News & Updates – January 29, 2014; Issue 195

The Joint Commission: Revised Requirements for Opioid Treatment Programs (OTPs)

Joint CommissionOn January 15 the Joint Commission issued for prepublication revised requirements for opioid treatment programs that will become effective March 23. The requirements address four areas:

  • Care, Treatment, and Services
  • Information Management
  • Medication Management
  • Rights and Responsibilities of the Individual

The prepublication requirements can be accessed at:

http://www.jointcommission.org/assets/1/18/Opioid_BHC.pdf

Source: The Joint Commission – January 15, 2014

Open Access Journal Article: Advancing Service Integration in Opioid Treatment Programs for the Care and Treatment of Hepatitis C Infection

liverABSTRACT

It is estimated that approximately 200 million people globally are infected with the hepatitis C virus and that roughly half of these people live in Asia. Without treatment, it is estimated that roughly twenty percent of those infected with hepatitis C virus progress to chronic liver disease, then subsequently, end-stage liver disease. Thus, access to hepatitis C testing and subsequent care and treatment of chronic hepatitis C infection are essential to address the global burden of disease.

In the United States, the Center for Disease Control and Prevention estimates that 60% of new cases of hepatitis infection are due to injection drug use. Opioid Treatment Programs (OTP’s) dispense methadone and buprenorphine under specific federal regulations to injection drug users diagnosed with opioid dependence. OTPs are developing comprehensive care and treatment model programs that integrate general medical and infectious disease-related medical care with substance abuse and mental health services. Integrating hepatitis care services and treatment in the substance abuse treatment settings fosters access to care for patients with hepatitis C infection, many who otherwise would not receive needed care and treatment.

This may serve as a national model for highly cost-efficient healthcare that has a measurable outcome of improved public health with reduced hepatitis C prevalence.

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=42589#.Uul-AJtALzZ

Source: International Journal of Clinical Medicine – January 2014

Medicaid Cutbacks in Maine Leave 400 OTP Patients without Coverage

medicaid“In what appears to be insult added to injury, Maine opioid treatment program (OTP) patients not only face having to prove themselves in order to stay in treatment for more than medicaidtwo years, but, due to a cutback in Medicaid, 400 of them will be left with no access to state-paid treatment no matter how well they are doing.”

Alcoholism Drug Abuse Weekly asked John A. Martins, spokesman for the Maine Department of Health and Human Services, in an e-mail what the state’s plans are for those patients.

“Substance use and abuse is not new in Maine or across the nation and occurred long before Maine’s initial expansion of the MaineCare program in 2002 to cover those who are losing coverage,” said Martins. “We remain committed to effective and efficient use of non-MaineCare resources to improve education and successfully prevent addiction and intervene early before addiction occurs.

http://www.alcoholismdrugabuseweekly.com/m-article-detail/medicaid-cutbacks-in-maine-leave-400-otp-patients-without-coverage.aspx

Source: AlcoholismDrugAbuseWeekly.com – January 27, 2014

Prescription Drugs a ‘Tipping Point’ For Dating Violence among Urban Youth

A new University of Michigan Injury Center study recently found a link between misuse of prescription drugs and physical violence among dating partners.

Alcohol and other drugs have been a well-studied health concern among youth with a history of substance use. Previous studies asking youth about daily use over the course of a month show that alcohol and drugs are more likely to be used on days in which violence, both dating and nondating, occurs than on days when there was no violence.

This latest research indicates a connection with misusing prescription sedatives and opioids prior to incidents of dating violence, which many youth or adults may not think of as a risk factor for dating violence.

“Without the alcohol or prescription drugs involved, they simply might walk away from a potentially violent situation,” said Quyen Epstein-Ngo, a fellow at the U-M Injury Center and researcher at the Institute for Research on Women and Gender. “The alcohol and other substance use may be the tipping points.”

