Obama Drug Strategy Aims to Change How Americans See Drug Abuse

White HousePresident Obama’s annual drug control strategy, released July 7, targets the rise of heroin but also seeks to portray drug abuse as a disease, not a moral failure.

“When Michael Botticelli, President Obama’s acting “drug czar,” unveiled the administration’s annual drug control strategy on Wednesday morning, he emphasized that “we cannot arrest or incarcerate our way out of the drug problem.”

The 98-page strategy follows the template of Obama’s previous drug policy statements, but it also raises the alarm on the nation’s growing middle-class problem of opioid addictions, as heroin and painkillers become a suburban and middle-America scourge.”

http://www.csmonitor.com/USA/Politics/2014/0709/Obama-drug-strategy-aims-to-change-how-Americans-see-drug-abuse

The White House press release on the 2014 strategy can be accessed at: http://www.whitehouse.gov/ondcp/news-releases/2014-national-drug-control-strategy

The strategy can be accessed at: http://www.whitehouse.gov/sites/default/files/ndcs_2014.pdf

See related article – ASAM Applauds ONDCP’s 2014 National Drug Control Strategy: Applauds Focus on Opioid Epidemic available at: http://www.asam.org/magazine/read/article/2014/07/15/asam-applauds-ondcp’s-2014-national-drug-control-strategy-applauds-focus-on-opioid-epidemic

Source: The Christian Science Monitor – July 9, 3024, American Society of Addiction Medicine – July 15, 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

Now Available From SAMHSA – Prescription Drug Abuse Fact Sheets

ROUND PILLSWould you like to add your organization’s name to any of a growing list of 20 SAMHSA prescription drug abuse fact sheets?

SAMHSA’s Preventing Prescription Abuse Workplace (PAW) Technical Assistance Center is pleased to offer reproducible PDFs of its 30 fact sheets with customized names added at no charge. The fact sheets are not copyrighted, and you are free to download them from the link, reproduce or print them in bulk, or reuse our text in your materials.

Two of the fact sheets introduced in May include: Prescription Drug Misuse Among Older Adults and Understanding The Problem and Youth and Prescription Drug Abuse.

The fact sheets can be accessed at: http://www.hsc.wvu.edu/icrc/Pages/SAMHSA-Prevention-of-Prescription-Drug-Abuse-in-th/SAMHSA-Fact-Sheets

Source: The Substance Abuse Mental Health Services Administration- May 2014

National Institutes of Health Press Release: HHS Leaders Call For Expanded Use of Medications to Combat Opioid Overdose Epidemic

New England Journal of Medicine commentary describes that vital medications are currently underutilized in addiction treatment services and discusses ongoing efforts by major public health agencies to encourage their use

A national response to the epidemic of prescription opioid overdose deaths was outlined in the New England Journal of Medicine by leaders of agencies in the U.S. Department of Health and Human Services (HHS). The commentary calls upon health care providers to expand their use of medications to treat opioid addiction and reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and use of data-driven tracking to monitor program progress.

The commentary was authored by leaders of the National Institute on Drug Abuse (NIDA) within the National Institutes of Health, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS).

“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author and NIDA Director Nora D. Volkow, M.D. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”

Research has led to several medications that can be used to help treat opioid addiction, including methadone, usually administered in clinics; buprenorphine, which can be given by qualifying doctors; and naltrexone, now available in a once-a-month injectable, long-acting form. The authors stress the value of these medications and describe reasons why treatment services have been slow to utilize them. The reasons include inadequate provider education and misunderstandings about addiction medications by the public, health care providers, insurers, and patients. For example, one common, long-held misperception is that medication-assisted therapies merely replace one addiction for another – an attitude that is not backed by the science. The authors also discuss the importance of naloxone, a potentially life-saving medication that blocks the effects of opioids as a person first shows symptoms of an overdose.

The article describes how HHS agencies are collaborating with public and private stakeholders to expand access to and improve utilization of medication-assisted therapies, in tandem with other targeted approaches to reducing opioid overdoses.  For example, NIDA is funding research to improve access to medication-assisted therapies, develop new medications for opioid addiction, and expand access to naloxone by exploring more user-friendly delivery systems (for example, nasal sprays). CDC is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices. CDC is also establishing statewide norms to provide better tools for the medical community in making prescription decisions.

