News & Updates – February 1, 2013: Issue 178

Effective Risk Management Strategies in Outpatient Methadone Treatment – Trainer’s Manual and PowerPoint Slides

This one-day training program available from The Institute for Research, Education, and Training in Addictions (IRETA)  is designed to increase opioid treatment providers’ (both clinical and administrative staff) knowledge and skills on the most effective ways to conduct risk management strategies for opioid treatment centers.

Training materials include a Trainers Manual and nine PowerPoint presentations, one for each of the nine training modules.

The manual was created as a guide to facilitate the successful delivery of “Effective Risk Management Strategies in Outpatient Methadone Treatment”. It includes suggested scripts and activities for each module to help guide you through the entire training process.

The modules include:

  • Module 1: What’s Going On Out There? (Introduction, Methadone-Associated Mortality, Professional Liability)
  •  Module 2: Managing Risk
  •  Module 3: Risk Management and OTP Practice
  • Module 4: Impairment
  • Module 5: Take-Home Medication
  •  Module 6: Three Case Studies
  • Module 7: Recovery-Oriented Methadone Maintenance (ROMM)
  • Module 8: Pain Management Therapy
  • Module 9: Special Populations and Risk

Modules 1-6 provide information and content for a standalone training of approximately 7 hours – not including breaks and lunch. Modules 7-9 are supportive content to the topic of risk management and can be delivered in approximately three additional hours.

Source: The Institute for Research, Education, and Training in Addictions – January 2013

No Additional Benefit of CBT in Treating Opioid Addiction with Buprenorphine

The addition of cognitive behavioral therapy (CBT) to medical treatment for opioid dependence does not significantly enhance outcomes compared with medical treatment alone, new research shows. The study, published in the January issue of the American Journal of Medicine, involved 141 opioid-dependent patients recruited from a primary care clinic who were being treated with buprenorphine.

David Fiellin, MD, and colleagues from the Yale University School of Medicine, New Haven, Connecticut, found that CBT provided by trained clinicians did not improve abstinence from opioid use or retention rates in treatment programs when added to physician management alone.

On January 23, 2013 the full article was available for free to view online at:

Source: Medscape Medical News – January 10, 2013

Prescription Drug Misuse Remains a Top Public Health Concern

Prescription drug misuse is second only to marijuana as the nation’s most prevalent illicit drug problem, with approximately 22 million persons nationwide initiating nonmedical pain reliever use since 2002, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report also shows variations in use by state, with combined 2010 and 2011 data indicating that rates of past year misuse among those aged 12 or older ranged from 3.6 percent in Iowa to 6.4 percent in Oregon.

“Addressing prescription drug misuse remains a top public health priority, as we’ve seen inconsistent progress in addressing the issue across the states,” said SAMHSA Administrator Pamela S. Hyde. “Data from this report helps up better understand geographic variations in use, and should help with the development of more targeted and effective prevention and treatment programs. The key is educating the public on the serious health risks involved, and ensuring that we are providing the necessary treatment to those who need it.”

 Seven of the 10 states with the highest rates of nonmedical use of prescription pain relievers were in the West (Arizona, Colorado, Idaho, Nevada, New Mexico, Oregon, and Washington). Four of the 10 states with the lowest rates were in the Midwest (Illinois, Iowa, North Dakota, and South Dakota), and four were in the South (Florida, Georgia, Maryland, and North Carolina).

A comparison of the combined 2009 and 2010 data with combined 2010 and 2011 data revealed a decrease in prescription drug misuse among those aged 12 or older in 10 states (Kentucky, Louisiana, Massachusetts, Mississippi, New Hampshire, New York, Ohio, Oklahoma, Rhode Island, and West Virginia). None of the states saw an increase.

The report The NSDUH Report: State Estimates of Nonmedical Use of Prescription Pain Relievers: 2010-2011, is based on data from the SAMHSA National Survey on Drug Use and Health (NSDUH). The NSDUH report is available at:

Detailed tables and maps are available at:

Source: Substance Abuse and Mental Health Services Administration – January 8, 2013

FDA Issues Draft Guidance on Abuse-Deterrent Opioids

The U.S. Food and Drug Administration (FDA) issued a draft guidance document to assist industry in developing new formulations of opioid drugs with abuse-deterrent properties.

The document “Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling,” explains the FDA’s current thinking about the studies that should be conducted to demonstrate that a given formulation has abuse-deterrent properties, how those studies will be evaluated by the agency, and what labeling claims may be approved based on the results of those studies.

FDA is seeking public comment on the draft guidance for 60 days and encourages additional scientific and clinical research that will advance the development and assessment of abuse-deterrent technologies. Instructions on how to submit comments will be announced in an upcoming Federal Register notice. The FDA will also hold a public meeting to discuss and receive feedback on the draft guidance. In finalizing the guidance document, the agency will consider the information received from the public.