The study examined substance use—prescription sedatives and opioids—immediately preceding dating violent conflicts on the day of the conflict among high-risk urban youths. Data was collected from 575 participants ages 14-24 in the Flint Youth Injury Study, funded by the National Institutes of Health and supported by the U-M Injury Center, which looks at substance use and violence among youth treated in an urban emergency room. They reported substance use and instances of violence over a12-month period.

 http://www.healthcanal.com/substance-abuse/46532-prescription-drugs-a-tipping-point-for-dating-violence-among-urban-youth.html

Source:  HealthCanal.com – January 11, 2014

Dr. Westley Clark on Overdose – Prevention of Prescription Drug Abuse Can Start With Education about the Risk of Overdose Death

ClarkOn January 16, the ATTC Network hosted a free webinar, “SAMHSA’s Opioid Overdose Prevention Toolkit & Prescription Drug Abuse,” led by the Director of the Center for Substance Abuse Treatment at SAMHSA, Dr. H. Westley Clark.

In addition to an overview of the toolkit itself, Clark’s presentation included epidemiological details about the current overdose epidemic, federal-level efforts to address overdose, and the importance of access to evidence-based treatment (including medications).

The recorded webinar is available online for on-demand viewing.  You can also download the slides for an overview of the talk.

Here are two salient points:

  • The exchange of prescription pain relievers is happening at a person-to-person level.
  • Prevention of prescription drug abuse can start with education about the risk of overdose death. 

The risk of death from an overdose, said Clark, is a good jumping off place for a larger conversation about substance use.  Not only is pill-popping not harmless, it can actually kill you or someone you love. “We can use overdose as a starting point to get people to be aware of some of the consequences of the misuse of prescription opioids or heroin, for that matter,” he said. “We’ve got friends and relatives who are handing people very powerful drugs with the assumption that if they can take it, then anybody can take it.  And that is not the case.”

Emphasizing the long-term consequences of a behavior–like the possibility of becoming addicted as a result of recreational painkiller use–doesn’t always get through to people.  But the possibility of dying from a drug overdose today or tomorrow?  No kindly neighbor wants to bear responsibility for that.

The Institute for Research, Education & Training in Addictions (IRETA) blog also provides a list of currently available and forthcoming resources to help individuals and communities prevent prescription drug abuse and overdose.

http://iretablog.org/author/iretablog/

Source:  Institute for Research, Education & Training in Addictions – January 27, 2014

Parity Law Has Little Effect on Spending For Substance Abuse Treatment

Despite predictions that requiring health insurers to provide equal coverage for substance use disorder treatment would raise costs, a Yale study finds that the economic impact so far has been minimal. The study is published online in The American Journal of Managed Care.

A team of researchers led by Susan Busch of the Yale School of Public Health studied the first year of the federal parity law’s implementation and found that it did not result in an increase in the proportion of enrollees seeking treatment for substance use disorders (SUDs). Their analysis also identified only a modest increase in spending for substance use disorder treatment—$10 annually per health plan enrollee.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, named after two former U.S. senators and chief supporters of the legislation, was enacted by Congress in 2008 and went into effect for most plans in 2010. Prior to the law’s passage, health plans often imposed limitations on treatment for SUDs, including restricting the number of visits and requiring higher cost-sharing.

“To my knowledge this is the first peer-reviewed study to examine the effects of the 2008 federal parity law on substance use treatment,” said Busch, associate professor and chair of the department of health policy and management. “The small increase in per-enrollee spending suggests plans are unlikely to drop coverage for SUD treatment in response to the law.”

During congressional debate on the bill, some employers and health plans opposed the parity measure on the grounds that it would significantly raise their costs. The researchers concluded that in terms of SUD treatment, it appears that this concern was unfounded.

Busch and her coauthors from the University of Pennsylvania and the John Hopkins Bloomberg School of Public Health noted that their analysis only considered the first year after the law took effect and further research is needed to gauge subsequent impact.

