Opioid Painkiller Prescribing Varies Widely Among States

Capsule and Pills“Health care providers wrote 259 million prescriptions for opioid painkillers in 2012 – many more in some states than in others – according to a Vital Signs report released this month by the Centers for Disease Control and Prevention that highlights the danger of overdose. The report also has an example of a state that reversed its overdose trend.

Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii. Most of the highest prescribing states were in the South. Previous research has shown that regional variation in use of prescriptions cannot be explained by the underlying health status of the population.

“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, M.D., M.P.H. “Overdose rates are higher where these drugs are prescribed more frequently. States and practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”

The report suggested that states consider ways to increase use of prescription drug monitoring programs, and  consider policy options (including laws and regulation) relating to pain clinics (facilities that specialize in pain treatment) to reduce prescribing practices that are risky to patients.

http://www.cdc.gov/media/releases/2014/p0701-opioid-painkiller.html

Source: Centers for Disease Control and Prevention – July 2014

 

Heroin Users Are 90 Percent White, Living Outside Urban Areas

“The image of the heroin user is changing, according to researchers who say the great majority are now white men and women who mostly live outside the cities.

Their study published in JAMA Psychiatry, tracked data from almost 2,800 heroin users and found that first-time users are now generally older than those who began taking the drug in the 1960s. About 90 percent are white, according to the study, and 75 percent now live in non-urban areas.

The research also confirmed a link between the rise of opioid abuse and the growing use of heroin that had been noted in earlier studies. Heroin use has jumped 80 percent to 669,000 users from 2007 to 2012, according to the National Survey on Drug Use and Health, after being relatively stable since 2000.”

http://washpost.bloomberg.com/Story?docId=1376-N6AV3H6S972C01-71HUL1EQ4U5J4QKSAPSPOBBT5I

See related article  - Opioids leading to new class of heroin abusers, study finds at: http://www.jsonline.com/news/health/opioids-leading-to-new-class-of-heroin-abusers-study-finds-b99278535z1-260996001.html

Source: WashingtonPost.com – May 29, 2014

Opioid Prevention Programs Could Reduce Deaths from Overdose

hospital sign purchasedshutterstock_33280960“Researchers at the University of Cincinnati  School of Medicine conducted a study that analyzed 19 published studies evaluating the effectiveness of Opioid Overdose Prevention Programs (OOPPs) in terms of recognition, prevention, and risk factors for opioid overdoses. Fourteen of the studies analyzed featured follow-up data on over 9,000 people enrolled in an OOPP, of which half had experienced an overdose and 80% witnessed one.

The research found that eleven of the OOPP studies reported a 100% survival rate when administering naloxone, and the others featured at least an 83% rate. The percentages were determined out of nearly 2,000 naloxone administrations.

However, the researchers believe further studies must be conducted to ensure the strength of knowledge of overdose prevention and risk factors for those who are enrolled in OOPPs. Their findings are promising, but there is limited research and data on OOPPs and that’s really the only way more can be determined about overdose prevention efforts.”

http://www.scienceworldreport.com/articles/15166/20140603/opioid-prevention-programs-reduce-deaths-overdose.htm

The article Development and Implementation of an Opioid Overdose Prevention Program Within a Preexisting Substance Use Disorders Treatment Center which was published in the Journal of Addiction Medicine.

Also see article from Medscape ‘Project Lazarus’ Making Headway on Opioid Overdoses available at: http://www.medscape.com/viewarticle/826865. Free registration required.

Source: ScienceWorldReport.com – June 3, 2014

Death by Prescription Painkiller – First Major Review Provides Evidence of Sharp Increase in Deaths from Painkillers in US and Canada and Leading Causes

The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to researchers at McGill University. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the US and Canada rank #1 and #2 in per capita opioid consumption.

In an effort to identify and summarize available evidence, Nicholas King, of the Biomedical Ethics Unit in the Faculty of Medicine and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quantitative evidence.

“We also wanted to find out why thousands of people in the U.S and Canada are dying from prescription painkillers every year, and why these rates have climbed steadily during the past two decades,” says King. “We found evidence for at least 17 different determinants of increasing opioid-related mortality, mainly, dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like Oxycontin and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic factors.”

“We found little evidence that Internet sales of pharmaceuticals and errors by doctors and patients–factors commonly cited in the media — have played a significant role,” Prof. King adds.

The findings point to a complicated “epidemic” in which physicians, users, the health care system, and the social environment all play a role, according to the researchers.

