News & Updates – September 28, 2012: Issue 173

New Report Recommends Expanding Access to Medication-Assisted Treatment in Armed Forces

In order to better understand current substance use problems within the U.S. military, the Department of Defense (DoD) asked the Institute of Medicine (IOM) to analyze policies and programs that pertain to prevention, screening, diagnosis, and treatment of substance use disorders (SUDs) for active duty service members in all branches, members of the National Guard and Reserve, and military families.

Service members’ rising rate of prescription drug addiction and their difficulty in accessing adequate treatment for alcohol and drug-related disorders were among the concerns that prompted members of Congress to request this review.

The IOM committee presented its findings and recommendations in a report Substance Use Disorders in the U.S. Armed Forces.

While rates of both illicit and prescription drug abuse are low, the rate of medication misuse is rising.  Just 2 percent of active duty personnel reported misusing prescription drugs in 2002 compared with 11 percent in 2008.  The armed forces’ programs and policies have not evolved to effectively address medication misuse and abuse, the committee noted.

TRICARE, which provides health insurance to service members and their dependents, does not cover several evidence-based therapies that are now standard practice, the committee found.  It also does not permit long-term use of certain medications for the treatment of addiction and covers treatment delivered only in specialized rehabilitation facilities.

The report recommended that TRICARE’s benefits should be revised to cover maintenance medications and treatment in office-based outpatient settings delivered by a range of providers, which would enable ongoing care for patients struggling to avoid relapses.

Data from fiscal year 2010 shows that only 6 active duty service members received methadone treatment for opioid addiction averaging a 42-day supply. A total of 405 active duty service members received buprenorphine treatment averaging an 89 day supply.

Medications for Addiction Treatment Given to Active Duty Service Member and Active Duty Family Member Adult Dependent Beneficiaries (Aged 18 and Over),
All Systems of Care (FY 2010)

Active Duty Service Members Active Duty Family Members
Medication Sum of Days Supply # Users Sum of Days Supply # Users
Antabuse 35,560 605 14,127 214
Buprenorphine 35,966 405 60,718 668
Campral 30,024 619 21,736 343
Methadone 250 6 1,405 20
Naltrexone 54,057 1,034 26,518 371
Vivitrol 956 14 270 3

Source: Personal communication, Greg Woskow, TRICARE Management Activity, May 7, 2012.

The press release can be accessed at: http://www.iom.edu/Reports/2012/Substance-Use-Disorders-in-the-US-Armed-Forces/Press-Release.aspx

The report brief can be accessed at: http://www.iom.edu/Reports/2012/Substance-Use-Disorders-in-the-US-Armed-Forces/Report-Brief.aspx

The full report can be accessed at: http://www.nap.edu/catalog.php?record_id=13441

Sources: Institute of Medicine and National Academy Press – September 17, 2012

Medical Consensus or Child Abuse? Moms on Methadone Caught in the Middle



 “Cases like Rebecca’s have become increasingly common in recent years, according to maternal-health and drug-treatment advocates, who say they are seeing more parents charged with child abuse for undergoing methadone maintenance, despite scientific evidence showing that it is the best way to wean addicts off opiates. The treatment may even save a fetus’s life, since going cold turkey can bring on premature birth or in some cases a miscarriage.”

“But because methadone is an opiate, like the drugs it is prescribed to treat, there is confusion among some doctors, child welfare workers and judges that using it is just substituting one drug for another, said Jocelyn Woods of the National Alliance for Medication Assisted Recovery.”

Mothers get caught in the middle. “Judges and caseworkers are practicing medicine without a license, even against medical advice,” said Emma Ketteringham of National Advocates for Pregnant Women, who worked on Rebecca’s case.

http://www.thedailybeast.com/articles/2012/09/02/medical-consensus-or-child-abuse-moms-on-methadone-caught-in-the-middle.html

Source: The DailyBeast.com – September 2, 2012

September 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:

  •  Assessing the current state of opioid-dependence treatment across Europe: methodology of the European Quality Audit of Opioid Treatment (EQUATOR) project
  • Is substance use disorder with comorbid adult attention deficit hyperactivity disorder and bipolar disorder a distinct clinical phenotype?
  • Economic evaluation of opioid substitution treatment in Greece
  •  The journey into injecting heroin use
  • Cognitive behavioural coping skills therapy in cocaine using methadone maintained patients: a pilot randomised controlled trial

The September issue can be accessed at: Heroin Addiction and Related Clinical Problems September 2012 (2.12 MB, 116pp)

Medication Assisted Treatment (MAT) Part 3: Implementation Challenges and Strategies

Part 3 of a three-part article series made available from the Addiction Technology Transfer Center (ATTC) discusses challenges and strategies related to MAT implementation. Topics include finding and communicating with physicians, getting medications paid for, first steps in implementation, and effective outreach and services with special populations.