“It will be important to look at the effects of federal parity in future years. Since 2010 new federal regulations have taken effect that may have additional impacts on SUD use and spending,” said Busch.

 http://medicalxpress.com/news/2013-10-parity-laws-substance-disorders-linked.html#inlRlv

Source: MedicalExpress.com – January 24, 2014

ONDCP: What Does The New Budget Deal Mean For Drug Policy Reform?

White House“Over the past four years, we’ve worked hard to support drug policy reform rooted in science, evidence, and research.  A difficult budget environment hasn’t made it easy.  Damaging cuts caused by sequestration have placed real obstacles in the way of ensuring full support for services and programs that expand prevention, treatment, and smart-on-crime initiatives that represent a 21st century approach to drug policy.

But there is good news.

The bipartisan appropriations bill passed by Congress this week finally begins to repair some of these cuts. It also includes support for innovative alternatives that will protect public health and public safety while saving taxpayer dollars over the long run.

Some highlights from the bill:

  • $1.8 billion in funding for the Substance Abuse Block Grant – a $110 million increase compared to FY2013. The grant gives states the ability to establish and expand substance use prevention and treatment services in order support people recovering from substance use disorders.
  • $92 million will support the Drug Free Communities Support Program, which provides resources to local coalitions working to prevent substance use among young people.
  •  $45 million to support early health interventions through SAMHSA’s Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiative. SBIRT helps doctors and medical professionals identify and address the signs and symptoms of problematic drug use before it becomes a more serious, chronic condition.
  • Supporting the administration of an estimated $4.6 billion for drug treatment services and related costs through the Centers for Medicaid & Medicare Services.
  • Restoration of a significant portion of funding for vital drug abuse research through the National Institutes of Health, including research emphasizing the health effects of heroin and prescription painkiller abuse.
  •  $68 million to fund programs designed to help formerly incarcerated offenders find employment, housing, and support through the Second Chance Act, and $27.5 million to advance criminal justice reforms at the state and local level via the Justice Reinvestment Initiative.
  • Drug Courts, which work to divert non-violent offenders into alternatives to incarceration, including treatment in appropriate cases, were provided $40.5 million.
  • For the first time ever, the bill also includes $4 million to support expansion of the innovative HOPE diversion model for drug offenders. The HOPE program uses swift, certain sanctions that have shown promise in reducing recidivism and drug use.

This bill is not perfect, and no one got everything they wanted (that’s the nature of compromise), but these are real investments in making our Nation healthier and stronger. Reducing drug use and its consequences is a vital issue that spans the political spectrum and this is a step in the right direction.”

http://www.whitehouse.gov/blog/2014/01/17/what-does-new-budget-deal-mean-drug-policy-reform

Source: WhiteHouse.gov – January 17, 2014

International Journal of Drug Policy Celebrates its 25th Anniversary – 25 Free Downloads Available from Past Issues

Articles of interest related to opioid dependence and addiction include:

  • Gender sameness and difference in recovery from heroin dependence: A qualitative exploration – September 2013
  • Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness – August 2013
  • What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries – October 2013
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  • Syringe access, syringe sharing, and police encounters among people who inject drugs in New York City: A community-level perspective – August 2013
  • “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention – August 2013
  • Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users – June 2013
  • Does informing people who inject drugs of their hepatitis C status influence their injecting behaviour? Analysis of the Networks II study – December 2013

http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0007-6

Source: International Journal of Drug Policy – January 2014

Saying “Farwell” to Pain-Topics.org

At the end of January, the Pain-Topics.org website was permanently shut down. However, most of the Pain-Topics.org resources, including proprietary research/review articles, will be moved to The Pain Community (TPC) website — at http://paincommunity.org — allowing continued and free access by all interested persons.

The Pain-Topics News/Research UPDATES will continue to be posted on a periodic basis at http://pain-topics.blogspot.com. If you would like to receive notification of when the UPDATES are posted you can subscribe via FeedBurner at: http://feedburner.google.com/fb/a/mailverify?uri=PainTopicsUpdates&loc=en_US

Source: PainTopics.org – January 2014

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