Charged with providing access to treatment programs, SAMHSA is encouraging medication-assisted therapy through the Substance Abuse Prevention and Treatment Block Grant as well as regulatory oversight of medications used to treat opioid addiction. SAMHSA has also developed an Opioid Overdose Toolkit  to educate first responders in the use of naloxone to prevent overdose deaths. The toolkit includes easy-to-understand information about recognizing and responding appropriately to overdose, specific drug-use behaviors to avoid, and the role of naloxone in preventing fatal overdose.

“SAMHSA’s Opioid Overdose Toolkit is the first federal resource to provide safety and prevention information for those at risk for overdose and for their loved ones,” said co-author and SAMHSA Administrator Pamela S. Hyde, J.D. “It also gives local governments the information they need to develop policies and practices to help prevent and respond appropriately to opioid-related overdose.”

CMS is working to enhance access to medication-assisted therapies through a more comprehensive benefit design, as well as a more robust application of the Mental Health Parity and Addiction Equity Act.

“Appropriate access to medication-assisted therapies under Medicaid is a key piece of the strategy to address the rising rate of death from overdoses of prescription opioids,” said co-author Stephen Cha, M.D., M.H.S., chief medical officer for the Center for Medicaid and CHIP [Children’s Health Insurance Program] Services at CMS. “CMS is collaborating closely with partners across the country, inside and outside government, to improve care to address this widespread problem.”

However, the authors point out that success of these strategies requires engagement and participation of the medical community.

The growing availability of prescription opioids has increased risks for people undergoing treatment for pain and created an environment and marketplace of diversion, where people who are not seeking these medications for medical reasons abuse and sell the drugs because they can produce a high.

The press release can be accessed at: http://www.nih.gov/news/health/apr2014/nida-24.htm

The New England Journal of Medicine article can be accessed at: http://www.nejm.org/doi/full/10.1056/NEJMp1402780?query=featured_home

Source: National Institutes of Health – April 24, 2014

Heroin a Growing Threat Across USA, Police Say

heroin and injection“Between 2009 and 2013, according to the assessment produced by the government’s National Drug Intelligence Center, heroin seizures increased 87%. The average size of those seizures increased 81% during the same time.”

“The consciousness of the nation has not really focused on the problem,” Attorney General Eric Holder told the conference of more than 200 officials organized by the Police Executive Research Forum, a D.C.-based think tank. “People saw this more as a state and local problem. …This is truly a national problem. Standing by itself, the heroin problem is worthy of our national attention.”

http://www.usatoday.com/story/news/nation/2014/04/16/heroin-overdose-addiction-threat/7785549/

Source: USAToday.com – April 17, 2014

FDA Commissioner Margaret A. Hamburg Statement on Prescription Opioid Abuse

FDA“For more than a decade, the U.S. Food and Drug Administration has been working to address the important public health problems associated with the misuse, abuse, addiction and overdose of opioid analgesics, while at the same time working to ensure continued access to effective and appropriate medications for millions of Americans currently suffering from pain. I firmly believe that these goals are compatible, and that actions to address one should not be at the expense of the other.

Tragically, the most recent data shows that more than 16,000 lives are lost each year due to opioid-related overdoses. In fact, drug overdose deaths, driven largely by prescription drug overdose deaths, are now the leading cause of injury death in the United States – surpassing motor vehicle crashes. We know that the illegal diversion, misuse, and abuse of prescription opioids are often fueled by inappropriate prescribing, improper disposal of unused medications, and the illegal activity of a small number of health care providers. This highlights the important role that education of prescribers and patients can play in addressing this epidemic. The FDA has taken steps to address this but more work remains to be done.

Combatting the serious public health problem of misuse, abuse, addiction and overdose from opioid analgesics is a high priority. Since 2001 the FDA has taken a number of actions designed to help address prescription opioid abuse and to encourage the development of new drug treatments for pain. These actions include:

  • Revising the labeling for opioid medications to foster their safe and appropriate use, including recent changes to the indications and safety warnings of extended-release and long-acting opioids.
  • Requiring that manufacturers conduct studies of the safety of long-term use of prescription opioids.
  • Improving appropriate prescribing by physicians and use by patients through educational materials required as a part of a risk mitigation strategy for extended-release and long-acting opioids.
  • Using the agency’s expedited review programs to advance development of new non-opioid medications to treat pain with the goal of bringing new non- or less-abusable products to market.
  • Working with other federal agencies and scientists to advance our understanding of the mechanisms for pain and how to treat it, including the search for new non-opioid medications for pain.
  • Recommending that hydrocodone-containing combination products have additional restrictions on their use by rescheduling them from Schedule III to Schedule II.
  • Strengthening surveillance efforts to actively monitor the changing nature of prescription opioid abuse and to identify emerging issues.
  • And, importantly, encouraging the development of medications to treat opioid abuse, such as buprenorphine for use in medication-assisted treatment, and to reverse opioid overdoses, such as naloxone.

