MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
Addiction Treatment Forum reports on substance abuse news of interest to opioid treatment programs and patients in methadone maintenance treatment.
This report examines the prevalence of opiate addiction in the criminal justice system, its devastating consequences, and the widespread denial of access to one of its most effective forms of treatment: medication assisted treatment (MAT). The report then analyzes the circumstances in which the denial of MAT violates Federal anti-discrimination laws and the United States Constitution.
Source: Legal Action Center – December 1, 2011
This article was published in the October 8, 2011 issue of International Journal of Environmental Research and Public Health. The article authors are Thomas F. Kresina and Robert Lubran of the Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.
Abstract - Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage.
The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best “one stop shopping” approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations.
Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.
Free access to the article is available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210600/?tool=pubmed
Source: PubMed Central – October 24, 2011
A new study has shown harmful prescription patterns of powerful painkillers among a substantial number of Ontario Canada patients who received methadone therapy to treat their opioid addiction.
According to a new study by the Centre for Addiction and Mental Health (CAMH) and Institute for Clinical Evaluative Sciences (ICES), 18% of methadone maintenance therapy patients also received prescriptions for more than a week’s supply of other opioids.
“It is concerning when large quantities of these types of opioids are combined with methadone therapy, as it can lead to overdose or fatal consequences,” says Dr. Paul Kurdyak, head of CAMH’s Emergency Crisis Services and Research.
The study is published online in the journal Addiction. It should be noted that these data were collected before the Government of Ontario announced its narcotics strategy. The strategy includes improved monitoring of narcotics prescribing which took effect November 1, 2011.
On average, this group of methadone patients had 12 non-methadone opioid prescriptions a year during a seven-year period from 2003-2010. In addition, nearly half (46%) of the non-methadone opioid prescriptions were from physicians and pharmacies that were not involved in prescribing and monitoring methadone use.
“If someone on methadone maintenance therapy needs pain management, they should be prescribed short-acting opioids for short periods of time, and these prescriptions should be written by the methadone prescriber so that the patients can be monitored,” says Dr. Kurdyak, adjunct scientist at ICES and assistant professor of medicine at the University of Toronto.
Opioid prescriptions and related overdoses and deaths have increased dramatically in recent years in North America. Recent research has suggested that the cause of many methadone-related deaths could be the use of non-methadone opioids.
The researchers used the Ontario Drug Benefit (ODB) database to identify prescription records for methadone and other opioids, and examined opioid prescription patterns among 18,759 people who received methadone maintenance therapy.
“People taking methadone should not be taking other opioids for extended periods. The fact that we’re seeing this happen in nearly one in five cases, coupled with the observation that multiple doctors and pharmacies are often involved suggests that, in some instances at least, patients in methadone treatment programs are deceiving doctors to obtain other opioids,” says Dr. David Juurlink, co-author of the study and ICES scientist.
Because patients on methadone therapy undergo random urine tests – and could face consequences if additional opioids are found in their system – it is also possible that these prescriptions are being sold illicitly.
“One remedy to this problem is a prescription monitoring system that allows pharmacies to communicate in real time, similar to what British Columbia implemented in the mid-1990s,” says Juurlink. “Had such a system been in place in Ontario, I imagine that our findings might have been very different.”
Source: Canada Centre for Addiction and Mental Health – November 23, 2011
The new harder to crush version of OxyContin has a lower street price than the original, according to research revealed at a conference of law enforcement officers November 15. A new formulation of the opioid pain reliever OxyContin was launched in 2010, accompanied by hope that it would deter drug abuse, injection and overdose. A year later, researchers have shown that the new formulation sells for 28% less than the original OxyContin on the black market, using street price data from the RADARS® System StreetRx.com. The price per milligram of the new difficult to crush OxyContin is $0.56, compared to $0.78 for the original during the first half of this year. Similar results were seen in a survey of law enforcement officers from the RADARS System Drug Diversion program.
Source: RADARS System StreetRx.com – November 15, 2011
The survey, which asked respondents their opinions and concerns regarding narcotic pain killers, found that 49.7 percent have used these drugs in the past. Of those, over one-third of respondents said they used the drugs despite having concerns regarding their use. The top concerns reported were potential side effects (44.9 percent), fear of addiction (27.5 percent) and concern about potential long-term health impacts (15.5 percent). Other findings include:
“With such a significant number of responders having been prescribed a narcotic pain killer, our results suggest that these drugs are relatively easy to access despite the need for a physician’s prescription,” said Raymond Fabius, M.D., chief medical officer at the healthcare business of Thomson Reuters. “It’s encouraging to see a healthy understanding of the addictive properties of narcotics among our survey population, but refusing to use them when they can be helpful may cause people to experience unnecessary pain.
The results are based on responses from 3,009 survey participants interviewed from October 1-13, 2011. The margin of error is 1.8 percent.
