New AATOD Policy Statement: Increasing Access to Medication to Treat Opioid Addiction

AATODEarlier this month AATOD issued a policy paper “Increasing Access to Medication to Treat Opioid Addiction – Increasing Access for the Treatment of Opioid Addiction with Medications.” AATOD noted that “this paper raises a number of questions in order to stimulate a thoughtful policy discussion given the urgency of the public health crisis of untreated opioid addiction”.

The statement provides a discussion of: the value of providing comprehensive treatment services to treat a complicated illness, current policy debates on OTPs, DATA 2000 practices, reports of medication diversion, and future policy considerations

http://www.aatod.org/wp-content/uploads/2014/07/MAT-Policy-Paper-FINAL-070214-2.pdf

Source: The American Association of the Treatment of Opioid Dependence – July 2, 2014

 

Treat Patients with Addiction During, After Hospitalization, Researchers Say

hospital sign purchasedshutterstock_33280960The results of a new study demonstrate that starting hospitalized patients who have an opioid (heroin) addiction on buprenorphine treatment in the hospital and seamlessly connecting them with an outpatient office based treatment program can greatly reduce whether they relapse after they are discharged.

Led by researchers at Boston Medical Center (BMC), the study shows the important role that providers play in offering these patients addiction treatment both while in the hospital and after – even if their primary reason for being in the hospital is not for their addiction.

In this study, 139 hospitalized individuals with opioid addiction who were not already in treatment were randomized into two groups. One group received a tapered dose treatment of buprenorphine for withdrawal and referral information about community treatment programs and the other were initiated on buprenorphine, an opioid substitute proven to treat opioid addiction, along with referral to a primary care office-based buprenorphine treatment program.

Of those in the buprenorphine maintenance group, more than one third (37 percent) reported no illicit opioid/drug use for the month after they left the hospital compared to less than one in ten (nine percent) among the control group. These patients also reported, on average, fewer days of illicit drug use and continued to use less over the following six months. This effect was evident despite the fact that these patients did not initially come to the hospital seeking treatment for their addiction.

“Unfortunately, referral to substance abuse treatment after discharge is often a secondary concern of physicians caring for hospitalized patients,” said Jane Liebschutz, MD, MPH, a physician in general internal medicine at BMC and associate professor of medicine at Boston University School of Medicine, who served as the study’s corresponding author. “However, our results show that we can have a marked impact on patient’s addiction by addressing it during their hospitalization.”

This study is published in JAMA Internal Medicine.

http://medicalxpress.com/news/2014-06-patients-addiction-hospitalization.html

Source: Boston Medical University –  June 30, 2014

Opinion by Maia Szalavitz : We Try More Drugs than Anyone Else, and 9 Other Ways Addiction Is Different in America

“We Americans like to think of ourselves as exceptional, the land of the free and the home of the brave, the City on the Hill and all that. When it comes to the politics and culture of drugs, we are indeed special—or at least dramatically different from the rest of the Western world. Too often, however, we are special for the wrong reasons.”

  1. We Try More Drugs Than Anyone Else
  2. We Incarcerate More People Than Anyone Else
  3. We Use More Opioids Medically (But Not for the Reasons You Might Think)
  4. We’re in the Middle of the Road on Alcohol
  5. We Have the World’s Highest Legal Drinking Age
  6. Our Treatment System Is Dominated by 12-Step Programs
  7. Coercion Is a Common Route to Treatment
  8. We Spend the Most Money on Addiction Research
  9. We Determine What Is and What Isn’t Legal Worldwide (But for No Rational Reason)
  10. We’re Not Very Good at Measuring Addiction

http://www.psmag.com/navigation/health-and-behavior/try-drugs-anyone-else-9-ways-addiction-different-america-85093/

Source:Pacific Standard – July 4, 2014

 

How Heroin Baggies are Marketed Like iPhones

“Nine years ago, when Graham MacIndoe was living in New York City and addicted to heroin, he started collecting the small glassine bags that held the drugs he bought. MacIndoe was a commercial photographer, and even in the grip of a years-long addiction that would ultimately leave him broke, imprisoned on Riker’s Island, and facing deportation, he became interested in the baggies on a visual level.