Part 3 is available at: http://www.atforum.com/addiction-resources/documents/MATPartIII.pdf

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 – September 2012

Gateway Drugs Linked to Prescription Drug Abuse

Researchers at the Yale School of Medicine analyzed nationally-representative survey data to explore a possible link between alcohol, cigarette, and marijuana use as an adolescent and subsequent abuse of prescription pain medication as a young adult. Their paper, published in the Journal of Adolescent Health, was the first to find that a link between these “gateway drugs” and prescription painkillers. They found that all three drugs are associated with higher levels of prescription drug abuse in men, but only marijuana use is associated with higher levels of prescription drug abuse in in women.

http://www.yaledailynews.com/news/2012/sep/04/gateway-drugs-linked-to-prescription-drug-abuse/

Source: Yale Daily News – September 4, 2012

WVU Study Finds Link Between ‘Doctor Shopping,’ Overdose Deaths

 A published study conducted by researchers at West Virginia University (WVU) has found that doctor and pharmacy shoppers are at a greater risk for drug-related death.

Marie Abate, Phar.D., professor in the WVU School of Pharmacy and faculty affiliate with the WVU Injury Control Research Center, was part of a team of researchers who explored prescription and drug-related death data to determine how many subjects visited multiple doctors and pharmacies to obtain medications.

The study examined information from the West Virginia Controlled Substance Monitoring Program (WV CSMP) and drug-related death data compiled by the Forensic Drug Database from July 2005 through December 2007. Of the more than one million subjects 18 years and older, 698 were categorized as deceased. Doctor shoppers accounted for about 25 percent of deceased subjects, while nearly 17.5 percent of the deceased were pharmacy shoppers.

In addition, approximately 20 percent of doctor shoppers were also pharmacy shoppers, and 55.6 percent of pharmacy shoppers were doctor shoppers. Younger age and greater number of prescriptions dispensed also contributed to having greater odds of drug-related death.

The article reporting this research, “Doctor and Pharmacy Shopping for Controlled Substances,” appeared in the June 2012 issue of “Medical Care.” It concludes that prescription monitoring programs may be useful in identifying potential shoppers at the point of care.

The press release is available at: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2012/SEPTEMBER/WVU-study-finds-doctor-and-pharmacy-shopping-are-l

Source: West Virginia University – September 6, 2012

5 Damaging Myths about Addiction

A study currently being conducted at the University of California Los Angeles, is finding even more evidence that one of the top reasons addicts put off treatment is a fear of the social consequences. “In a nutshell, people fear the label of “recovered addict” more than they do the hardships of going “cold turkey.” Why? Because in many cases they risk facing social humiliation and a variety of legal restrictions on driving, housing, custody of children, business licensing, as well as an extended period of mandated drug testing, many of which stem from a misunderstanding of addiction.
The article discusses the following five addiction myths:

  • Myth No. 1: There is an addiction gene
  • Myth No. 2: Marijuana is a ‘gateway drug’
  •  Myth No. 3: Addiction is for life
  • Myth No. 4: Drugs ‘fry’ your brain
  • Myth No. 5: You have to hit ‘rock bottom’

 http://www.cnn.com/2012/09/13/health/jaffe-addiction-myths/index.html?iref=allsearch

Source: CNN.com – September 13, 2012

The Machinery of the Mind Webinar

The DSM-IV lists 5 behavioral symptoms of addiction but does not tell us why these behaviors appear in people of very different psychosocial backgrounds using widely different substances. The answer resides in the drug-altered human brain. This session reports from the currently published research what we know about how and why the changed brain gives us those behaviors. Such knowledge helps both the counselor and the patient better understand what has happened to the brain and what can be done to heal it.

When: Wednesday, October 3, 2012, 2:00 PM – 4:00 PM EDT

Trainer: Allan Barger, MSW

Register: https://www2.gotomeeting.com/register/153154034

Source: Institute for Research, Education & Training in Addictions

New Report: The U.S. Drug Policy Landscape Insights and Opportunities for Improving the View

This new report from RAND Corporation provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain.

The press release can be accessed at: http://www.rand.org/news/press/2012/09/18.html

The report can be accessed at: http://www.rand.org/pubs/occasional_papers/OP393.html

Source: RAND Corporation – September 18, 2012

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