News & Updates – December 26, 2012: Issue 176

Federal Rule Provides Flexibility in Dispensing Buprenorphine for Opioid Addiction Treatment in OTPs

The Substance Abuse Mental Health Services Administration (SAMHSA) issued a Federal rule to allow patients being treated through an opioid treatment program (OTP) to receive take-home supplies of buprenorphine from an OTP in a more flexible manner. Buprenorphine is a medication used in opioid addiction treatment. The regulation takes effect on January 7, 2013.

Under the rule change, OTPs will be permitted to dispense buprenorphine to eligible patients without having to adhere to previous length of time in treatment requirements. Currently, OTPs require a person to be in treatment a certain amount of time before being given a multiple days’ supply of medicine to take home.

The change in the rule will not affect requirements for dispensing methadone. SAMHSA based the change in the restrictions for dispensing buprenorphine on several factors. These include differences in the abuse potential between methadone and buprenorphine, as well as the actual abuse and mortality rates (buprenorphine is lower in each instance).

For more information on the rule, go to:

The Federal Register notice can be accessed at:

Source: The Substance Abuse Mental Health Services Administration – December 6, 2012

One-Half of Buprenorphine-Related Emergency Department Visits for Nonmedical Use

Slightly more than one-half (52%) of the estimated 30,135 buprenorphine-related emergency department visits in the U.S. in 2010 were for nonmedical use of the drug, according to data from the Drug Abuse Warning Network (DAWN). Approximately one-fourth of these visits, in which buprenorphine was involved as either a direct cause or a contributing factor, were related to seeking detoxification and 13% were for adverse reactions. The estimated number of emergency department visits related to the nonmedical use of buprenorphine has more than tripled since 2006 (see CESAR FAX, Volume 21, Issue 31).

Types of U.S. Buprenorphine-Related Emergency Department Visits, 2010


NOTES:  Nonmedical use of buprenorphine includes taking more than the prescribed dose; taking buprenorphine prescribed for another individual; deliberate poisoning with buprenorphine by another person; and documented misuse or abuse of buprenorphine. Adverse reaction includes visits related to adverse reactions, side effects, drug-drug interactions, and drug-alcohol interactions resulting from using buprenorphine for therapeutic purposes. Seeking detox includes patients seeking substance abuse treatment, drug rehabilitation, or medical clearance for admission to a drug treatment or detoxification unit. Accidental ingestion includes childhood drug poisonings, individuals who take the wrong medication by mistake, and a caregiver administering the wrong medicine by mistake. It does not include a patient taking more medicine than directed because the patient forgot to take it earlier. Suicide includes visits for overdoses, as well as suicide attempts by other means if drugs were involved or related to the suicide attempt.

*The number of buprenorphine-related ED visits categorized as accidental ingestion and as suicide attempts did not meet DAWN’s standards of precision (i.e., the estimate had a standard of error greater than 50% or the unweighted count or estimate was less than 30).  For this analysis, the two categories were combined and the percentage derived from the difference remaining after accounting for the categories that were known. Percentages do not sum to 100 due to rounding.

Adapted by CESAR from data from the Substance Abuse and Mental Health Services Administration (SAMHSA), Drug Abuse Warning Network, 2010: Selected Tables of National Estimates of Drug-Related Emergency Department Visits.

Source:  Cesar Fax, Vol. 21, Issue 47, November 26, 2012

Why Do We Have Methadone Clinics? An OpEd by Dr. Alen-Salarian

“The rules of treatment are straightforward: attend classes 365 times a year, be on time, and be patient; do not complain, wait for turn, take your pill, walk away and when asked do not protest and give urines for you’re not a man or a woman to be trusted; you are an addict after all and you have no right. You are something less than good.”

“If this is an exaggeration, why then do we make people attend clinics every day, 365 days a year, and deprive them of their freedom to travel? Why do they have to wait for their medications? What is unsafe about methadone? The truth is methadone is one of the safest and nonabusable medications. Yes, methadone is not abusable, but patients who take them are. If a diabetic can go to a pharmacy and obtain needles and insulin and is not forced to go to a clinic every day, why then do we make a patient with addiction endure humiliation and indignity to receive care?”

Alen J. Salerian, MD is a Washington, DC based physician, author, and historian who has been practicing psychiatry and psychopharmacology for 35 years. He is the former chief psychiatrist of the FBI’s mobile psychiatric unit. He has authored numerous newspaper and peer reviewed articles in publications ranging from The Washington Post to The Lancet.

Source: – November 29, 2012

Opioid Overdose Treatment and Prevention: Often Overlooked at Community Level

hospital signTraci Green MSc, PhD, Assistant Professor of Emergency Medicine and Epidemiology, studied prescription opioid overdoses in three communities in Connecticut and Rhode Island that were experiencing a rash of deaths from opioid overdoses in 2009.

 “We found that awareness around the topic of overdose and drug poisoning was lacking,” Dr. Green said. “People didn’t know it was a problem. They didn’t know what an overdose looks like. It made us realize that in these communities, there is a great deal of stigma around prescription opioid overdoses.”

Source:  – – December 7, 2012

Baker Institute Viewpoints on Prescription Drugs

As policymakers grapple with how to address the growing problem of prescription drug abuse — including a quiet reassessment of U.S. policies that focus on keeping illegal drugs out of the country — drug policy experts at the Baker Institute ask: What does rising prescription drug abuse mean for the “war on drugs”?

Nonresident drug policy fellow Gary Hale, former chief of intelligence in the Houston Field Division of the Drug Enforcement Administration, leads off this three-day installment of Baker Institute Viewpoints by laying out the scope of the problem.

In the second of three posts in this installment, Tony Payan, the visiting Baker Institute Scholar for Border and Immigration Studies, examines how our approach to prescription drug abuse can inform how the U.S. deals with illegal drugs.