The results of this research are published in the American Journal of Public Health.

Source: McGill University – June 17, 2014

A Fix Special Report—The Maddening State of Addiction Research Funding

funding“Most of us understand that substance addiction and alcoholism is a major social, health, and economic issue. The costs to the economy alone in health care, productivity loss, crime, drug enforcement and incarceration are estimated to be more than $500 billion a year – and that number is from a study ten years ago. In response, only a tiny percentage of this is spent every year by all players – government, private Pharma companies and foundations – on developing and testing a variety of would-be miracle cures (or even just helpful medications or processes).

In the substance abuse funding game there are gamemakers – those who decide which projects are worthy of the awarded dollars – and competitors: researchers vying for limited funds. The gamemakers come from the public and private sector and ultimately determine whether a competitor moves forward or gets denied.

This article is an inside peek at how that game is played and who gets to be the winners and who the losers.”

http://www.thefix.com/content/fix-special-report-maddening-state-addiction-research-funding

Source: TheFix.com – June 6, 2014

Opioid Substitution Therapy Is Linked to Lowered HIV Risk

“Methadone maintenance therapy and treatment with buprenorphine-naloxone are equally effective at reducing HIV injecting risk behaviours among people who inject drugs, investigators from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Both treatments were associated with significant reductions in injecting practices linked to a risk of HIV transmission. Sexual risk behaviour also decreased in women taking both therapies. However, drop-out rates were higher among people treated with buprenorphine-naloxone and men taking this therapy reported significantly higher rates of sexual risk-taking.”

http://www.aidsmap.com/Methadone-and-buprenorphine-naloxone-both-associated-with-reduced-HIV-risk-among-people-who-inject-drugs/page/2849368/

Source: Aidsmap.com – April 29, 2014

Doctors Have ‘Knowledge Gaps’ About Opioid Abuse (Free registration required to view article)

“Many physicians still have a lot to learn about opioid misuse, abuse, and diversion, according to the results of a survey of clinicians who attended 1 of last year’s major pain meetings.

“Clinicians in the real world are not reading the data that we currently have about opioid abuse-deterrent formulations, they don’t understand how big the problem of diversion is, and they have serious knowledge gaps about where people who abuse opioids are getting these drugs,” Joseph V. Pergolizzi, MD, from Johns Hopkins Medical School, Baltimore, Maryland, told Medscape Medical News.

Less than half (45%) were aware that most (71%) prescription opioids that are abused are obtained from a friend or a relative, and only 53% believed that more than half of recreational abuse is sourced through diversion of a legitimate prescription.”

http://www.medscape.com/viewarticle/824702

Source:  Medscape.com -May 6, 2014

Belgium Study Suggests Heroin-Assisted Treatment Superior to Methadone for Heroin Addiction (Free registration required to view article)

“Patients severely addicted to heroin may respond to a treatment practice that incorporates pharmaceutical heroin, a new feasibility study suggests.

An open-label, randomized controlled trial (RCT) of 74 patients showed that significantly more of those who received diacetylmorphine under strict nurse supervision in a specialized center responded at 3, 6, and 9 months after starting treatment than those who received methadone.

http://www.medscape.com/viewarticle/825108

Source:  Medscape.com -May 13, 2014

Study Addresses Treatments for Waited-Listed Opioid-Dependent Individuals

waiting line“Addiction to heroin and prescription painkillers – has reached epidemic levels across the country, with treatment waitlists also at an all-time high. However, ensuring timely access to effective treatment – particularly in rural states like Vermont – has become a substantial problem. University of Vermont (UVM) Associate Professor of Psychiatry Stacey Sigmon, Ph.D., has taken a stand to address this issue and has a new grant to support her campaign.

Sigmon’s latest project, funded by a National Institute on Drug Abuse (NIDA) award, will develop a novel Interim Buprenorphine Treatment (IBT) to help opioid-dependent Vermonters bridge challenging waitlist delays. She’s proposed a treatment “package” of five key components designed to maximize patient access to evidence-based medication for opioid dependence while minimizing common barriers to treatment success, including risks of medication non-adherence, abuse and diversion.”

The five components include:

  • Three months of maintenance therapy using buprenorphine.
  • A, computerized portable device manufactured in Finland called a Med-O-Wheel, which dispenses each day’s dose at a predetermined time, after which all medication is locked away and inaccessible.
  • Clinical support will come from a mobile health platform that uses technology to deliver patient monitoring and support beyond the confines of the medical office.
  • The fourth component involves an automated call-back procedure during which participants are contacted at randomly-determined intervals and directed to visit the clinic for a pill count and urinalysis.
  • Development and provision of an HIV and hepatitis educational intervention delivered via a portable iPad platform.

