News & Updates – March 26, 2014; Issue 198

New Resources and Events Available on ATForum.com

Have you visited ATForum.com lately? Over 30 new meetings, conferences, and webinars have been added to the site in addition to key new resources including the following on medication-assisted treatment.

Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care
Association of State and Territorial Health Officials – March 2014.

Confronting the Stigma of Opioid Use Disorder—and Its Treatment
Journal of the American Medical Association – February 26, 2014.

Medication-Assisted Treatment With Methadone: Assessing the Evidence
Psychiatric Services – February 1, 2014.

Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Psychiatric Services – February 1, 2014.

Medscape Ask the Pharmacist: Methadone or Buprenorphine for Maintenance Therapy of Opioid Addiction: What’s the Right Duration
Medscape – February 3, 2014. Note: A Medscape account is required to view this article. If you do not have a Medscape account you can create one for free.

Advancing Service Integration in Opioid Treatment Programs for the Care and Treatment of Hepatitis C Infection
International Journal of Clinical Medicine – January 2014.

Advancing Access to Addiction Medications Report
American Society of Addiction Medicine (ASAM) – December 2013.

Medication Assisted Treatment: A Standard of Care. An interview with Elinore McCance-Katz, MD, PhD, Chief Medical Officer, SAMHSA

Edit-Dr.M-KNote: This interview was issued by SAMHSA’s HRSA Center for Integrated Health Solutions in their February 2014 eSolutions newsletter.

“We have a huge need in our country to treat mental health and substance use concerns, and we have a chronic shortage of specialty care programs with enough capacity to treat everyone with a substance use concern. It is our responsibility to expand access to this care in a way that allows greater choice of where individuals can receive treatment.

With the Affordable Care Act, the treatment of substance use disorders is now an essential benefit. Individuals with multiple complex healthcare needs, including mental health and substance use concerns, can be seen in integrated care settings and health homes.

We are going to see more and more integrated care. All healthcare providers, whether in primary care, mental health, or substance use treatment, will need to learn how to provide treatment for disorders they may not have historically treated. Providers who are not used to treating patients with certain types of problems may not feel confident about providing care. When that happens, the individual is less likely to get the care they need. Primary care providers especially will need to be ready to assess and provide treatment for clients who present with mental health and substance use concerns.

The Need for Medication Assisted Treatment

Medication assisted treatment (MAT) is a standard of care. There are a variety of medications that have been shown to be effective in treating substance use disorders and that can be used safely. Specifically, there are a number of FDA-approved medications for tobacco, alcohol and opioid abuse treatments.

MAT is an effective form of care, when medication is taken as prescribed, used properly, and the individual is engaged with other supports and services. With opioid use disorders, studies show that clients who get medical detoxification only have a greater than 90% relapse rate.

We have to think about how effective the treatment is, what the alternative is if not treated, and where an individual is in their recovery. Individuals with chronic relapsing diseases should have access to MAT. It’s just the standard of care. We cannot diminish the importance of that.

Substance use disorders are not simply treated by taking a medication. In fact, taking medications can be part of the problem. Just giving someone medication is not enough. Psychosocial interventions, counseling, and other services are absolutely necessary and will always be very important.

Integrated care providers are going to have to learn about how to use these medications. Many medications can be used within primary care. We’re going to see a spectrum of severity with clients in primary care. Some may need referral to specialty care and others can be treated at the primary care organization.”

The interview can be accessed at: http://www.atforum.com/addiction-resources/documents/SAMHSA-MAT-A-Standard-of-Care-Feb-2014.pdf

Source: The Substance Abuse Mental Health Services Administration – February 2014

Buprenorphine Prescribing ‘Disappointingly Low’

Buprenorphine Prescribing ‘Disappointingly Low’

“Few family doctors who complete the required training to prescribe buprenorphine for opioid-addicted patients actually do, new research shows.

A study conducted by researchers at the University of Washington in Seattle showed that following completion of training, fewer than a third of physicians reported prescribing buprenorphine to treat addiction.”

“It’s actually quite frustrating because the problem of opioid addiction has grown enormously in the US over the last 15 years, to the extent that unintentional lethal overdoses from opioids now exceed the number of deaths from car accidents,” study investigator Roger A. Rosenblatt, MD, MPH, of the Department of Family Medicine, University of Washington, told Medscape Medical News.”

A one-time free registration is required to view the article.
http://www.medscape.com/viewarticle/821902

The study was published online March 10 in Annals of Family Medicine.

Source: Medscape.com - March 13, 2014

Prescriptions for Opioids Stabilizing After Fivefold Increase in 10-Year Span

Pg_3_pillsDeath rates from opioids have been soaring in the U.S. since the 1990s. To support the appropriate use of these controlled substances and inform public health interventions to prevent drug abuse, most states have implemented a prescription drug monitoring program (PDMP). In a latest study, researchers at Columbia University’s Mailman School of Public Health evaluated the impact of these state-wide programs and found that after tripling until 2007, annual rates of prescriptions for opioid analgesics have stabilized although the effects of PDMPs on opioid dispensing vary markedly by state. Findings are published in the March/April issue of Public Health Reports.

From 1991 to 2010 the annual number of prescriptions for opioid analgesics in the U.S. almost tripled, from about 76 million to almost 210 million

“We found that PDMPs administered by state health departments appeared to be more effective than those administered by other government agencies, such as the bureau of narcotics and the board of pharmacy, ” said senior author Guohua Li, MD, DrPH, Mailman School of Public Health professor of Epidemiology and director of the Center for Injury Epidemiology and Prevention.”