Today’s FDA approval of Evzio (naloxone autoinjector) provides an important new tool in our arsenal to more effectively combat the devastating effects of opioid overdose, which is one part of our comprehensive work to support opioid safety. Reflecting the FDA’s commitment to encouraging important new therapies, the FDA’s review of Evzio was granted priority status, and the application was reviewed by the FDA in just 15 weeks.

This product is the first auto-injector designed to rapidly reverse the overdose of either prescription or illicit opioids. While the larger goal is to reduce the need for products like these by preventing opioid addiction and abuse, they are extremely important innovations that will help to save lives.

The FDA will continue to work to reduce the risks of abuse and misuse of prescription opioids, but we cannot solve this complex problem alone. A comprehensive and coordinated approach is needed; one that includes the White House Office of National Drug Control Policy, the Drug Enforcement Administration and many of our sister agencies within the Department of Health and Human Services, as well as state and local governments, public health experts, health care professionals, addiction experts, researchers, industry, and patient organizations.

I am confident that this can be accomplished, but we will all need to work together to invest in strategies and responsible approaches that deter or mitigate the effects of abuse while preserving access to pain medicines for the patients that need them the most.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391590.htm

See related press release on EVZIO available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391465.htm

Source: Federal Drug Administration – April 3, 2014

States That Don’t Expand Medicaid Leave Millions of Mentally Ill Uninsured: Report

“About 3.7 million Americans, who live in states that have not expanded their Medicaid programs under the Affordable Care Act, suffer from mental illness, psychological distress or a substance use disorder and don’t have health insurance, according to a recent report.

Twenty-four states have not expanded their Medicaid programs, according to USA Today. In the states that did expand Medicaid, about 3 million people with a mental health or substance use disorder, who were formerly uninsured, now are eligible for coverage. The findings come from the American Mental Health Counselors Association (AMHCA).”

http://www.drugfree.org/join-together/community-related/states-that-dont-expand-medicaid-leave-millions-of-mentally-ill-uninsured

Source: JoinTogether.org – April 9, 2014

Medication Assisted Treatment: A Standard of Care. An interview with Elinore McCance-Katz, MD, PhD, Chief Medical Officer, SAMHSA

Edit-Dr.M-KNote: This interview was issued by SAMHSA’s HRSA Center for Integrated Health Solutions in their February 2014 eSolutions newsletter.

“We have a huge need in our country to treat mental health and substance use concerns, and we have a chronic shortage of specialty care programs with enough capacity to treat everyone with a substance use concern. It is our responsibility to expand access to this care in a way that allows greater choice of where individuals can receive treatment.

With the Affordable Care Act, the treatment of substance use disorders is now an essential benefit. Individuals with multiple complex healthcare needs, including mental health and substance use concerns, can be seen in integrated care settings and health homes.

We are going to see more and more integrated care. All healthcare providers, whether in primary care, mental health, or substance use treatment, will need to learn how to provide treatment for disorders they may not have historically treated. Providers who are not used to treating patients with certain types of problems may not feel confident about providing care. When that happens, the individual is less likely to get the care they need. Primary care providers especially will need to be ready to assess and provide treatment for clients who present with mental health and substance use concerns.

The Need for Medication Assisted Treatment

Medication assisted treatment (MAT) is a standard of care. There are a variety of medications that have been shown to be effective in treating substance use disorders and that can be used safely. Specifically, there are a number of FDA-approved medications for tobacco, alcohol and opioid abuse treatments.

MAT is an effective form of care, when medication is taken as prescribed, used properly, and the individual is engaged with other supports and services. With opioid use disorders, studies show that clients who get medical detoxification only have a greater than 90% relapse rate.