The report can be accessed at: http://healthcare.thomsonreuters.com/npr/assets/NPR_report_PainKillers.pdf
Source: Thomson Reuters – November 22, 2011
Many Americans with substance use problems will have opportunities to receive coordinated health care through the integration of primary care and specialty care for substance use disorders under the Patient Protection and Affordable Care Act of 2010. Sharing of patient health records among care providers is essential to realize the benefits of electronic health records.
Health information exchange through meaningful use of electronic health records can improve health care safety, quality, and efficiency. Implementation of electronic health records and health information exchange presents great opportunities for health care integration, but also makes patient privacy potentially vulnerable. Privacy issues are paramount for patients with substance use problems.
This paper discusses major differences between two federal privacy laws associated with health care for substance use disorders, identifies health care problems created by privacy policies, and describes potential solutions to these problems through technology innovation and policy improvement.
The full article can be accessed free at: http://dovepress.com/privacy-protection-for-patients-with-substance-use-problems-peer-reviewed-article-SAR
Source: Substance Abuse and Rehabilitation – December 2011 Volume 2011:2(1) 227 – 233.
Employers Helping Workers Fight Opioid Abuse
With opioid prescription abuse on the rise nationwide, workers compensation experts are seeking ways to help addicted workers return to sobriety. Insurers, brokers and third-party administrators say they’re working with primary physicians to help wean claimants off Schedule II narcotics, such as oxycodone and methadone, if they start to develop a dangerous dependence on such drugs.
Some companies also are creating strategies to assist workers who already have become hooked in hopes of preventing opioid overdoses and deaths, as well as containing medical claim costs.
Source: Business Insurance – November 30, 2011
For older adults, drinking too much and misusing medications are the major substance use problems, affecting as many as 20 percent of them. They are particularly vulnerable to the mental and physical effects of alcohol and drugs because of physiological and cognitive changes that take place with age. And, even if they are not addicted to alcohol or illegal substances, they are at risk for serious problems
Source: HuffingtonPost.com – November 27, 2011
The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking applications from qualified opioid treatment programs (OTPs) and office-based opioid treatment providers (OBOT) for the 2012 Science and Service Awards Program. This national awards program promotes excellence in the treatment of opioid addiction by honoring OTPs and OBOT providers using pharmacotherapy and other innovative approaches to enhance patient outcomes.
The OTP awards will be announced at the 2012 national conference of the American Association for the Treatment of Opioid Dependence (AATOD), and the OBOT awards will be announced at the 43rd Annual Medical Scientific Conference of the American Society for Addiction Medicine (ASAM). A panel of experts will review the award applications and select five awardees from two categories: OTPs and OBOTs.
All winners will receive a Science and Service award and will be prominently highlighted on SAMHSA’s web site.
Both SAMHSA certified and accredited OTPs and physicians who have submitted a notification of intent to SAMHSA and who have been assigned a unique identification number (x-number) by the Drug Enforcement Administration (DEA) under the Drug Addiction Treatment Act of 2000 (DATA 2000) are eligible.
The application form is available at: http://www.samhsa.gov/Scienceandservice/index.aspx
The deadline for submitting a completed application, electronically or hard copy is Friday, January 13, 2012, at 5:00 pm, Eastern Standard Time.
Source: Substance Abuse and Mental Health Services Administration – December 8, 2011
Source: Substance Abuse and Mental Health Services Administration – December 8, 2011
A new report shows that while the overall rate of substance abuse treatment admissions among those aged 12 and older in the U.S. has remained nearly the same from 1999 to 2009, there has been a dramatic rise (430 percent) in the rate of treatment admissions for the abuse of prescription pain relievers during this period. The report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that the rate of treatment admissions primarily linked to these drugs rose from 10 per 100,000 in the population in 1999 to 53 per 100,000 population in 2009.
The rise in treatment admissions related to the abuse of prescription drug pain relievers occurred in every region of the country, but was highest in the states of Maine, Vermont, Delaware, Kentucky, Maryland, Arkansas, Rhode Island, and West Virginia.
“While some aspects of substance abuse treatment admissions have changed – meeting the overall need remains an essential public health priority,” said SAMHSA Administrator Pamela S. Hyde. “The increasing numbers of people entering treatment for prescription drug abuse is the latest indicator of the severity of the problem.”
The report, “Treatment Episode Data Set (TEDS) 1999 to 2009, State Admissions to Substance Abuse Treatment Services” is based on the report of thousands of substance abuse treatment facilities throughout the nation and Puerto Rico. TEDS is an administrative data system providing descriptive information about the national flow of admissions to specialty providers of substance abuse treatment.
The 177 page report can be accessed at: http://atforum.com/addiction-resources/documents/TEDSState2010.pdf
Source: Substance Abuse and Mental Health Services Administration – December 8, 2011
According to a recent TEDS Report, the number of injection admissions to substance abuse treatment increased from over 199,000 in 1992 to nearly 278,000 in 2009, although they remained a relatively constant proportion of all admissions (13.2 percent of all substance abuse treatment admissions in 1992 and 14.3 percent in 2009). In 2009, most injection admissions (85.1 percent) reported that they injected their primary drug of abuse, 1 in 7 (14.9 percent) injected their secondary or tertiary drug of abuse.
