified to prescribe buprenorphine are increasingly likely to perceive diversion and abuse of the drug, according to a survey funded by the manufacturer as part of a national post-marketing surveillance program*. Nearly one-half (46%) of physicians certified to prescribe buprenorphine in 2009 knew of buprenorphine products being bought or sold on the street, compared to 27% in 2005. In addition, a majority (81%) of the physicians surveyed believed that buprenorphine was easier than methadone to buy on the street in their community in 2009, a 56% increase from 2005 (see figure).

Forty-four percent reported that they knew someone who used illegal buprenorphine/naloxone to manage opioid withdrawal, 34% for maintenance until entering treatment, 17% to try out its effect, and 7% to get high (data not shown). The authors suggest that “the increase in diversion may be driven by the increase in abuse” as evidenced by the increasing percentage of treatment applicants who said they knew of buprenorphine being used to get high (from 5% in 2005 to 21% in 2009; see CESAR FAX, Volume 21, Issue 25). However, the increase in diversion may also “be driven by therapeutic demand, suggesting treatment expansion may be necessary. Finding a balance between diversion and abuse of a medication versus expanded treatment remains a challenge”.

Perceptions of Buprenorphine Diversion/Misuse, Physicians Federally Certified
to Prescribe Buprenorphine
(n=8,194 from 2005 to 2009)

*Conducted by an independent contractor for Reckitt Benckiser Pharmaceuticals, the Surveillance of Diversion and Abuse of Therapeutic Agents (SODATA) utilizes several national indicators of diversion and abuse combined with a survey of applicants to substance abuse treatment programs and a survey of CSAT-certified physicians. A total of 8,194 quarterly surveys were conducted with randomly-selected physicians federally-certified to prescribe buprenorphine from 2005 to 2009.

See 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 for more information on buprenorphine diversion and abuse.

Source: Adapted by CESAR from Johanson, C-E; Arfken, C. L.; di Menza, S.; and Schuster, C. R., “Diversion and Abuse of Buprenorphine: Findings from National Surveys of Treatment Patients and Physicians,” Journal of Drug and Alcohol Dependence 120:190-195, 2012. For more information, contact Chris-Ellyn Johanson at

June 2012 Issue of Heroin Addiction and Related Clinical Problems is 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 this issue include:

  • Ethnicity and drug addiction history. A comparison between Italian and Slovenian heroin addicts.
  • The Opiate Treatment Index (OTI) clinical interview: New evidence of its reliability and validity.
  • The effects of psychopathology and personality on substance abuse in twelve-step treatment programme abstainers, opiate substance abusers and a control sample.
  • Maladaptive behaviours after catastrophic events: the contribute of a “spectrum” approach to post traumatic stress disorders.
  • Reduction of psychotic symptoms during the use of exogenous opiates.
  • Clinical and social aspects of the illegal activities of people with psychoactive substance dependence in Russia.

The PDF file is available at

New Drug Abuse Warning Network (Dawn) Report Issued on Drug-Related Emergency Department Visits

The Substance Abuse Mental Health Services Administration (SAMHSA) issued a report July 2 on drug-related emergency room (ER) visits in 2010. There were 4.0 million drug-related ED visits made by patients aged 21 or older in 2010. Of these visits, 1.9 million, 47.2 percent, involved drug misuse or abuse.

The total number of drug-related ED visits increased 94 percent from 2004 (2.5 million visits) to 2010 (4.9 million visits).

  • ED visits involving misuse or abuse of pharmaceuticals increased 115 percent between 2004 and 2010.
  • ED visits involving misuse or abuse of narcotic pain relievers increased 156 percent between 2004 and 2010.
  • ED visits involving misuse or abuse of oxycodone products increased 255 percent between 2004 and 2010.
  • ED visits involving misuse or abuse of benzodiazepines increased 139 percent between 2004 and 2010.
DAWN Report: Misused or Abused Drugs Most Commonly Involved in Emergency Department (ED) Visits:
2004 to 2010
Drug 2004 Number of ED Visits 2010 Number of ED Visits % Change, 2004 to 2010 2010 ED Visits per 100,000 Population 


Alcohol – In Combination with Other Drugs NA 564,796 NA 182.5
Alcohol – Underage Drinking** NA 189,060 NA 215.4
Illicit Drugs 991,640 1,171,024 NC 378.5
Cocaine NA 488,101 NA 157.8
Heroin NA 224,706 NA 72.6
Marijuana 281,619 461,028 64 149.0
Pharmaceuticals 626,472 1,345,645 115 434.9
Anti-anxiety and Insomnia Drugs 210,711 472,769 124 152.8
Benzodiazepines 170,471 408,021 139 131.9
Antidepressants NA 105,229 NA 34.0
Pain Relievers 282.275 659, 969 134 213.3
Narcotic Pain Relievers 166,338 425,247 156 137.4
Hydrocodone Products 46,536 115,739 149 37.4
Oxycodone Products 51,418 182,748 255 59.1

* Because a visit may involve multiple drugs, the sum of visits by drug will be greater than the total.
**Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for patients aged 20 or younger.