Nathan Jones, the institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy, wraps up this installment of Baker Institute Viewpoints with a look at the impact of prescription pill abuse on Mexican drug cartels.

Source: Baker Institute – December 3-5, 2012

State Drug Monitoring Programs Should Make Data More Accessible, Study Says

 Currently, data from the Prescription drug monitoring programs (PDMP) are not used as much as they could be, cannot be easily exchanged across states, and are difficult for providers to find, a new government report states. Five to 39 percent of providers use PDMP data, according to the report. Reasons for the low usage include many providers are not aware of the systems, and the data is not current. In addition, members of healthcare teams that support doctors and pharmacists often are not allowed to access the systems.|

Source: – December 6, 2012

U.S. Military Working on Combination Anti-Heroin/HIV Vaccine

A scientist at the Walter Reed Army Institute of Research is developing a vaccine designed to treat heroin addiction while at the same time prevent HIV infection. This project is one of a number of research initiatives around the world that are working toward new vaccines to fight addiction.

The National Institute on Drug Abuse recently pledged $5 million toward Dr. Gary Matyas’ work on the new dual vaccine. The goal of the vaccine is to fight heroin abuse and the high risk of HIV infection among heroin users who inject the drug.

Source: – November 30, 2012

Michael Botticelli Sworn in as Deputy Director of the Office of National Drug Control Policy

On November 27 R. Gil Kerlikowske, Director of National Drug Control Policy, announced that Michael Botticelli has joined the Office of National Drug Control Policy (ONDCP) as its new Deputy Director. President Obama nominated Botticelli to serve as Deputy Director of the National Drug Policy in January 2012.

Prior to joining ONDCP, Mr. Botticelli served as Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, where he successfully expanded innovative and nationally recognized prevention, intervention, treatment, and recovery services for the Commonwealth of Massachusetts. Botticelli also forged strong partnerships with local, state, and Federal law enforcement agencies; state and local health and human service agencies; and stakeholder groups to guide and implement evidence-based programs. He also supported efforts to expand services, including the establishment of a treatment system for adolescents, early intervention and treatment programs in a wide variety of primary healthcare settings, jail diversion programs, re-entry services for those leaving state and county correctional facilities, and overdose prevention programs. Mr. Botticelli is also in long-term recovery from addiction himself, celebrating more than 24 years of sobriety.

Source: Office of National Drug Control Policy – November 27, 2012

Report Says Adults Who Had Mental Illness in the Past Year Were More Than Three Times as Likely to Have Met the Criteria for Substance Dependence or Abuse

One in 5 American adults aged 18 or older, or 45.6 million people, had mental illness in the past year, according to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The 2011 National Survey on Drug Use and Health (NSDUH): Mental Health Findings report presents results pertaining to mental health from the 2011 NSDUH, the primary source of statistical information on the use of illegal drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years or older. Conducted by the federal government since 1971, the survey collects data through face-to-face interviews with approximately 65,750 people aged 12 years or older nationwide, at the respondent’s place of residence.

According to the report, rates for substance dependence or abuse were far higher for those who had mental illness than for the adult population which did not have mental illness in the past year. Adults who had mental illness in the past year were more than three times as likely to have met the criteria for substance dependence or abuse in that period than those who had not experienced mental illness in the past year (17.5 percent versus 5.8 percent). Those who had serious mental illness in the past year were even more likely to have had substance dependence or abuse (22.6 percent).

The complete survey findings from this report are available on the SAMHSA Web site at

Source: The Substance Abuse Mental Health Services Administration – November 27, 2012

APA Board of Trustees Has Approved the Final Diagnostic Criteria for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

The American Psychiatric Association (APA) Board of Trustees has approved the final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The trustees’ action marks the end of the manual’s comprehensive revision process, which has spanned over a decade and included contributions from more than 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries. These final criteria will be available when DSM-5 is completed and published in spring 2013.

 DSM-5 is the guidebook used by clinicians and researchers to diagnose and classify mental disorders. Now that the criteria have been approved, review of the criteria and text describing the disorders will continue to undergo final editing and then publication by American Psychiatric Publishing.

 The manual will include approximately the same number of disorders that were included in DSM-IV. This goes against the trend from other areas of medicine that increase the number of diagnoses annually.

 Message from the APA President is available at:

The APA press release can be accessed at:–newsroom

Source: The American Psychiatric Association – December 1, 2012

Blog: The Deadly Stigma of Addiction – Is it Possible to Separate the Disease of Addiction from the Stigma? Here Are Eight Life-changing Reasons We Should Try

The American Society of Addiction Medicine characterizes addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” The National Institute on Drug Abuse defines addiction as a ‘chronic, relapsing brain disease” that changes the structure and functionality of the brain. So why do so many people still think of addiction as a moral failing? Why do they still refer to victims of substance misuse disorders as meth freaks, alcoholics, junkies, crack heads and garden-variety drunks?

The answer is simple as it is depressing: because that’s the way it’s always been.

Source: - December 5, 2012

Prisoners Face Long Wait for Drug-Rehab Services

Although drug offenders represent the single-largest category of prisoners in the burgeoning federal prison system, thousands wait months to begin drug education or rehabilitation because of staff shortages and limited resources, according to federal investigators.

More than 51,000 inmates were on waiting lists in 2011 — some up to three months — for basic drug-education programs, far more than the 31,803 who were enrolled, according to a Government Accountability Office (GAO) report.

The report, released this fall, focused primarily on severe overcrowding in the system that houses 218,000 inmates, nearly 40% over capacity. A troubling byproduct of that crowding, investigators found, was a crushing need for more access to critical rehabilitation programs, some of which serve as pathways to early release.

Source: - December 4, 2012

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