The proportion of heroin injection admissions that were young adults (aged 18 to 25) more than tripled between 1992 and 2009 from 8.7 to 28.2 percent. The proportion of heroin injection admissions age 50+ more than doubled from 5.0 percent to 11.6 percent (see Table below).
The pattern of admissions for heroin injection drug use by race/ethnicity also changed between 1992 and 2009. The proportion of all heroin injection admissions that were non-Hispanic White increased from 49.4 percent in 1992 to 69.9 percent in 2009.
Opiates Other Than Heroin
The proportion of opiates other than heroin injection admissions that were young adults (aged 18 to 25) increased more than 400 percent between 1992 and 2009 from 7.3 to 40.4 percent while the proportion of opiates other than heroin admissions age 50+ declined by over 60 percent from 5.0 percent to 11.6 percent.
The pattern of admissions for opiates other than heroin injection drug use by race/ethnicity also changed between 1992 and 2009. The proportion of all heroin injection admissions that were non-Hispanic White increased from 82.9 percent in 1992 to 91.0 percent in 2009.
TEDS Report: Percent Distribution of Injection Admissions, by Age, Race/Ethnicity, and Substance of Abuse: 1992 and 2009
|Age and Race/Ethnicity||All||Heroin||Opiates Other
|50 or Older||4.1%||10.4%||5.0%||11.6%||3.1%||4.3%|
|American Indian/Alaska Native||1.4%||1.2%||1.0%||0.7%||1.2%||2.0%|
The report also noted that the data show that examining primary injection admissions alone would ignore a substantial number of secondary/tertiary injection admissions. Overall, about 1 in 7 injection admissions in 2009 were non-primary injection admissions. Public health professionals and substance abuse providers who monitor secondary/tertiary injection drug use may identify users at risk for disease transmission who would otherwise be overlooked if surveillance focused only on primary injection drug use.
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 1, 2011). The TEDS Report: Injection Drug Abuse Admissions to Substance Abuse Treatment: 1992 and 2009. Rockville, MD.
Articles in the new issue of SAMHSA News include:
The newsletter is available online at: http://www.samhsa.gov/samhsaNewsletter/default.aspx
Source: The Substance Abuse Mental Health Services Administration (SAMHSA)
The Food and Drug Administration (FDA), Center for Drug Evaluation and Research (CDER), in collaboration with the Office of the Assistant Secretary for Health, National Institutes of Drug
Abuse, and the Centers for Disease Control and Prevention, is announcing a scientific workshop to initiate a public discussion about the potential value of making naloxone more widely available outside of conventional medical settings to reduce the incidence of opioid overdose fatalities.
Source: Federal Register / Vol. 76, No. 222 / Thursday, November 17, 2011 / Notices
Patients in methadone maintenance treatment facilities, known to be at higher risk for hepatitis C virus (HCV) infection than the general population, might also have higher rates of vaccine-preventable hepatitis A (HAV) and B (HBV) infection, according to research presented at the American Public Health Association 139th Annual Meeting.
http://www.medscape.com/viewarticle/754613?src=sttwit%3Fsrc%3Dstfb (Free log-in required)
Source: Medscape News Business of Medicine – December 2, 2011
Background: An estimated 1.2 million persons in the United States were living with human immunodeficiency virus (HIV) infection in 2008. Improving survival of persons with HIV and reducing transmission involve a continuum of services that includes diagnosis (HIV testing), linkage to and retention in HIV medical care, and ongoing HIV prevention interventions, including appropriately timed antiretroviral therapy (ART).
Methods: CDC used three surveillance datasets to estimate recent HIV testing and HIV prevalence among U.S. adults by state, and the percentages of HIV-infected adults receiving HIV care for whom ART was prescribed, who achieved viral suppression, and who received prevention counseling from health-care providers. Published data were used to estimate the numbers of persons in the United States living with and diagnosed with HIV and, based on viral load and CD4 laboratory reports, linked to and retained in HIV care.
Results: In 2010, 9.6% of adults had been tested for HIV during the preceding 12 months (range by state: 4.9%–29.8%). Of the estimated 942,000 persons with HIV who were aware of their infection, approximately 77% were linked to care, and 51% remained in care. Among HIV-infected adults in care, 45% received prevention counseling, and 89% were prescribed ART, of whom 77% had viral suppression. Thus, an estimated 28% of all HIV-infected persons in the United States have a suppressed viral load.
Conclusions: Prevalence of HIV testing and linkage to care are high but warrant continued effort. Increasing the percentages of HIV-infected persons who remain in HIV care, achieve viral suppression, and receive prevention counseling requires additional effort.
Implications for Public Health Practice: Public health officials and HIV care providers should improve engagement at each step in the continuum of HIV care and monitor progress in every community using laboratory reports of viral load and CD4 test results.
The full report can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1129a1.htm?s_cid=mm60e1129a1_e&source=govdelivery
Source: Centers for Disease Control and Prevention – November 29, 2011
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