News & Updates – December 23, 2013: Issue 193

LETTER to the Editor: Treating Opioid Addiction – Response to the NY Times Article Addiction Treatment With a Dark Side from ASAM

ASAM logoIn mid-November the New York Times ran an article “A Double-Edged Drug - Addiction Treatment on the Dark Side.”  As of December 19, the article has generated almost 400 responses and numerous other websites/blogs have responded to the article.

On November 25, Stuart Gitlow, R. Jeffrey Goldsmith, and Louis E. Baxter Sr. of the American Society of Addiction Medicine (ASAM) sent a Letter to the Editor responding, “Physicians alone cannot solve our nation’s opioid epidemic. Public education about the benefits of treatment, recovery and quality care can. We hope that your article encourages a national dialogue about the importance of expanding access to quality care for a highly stigmatized, underserved patient population.”

The writers are, respectively, president, president-elect and past president of ASAM.

Source: – November 25, 2013

Among Prescription Painkillers, Drug Abusers Prefer Oxycodone

prescriiption pad“A nationwide survey of opioid drug abusers in rehab indicates that because of the high it produces, the prescription painkiller oxycodone is the most popular drug of choice. Hydrocodone, also prescribed to treat pain, is next in line. In all, some 75 percent of those surveyed rated one of these drugs as their favorite.

Researchers at Washington University School of Medicine in St. Louis and Nova Southeastern University in Miami questioned more than 3,500 people in 160 drug-treatment programs across the United States, asking which drugs they abuse and why. Oxycodone was favored by 45 percent, and hydrocodone was preferred by about 30 percent.

Although the drugs are meant to be taken orally, almost 64 percent of oxycodone abusers and just over one-quarter of hydrocodone abusers crushed the tablets and inhaled the drug, while one in five oxycodone abusers reported that they sometimes dissolved the drug in water and injected it. Less than 5 percent reported taking hydrocodone intravenously.

Personality, age and gender all played a role in drug preferences, the research showed. Oxycodone was attractive to those who enjoy taking risks and prefer to inject or snort drugs to get high. Young, male drug users tend to fit that profile.

In contrast, hydrocodone is the more popular choice among women, older people, people who don’t want to inject drugs and those who prefer to deal with a doctor or friend rather than a drug dealer.

The research is published in the current issue of the journal PAIN.

“Opioids are prescribed to treat pain, but their misuse has risen dramatically in recent years,” said principal investigator Theodore J. Cicero, PhD, a Washington University researcher who studies prescription drug abuse. “Our goal is to understand the personal characteristics of people who are susceptible to drug abuse, so we can detect problems ahead of time.”

Among those surveyed, 54 percent said the quality of the high was considered much better for oxycodone, compared with 20 percent who preferred the high they got from hydrocodone.

“Among the reasons addicts prefer oxycodone is that they can get it in pure form,” Cicero said. “Until recently, all drugs with hydrocodone as their active ingredient also contained another product such as acetaminophen, the pain reliever in Tylenol. That turns out to be very important because addicts don’t like acetaminophen.”

Acetaminophen causes considerable irritation when it’s injected, and when taken orally in large amounts, it can cause severe liver damage, he explained.

“Interestingly, addicts, while they’re harming their health in one respect by taking these drugs, report being very concerned about the potentially negative side effects of acetaminophen,” said Cicero, a professor of neuropharmacology in psychiatry.

Those side effects, combined with a preference for the high provided by oxycodone, have led drug abusers to seek out that drug, either on the street or by visiting physicians and attempting to convince doctors that they have pain severe enough to warrant a prescription pain killer.

Cicero is concerned with the U.S. Food and Drug Administration’s (FDA) recent approval of a new, pure form of hydrocodone without acetaminophen, a formulation he expects will be attractive to abusers.

The study also found that even among people in treatment for drug dependence, there seems to be little appetite for moving to stronger prescription narcotics such as fentanyl or various derivatives of morphine.”

The press release can be accessed at:

Source: Washington University School of Medicine – November 25, 2013


CRC Health Group Announces Acquisition of Nation’s Fourth Largest Opiate Addiction Treatment Network Habit OPCO

“CRC Health Group, the nation’s largest provider of addiction treatment and related behavioral health services, announced the acquisition of Habit OPCO, the nation’s fourth largest provider of opiate addiction treatment clinics. Founded in 1985, Habit OPCO has 22 treatment locations in Massachusetts, Vermont, New Hampshire, New Jersey and Pennsylvania. The acquisition increases CRC Health’s total number of comprehensive treatment centers to 80. The deal is expected to close in the first quarter of 2014.”