We have to think about how effective the treatment is, what the alternative is if not treated, and where an individual is in their recovery. Individuals with chronic relapsing diseases should have access to MAT. It’s just the standard of care. We cannot diminish the importance of that.

Substance use disorders are not simply treated by taking a medication. In fact, taking medications can be part of the problem. Just giving someone medication is not enough. Psychosocial interventions, counseling, and other services are absolutely necessary and will always be very important.

Integrated care providers are going to have to learn about how to use these medications. Many medications can be used within primary care. We’re going to see a spectrum of severity with clients in primary care. Some may need referral to specialty care and others can be treated at the primary care organization.”

The interview can be accessed at: http://www.atforum.com/addiction-resources/documents/SAMHSA-MAT-A-Standard-of-Care-Feb-2014.pdf

Source: The Substance Abuse Mental Health Services Administration – February 2014

How Obamacare May Lower the Prison Population More Than Any Reform in a Generation

healthcare reform 2“While many have focused on the individual mandate, and the online (and glitchy) insurance exchanges, one of the most potentially impactful elements of the Patient Protection and Affordable Care Act (ACA) has flown more or less under the radar. It may be the biggest piece of prison reform the U.S. will see in this generation.

The Justice Department estimates suggest that with the expansion of Medicaid, 5.4 million ex-offenders currently on parole or probation could get the health care they need. (It’s important to note that 25 states plus Washington, D.C. have implemented the Medicaid expansion as of 2014. However, many policy experts expect the remaining states to fall in line, citing the historical example of how CHIP was initially rejected by many states when it rolled out in 1997, but is now utilized in every state in the country.)

Even with coverage, those ex-offenders will still need to actually utilize those health benefits, and the key will be making the connection at the time of release. The biggest challenge will be getting state justice systems and health systems – not exactly happy bedfellows in past years – to work together to create coordinated discharge planning between jails and community healthcare.”

http://www.newsweek.com/how-obamacare-may-lower-prison-population-more-any-reform-generation-230695

See related article from the George Washington University Milken School of Public Health –  Affordable Care Act Brings Crucial Health Coverage to Jail Population available at: http://sphhs.gwu.edu/content/affordable-care-act-brings-crucial-health-coverage-jail-population

See related article from the Fix – Obamacare Rolls Out, Transforming Addiction Coverage available at: http://www.thefix.com/content/obamacare-rolls-out-addiction-coverage-transforms

Source: Newsweek.com – March 10, 2014

Doctors Urge FDA to Reverse Approval of Zohydro, Controversial New Pain Drug

zoA coalition of addiction experts, physicians and others is urging U.S. health officials to reverse course and block the launch of a powerful painkiller called Zohydro, expected to hit the market next month. The opioid drug, manufactured by Zogenix Inc, contains a potent amount of an active ingredient that could be lethal to new patients and children and is not safer than other current pain drugs, the groups told the Food and Drug Administration.

In December, attorneys general from 28 states also urged the FDA to reconsider its approval of the drug.”

http://www.nydailynews.com/life-style/health/docs-urge-fda-halt-launch-controversial-pain-drug-article-1.1706470

Source: New York Daily News – February 28, 2014

National Institute on Drug Abuse (NIDA) Updated Research Report on Heroin

NIDA Blog: Addiction and Free Choice

choices“The recent death of Phillip Seymour Hoffman as a result of drug addiction has provoked many thoughtful, sympathetic responses in the media, from people in recovery who understand how hard it is to wrestle with addiction, as well as from scientifically informed journalists who understand that addiction is a disease. But it has also prompted others to express the age-old notion than drug use is a choice, and that those who die as a consequence of their drug use are just reaping the consequences of their freely chosen actions. It is unfortunate that that view persists in our society, despite the decades of scientific research soundly disproving it.

Choices do not happen without a brain—it is the mechanism of choice. The quality of a person’s choices depends on the health of that mechanism. However much we may wish that a person’s choices were free in all instances, it is simply a fact that an addicted person’s failures in the realm of choice are the product of a brain that has become greatly compromised—it is readily apparent when we scan their brains. Even if taking a drug for the first time is a “free” choice, the progression of brain changes that occurs after that involves the weakening of circuits in the prefrontal cortex and elsewhere that are necessary for exerting self-control and resisting the temptations of drug use. Once addiction takes hold, there is greatly diminished capacity, on one’s own, to stop using. This is why psychiatry recognizes addiction as a disease of the brain, and why professional intervention is needed to treat it in most instances.

