News & Updates – September 5, 2012: Issue 172

Medication-Assisted Treatment (MAT) Part 2: Helping Patients Succeed

Part 2 of a three-part article series made available from the Addiction Technology Transfer Center (ATTC),  discusses practical ways behavioral health providers can support patients who utilize MAT, including strategies for helping them deal with stigma, and ideas for helping them manage and adhere to their medications.

Part 2: Helping Patients Succeed is available at: http://atforum.com/addiction-resources/documents/MATPart2.pdf

Part 1: Setting the Context is available at: http://atforum.com/addiction-resources/documents/MATPart1.pdf

Source: Addiction Technology Transfer Center – August 2012

How I Learned to Stop Worrying and Love Methadone by Maia Szalavitz

“I used to believe that “maintenance” was as bad—if not worse—than active addiction. Here’s how I came to understand how fatally wrong I was.”

“The 180-degree turn in my thinking wasn’t just due to data. As I researched my book, I met people on long-term maintenance who I came to admire and respect. Indeed, one of the smartest people I’ve ever known, and one of the UK’s leading thinkers on addiction, has been on maintenance for multiple decades. But what really leveled me and made me deeply ashamed of my prior ignorance was when another methadone patient—who also ultimately became a leading recovery activist—told me a story about methadone myths that nearly destroyed her.”

http://www.thefix.com/content/russell-brand-misguided-crusade-against-methadone-maintenance00228?page=all

Source: TheFix.com August 19, 2012

3Qs: When Painkillers Kill

The U.S. Food and Drug Administration recently introduced a series of safety measures designed to reduce the risk of extended-​​release and long-​​acting opioid medications. Northeastern University news office asked drug policy expert Leo Beletsky, an assistant professor of law and health sciences at Northeastern University, to expound upon the threat posed by opioid analgesics, 22.9 million prescriptions of which were dispensed last year. The Q & A’s include:

  • Why has opioid abuse increased over the last decade?
  • How has President Barack Obama’s 2011 Prescription Drug Abuse Prevention Plan fared in curbing the abuse of prescription drugs, the second-most abused category of drugs after marijuana?
  • What would be your strategy for improving the safe use of opioids while ensuring access to prescription drugs for patients in pain?

http://www.northeastern.edu/news/2012/08/opioids/

Source: MedicalExpress.com – August 3, 2012

Estimated Number of Buprenorphine- and Hydromorphone-Related ED Visits More Than Doubles from 2006 to 2010

The estimated number of emergency department (ED) visits related to the nonmedical use of opioid pain killers increased 79% from 201,280 in 2006 to 359,921 in 2010, according to the most recent data from the Drug Abuse Warning Network (DAWN). The greatest increases were seen in buprenorphine- and hydromorphone-related ED visits. In 2006, the nonmedical use of buprenorphine was involved as either a direct cause or a contributing factor in an estimated 4,440 ED visits, compared to 15,778 in 2010—an increase of 255%. The estimated number of visits related to the nonmedical use of hydromorphone increased 161% over the same 5-year period (see figure below).

While the number of ED visits for the nonmedical use of buprenorphine and hydromorphone is relatively small compared to other opioid pain relievers, the magnitude of the increase suggests that there may be emerging problems with the nonmedical use of these drugs that warrant the monitoring of their use and related consequences.

Estimated Number of U.S. Emergency Department Visits Related to the Nonmedical Use of Opioid Pain Relievers, 2006 to 2010

Drug Name (Common Brand Names) Number of ED Visits for Nonmedical Use

2006                       2010

Percent Change 2006 to 2010
Buprenorphine (Suboxone, Subutex, Temgesic, Buprenex)

 

4,440 15,778 +255%
Hydromorphone (Palladone, Dilaudid)

 

6,780 17,666 +161%
Oxycodone (Oxycontin, Percodan, Percocet)

 

64,891 146,355 +126%
Hydrocodone (Vicodin, Lorcet, Lortab)

 

57,550 95,972 +67%
Methadone (Methadose) 45,130 65,945

 

+46%
Morphine (MS Contin, Morphine IR)

 

20,416 29,605 +45%
Propoxyphene (Darvon) 6,220 8,832

 

+42%
Fentanyl (Actiq, Duragesic) 16,012 21,196

 

+32%
Codeine (Tylenol with Codeine)

 

6,928 7,928 +14%
Meperidine (Demerol) 1,440 1,151

 

-20%
Total Opioid Pain Relievers

201,280 359,921 +79%

Notes Nonmedical use includes taking more than the prescribed dose; taking a drug prescribed for another individual; deliberate poisoning by another person; and documented misuse or abuse. Five categories of opioid pain relievers (dihydrocodeine, opium, pentazocine, phenacetin, and all other narcotic analgesics) were not included in the above table because the estimate for either 2006 and/or 2010 did not meet standards of precision (relative standard error greater than 50% or an unweighted count or estimate less than 30).

Adapted by CESAR from Substance Abuse and Mental Health Services Administration (SAMHSA), National Estimates of Drug-Related Emergency Department Visits, 2004-2010 – Nonmedical Use of Pharmaceuticals, 2012. Available online at http://www.samhsa.gov/data/DAWN.aspx#DAWN%202010%20ED%20Excel%20Files%20-%20National%20Tables.

