Genes Found That May Protect Infants Born to Addicted Mothers

“Genes tied to addiction in adults may help guide doctors to better treatments for infants born withdrawing from narcotics, according to researchers who identified the genetic link.

Babies exposed in the womb to opioid drugs who have certain variations to two genes had less severe withdrawal symptoms than those without the variants, according to a study in the Journal of the American Medical Association. The babies left the hospital sooner and needed fewer treatments, researchers said. The study, the first to look at the link between genetics and opioid withdrawal in infants, may help researchers find more effective way to treat these babies, said Jonathan Davis, senior study author and chief of newborn medicine at Floating Hospital for Children at Tufts Medical Center in Boston.”

http://www.businessweek.com/news/2013-04-30/genes-found-that-may-protect-infants-born-to-addicted-mothers

Source: BusinessWeek.com – April 30, 2013

Vaccine Halts Heroin Addiction in Rats

Needle1“A vaccine to treat heroin addiction has proven effective in keeping drug-addicted rats from relapsing in a preclinical trial, according to a study published this week in Proceedings of the National Academy of Sciences. Researchers from the Scripps Research Institute in California say the vaccine is now ready for human trials.

Initial research into the vaccine in 2011 found that it could effectively keep rats from becoming addicted to heroin without affecting the pain relief they experienced from other opiates. This study built on those results using rats that were already addicted, finding that the vaccine could keep them from resuming compulsive drug-taking behavior even after they experienced withdrawal.”

http://www.popsci.com/science/article/2013-05/vaccine-halts-heroin-addiction-rats

Source: PopSci.com – May 7, 2013

New Poll Ranks Chronic Pain Well Below Drug Addiction As A Major Health Problem

“A new national public opinion poll commissioned by Research!America shows only 18% of respondents believe chronic pain is a major health problem, even though a majority of Americans (63%) say they know someone who experienced pain so severe that they sought prescription medicines to treat it. Chronic pain conditions affect about 100 million U.S. adults at a cost of approximately $600 billion annually in direct medical treatment costs and lost productivity.

Most Americans are concerned about the misuse of pain medication to treat chronic pain. A high percentage (82%) believes that taking prescription painkillers for long-term, chronic pain could result in addiction, which nearly 50% of Americans describe as a major health problem. An overwhelming majority (85%) are very concerned or somewhat concerned that prescription pain medication can be abused or misused. Indeed, 40% believe that prescription medication abuse and addiction is a major problem in their community.”

http://www.medicalnewstoday.com/releases/258897.php

Source: MedicalNewsToday.com – April 12, 2013

NASADAD Prescription Drug Inquiry Reveals SSAs Very Concerned About Prescription Drug Misuse and Abuse

doctor and prescription bottlePrescription drug abuse—something a whole industry of monitoring and law enforcement is growing up around—is a public health problem first, according to the state substance abuse officials responsible for treatment and prevention. That said, these same directors—the single state agencies (SSAs) with authority over the Substance Abuse Prevention and Treatment block grant—also want to participate in the prescription drug abuse conversation, explains Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD).

Based on an inquiry of its entire membership, NASADAD staff found that single state agencies consider prescription drug misuse and abuse very important—for some, the most important—issue they face. The inquiry took place last year and was released in fall of 2012.

Forty-seven states responded to the inquiry, which yielded the following results:

  • Prescription drugs are the most important issue affecting states (23%), very important (58%), or important/moderately important (19%)
  • Of the states surveyed,
    • 62% currently have a task force addressing prescription drugs
    • 15% had a task force on prescription drugs that completed its work
    • 68% passed legislation in the past 5 years addressing prescription drug misuse and abuse
    • 83% have undertaken education efforts about prescription drug abuse for the general public
  • Among states with prescription drug monitoring programs (PDMPs),
    • 54% have some single state agency (SSA) involvement with the PDMP
    • 43% have no SSA involvement with the PDMP
    • 64% find PDMP data very useful or useful
    • 13% describe the data as somewhat useful in addressing prescription drug abuse issues

There are continued challenges to SSAs trying to address prescription drug misuse and abuse “related to data, funding constraints, collaboration, workforce development, public education, and ease of access to pills,” according to the report. It found that “although PDMPs and the data they provide are useful to SSAs, the level of oversight, access, and involvement of SSAs continues to be limited.”