The press release can be accessed at: http://www.eurekalert.org/pub_releases/2014-03/cums-pfo031014.php

Source: Columbia University’s Mailman School of Public Health – March 10, 2014

Half of Veterans Prescribed Medical Opioids Continue to Use Them Chronically, Study Finds

“Of nearly 1 million veterans who receive opioids to treat painful conditions, more than half continue to consume opioids chronically or beyond 90 days, new research says. Results presented at the 30th Annual Meeting of the American Academy of Pain Medicine reported on a number of factors associated with opioid discontinuation with the goal of understanding how abuse problems take hold in returning veterans.

Of 959,226 veterans who received an opioid prescription, 502,634 (representing 52.4% of the total sample) used opioids chronically.

The preliminary analysis showed that certain factors were more likely to be present in veterans who continued to use opioids chronically. They include post-traumatic stress disorder, tobacco use, being married, having multiple chronic pain conditions, the use of multiple opioids and opioid dose above 100 mg per day.

Some findings did not align with previous research in the fields of pain and addiction.

The press release is available at: http://www.newswise.com/articles/half-of-veterans-prescribed-medical-opioids-continue-to-use-them-chronically-study-finds

Source: American Academy of Pain Medicine (AAPM) – March 7, 2014

IRETA Blog: Women Have Been Particularly Affected By the War on Drugs, Part II

“How can we use what we know about women and the War on Drugs to create real drug policy reform?

In our first installment about women, addiction, and the criminal justice system, we shared some stark facts about the impact of “War on Drugs” policies on American women.  Here are two:

  • The number of women in prison has grown by over 800% in the past three decades. The female prison population grew by 832% from 1977 to 2007. The male prison population grew 416% during the same time period.
  • Two thirds of women in prison are there for non-violent offenses, many for drug-related crimes. In the 10-year period from 1999 to 2008, arrests of women for drug violations increased 19%, compared to 10% for men.

This blog addresses three ways to make drug policy reform matter to women.

  • Expand alternatives to incarceration
  • Improve access to treatment for incarcerated women
  • Make prisons and correctional services more gender-responsive

The blog can be accessed at: http://iretablog.org/2014/03/14/women-have-been-particularly-affected-by-the-war-on-drugs-part-ii/

Source: Institute for Research, Education and Training in Addictions – March 14, 2014

How Obamacare May Lower the Prison Population More Than Any Reform in a Generation

healthcare reform 2“While many have focused on the individual mandate, and the online (and glitchy) insurance exchanges, one of the most potentially impactful elements of the Patient Protection and Affordable Care Act (ACA) has flown more or less under the radar. It may be the biggest piece of prison reform the U.S. will see in this generation.

The Justice Department estimates suggest that with the expansion of Medicaid, 5.4 million ex-offenders currently on parole or probation could get the health care they need. (It’s important to note that 25 states plus Washington, D.C. have implemented the Medicaid expansion as of 2014. However, many policy experts expect the remaining states to fall in line, citing the historical example of how CHIP was initially rejected by many states when it rolled out in 1997, but is now utilized in every state in the country.)

Even with coverage, those ex-offenders will still need to actually utilize those health benefits, and the key will be making the connection at the time of release. The biggest challenge will be getting state justice systems and health systems – not exactly happy bedfellows in past years – to work together to create coordinated discharge planning between jails and community healthcare.”

http://www.newsweek.com/how-obamacare-may-lower-prison-population-more-any-reform-generation-230695

See related article from the George Washington University Milken School of Public Health –  Affordable Care Act Brings Crucial Health Coverage to Jail Population available at: http://sphhs.gwu.edu/content/affordable-care-act-brings-crucial-health-coverage-jail-population

See related article from the Fix – Obamacare Rolls Out, Transforming Addiction Coverage available at: http://www.thefix.com/content/obamacare-rolls-out-addiction-coverage-transforms

Source: Newsweek.com – March 10, 2014

U.S. Attorney General Holder Urges Use of Drug to Help In Heroin ODs

Attorney General Eric Holder declaring heroin addiction is an “urgent and growing public health crisis,” urged first responders to carry the drug naloxone that helps resuscitate victims from an overdose.

“Addiction to heroin and other opiates — including certain prescription pain-killers — is impacting the lives of Americans in every state, in every region, and from every background and walk of life — and all too often, with deadly results,” Holder said in a video message posted Monday on the Justice Department website.”

http://www.usatoday.com/story/news/politics/2014/03/10/holder-heroin-overdose-help/6247281/

Source: USAToday.com – March 10, 2014

New York Attorney General A.G. Schneiderman Announces Settlement with Health Insurer That Wrongly Denied Mental Health Benefits to Thousands Of New Yorkers

“After an investigation uncovered widespread violations of mental health parity laws, Attorney General Eric T. Schneiderman today announced a settlement with Schenectady-based MVP Health Care, requiring the health insurer to reform its behavioral health claims review process, cover residential treatment and charge the lower primary care co-payment for outpatient visits to most mental health and substance abuse treatment providers. The settlement, the second against a health insurer so far this year enforcing the parity laws, also requires the health insurance plan — which has more than 500,000 members in the Albany region, Central New York and the Hudson Valley — to submit previously denied mental health and substance abuse treatment claims for independent review, which could result in more than $6 million being returned to its members.”

http://www.ag.ny.gov/press-release/ag-schneiderman-announces-settlement-health-insurer-wrongly-denied-mental-health

Source:  Attorney General Eric. T. Schneiderman – March 20, 2014

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