Source: CesarFax.com – August 6, 2012

150 Soldiers Have Died of Drug Overdose in the Last Two Years, Says Congressman

Congressman Hal Rogers from Kentucky gave a speech on August 1 in the House of Representatives about the issue of prescription drug abuse in America, where he mentioned a growing problem – members of the United States military dying from prescription medications.

“Our military soldiers are coming back from Iraq and Afghanistan hooked on these pain pills. In the last 2 years, over 150 of our soldiers have died from overdoses”, Congressman Rogers said.

http://www.examiner.com/article/150-soldiers-have-died-of-drug-overdose-the-last-two-years-says-congressman

Source: Examiner.com – August 3, 2012

Preventing Overdose: Obama Administration Drug Czar Calls for Wider Access to Overdose Antidote

governmentSpeaking at a North Carolina overdose-prevention program, the Obama administration’s drug czar Gil Kerlikowske called for increased action to prevent drug overdose deaths. Notably, for the first time Kerlikowske urged wider distribution of a medication called naloxone, an antidote to overdoses of opioid drugs, including prescription pain relievers and heroin, saying that “naloxone can be expanded beyond public health officials.”

http://healthland.time.com/2012/08/22/preventing-overdose-obama-administration-drug-czar-calls-for-wider-access-to-overdose-antidote/

Source: Healthland.Time.com – August 22, 2012

Why Heroin? A Federal Agent Offers an Overview of the Opiate Trade

According to Will Taylor, who works as a special agent with the federal Drug Enforcement Administration out of Chicago, “traffickers move drugs based on supply and demand, and as a prescription drug habit costs more to get high as tolerance levels increase, a hit of heroin is relatively inexpensive.”

“When they buy a bag of heroin, they have no idea if it is two or three times stepped or what it’s cut with,” he said. “The user never knows what they’re getting. That’s how we get clusters of overdoses. There is no consistency. There is no science to this.”

http://www.greenbaypressgazette.com/article/20120804/ADV01/308040078/Why-heroin-federal-agent-offers-an-overview-opiate-trade

Source: GreenBayPressGazette.com – August 3, 2012

Welcome to Dopamine Nation

Despite a proliferation of treatment options in America, addictive behavior and unhealthy coping strategies are more common than ever. Here’s why.

“While we may admire the American impulse to applaud hard work, innovation, and daring, the rewards of these labors aren’t immediate. We’re an impatient nation; we seek more immediate gratification. We’ve come to accept an approach of “why wait?”, so we grab ahold of whatever it takes to feel better, to keep feeling better, to make it through the day. In our addicted culture, we go for the artificially-induced dopamine spike—and not just one, but one right after the next.”

http://www.thefix.com/content/dopamine-nation-richard-juman7987

Source: TheFix.com by Dr. Richard Juman  – July 30, 2012

Congressional Research Service Report on Prescription Drug Monitoring Programs

The Congressional Research Service has created a report for Congress on Prescription Drug Monitoring Programs (PDMPs).  The report issued in July provides an overview of prescription drug abuse, overview of current PDMPs, PDMP effectiveness, Federal grant programs for PDMPs, and information on some key policy issues such as balancing stakeholder concerns.

The available evidence suggests that PDMPs are effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and reducing prescription drug abuse; however, research on the effectiveness of PDMPs is limited.

Assessments of effectiveness may take into consideration potential unintended consequences of PDMPs, such as limiting access to medications for legitimate use or pushing drug diversion activities over the border into a neighboring state. Experts suggest that PDMP effectiveness might be improved by increasing the timeliness, completeness, consistency, and accessibility of the data.

The report can be found online at:  http://www.fas.org/sgp/crs/misc/R42593.pdf

Source: Congressional Research Service – July 11, 2012

RI Hospital: Use of PMP May Increase Demand for Drug Treatment, Reduce Painkiller Abuse

A Rhode Island Hospital researcher has found that the use of electronic prescription drug monitoring programs (PMPs) may have a significant impact on the demand for drug treatment programs and how prescribers detect and respond to abuse of painkillers. The study by Traci C. Green, PhD, MSc, research scientist in Rhode Island Hospital’s department of general internal medicine is published in the journal Pain Medicine.The study found that prescribers’ use of an electronic PMPs may influence medical care and decisions, especially with opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.

When prescribers suspected a patient of doctor shopping or diverting medications, PMP users were more likely to ramp up clinical monitoring with urine drug screens or refer the patient to drug treatment. PMP users were also less likely to ignore the warning signs or to call law enforcement.

“One thing is clear,” Green said, “Clinicians, not law enforcement, have the medical and behavioral health care expertise to guide patients struggling with addiction to get the help they need, when they are ready for it. PMPs can be an important clinical tool to address possible addiction issues and start that conversation.”

Green added, “Our study suggests that if states want wider use of PMPs by their prescribers, we need to increase access to drug treatment, especially opioid-dependence treatment options, if we are going to make headway on the epidemic of painkiller abuse and overdose death in our communities.”

http://www.rhodeislandhospital.org/wtn/Page.asp?PageID=WTN000287

Source: – Lifespan – August 16, 2012

U.S. Health Panel Likely to Make HIV Tests Routine

Reuters reported on August 19 that the United States Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

http://www.reuters.com/article/2012/08/19/us-usa-health-hiv-idUSBRE87I04J20120819

Source: Reuters.com – August 19, 2012

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