“These technologies are particularly compatible with rural settings, says Sigmon, where there are multiple burdens – including long distances and transportation barriers – that can make it hard for a patient to come to a treatment center on a daily basis.

Once developed, these treatment components also don’t need to be limited to people on wait lists. In fact, they can also be used to support the physicians with patients already enrolled in a methadone, office-based buprenorphine or pain management clinics,” says Sigmon.”

http://medicalxpress.com/news/2014-04-treatments-waited-listed-opioid-dependent-individuals.html

Source: MedicalXpress.com – April 10, 2014

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.

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

Fewer Opioid Treatment Programs Offer HIV Testing

“According to a study, fewer opioid treatment programs are offering onsite testing for HIV and sexually transmitted infections (STIs), despite guidelines from the Centers for Disease Control and Prevention (CDC) recommending routine HIV testing in all health care settings.

The absolute number of programs offering testing for HIV, STIs, and HCV increased from 2000 to 2011. However, the percentage of programs offering HIV testing decreased significantly, by 18%, and the percentage of those offering testing for STIs fell by 13% throughout the study. Testing for each infection did not change over time in public programs, but HIV testing dropped by 20% among for-profit programs and 11% in nonprofit programs.

http://www.pharmacytimes.com/publications/issue/2014/February2014/Fewer-Opioid-Treatment-Programs-Offer-HIV-Testing

Source: PharmacyTimes.com - February 19, 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
  •  
  • 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

New Mexico Jail Methadone Program Shows Mixed Results

jail croppedjailjail cropped
jail cropped“A recent study conducted by the University of New Mexico found that inmates in the methadone maintenance program, which provides a daily dose of methadone to inmates already enrolled in a community-based methadone program, spent almost 40 days longer out of jail than their opiate-addicted counterparts not enrolled in a methadone program. That amounts to per-inmate savings to taxpayers of almost $2,700, according to the study, as taxpayers shell out around $69 to house an inmate per day.

The study published in early December, however, contains another finding that erases the savings: Inmates enrolled in the methadone program tended to stay in jail 36 days longer than other inmates. It’s unclear what causes methadone inmates to stay longer, though the program’s directors and others have a couple guesses – that methadone-receiving inmates are more comfortable in jail than those addicted to heroin, and that inmates getting methadone tend to prefer serving their full sentences and leaving jail without probation.”

http://www.abqjournal.com/331644/news/methadone-program-shows-mixed-results.html

Source:  ABQJournal.com – January 6, 2014

Beating the Poppy Seed Defense: New Test Can Distinguish Heroin Use from Seed Ingestion

“Heroin is one of the most widely used illegal drugs in the world, but drug testing has long been challenged by the difficulty in separating results of illicit heroin users from those who have innocently eaten poppy seeds containing a natural opiate. Research in Drug Testing and Analysis explores a new test which may present a solution to this so-called ‘poppy seed defense.’

The team sought to identify an acetylated derivative which is known to be present in street heroin, but would not be found in either poppy seeds or medicines containing opiates. The authors identified a unique glucuronide metabolite (designated ‘ATM4G’) which could be used as a marker of street heroin use. A high frequency for the presence of ATM4G in urine strongly suggests that detection of this metabolite may offer an important advance in workplace drug testing and forensic toxicology, providing a potential solution to the poppy seed defense.

‘This research report addresses a longstanding analytical problem in forensic toxicology and workplace drug testing, by identifying a urinary marker that differentiates street heroin users from those whom have ingested morphine present in poppy seeds’ said Dr. Andrew Kicman, from the Department of Forensic and Analytical Science at King’s College, London.”

http://www.eurekalert.org/pub_releases/2014-01/w-btp010714.php

Source:  Eurekalert.org – January 7, 2014

Monitoring the Future Results Released

In mid-December, The National Institute on Drug Abuse (NIDA) announced the results of its 2013 Monitoring the Future (MTF) survey. The survey, conducted earlier in the year by scientists at the University of Michigan, tracks annual drug abuse trends of eighth, 10th, and 12th-grade students. NIDA is a component of the National Institutes of Health (NIH).

