News & Updates – January 14, 2013: Issue 177

AATOD Issues Policy Statement for Five-Year Game Plan (2012-2016

The American Association for the Treatment of Opioid Dependence recently issued this policy statement that addresses the following topics:

  • Conference Development and Training
  • Healthcare Reform
  • Criminal Justice
  • Prescription Opioid Use and Addiction
  • Expanding the Use of Medications for the Treatment of Opioid Addiction in OTPs
  • International Work
  • Challenges to the System

Source: The American Association for the Treatment of Opioid Dependence

Sharp Rise in Admissions for Certain Drug Combinations Over 10 Years

Substance abuse treatment admissions for addiction involving combined use of benzodiazepine and narcotic pain relievers (NPR) rose a total of 569.7 percent, to 33,701, from 2000 to 2010, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). Overall substance abuse treatment admissions of people ages 12 and older in the same period rose 4 percent, to 1.82 million, the agency said.

 “Clearly, the rise in this form of substance abuse is a public health problem that all parts of the treatment community need to be aware of,” said SAMHSA Administrator Pamela S. Hyde. “When patients are battling severe withdrawal effects from two addictive drugs, new treatment strategies may be needed to meet this challenge. These findings will help us better understand the nature and scope of this problem and to develop better approaches to address it.”

The report showed that 38.7 percent of those with this combined addiction began use of both drugs in the same year; 34.1 percent first used narcotic pain relievers, and the remaining 27.1 percent started with benzodiazepines.

Almost half of patients admitted for combined use also had a co-occurring psychiatric disorder, were largely self-referred, and were less likely to receive regular outpatient treatment than other admissions.

Specific demographic groups have higher rates of admission for combination benzodiazepine/NPR treatment when compared with admissions for other treatment. Non-Hispanic whites account for 91.4 percent of combination admissions versus only 55.8 percent of other admissions. Females make up 49.2 percent of combined admissions versus 30.2 percent of other admissions, and people aged 18-34 account for 66.9 percent of combined admissions versus 43.7 of other admissions.

“The public health and safety threat we face from the abuse of prescription drugs is indisputable and these data show the increasing need for treatment for those suffering from addiction to prescription drugs,” said Office of National Drug Control Policy Director Gil Kerlikowske. “While prevention is a critically important pillar of our prescription drug prevention plan, equally important is ensuring that treatment is available to those in need.”

Source: Substance Abuse and Mental Health Services Administration – December 13, 2012

Suboxone® Sales Estimated to Reach $1.4 Billion in 2012—More Than Viagra® or Adderall®

Sales data from the first three quarters of 2012 indicate that Suboxone retail sales in the U.S. will likely reach $1.4 billion this year—nearly a ten-fold increase over the $137.1 million in sales in 2006. Suboxone currently has the 28th highest retail sales of all prescription drugs in the U.S., up from 198th in 2006. Suboxone sales will likely continue to increase in light of new SAMHSA regulations allowing Opioid Treatment Programs (OTPs) to dispense a multiple days’ supply of take-home buprenorphine, the main ingredient in Suboxone, to eligible patients without having to adhere to previous length of time in treatment requirements. The steady and rapid increase in Suboxone sales suggests that the drug is being widely adopted in the treatment of opioid dependence, likely because of its effectiveness and because it can be prescribed in both private physicians’ offices and OTPs.

Further information is available at:

 Source: Cesar Fax – December 10, 2012 Vol. 21, Issue 49

Is The Era Of OxyContin Abuse Over?

“OxyContin? That’s going out of style,” says Dr. Gregory G. Davis, professor of pathology at the University of Alabama at Birmingham, and associate coroner for Jefferson County, which includes the city. “Right now it’s heroin. We’ve gone from one or two heroin deaths per year to one to two per week.”

Dr. Kevin Whaley, Assistant Chief Medical Examiner for the Commonwealth of Virginia, has seen the same thing: “There has been a decrease in oxycodone [the active ingredient in OxyContin] overdosage as a consequence of the tamper-resistant measures taken by the manufacturer,” he says via email.

