MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
About one percent of pregnant women report recreational use of opioid painkillers like Oxycontin, according to the National Household Survey on Drug Use and Health, a number that has stayed constant since 2003. The new treatment guidelines that were published on January 30 in the journal Pediatrics recommends that pregnant women addicted to prescription pain relievers or heroin should be maintained on either methadone or buprenorphine (Suboxone, Subutex). These recommendations are in line with prior consensus documents from the National Institutes on Health and World Health Organization.
Free access to the Pediatrics article is available at: http://pediatrics.aappublications.org/content/129/2/e540.full.pdf+html
Source: Healthland.time.com – January 30, 2012
Topics of debate in this series of articles include:
Source: NYTimes.com – February 16, 2012
A report appended to the Defense Department’s 2012 budget noted, “25-35 percent of wounded soldiers are addicted to prescription or illegal drugs while they await medical discharge.” Roughly half of soldiers returning from Iraq and Afghanistan “report pain-related problems and symptoms,” according to the Defense Department study, which says that roughly 14 percent of soldiers have been prescribed an opioid painkiller. Oxycodone accounts for 95 percent of those prescriptions.
Source: Christian Science Monitor.com – January 20, 2012
The Defense Department announced an expansion of its drug testing program to include widely abused prescription medications containing hydrocodone and benzodiazepine, but it’s offering an unprecedented 90-day amnesty period for service members to come clean or get treatment.
Source: Stars and Stripes – February 2, 2012
Since 1999, the Ohio Substance Abuse Monitoring Network (OSAM) has been monitoring local substance abuse trends. Their most recent report, covering January to June 2011, indicates that the “availability of Suboxone remains high in all regions, with the exception of Toledo where it remains moderately available.” Obtaining Suboxone is described by another user as “super easy; like candy machines, a dime a dozen.” According to a treatment provider, Suboxone “is becoming easier to get than methadone.” Following is a summary of Suboxone use in Ohio, in the words of users (U), treatment providers (TP), and law enforcement officers (LE).
How Is Suboxone Obtained? “You’ve got people at [12-step] meetings handing them [Suboxone] off. They’re being sold like any other drug” (TP). “When they prescribe it …, they prescribe a lot of it, and people don’t use the whole prescription. They [users] would then sell it on the street” (LE). “They’re [heroin addicts] getting Suboxone and turning around and selling it” (U). “People pick up prescriptions [for Suboxone] and call [their dealer] and sell them” (U). “The dealers will give them [users] a free Suboxone with their heroin. Customer satisfaction.” (TP).
Fight Withdrawal: “[Some users] don’t want to get off [opioids] for good. They just want to not be sick, so they have Suboxone stashed away for when they feel sick” (TP). “They [opiate addicts] use it … like Tylenol 3, to use till they can get a fix. [Suboxone is] a drug of convenience” (TP). “Some start off using it …to assist with withdrawal, but find that they like how it feels and become addicted” (TP). “I quartered them [Suboxone] …to take the bare minimum, so I wouldn’t be sick, but that way I could still use an opiate; I would buy them …to come off other stuff, but it never worked that way. ‘Cuz you could get high off Suboxone if you hadn’t had any opiates in a couple of days …If you are addicted to opiates, you take the smallest piece of Suboxone—it makes you feel normal” (U).
Get High: “If you are clean [opioid free], you will get very high from Suboxone” (U). “For a buzz … can snort Suboxone, as long as you don’t have other opiates in the system” (U, p. 50). “If you are not addicted to opiates and you take a Suboxone, it’s very, very strong. It can make you high for three days” (U). “People … will use Xanax a half-hour before Suboxone and will get high. Some clients say the effects are as good as, or better than, that of OxyContin®” (TP). “[A] lot of people are being introduced to opioids through Suboxone now because, if they were not Suboxone users, the buprenorphine …the active agent in Suboxone is giving them the opiate effect, and now they’re looking for stronger opioids. So now it’s …a gateway drug to opioid addiction” (TP).
Avoid Detection: “Participants also reported that individuals who need to avoid detection of drug use on urine drug screens (probationers) use Suboxone because it is often not screened” (Report). “[Suboxone is] the institutional drug of choice” (U).
“People typically put them …under their tongue, or they chew them up. I’ve actually witnessed a couple people shoot [inject] them up; I would eat the full 8 mg Suboxone” (U). “I snorted it … when I would take it. It made me not sick” (U). “Well, I shoot [Suboxone] in my neck, so, um, it goes straight to you, you know” (U). “I do know a few people that when switched to the films [Suboxone strips], they say that those are a lot easier to shoot up [inject]. Yeah, ‘cause they dissolve in water; they dissolve completely, and I’ve heard people say that those actually work really well” (U).
Source: CESAR FAX (University of Maryland) – January 16, 2102
A total of 57 inmates tested positive for the use of Suboxone, a drug containing buprenorphine, a medication used to treat opiate addiction.