Moreover, even the “freely willed” first choice to take a drug cannot be the basis for judgment and stigma against people suffering from addictions. Matters of choice and lifestyle—what you eat, how active you are, where you live—may contribute to the risk for, or even directly cause, a wide range of medical conditions, including chronic diseases like heart disease, type 2 diabetes, and several cancers. We do not withhold or impede treatment of people suffering from those conditions, even if their health may have turned out differently had they made different choices at various points in their lives.

There is no way of precisely predicting which freely chosen adolescent drink, or cigarette, or experimentation with an illegal substance, opened the door to a later loss of free-choice capacity in a person who has become addicted. But once addiction is established, the sufferer from this disease cannot will themselves to be healthy and avoid drugs any more than a person with heart disease can will their heart back to perfect functioning, or a person with diabetes can will their body’s insulin response to return to normal.

Thus, those who say “it was their own choice” after a person dies of an overdose fail to grasp that an addicted person’s brain has a disrupted choice mechanism. And as revealed by Hoffman’s tragic, ultimately fatal relapse into drug taking, the neuronal disruptions in the brain of an addicted person can persist even after decades of sobriety. Speaking of “free choice” is simply not useful when trying to understand an individual’s addiction or its consequences, as addiction is precisely a disease that disrupts the neuronal circuits that enable us to exert free choice.”

http://www.drugabuse.gov/about-nida/noras-blog/2014/02/addiction-free-choice

Source: National Institute on Drug Abuse Dr. Nora Volkow Director – February 18, 2014

Supreme Court: Heroin Dealer Can’t be Given Longer Sentence Because Client Died

Pg8_law“The U.S. Supreme Court unanimously ruled a heroin dealer cannot be held liable for a client’s death and given a longer sentence if heroin only contributed to the death, and was not necessarily the only cause.

The ruling is likely to result in a shorter sentence for Marcus Burrage, who received 20 extra years in prison because of his client’s death, according to USA Today. The decision is also likely to make it more difficult in the future for prosecutors to extend drug sentences, the article notes.”

SAMHSA’s New Report Tracks the Behavioral Health of America

 

samhsa“A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends – many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.

SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key indicators of behavioral health problems including rates of serious mental illness, suicidal thoughts, substance abuse, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.

The Barometer indicates that the behavioral health of our nation is improving in some areas. For example, the rate of prescription pain reliever abuse has fallen for both children ages 12-17 and adults ages 18-25 from 2007 to 2011 (9.2 percent to 8.7 percent and 12.0 percent to 9.8 percent respectively).

In the United States, only 14.8% of persons aged 12 or older with illicit drug dependence or abuse (an estimated 1.1 million individuals) in 2012 received treatment for their illicit drug use within the year prior to being surveyed.

The Barometer also shows more people are getting the help they need in some crucial areas. A case in point is that the number of people getting buprenorphine treatment for a heroin addiction has jumped 400 percent from 2006 to 2010. In 2012 the number of people who received buprenorphine as part of their substance abuse treatment was 39, 223. The number of people who received methadone as part of their substance abuse treatment was 311,718 in 2012.

The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.

“The Barometer is a dynamic new tool providing important insight into the “real world’ implications of behavioral health issues in communities across our nation,” said SAMHSA’s Administrator, Pamela S. Hyde.”Unlike many behavioral health reports, its focus is not only on what is going wrong in terms of behavioral health, but what is improving and how communities might build on that progress.”

The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.”

To view and download copies of the national or any state Behavioral Health Barometer, please visit the SAMHSA web site at http://store.samhsa.gov/product/SMA13-4796?from=carousel&position=1&date=0130214

http://www.samhsa.gov/newsroom/advisories/1401301041.aspx

Source: – Substance Abuse and Mental Health Services Administration – 1/31/14

Winter 2014 Issue of SAMHSA News Now Available Online

Articles of interest on parity and the Affordable Care Act include:

  •  Final Parity Rule Issued – Learn what the final rule on the Federal Parity Law means for insurance coverage of behavioral health services.
  • Affordable Care Act Update – Q&As on the Health Insurance Marketplace and the latest on efforts to enroll consumers.

http://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_1/default.aspx

Source: Substance Abuse and Mental Health Services Administration – February 3, 2014

From the Publisher—Special Issue on Recovery From Opioid Addiction

people-sunlight

For six decades methadone maintenance has been an approved treatment for opioid addiction. People who are taking methadone are no different from those who manage their diabetes by taking insulin: they are in recovery. Yet some policymakers—and even some medical, and yes, some addiction authorities—don’t believe it. Although that may change as more and more professionals buy into the scientific fact that addiction is a brain disease, and therefore it can be treated, and people can recover from it.