The FDA: Draft Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling is available at:

Source: Federal Drug AdministrationJanuary 9, 2013

Drug Abuse Treatment Could Save Billions in Criminal Justice Costs

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community.

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.

The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison.

According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.

The study builds on previous research led by RTI indicating that increased investment in treatment for substance-abusing prisoners can reduce crime rates and cut criminal justice spending. In a study released earlier this year, Zarkin and colleagues found that increasing and improving prison-based drug treatment programs could save up to $17 billion in criminal justice system costs.

Source: RTI International – January 9, 2013

Parents Numb to Misuse of Narcotic Pain Meds by Youth, New Poll Shows

Despite data on rising rates of abuse and overdoses of narcotic pain medicines across all age groups, in a new poll from the University of Michigan, most parents said they are not very concerned about misuse of these medicines by children and teens.

In addition, parent support was lukewarm for policies that would discourage abuse of drugs like Vicodin or Oxycontin, according to the most recent University of Michigan Mott Children’s Hospital National Poll on Children’s Health.

Report highlights include:

  • ¨About one-third of parents report they had received at least one pain medicine prescription for their children in the last five years.
  • ¨35% of parents are very concerned about misuse of narcotic pain medicines by children and teens in their communities; only 19% are concerned about misuse in their families.
  • ¨Nearly one-half of parents do not favor a requirement that they return unused pain medicine to the doctor or pharmacy.

The press release is available at:

Source: Newswise/University of Michigan Health System – January 23, 2013

NYPD Will Implant GPS Chips Into Pill Bottles To Combat Prescription Drug Abuse

“In an effort to curb the growing epidemic of Americans abusing prescription drugs, the New York Police Department will begin asking pharmacies in the city to mix in so-called “bait bottles” containing GPS locator chips into their stocks of prescription drug medications, CBS News reports. Police hope that putting locator chips in some medication bottles will allow them to effectively track stolen bottles and uncover large-scale prescription drug stash houses.”

Source: – January 15, 2013

Reducing Opioid Prescription Painkiller Abuse, New York Mayor Bloomberg Announces New Guidelines

“New emergency room guidelines to prevent opioid prescription painkiller abuse have been announced by New York Mayor Bloomberg, Deputy Mayor for Health and Human Services Linda I. Gibbs and Chief Policy Advisor John Feinblatt. The guidelines will be used in all New York City’s public hospitals. He explained that public hospital emergency departments will no longer prescribe long-acting opioid painkillers. Doctors in emergency departments will only prescribe a three-day supply of such medications – all destroyed, lost or stolen prescriptions will not be able to be refilled in emergency departments.”

Source: Medical News Today – January 14, 2013

The December 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:

  • Quality of Care Provided to Patients Receiving Opioid Maintenance Treatment in Europe: Results from the EQUATOR analysis
  • Outcomes of opioid-dependence treatment across Europe: identifying opportunities for improvement
  • Assessing the current state of public-health-related outcomes in opioid dependence across Europe: data from the EQUATOR analysis
  • Barriers to treatment access and informed patient choice in the treatment of opioid
    dependence in Europe
  • Aggressive behaviour and heroin addiction
  • Post-traumatic stress spectrum and maladaptive behaviour (drug abuse included) after catastrophic events: L’Aquila 2009 earthquake as case study

The PDF file is available for download at:

Researchers Say MRI Could Help Predict Success of Drug Addiction Treatment

Scientists at the University of Pennsylvania say MRI scans may be able to predict which patients will succeed with certain addiction treatments, and which ones will relapse, according to the Philadelphia Daily News.

Researchers at the university’s Center for Studies of Addiction are watching how regions of the brain react to drug-related photos, such as pictures of a heroin needle or a crushed pill. They hope to use this research to develop more effective treatments. One day, they hope that treatment could be tailored to a person’s mental strengths and vulnerabilities. These factors are influenced by genetics, life experiences and drug use, they say.

Source: – January 18, 2013

Access to Health Care Services for Addiction Will Improve Dramatically: Faces & Voices of Recovery

Once the Affordable Care Act (ACA) is fully implemented in 2014, access to effective health care services for addiction will improve dramatically, according to Faces & Voices of Recovery. In an issue brief, the advocacy group describes how the new legislation will make it possible for many in or seeking recovery to be included in the health care system for the first time.

Those who will benefit from the new law include people who were previously enrolled in Medicaid, and then were disenrolled; those who are coming out of the criminal justice system; and people who have not been able to afford insurance.

Source: – January 18, 2013

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