“There was just something about the design, the typography, the branding,” MacIndoe tells Quartz. “And just being around the drug trade myself, the promises that were in the bags—of good times and money, and this elusive lifestyle that you thought drugs would bring you.

MacIndoe found that marketing in the underground economy mirrored the corporate one in other ways. Special offers often accompanied a new drug’s introduction. Popular brands quickly attracted imitators, who adopted the visual look of the packaging but filled it with a lower-quality product. A kind of built-in obsolescence was common too, with suppliers “cutting” (i.e., adulterating) initially potent brands to maximize profits—a pressure to upgrade that MacIndoe compares to Apple’s strategy with the iPhone. “They’re giving you a product that seems really great at the time,” he says, “and then after a little while you realize you’ve got to move on, because they’re telling you something else is better—and they’re making it better intentionally so you’ll move on to a different brand.”

http://qz.com/229470/how-heroin-baggies-are-marketed-like-iphones/

Source: Quartz – July 7, 2014

APA Archived Webinar: Managing Pain in Patients with an Addiction History

pain collagePCCS-MAT has a new webinar archived on their website made available from the American Psychiatric Association on “Managing Pain in Patients with an Addiction History”. The webinar can be accessed at: http://pcssmat.org/education-training/archived-webinars/apa-archived-webinar-managing-pain-in-patients-with-an-addiction-history/.

The 1 hour webinar is presented by Jan Kauffman, RN, Vice President, Addiction Treatment Services North Charles Foundation, Inc., and Assistant Professor of Psychiatry, Harvard Medical School. One CME credit is available.

The goal of the presentation is to familiarize clinicians with the tools to identify chronic pain patients at risk for misuse of opioids, and provide strategies for managing chronic pain patients with addictive disorders. Guidelines for risk stratification, safe prescribing, and assessing, monitoring and managing errant behavior will be discussed.

Source: PCSS – MAT Training – May 13, 2014

A New Edition of Slaying the Dragon: The History Of Addiction Treatment And Recovery In America By William L. White

Slaying the Dragon“A new edition of Slaying the Dragon: The History of Addiction Treatment and Recovery in America has just rolled off the presses. The first edition (1998) went through multiple printings and has been used as a text in collegiate addictions studies programs. Of even greater import has been how this history helped many people in recovery see themselves as “a people” and contributed to the rise of a new recovery advocacy movement in the U.S.

Multiple circumstances created the need for a new edition of Slaying the Dragon–recent seminal research on earlier periods of history, the accumulation of more than 16 years of new addiction and recovery research and, of course, events of enormous significance that have transpired since 1998. That addiction treatment has gone through significant challenges and changes in the past 16 years is self-evident, but readers may not appreciate some of the momentous and unprecedented events that have occurred within the larger history of addiction recovery. Such events include the growth and diversification of recovery mutual aid societies, the cultural and political mobilization of people in recovery, the emergence of new grassroots recovery support institutions, the rise of recovery as a potentially new organizing paradigm for national drug policy, key breakthroughs in recovery research, and rising efforts to fundamentally redesign addiction treatment.”

http://www.williamwhitepapers.com/blog/2014/06/year-of-the-dragon.html

Source: WilliamWhitePaper.com – June 29, 2014

Feds Seek Ways to Expand Use of Addiction Drug

White House“The government’s top drug abuse experts are struggling to find ways to expand use of a medicine that is considered the best therapy for treating heroin and painkiller addiction.

Sen. Carl Levin of Michigan on Wednesday pressed officials from the White House, the National Institute of Drug Abuse and other agencies to increase access to buprenorphine, a medication which helps control drug cravings and withdrawal symptoms. It remains underused a decade after its launch.