Source: – December 13, 2012

Accidental Exposures of Children to Drug that Treats Opioid Addiction Alarms Utah Poison Control and Health Officials

Buprenorphine is a safe and effective drug for treating opioid addiction. But as the prescribed use of buprenorphine has dramatically increased in recent years, accidental exposure of children to the drug has risen sharply, placing them at risk for serious injury, and in extremely rare cases even death, according to researchers at the Utah Poison Control Center (UPCC), U School of Medicine’s Department of Family and Preventive Health, and the Utah Department of Health (UDOH).

In a study published Thursday, Dec. 13, 2012, by the U.S. Centers for Disease Control and Prevention, the Utah experts urge physicians to carefully educate their patients about the proper storage and use of buprenorphine, which is available under the names of Suboxone® (a combination with another drug) and Subutex®, about the proper storage and use of the drug. Karen C. Thomas, Pharm.D., Ph.D., certified poison information specialist at the UPCC and adjunct professor of pharmacotherapy, and Christina A. Porucznik, Ph.D., assistant professor of family and preventive medicine, led the study.

“A toddler or child who ingests buprenorphine can become extremely sick,” says Thomas.  “Therefore, it is critical that patients prescribed this drug understand how dangerous it can be for children and how to properly store it.”

As opioid addiction has become an increasing problem in recent years, the number of buprenorphine prescriptions has risen markedly. A UDOH analysis of data from the Utah Controlled Substance Database shows that since 2002 the number of Utah patients prescribed buprenorphine has increased 444-fold while the number of providers prescribing the drug increased 67-fold.

In that same period, the number of accidental exposures to buprenorphine reported to the UPCC increased 13-fold and averaged 36 a year from 2009-2011. The majority of exposures of children younger than 6 required evaluation and treatment at a health care facility. Three people—one teenager and two adults—died from accidental exposure to Suboxone®.

.Robert Rolfs, M.D., deputy director of UDOH, says educating buprenorphine users about the potential risk to children can prevent serious injuries.

“Buprenorphine has benefits for treating addiction to heroin and prescription opioids, but it also has risks if used or stored improperly,” Rolfs says. “It is important to educate the patient on proper use and storage of the medication to protect children from the dangers described in this study.”

Source: University of Utah Health Care – December 13, 2012

Probuphine(R) Receives FDA Priority Review Designation for Adult Patients with Opioid Dependence

Titan Pharmaceuticals, Inc. today announced that the New Drug Application (NDA) for Probuphine® has been accepted for review and granted Priority Review designation by the U.S. Food and Drug Administration (FDA). Probuphine is a novel, subdermal implant and the first long-acting product designed to deliver six months of the drug buprenorphine hydrochloride following a single treatment. Titan submitted the NDA for the maintenance treatment of opioid dependence in adult patients in October 2012 under Section 505(b)(2) of the Food, Drug and Cosmetic Act and referenced the approved sublingual tablet formulations of buprenorphine.

Priority designation is given to therapies that offer potential major advances in treatment, including improved safety, or provide a treatment where no adequate therapy exists. Based upon the Prescription Drug User Fee Act (PDUFA), the FDA has set a target date of April 30, 2013 for FDA action on the NDA.

Source: Titan Pharmaceuticals, Inc. – January 2, 2013

Liver Toxicity Fears with Buprenorphine, Methadone Allayed

Data from a phase IV hepatic safety study show no evidence of liver toxicity from buprenorphine/naloxone and methadone.

“Doctors can tell their patients that neither buprenorphine/naloxone or methadone have apparent liver toxicity and can prescribe either medication without major concern for liver injury,” Dr. Andrew Saxon said.

Source: – December 14, 2012

Plan to End Methadone Use at Albuquerque Jail Prompts Alarm

For the last six years, the Metropolitan Detention Center, New Mexico’s largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so.

In November, however, the jail’s warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive.