Inmates testing positive were subject to disciplinary hearings that resulted in many cases, solitary confinement, the loss phone use and commissary privileges, loss of family visitation and loss of accrued “good time status”, which can affect parole hearing outcomes.
After nearly a month of complaints, the Superintendent of Attica contacted the manufacturer of the drug testing equipment, who, after testing, found it to be mis-calibrated, leading to the false-positive results.
As a result, 48 of the 57 prisoners who tested positive for Suboxone will have their positive test reversed and have imposed sanctions reversed.
Source: Buffalo, New York WKBW.com – January 21, 2012
On January 27 the state of New York introduced an ACT to amend the mental hygiene law, in relation to the location of methadone treatment centers. The ACT would prohibit the establishment or continued operation of a methadone clinic within five hundred feet of an educational institution at the secondary level or below, day care center, park, church, synagogue or other place of worship unless located within a hospital.
Source: State of New York Assembly – January 27, 2012
Florida’s three-year attack on pill mills and rogue doctors has taken a bite out of sales of oxycodone, the prescription drug that turned South Florida into the pain-pill capital of the Southeast.
Sales of the narcotic painkiller fell 20 percent last year at Florida pharmacies and other outlets, according to data released this week by the Drug Enforcement Administration.
The main reason: Some of the area’s biggest pill mill operators and doctors were shut down or arrested, slowing a parade of out-of-state drug dealers and addicts seeking pain drugs, officials said.
Source: Sun-Sentinel.com – February 1, 2012
This TIP was developed to assist behavioral health professionals who treat people with substance abuse problems in understanding the implications of a diagnosis of hepatitis. The TIP discusses screening, diagnosis, and referrals and explains how to evaluate a program’s hepatitis practices.
TIP 54 was developed to help equips clinicians with practical guidance and tools for treating chronic pain in adults with a history of substance abuse. The document discusses chronic pain management, including treatment with opioids, and offers information about substance abuse assessments and referrals.
Source: The Substance Abuse and Mental Health Services Administration – December 2011 & January 2012
A new national report reveals that 45.9 million American adults aged 18 or older, or 20 percent of this age group, experienced mental illness in the past year. The rate of mental illness was more than twice as high among those aged 18 to 25 (29.9 percent) than among those aged 50 and older (14.3 percent). Adult women were also more likely than men to have experienced mental illness in the past year (23 percent versus 16.8 percent).
According to the report, rates for substance dependence were far higher for those who had experienced either any mental illness or serious mental illness than for the adult population which had not experienced mental illness in the past year. Adults experiencing any mental illness in the past year were more than three times as likely to have met the criteria for substance dependence or abuse in that period than those who had not experienced mental illness in the past year (20 percent versus 6.1 percent).
The SAMHSA press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1201185326.aspx
The complete survey findings from this report are available at: http://www.samhsa.gov/data/NSDUH/2k10MH_Findings/
Source: The Substance Abuse and Mental Health Services Administration – January 19, 2012
This new 8-page advisory describes rapid HIV testing and reviews the benefits of its use in substance abuse treatment facilities. The document reviews testing regulations and outlines the procedures for implementing the testing, including factors associated with pretest and posttest counseling.
Source: The Substance Abuse and Mental Health Services Administration – December 2011
In 2007, approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. The increase in unintentional drug overdose death rates in recent years has been driven by increased use of a class of prescription drugs called opioid analgesics. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined. In addition, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report nonmedical uses of opioid analgesics.
Implementing strategies that target those persons at greatest risk will require strong coordination and collaboration at the federal, state, local, and tribal levels, as well as engagement of parents, youth influencers, health-care professionals, and policy-makers.
Source: Centers for Disease Control and Prevention – January 13, 2012
Since the mid-1990s, community-based programs have offered opioid overdose prevention services to persons who use drugs, their families and friends, and service providers. Since 1996, an increasing number of these programs have provided the opioid antagonist naloxone hydrochloride, the treatment of choice to reverse the potentially fatal respiratory depression caused by overdose of heroin and other opioids.
In October 2010, the Harm Reduction Coalition, a national advocacy and capacity-building organization, surveyed 50 programs known to distribute naloxone in the United States, to collect data on local program locations, naloxone distribution, and overdose reversals. This report summarizes the findings for the 48 programs that completed the survey and the 188 local programs represented by the responses. Since the first opioid overdose prevention program began distributing naloxone in 1996, the respondent programs reported training and distributing naloxone to 53,032 persons and receiving reports of 10,171 overdose reversals.
Nineteen (76.0%) of the 25 states with 2008 drug overdose death rates higher than the median and nine (69.2%) of the 13 states in the highest quartile did not have a community-based opioid overdose prevention program that distributed naloxone.
Twenty-one (43.7%) responding programs reported problems obtaining naloxone in the “past few months” before the survey. The most frequently reported reasons for difficulties obtaining naloxone were the cost of naloxone relative to available funding and the inability of suppliers to fill orders.
Source: Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) – February 17, 2012
Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed – they are most at risk.
Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days.
Source: Huffingtonpost.com – February 21, 2012
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