MTF is one of three major survey instruments the Department of Health and Human Services uses to monitor the nation’s substance abuse patterns among teens.

This year’s announcement focused on attitudes about and prevalence of marijuana use, as well as abuse of synthetic drugs, prescription medications, and tobacco.

Prescription Medications – There was mixed news regarding abuse of prescription medications. The survey shows continued abuse of Adderall, commonly used to treat attention deficit hyperactivity disorder, or ADHD, with 7.4 percent of seniors reporting taking it for non-medical reasons in the past year. However, only 2.3 percent of seniors report abuse of Ritalin, another ADHD medication. Abuse of the pain reliever Vicodin has shown a marked decrease in the last 10 years, now measured at 5.3 percent for high school seniors, compared to 10.5 percent in 2003.

Heroin – For cocaine and heroin, while there was no significant change from the 2012 rates, there continues to be a gradual decline in use, with both drugs at historic lows in all three grades. The 2013 rate for high school seniors for past year cocaine use is 2.6 percent, compared to a peak of 6.2 percent in 1999. Similarly, the reported use of heroin by 12th-graders is 0.6 percent this year, compared to a peak of 1.5 percent in 2000.

http://www.drugabuse.gov/related-topics/trends-statistics/monitoring-future

Source: National Institute on Drug Abuse – December 16, 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: http://news.wustl.edu/news/Pages/26204.aspx

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

 

Keeping OTP Patients in Treatment Longer: Methadone vs. Buprenorphine

hour glass1Data from the first large randomized U.S. trial comparing treatment retention of methadone and buprenorphine patients confirm what a Cochrane review—generally considered the Gold Standard—and other studies have found: treatment retention is much higher with methadone than with buprenorphine, although  the two are equally effective in suppressing illicit opioid use.

The current study is actually a secondary analysis, using data from a large, multisite, open-label study assessing liver function in individuals treated for opioid dependence. The original study enrolled participants from nine opioid treatment programs (OTPs) between 2006 and 2009, randomized to receive either methadone or buprenorphine (as buprenorphine/naloxone). Buprenorphine patients in that study were more than 50 percent less likely than methadone patients to remain in treatment for 24 weeks.

The data were gathered from 529 methadone and 738 buprenorphine patients. (Investigators changed the original 1:1 ratio to 2:1 because of a higher number of buprenorphine dropouts.) Measurements included patient characteristics at baseline, medication dose and urine drug screens at baseline and weekly, days in treatment, and treatment completion.

The goal of the study was to examine patient and medication characteristics associated with treatment retention and continued illicit opioid use in patients given methadone vs. buprenorphine/naloxone.

Study Group

  • Average age 37 years; two-thirds were male
  • 71% white, 12% Hispanic, 9% African American
  • About 90% smoked cigarettes, 27% used alcohol, 69% had injected drugs during the previous 30 days
  • Positive test results for drugs other than opioids: cocaine, 37%; amphetamine, 9%; marijuana, 24%

Patients were told to abstain from opioids for 12 to 24 hours before study onset, to achieve mild-to-moderate opioid withdrawal.

Key Findings

  • Significantly more buprenorphine patients than methadone patients (25% vs. 8%) dropped out within the first 30 days
  • Significantly more methadone than buprenorphine patients completed treatment (74% vs. 46%)
  • Completion rate was even higher with higher daily doses
    • For methadone: 80% or higher with 60 mg or more; 91% or higher with 120 mg or more
    • For buprenorphine (which showed a linear dose-relationship): 60% with 30 to 32 mg, the study maximum
    • Factors associated with higher dropout rates included being younger, being Hispanic (relative to white), and using heroin, cannabinoids, cocaine, or amphetamine during treatment
    • Higher medication dose was related to lower opiate use, especially in the buprenorphine group

Average maximum daily doses for methadone were 93.1 mg (range, 5 to 397 mg), and for buprenorphine, 22.1 mg (range, 2 to 32 mg).

Investigators noted three important findings about buprenorphine retention:

  • About 25% of buprenorphine patients dropped out during the first 30 days, “suggesting a critical period calling for special efforts in retaining these participants”
  • During the first 9 weeks, positive opiate urine results were significantly lower among those receiving buprenorphine, confirming the drug’s advantage of a much shorter induction time
  • A linear positive relationship between dose and treatment completion rate suggested “the benefit of dosing greater than the common practice of a maximum dose of 16 mg”

Buprenorphine Doses and Treatment Outcomes

Even patients taking 30 to 32 mg buprenorphine daily, the maximum for this study, had a retention rate lower than the methadone group (60 percent vs. 74 percent), and about 30 percent continued opioid use. “These findings suggest that participants may yet fare better with [buprenorphine] doses higher than the 32 mg used in this study,” the authors said. They commented on the generally high safety profile of buprenorphine: “We believe with proper monitoring safety will not be a clinical concern in such an effort.”