Moreover, Mr. Rustin, a former warden of the Allegheny County Jail in Pennsylvania and a 32-year veteran of corrections work, said he did not believe that the program truly worked.

Source: – January 13, 2013

Study: Distributing Naloxone Injection Kits Could Help Addicts Reverse Heroin Overdoses

Distributing a drug that reverses drug overdoses in heroin users would save lives and be cost-effective, according to a new analysis.

U.S. researchers, who published their findings in the Annals of Internal Medicine on Monday, calculated that one death may be prevented for every 164 naloxone injection kits they distribute to heroin users. That, the researchers say, works out to be a few hundred dollars for every year of healthy life gained.

“The great news here is these overdose deaths can be prevented, it’s cost effective to do so, and may even be cost saving,” said Dr. Phillip Coffin, the study’s lead author from the San Francisco Department of Public Health.

Source: – December 31, 2012

Controversial Surgery for Addiction Burns Away Brain’s Pleasure Center

“How far should doctors go in attempting to cure addiction? In China, some physicians are taking the most extreme measures. By destroying parts of the brain’s “pleasure centers” in heroin addicts and alcoholics, these neurosurgeons hope to stop drug cravings. But damaging the brain region involved in addictive desires risks permanently ending the entire spectrum of natural longings and emotions, including the ability to feel joy.

In 2004, the Ministry of Health in China banned this procedure due to lack of data on long term outcomes and growing outrage in Western media over ethical issues about whether the patients were fully aware of the risks.

However, some doctors were allowed to continue to perform it for research purposes—and recently, a Western medical journal even published a new study of the results. In 2007, The Wall Street Journal detailed the practice of a physician who claimed he performed 1000 such procedures to treat mental illnesses such as depression, schizophrenia and epilepsy, after the ban in 2004; the surgery for addiction has also since been done on at least that many people.”

Source: – December 13, 2012

States Moving Forward to Implement the Health Care Law

Starting in 2014, consumers and small businesses in every state will have access to quality, affordable health insurance ­­– known as qualified health plans – offered through an Exchange – a marketplace where consumers can choose a private health insurance plan that fits their health needs.  The marketplace will provide consumers and small businesses one stop shopping for health insurance with better information about plan benefits, quality and cost­­ – simplifying the process for buying health insurance.

Last week marked a milestone for states setting up their own marketplace – it was the deadline to submit their Blueprint applications to run a type of marketplace called a State-based Exchange.  We have received State-based Exchange Blueprint applications from the following states: California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont, and Utah. We look forward to reviewing these applications, as well as working with other states as they continue to develop a marketplace that best meets the needs of their residents.

On Friday, we also announced that the District of Columbia, Kentucky, and New York have made significant progress setting up their marketplaces, and conditionally approved their plans.  These states are on track to meet all exchange deadlines and be ready for open enrollment in ten months.  Previously, HHS conditionally approved  Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington.

We know that some states will need more time before being ready to run their own marketplace or want to run part but not all of the exchange in 2014.  These states can choose to enter into a State Partnership Exchange in which the State assumes responsibility for plan management and/or consumer assistance.  A partnership exchange allows states to make key decisions and tailor the marketplace to local needs and market conditions.  States have until February 15, 2013 to choose a state partnership exchange.

Many states have received planning and establishment grant awards to help them modernize and develop IT systems and the business systems needed for exchange establishment.  We recently released the Health Insurance Market Rules, Essential Health Benefits Rules, and Payment Parameters Notice to ensure states have more information to continue their work.  We will continue to provide states with as much support and guidance as they need.

We continually strive to give states the resources, flexibility and guidance to design and build a marketplace that meets the needs of their state.  While last week was one milestone, we are not taking an “all or nothing” approach to exchanges.  Many states are making impressive progress and we are committed to working with all states as we approach open enrollment in October 2013.  We’re looking forward to January 1, 2014 when consumers and small businesses will be enrolled through the Exchanges in private health insurance plans and millions more Americans will have the coverage they need and deserve

Source: Health and Human Services – December 17, 2012

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