The 8-page report can be accessed at:

Source: 2010 SAMHSA Drug Abuse Warning Network (DAWN) – July 2, 2012

Medication-Assisted Treatment (MAT) – Three Part Article Series Available From the Addiction Technology Transfer Center (ATTC)

This series, focused on MAT, draws from and highlights information from the ATTC training modules for treatment providers, and includes introductory information; a discussion of the challenges and benefits involved in using and implementing MAT; and also issues related to outreach, access, and ethnicity/culture.

Part 1: Setting the Context is available at:

Source: Addiction Technology Transfer Center – July 2012

NIDA Backs Research on Vaccine Against Heroin, HIV

The National Institute on Drug Abuse (NIDA) has issued a $5 million grant to Gary Matyas, PhD, to support his research into a new vaccine that could treat heroin addiction as well as prevent HIV infection in those receiving the vaccine. Matyas, of the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Md., is the 2012 recipient of the NIDA Avant-Garde Award for Medications Development and will receive $1 million a year for five years.

NIDA and WRAIR began a research collaboration on development of the joint vaccine two years ago. At this point, the heroin component of the combination vaccine has been created and is ready for advanced preclinical testing. Matyas noted that “The possibility of creating a combination heroin-HIV vaccine provides an important opportunity to address both a unique treatment for heroin abuse as well as continuing the quest to develop an effective preventive HIV vaccine.”

Source: American Psychiatric Association – July 26, 2012

Research: Availability of Viral Hepatitis Services in U.S. Drug Treatment Programs

The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) is disproportionately high among individuals in U.S. drug treatment programs. Therefore, such programs are ideal settings for the provision of services targeting viral hepatitis, including screening, education, vaccine prevention, and treatment. This National Institute of Drug Abuse Clinical Trials Network (NIDA-CTN) study assessed the availability and comprehensiveness of viral hepatitis services within US drug treatment programs. Administrators from 319 drug treatment programs within the NIDA-CTN were invited to participate via survey, and 84% responded. Data were compared between programs that provided methadone (n=89) and those that did not (n=180). Most programs were private, not-for-profit, free-standing facilities but varied in most other aspects (e.g., geographic location, program size, and medical versus nonmedical staffing).

Testing for HCV-antibody was performed in 28% of programs and was more likely to be offered at methadone programs (55%) compared with programs that did not provide methadone (15%).

Vaccination for hepatitis A virus and HBV were offered either on-site or through contractual agreement with another provider in 68% of programs.

For all substance abuse treatment programs, HCV-related treatment was provided either on-site or through contractual agreement at 29% of programs and was more common in programs providing methadone than in programs that did not provide methadone (48% versus 22%, respectively). Fifteen percent of programs offered on-site HCV treatment, 3.5% offered treatment through contractual agreement with another provider, 67% referred patients to a community resource, and 15% did not offer treatment at all.

Comments: Less than one-third of drug treatment facilities offered HCV-antibody testing or HCV treatment either on-site or through contractual agreement with another provider. Programs that provided methadone were more likely to provide these services than programs that did not provide methadone. These data are likely biased in that they reflect programs enrolled in the NIDA-CTN, a group of programs that may be more likely to provide such services, and are limited by their self-report nature. The findings suggest a need to improve access to HBV and HCV screening and treatment at drug treatment programs to address this public health agenda.

Source: Alcohol, Other Drugs, and Health: Current Evidence – May/June 2012, Jeanette M. Tetrault, MD

Original Source: Bini EJ, Kritz S, Brown LS Jr, et al. Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States. J Subst Abuse Treat. 2012;42(4):438–445.

Infographic: Why Drug Treatment is More Effective Than Incarceration

Infographics are graphic visual representations of information, data or knowledge that present complex information quickly and clearly.


Kentucky – Prescription Drug Abuse Bill Making Its Mark Just Days After Going Into Effect, Officials Say

prescription drugsDays after a landmark prescription drug abuse law took effect, the law appears to have already effected changes in the medical field and positioned Kentucky as a leader in battling prescription drug abuse.

“The enforcement of this bill began just a couple of days ago, and yet we already know that four ‘pain management clinics’ in Kentucky have waved the white flag and notified us they will shut their doors,” said Gov. Steve Beshear, who joined Attorney General Jack Conway, lawmakers and medical providers in hailing the law’s impact.

House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring. The bill included multiple elements to prevent the abuse and diversion  of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices.

“We know that more than 9,000 medical providers have signed up for electronic prescription monitoring just since this law passed in April – more than doubling the number registered.

Source: – July 25, 2012

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