“As long as we have too few doctors certified to prescribe bupe, we will be missing a major weapon in the fight against the ravages of addiction,” Levin told the forum, which also included patients and non-government medical experts.”

http://bostonherald.com/business/business_markets/2014/06/feds_seek_ways_to_expand_use_of_addiction_drug

Source: BostonHerald.com – June 18, 2014

Across The US, An Explosion of Addiction

heroin and injection“Over the last 18 months, The Cincinnati Enquirer has used a team of reporters to cover the heroin problem locally. We joined with Gannett papers in Arizona, Delaware and Vermont for this series on heroin nationally.”

Part IThe Resurgence Of The Deadly Drug Has Sparked A Flurry Of Action From Governors’ Mansions And Statehouses Across New England And The Midwest To Small-Town Police Stations From Northern Kentucky To Wisconsin

Part II – Heroin’s Hidden Journey – Nearly All Heroin Fueling A U.S. Resurgence Enters Over the 1,933-Mile Mexico Border

Part III – Heroin addicts left trapped; families, heartbroken

Part IV – Scanning the battlefield in war on heroin

Part V – In Vermont, on the front lines of war on heroin

Source: USAToday.com – June 12, 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

Drugs for Treating Heroin Users: A New Abuse Problem in the Making?

“Evidence is mounting that certain drugs used to treat heroin users are themselves being sold on the streets – and may even be a ‘gateway’ to heroin or opioid use. As some experts herald their value for treating addiction, others ask if the ‘cure’ is making things worse.

More than a decade ago, the FDA partnered with a British company to develop Suboxone, a new treatment for addiction to opioids. But that effort has had highs and lows, experts say. Lifesaving to some opioid abusers, Suboxone and generic drugs like it have not helped others to whom they have been prescribed – in part, these experts say, because of poor oversight of how the opioids are dispensed and used.

Those drugs have also ended up where the U.S .government hoped they wouldn’t: on the street, where they are sold in the same illicit subculture in which heroin and prescription painkillers are peddled.”

http://www.csmonitor.com/USA/Society/2014/0530/Drugs-for-treating-heroin-users-a-new-abuse-problem-in-the-making

Source: Christian Science Monitor – May 30, 2014

To Beat Heroin Addiction, A Turn To Coaches

“Recommendations out this week from a task force on opiate abuse include more peer support and home-based counseling. Health insurers and state Medicaid leaders say they will look at funding for recovery coaches, but there is no plan to do so right now.

Across the country, there’s growing interest in using recovery coaches to help heroin users stop, says Robert Lubran, director of the division of pharmacologic therapies at the federal Substance Abuse and Mental Health Services Administration. At least one state, New York, is paying for coaches to help treat addiction through its Medicaid program.

“This is an evolving field,” Lubran says. “[We are] learning more and more about the best ways to treat addiction and certainly the use of peer counselors, or peer coaches, has become more and more widespread.”

http://commonhealth.wbur.org/2014/06/heroin-recovery-coaches

Source: WBUR’s CommonHealth Reform and Community – June 13, 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

Blog by Jana Burson – Naloxone

“Naloxone is the opioid buzz-kill drug… and it’s also the opioid overdose life saver.

People die from opioid overdoses because the brain gets saturated with opioids. The part of the brain that tells us to breathe during sleep, the medulla, also gets saturated, and eventually shuts off. This usually occurs gradually. The respiratory rate slows over one to three hours, until all respirations stop. Then tissues of essential organs like the brain and heart die from lack of oxygen.

If naloxone can be given during this process, the opioids are tossed off brain receptors, and the medulla fires urgent orders for the body to resume breathing. The patient wakes up, so long as irreversible damage hasn’t yet been done to the brain and heart. In some cases, the patient goes into full precipitated opioid withdrawal, but usually the naloxone doesn’t reverse all of the opioids on board, just enough to save the patient’s life.”

http://janaburson.wordpress.com/2014/06/15/naloxone/

Source: Jana Burson – June 15, 2014

ASAM Article: Twelve Step Recovery and Medication Assisted Therapies

“You’re not clean and sober if you keep taking that medication from your doctor!”

“You’re just substituting one drug for another.”

“You are depressed because you are not grateful enough.”