The federal government, from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the Office of National Drug Control Policy (ONDCP), states that medication-assisted treatment (MAT) is recovery. In this issue, we write about a comprehensive literature review funded by SAMHSA demonstrating the efficacy of MAT. And we cover an article by William L. White describing the stigma and other obstacles methadone patients face when joining 12-step groups—and the important role these groups could play in helping patients in recovery. We also interview Walter Ginter, peer, patient, and advocate, who spoke before the ONDCP in December on the topic of recovery and MAT. Mr. Ginter, a methadone patient in long-term recovery, is an articulate spokesman for methadone and for patients, helping to guide peer services across the country from his position at MARS, in New York City. We also interview Zac Talbott, based in the less-welcoming South, about his work as an advocate.

Not all of the news is good: In New Jersey, a state that strongly endorses methadone as a treatment for opioid-dependent pregnant women, a woman is facing child abuse and neglect charges simply for being in a methadone program while pregnant. The Supreme Court is due to hear the case, and legal and medical authorities are hopeful that the court will not in effect ban MAT for pregnant women. The woman was in recovery, doing the right thing for herself and her baby, yet was reported, and was held by a lower court to have committed child abuse and neglect by being on methadone while pregnant. On the bright side, the best legal and medical minds who know about MAT have filed a friend of the court brief on the mother’s behalf.

In Philadelphia, where AT Forum attended the AATOD conference last fall, recovery transformation is happening in a solid way, moving from treating addiction as an acute episode to a continuum instead, in which someone enters recovery as a person, not a patient. Roland Lamb discusses efforts to help opioid treatment programs (OTPs) provide what is needed for recovery, with more of a focus on the person than on the dosage and the monitoring. Methadone is a way to recovery—that’s why it was created—but the person taking it is the point of recovery.

Finally, a new evidence-based document from ASAM provides guidance for safe methadone induction and stabilization in OTP patients. This is the first time this vital information has been brought together in one place. Our article by Stewart Leavitt is recommended reading for everyone interested in methadone maintenance treatment.

I hope you enjoy this issue, and we look forward to your comments and feedback.

Sue Emerson
Publisher

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

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

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

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

Here are two salient points:

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

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

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

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

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

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

Parity Law Has Little Effect on Spending For Substance Abuse Treatment

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

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

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

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

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

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

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

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

Source: MedicalExpress.com – January 24, 2014

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

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

But there is good news.

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

Some highlights from the bill:

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

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

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

Source: WhiteHouse.gov – January 17, 2014

Blog: What Health Care Reform Could Mean for Drug Policy and Mass Incarceration

healthcare reform 2“What does the Affordable Care Act (ACA) mean for drug policy?. A new issue brief – From Handcuffs to Healthcare — published by the Drug Policy Alliance (DPA) and the American Civil Liberties Union(ACLU) outlines how the ACA could help our country end the war on drugs and move toward a health-based approach to drug policy

This paper is intended as a starting framework for criminal justice and drug policy advocates to navigate the ACA, and to take advantage of the conceptual and practical opportunities it offers shifting the conversation and the landscape.

Part One of this paper describes some of the major provisions of the ACA relevant to our work: the health insurance requirement; the places many people will buy insurance, called health exchanges; Medicaid expansion; insurance coverage requirements for substance use and mental health disorders; and opportunities for improved models of coordinated care.

Part Two of this paper outlines a series of practical recommendations, including program and policy examples and suggested action steps, across three broad categories:

  • Ensuring access to care for people most likely to be steered into the criminal justice system under the current framework
  • Leveraging the ACA to reduce incarceration and criminal justice involvement
  •  Moving from a criminalization-based drug policy approach to one rooted in health

The Brief can be accessed at: http://www.drugpolicy.org/sites/default/files/Healthcare_Not_Handcuffs_12.17.pdf

Source: HuffingtonPost.com - December 3, 2013 and DrugPolicy.org – December 2013

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