 Source: – December 10, 2013


New Resource: The Partnership at Launches Innovative Tool to Help Parents Understand Lifesaving Benefits of Medication-Assisted Treatment for Opiate Addiction

The Partnership at, a national nonprofit working to find evidence-based solutions to adolescent substance use, has launched a  new digital resource that helps parents better understand the potential life-saving benefits of medication-assisted treatment. The online tool is comprised of videos, testimonials and an e-book to help parents make an informed choice when they are looking for treatment options to help a teen or young adult recover from an addiction to prescription pain medications, heroin or other opiates.

 Source: – December 12, 2013

10 Strategies to Combat the Rx Abuse Epidemic – An Insurer’s Perspective

health insuranceTo address the opioid epidemic, a number of strategies have been developed at both the national and state levels in consultation with medical professionals, law enforcement, insurance companies, and public health and drug prevention experts. In October 2013, the Trust For America’s Health (TFAH) issued a report titled, “Prescription Drug Abuse: Strategies to Stop the Epidemic” identifying ten strategies being employed at the State level. In this article Property Casualty 360 provides a recap of the strategies and shares their thoughts on some insurance company considerations.

The 10 strategies include:

  • Prescription Drug Monitoring Program: Does the state have an operational Prescription Drug Monitoring Program (PDMP)?
  • Mandatory Use of PDMP: Does the State require mandatory use of PDMPs by providers? (i.e., any form of a mandatory use requirement).
  • Doctor Shopping Law: Does the state have a doctor shopping statute?
  • Support for Substance Abuse Services: Has the state expanded Medicaid under the Affordable Care Act, thereby expanding coverage of substance abuse treatment?
  • Prescriber Education Requirement: Does the state require or recommend education for prescribers of pain medications?
  • Good Samaritan Law: Does the state have a law in place to provide a degree of immunity from criminal charges or mitigation of sentencing for an individual seeking help for themselves or others experiencing an overdose?
  • Support for Narcan Use: Does the state have a law in place to expand access to, and use of, Narcan (a/k/a, Naloxone) for overdosing individuals given by lay administrators?
  • Physical Exam Requirement: Does the State require a healthcare provider to either conduct a physical exam of the patient, a screening for signs of substance abuse or have a bona fide patient-physician relationship that includes a physician examination, prior to prescribing prescription medications?
  • ID Requirement: Does the State have a law requiring or permitting a pharmacist to ask for identification prior to dispensing a controlled substance?
  • Pharmacy Lock-In Program:  Does the State’s Medicaid plan have a pharmacy lock-in program that requires individuals suspected of misusing controlled substances to use a single prescriber and pharmacy?—an

 Source: – December 2, 2013



Prescription Drug Abuse: A Policy Position Paper From the American College of Physicians

“The decision to develop this policy paper was made by the American College of Physicians’ (ACP’s) Health and Public Policy Committee, which is charged with addressing issues affecting the health care of the U.S. public and the practice of internal medicine and its subspecialties. Recommendations developed were informed through a literature review and input from the various College constituencies and nonmember experts in the field. The policy paper and related recommendations were reviewed and approved by the College’s Governing Board in July 2013.

This paper is intended to provide guidance to prescribers and policymakers regarding measures to effectively address the problem of prescription drug abuse and offers recommendations that have been published in the journal Annals of Internal Medicine.

 Source: Annals of Internal Medicine – December 10, 2013

Barriers to HCV Care Include Lack of Physical Symptoms, Treatment Side Effects

“Barriers to hepatitis C care for patients enrolled in opioid substitution treatment included the perception of being physically well and concerns about adverse effects associated with interferon-based hepatitis C virus treatment, according to results from the ETHOS study.

“Integrating treatment for hepatitis C within settings that provide treatment for drug dependence minimizes some of the barriers for clients wishing to undertake hepatitis C treatment,” study researcher Carla Treloar, PhD, deputy director of the Centre for Social Research in Health at the University of New South Wales, Australia, told Infectious Disease News. “However, treatment remains an unattractive option for some patients. Providing ways for those without hepatitis C symptoms to be assessed for liver damage may be important to open up alternative conversations about hepatitis C care.”