These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately, this so- called “advice” from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12- step policy of ” AA members should not give medical advice to each other.”

http://www.asam.org/magazine/read/article/2014/06/12/twelve-step-recovery-and-medication-assisted-therapies

Source: American Society of Addiction Medicine – June 12, 2014

Pope Francis Opposes Marijuana Legalization, Questions Methadone

Pope Francis said he opposed efforts to legalize marijuana and questioned the use of substitute drugs like methadone to treat heroin addicts.

“Substitute drugs, moreover, aren’t a sufficient therapy, but rather a hidden way to surrender,” Francis said. “I want to emphasize what I’ve said in other occasions. No to every type of drug. Simply no to every type of drug.”

http://www.bloomberg.com/news/2014-06-20/pope-francis-opposes-marijuana-legalization-questions-methadone.html

Source: – Bloomberg News.com – June 20, 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

Blog by William White: The Language of Recovery Advocacy

RecoverySome will question why we as recovery advocates should invest valuable time debating the words used to convey alcohol and other drug (AOD) problems and their solutions when there are suffering individuals and families that need to be engaged, recovery support resources that need to be created, communities that need to be educated, and regressive, discriminatory policies that need to be changed.  We must invest this time because achieving our broader goals depends on our ability to forge a recovery-oriented vocabulary.

Words have immense power to wound or heal.  The wrong words shame people with AOD problems and drive them into the shadows of subterranean cultures.  The wrong words, by conveying that people are not worthy of recovery and not capable of recovery, fuel self-destruction and prevent or postpone help-seeking. The right words serve as catalysts of personal transformation and offer invitations to citizenship and community service.  The right words awaken processes of personal healing, family renewal, and community and cultural revitalization.  The wrong words stigmatize and disempower individuals, families and communities.

It is time people in recovery rejected imposed language and laid claim to words that adequately convey the nature of our experience, strength and hope.  We must forge a new vocabulary that humanizes AOD problems and widens the doorways of entry into recovery.  We must forever banish language that, by objectifying and demonizing addiction, sets the stage for our sequestration and punishment.  We must counter the clinical language that reduces human beings to diagnostic labels that pigeon-hole our pathologies while ignoring our strengths and resiliencies.  We must also reject the disrespectful and demeaning epithets (e.g., “retreads”, “frequent flyers”) professionals sometimes use to castigate those who need repeated treatment episodes.”

http://www.williamwhitepapers.com/blog/2014/06/the-language-of-recovery-advocacy.html

Source: WilliamWhitePapers.com – June 7, 2014

Blog by William White: Volunteerism and Addiction Treatment

blog1“A 1976 national survey of addiction treatment programs in the United States revealed a workforce of nearly 60,000 workers.  The treatment workforce at that time consisted of 31,000 full-time workers and 15,000 part-time paid workers.  The paid professional workforce included 20,000 counselors, 5,000 nurses, 3,000 social workers, 2,500 psychologists, and a small and slowly growing cadre of physicians.  But what is most striking to me in this survey is the reported presence of more than 1,000 full-time volunteers and 13,000 part-time volunteers. As volunteers disappeared from the addiction treatment milieu during the 1980s and 1990s, the story of their role in early addiction treatment and what they meant to people seeking recovery also disappeared.”

http://www.williamwhitepapers.com/blog/2014/06/volunteerism-and-addiction-treatment.html

Source: WilliamWhitePapers.com – June 14, 2014

Tennessee Law Puts Pregnant Women on Medication-Assisted Treatment for Opioid Addiction in Danger of Arrest

shutterstock_39985291As of July 1, a pregnant woman who gives birth in Tennessee to a baby who has neonatal abstinence syndrome (NAS), a transient and easily treatable condition, could be arrested for assault. Many women in opioid treatment programs (OTPs) are likely to deliver a baby with NAS, so the American Association for the Treatment of Opioid Dependence (AATOD) and the state chapter worked hard to try to convince Gov. Bill Haslam not to sign the bill; however, April 29, he signed it.

It’s much safer for the fetus for a woman to stay on methadone or buprenorphine during her pregnancy than to come off it, medical experts agree. That’s why AATOD and other health care advocates are concerned that out of fear of being arrested, pregnant women will try to avoid or terminate treatment, or if they are not in treatment, avoid medical care altogether.