The authors cited a large investigation (Di Petta) linking daily buprenorphine doses as high as 56 mg with a retention rate of over 92 percent at 30 months. They also drew a comparison to the previous long-standing practice of limiting daily methadone doses to 40 mg—later shown to be highly inadequate, with most patients needing 60 to 120 mg or more.

(Although many sources cite a maximum daily dose of 32/8 mg buprenorphine/naloxone, this is not the first clinical study to investigate higher doses. Studies such as this are based on clinical evidence, designed with safety checks in place, and approved by an institutional review board.)

*   *   *

Reference

Hser YI, Saxon AJ, Huang D, et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. [Epub ahead of print August 20, 2013.]  Addiction. doi: 10.1111/add.12333.

 Resources

Di Petta G, Leonardi C. Buprenorphine high-dose, broad spectrum, long-term treatment: A new clinical approach to opiate alkaloid dependency. Heroin Add & Rel Clin Probl. 2005;7(3):21-26.

Kakko J, Grönbladh L, Dybrandt Svanborg K, et al. A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence: a randomized controlled trial. Am J Psychiatry. 2007;164:797-803. doi:10.1176/appi.ajp.164.5.797.

Mattick RP, Kimber J, Breen C, Davoil M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008;16(2):CD002207. doi: 10.1002/14651858.CD002207.pub3.

Pinto H, Maskrey V, Swift L, Rumball D, Wagle A, Holland R. The SUMMIT trial: a field comparison of buprenorphine versus methadone maintenance treatment. J Subst Abuse Treat. 2010;39(4):340-352. doi: 10.1016/j.jsat.2010.07.009. PMID: 20817384.

Longer-Term Buprenorphine Tapering Improved Opioid Abstinence

“Outpatients addicted to prescription opioids may benefit from a 4-week taper regimen followed by naltrexone maintenance, according to data published in JAMA Psychiatry.

Compared with prescription opioid-dependent adults who were tapered off for 1 or 2 weeks, those who were tapered off for 4 weeks experienced greater abstinence from opioids.

The double blind, 12-week randomized trial included 70 adult outpatients addicted to prescription opioids. Participants were randomly assigned to a buprenorphine tapering regimen of 1, 2 or 4 weeks, plus naltrexone therapy. The intervention was split into two phases: phase 1 occurred between 1 and 5 weeks from randomization, during which time participants attended the outpatient clinic daily; phase 2 occurred between weeks 6 and 12, and participants attended the clinic three times per week. Behavioral therapy and urine toxicology tests were provided during both phases of the trial.”

http://www.healio.com/psychiatry/substance-use-disorders/news/online/%7B7dfc4c9b-288c-4375-86f0-ac05ebef9c68%7D/longer-term-buprenorphine-tapering-improved-opioid-abstinence

Source: Healio.com – October 23, 2013

Almost Half of Hospitalized Heroin Users Self-Report Good Health

hospital sign purchasedshutterstock_33280960“Nearly half of heroin users who are hospitalized for medical or surgical treatment perceive themselves to be in good, very good, or excellent health, “underlining a disconnect between addiction and perceived health status,” according to a study of 112 patients.

The apparent disparity between self-reported health and disease burden suggests that “perceptions of health status may not actually reflect physical health but a different construct altogether,” Lidia Z. Meshesa and her colleagues wrote.

The investigators enrolled 112 non–treatment-seeking hospitalized heroin users in the study. The average age of the participants was 40 years, and 72% were male, reported Ms. Meshesa, of the Clinical Research and Education (CARE) Unit at Boston Medical Center, and her coauthors (Addict. Behav. 2013;38:2884-7). None was currently in treatment for substance abuse. All the participants completed a standard questionnaire on health-related quality of life and were asked detailed questions about their drug use and mental and physical health histories.”

http://www.clinicalpsychiatrynews.com/news/neurology/single-article/almost-half-of-hospitalized-heroin-users-self-report-good-health/572f62cb339ce00cb34f0fd033eb9228.html

Source: ClinicalPsychiatryNews.com – October 21, 2013

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