Source: – December 11, 2013

New from the Legal Action Center – FAQs on Recently Released Federal Parity Regulations

parityIn November the Legal Action Center issued Frequently Asked Questions on the final Federal Parity Regulations. Questions answered include:

  • What is the federal parity law?
  • How does the federal parity law work?
  • Which programs must comply with the federal parity law?
  • When does the final parity rule go into effect?
  • What are the major areas the final parity rule addresses?
  • How does the final parity rule address scope of service?
  • Does the final parity rule discuss residential treatment?
  • Does the final parity rule give additional guidance on the application of the parity law to non-quantitative treatment limitations (NQTLs)?
  • Does the final parity rule give additional examples of NQTLs?
  • How does the final parity rule address provider rates?
  • Under the final parity rule, what are plans required to disclose to consumers?
  • Who has primary monitoring and enforcement oversight over the parity law?
  • How does the final parity rule address the relationship between the federal parity law and state laws?
  • Which types of plans must comply with the final parity regulations?
  • What guidance governs other types of coverage that has to comply with the federal parity law?

The document also provides links to regulations and other forms of guidance the government has issued on the federal parity law. The document is available at:

Source: Legal Action Center – November 2013

HHS Announces Affordable Care Act Mental Health Services Funding

fundingThe U.S. Department of Health and Human Services (HHS) announced December 10 that it plans to issue a $50 million funding opportunity announcement to help Community Health Centers establish or expand behavioral health services for people living with mental illness, and drug and alcohol problems.  Community Health Centers will be able to use these new funds, made available through the Affordable Care Act, for efforts such as hiring new mental health and substance use disorder professionals, adding mental health and substance use disorder services, and employing team-based models of care.

“Most behavioral health conditions are treatable, yet too many Americans are not able to get needed treatment,” said Health Resources and Services Administration (HRSA) Administrator Mary K. Wakefield, Ph.D., R.N.  “These new Affordable Care Act funds will expand the capacity of our network of community health centers to respond to the mental health needs in their communities.”

“These new funds will further the Department’s work to develop integrated primary and behavioral health care services to better meet the needs of people with mental health and substance use conditions,” said Substance Abuse and Mental Health Services Administration Administrator, Pamela S. Hyde.

It is estimated these awards will support behavioral health expansion in approximately 200 existing health centers nationwide.

Source: U.S. Department of Health and Human Services – December 10, 2013

At The White House, Learning How Not To Talk About Addiction

White House“We don’t refer to someone who has anorexia or bulimia as having a “food abuse” problem. We say they have an eating disorder. So why do we refer to someone who is addicted to alcohol or pain pills as having a “substance abuse” problem?

Harvard’s John Kelly, director of the new Recovery Research Institute at Massachusetts General Hospital, made that point this week at what was billed as the first-ever White House summit on drug policy reform. The Obama administration has moved far from the old “war on drugs” model. The current federal drug czar, Gil Kerlikowske, wrote in his email invitation to the summit: “Drug policy reform should be rooted in neuroscience, not political science.” And “it should be a public health issue, not just a criminal justice issue. That’s what a 21st-century approach to drug policy looks like.”

Dr. Kelly, an associate professor of psychiatry, spoke to the summit-goers about the stigma around addiction — so pervasive it can even be seen in language. I asked him to elaborate; our conversation, edited.”

Source: – December 13, 2013

APA Calls for Better Training to Treat Chronic Pain, Addiction Among Vets

military“Pain management, addiction detection, and effective treatment are significant priorities for the nation’s veterans, and these objectives require better coordination of opioid and benzodiazepine prescribing inside and outside the Veterans Health Administration (VHA).

That’s what the American Psychiatric Association (APA) CEO and Medical Director Saul Levin, M.D., M.P.A., told the House Veterans Affairs Committee in a written statement about management of chronic pain and addiction to painkillers among veterans. The statement was in response to a House hearing titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.”

Levin focused on veterans and the returning military population, but noted that issues such as medication diversion, medication seeking, improper prescribing, inadequate informatics on prescription utilization, and the need for better pain management and utilization of medical options to assist with substance use disorders are prevalent for the United States population as a whole.

He outlined four overarching recommendations: the use of prescription drug management plans (PDMPs) and the need for coordination between the (VHA’s PDMP and state-based plans, the need to recruit and retain more psychiatrists within the VHA, training the VHA workforce in evidence-based pain management and addiction treatment, and the need for new research on pain medications.”

Source: – September 19, 2013

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