Although the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), which regulates OTPs and other treatment programs, has said that it doesn’t want women in treatment in OTPs to be arrested, it has no authority over what individual prosecutors and police officers decide to do.

“It continues to trouble us that the Department of Health and TDMHSAS has no authority over prosecutors,” said a joint press statement signed by AATOD president Mark Parrino, Deb Crowley (chair and president of the Tennessee chapter of AATOD), Joycelyn Woods (executive director of the National Alliance for Medication Assisted Recovery [NAMA-R]), and Zac Talbott (director of NAMA-R of Tennessee). “Under the new law the possibility remains that individual prosecutors could attempt to bring charges against pregnant women enrolled in MAT who deliver babies that show signs of neonatal abstinence syndrome.”

The law has no specific exemption for women in medication-assisted treatment (MAT) who do not test positive for any illicit substance, something that AATOD calls “frightening.” Women in treatment with methadone will be subject to criminal proceedings simply for following the best advice of their physicians.

This is not to say that AATOD thinks any women should be arrested for using drugs—in fact, nobody can be arrested for “using” drugs. What the Tennessee law does is to take another step toward calling a fetus a “person,” and criminalizing the mother for “assault” on the fetus by using drugs.

“This law could leave open the possibility for women to be criminally prosecuted for seeking and obtaining the medical treatment for their disease that is the medically accepted standard of care and most responsible decision they could make for the healthy development of their unborn babies,” concluded AATOD.

Asked whether women in MAT will be protected from arrest, TDMHSAS communications director Michael A. Rabkin said that the law “protects these women from arrest.”  The law says that women who complete a treatment program will not be arrested. What should providers do to protect their patients? “There is nothing specific that providers need to be doing to protect them, since it is the law that protects them from arrest.

Advocates, however, urge that treatment providers can do the best thing for their patients by safeguarding their confidentiality and not reporting them or turning over their records to authorities.

We asked what the TDMHSAS is recommending in terms of whether patients should stay on methadone while pregnant. Mr. Rabkin’s response: “Obstetricians have standards of care that they follow that generally say that pregnant women should stay on methadone, but this decision is an individual decision that must be made by each pregnant woman and her doctor.”

Jack McCarthy, MD, an expert on pregnancy and methadone who is with Bi-Valley Medical Clinic in Sacramento, California, is horrified by the law. “I would call detoxing a pregnant woman ‘fetus abuse,’” he says. “Legally the fetus might be allowed protection from cruel practices such as opioid withdrawal.” McCarthy published a paper on “Intrauterine Abstinence Syndrome” two years ago. Summed up, it says that “You can kill a fetus and you can severely stress a fetus by ‘detoxing’ the mother,’” he said.

The Hidden Dangers of Benzodiazepines (Infographic)

benzos 5-28-14“In the last year there have been several studies/stories about the risks associated with benzodiazepine abuse.  And while benzodiazepines have been prescribed for decades to treat anxiety and seizure disorders, the possible threat of overusing them is real and with that comes dependency, overdose and the potentiality of death.  Did you know that since 2010, there have been 6,507 US drug overdose deaths that involved benzodiazepines?  Because of this rising number, Foundations Recovery Networkcreated an infographic to help familiarize those about benzodiazepines but most importantly help create awareness regarding the possible addiction with benzodiazepines.”

Broken down in sections, the infographic (http://www.dualdiagnosis.org/benzodiazepine-addiction/) goes into detail about:

  • What are benzodiazepines: their brand names and the amount of prescriptions filled in the US in 2011, the number of related ER visits in 2010 and the confiscations by law enforcement for each associated drug.
  • Why prescribe benzodiazepines, specifically the disorders that are treated
  • Common side effects and contraindications with benzodiazepine use
  • Key statistics related to the dangers of abuse
  • Symptoms of overdose

Source: Foundations Recovery Network– May 2014

 

Site last updated July 17, 2014 @ 5:55 pm