Great emphasis has been placed on addressing the utility of PDMPs, but it’s important for the SSAs, as the public health and treatment experts, to be involved. SSAs would like to have more oversight, access, and involvement with PDMPs, according to the report.

In only three states—Vermont, Maine, and Maryland—is the PDMP operated under the purview of the SSA, and the agency could use the information to help get people who are misusing or abusing medications into appropriate treatment. “We have a steep growth curve here,” says Henrick Harwood, research director of NASADAD. “We need to increase the education so prescribers can help people get into treatment.”

The Office of National Drug Control Policy (ONDCP) has been very helpful in issuing a strategy and structure around which to build a public health approach to prescription drug abuse, says NASADAD’s Mr. Morrison.

 Connection to MAT

There is a clear connection between prescription opioid abuse and medication-assisted treatment (MAT). Many patients newly admitted to treatment are dependent on opioids—either because they started taking them for pain, then began misusing them, or abused them from the beginning. When they try to stop, they go into withdrawal. So some states have increased training for treatment staff, in particular on prescription drug abuse and on MAT.

And there are particular challenges for states in addressing prescription drug abuse. For example, PDMP data aren’t always of good quality or easy to utilize, according to the report. And substance use disorder treatment providers don’t always have a way to access it. There is also a dearth of financial resources, with lack of adequate funding for MAT and lack of funding for naloxone overdose kits, a promising public health response to overdoses, according to the report. And there are problems with states’ proposing to restrict MAT funding.

The NASADAD report is available at: http://nasadad.org/wp-content/uploads/2012/10/NASADAD-Report-SSAs-and-Prescription-Drug-Misuse-and-Abuse-09.20121.pdf

Stress & Addiction: Research Identifies How Stress Triggers Drug Relapse

Recent research from Brown University could pave the way for new methods of treatment for those recovering from addiction. Researchers identified an exact brain region in rats where the neural steps leading to drug relapse take place, allowing them to block a crucial step in the process that leads to stress-induced relapse.

Prior research has established that acute stress can lead to drug abuse in vulnerable individuals and increase the risk of relapse in recovering addicts. But the exact way that stress triggers the neural processes leading to relapse is still not clearly understood. The Brown study provides new insights on how stress triggers drug abuse, and could lead to more effective treatments for addiction. “

http://www.huffingtonpost.com/2013/03/11/stress-addiction-drug-relapse_n_2837819.html

Source: HuffingtonPost.com – March 11, 2013

Drug Abuse Treatment Could Save Billions in Criminal Justice Costs

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community.

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.

The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison.

According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.

The study builds on previous research led by RTI indicating that increased investment in treatment for substance-abusing prisoners can reduce crime rates and cut criminal justice spending. In a study released earlier this year, Zarkin and colleagues found that increasing and improving prison-based drug treatment programs could save up to $17 billion in criminal justice system costs.

http://www.newswise.com/articles/study-replacing-prison-terms-with-drug-abuse-treatment-could-save-billions-in-criminal-justice-costs

Source: RTI International – January 9, 2013

Parents Numb to Misuse of Narcotic Pain Meds by Youth, New Poll Shows

Despite data on rising rates of abuse and overdoses of narcotic pain medicines across all age groups, in a new poll from the University of Michigan, most parents said they are not very concerned about misuse of these medicines by children and teens.

In addition, parent support was lukewarm for policies that would discourage abuse of drugs like Vicodin or Oxycontin, according to the most recent University of Michigan Mott Children’s Hospital National Poll on Children’s Health.

Report highlights include:

  • ¨About one-third of parents report they had received at least one pain medicine prescription for their children in the last five years.
  • ¨35% of parents are very concerned about misuse of narcotic pain medicines by children and teens in their communities; only 19% are concerned about misuse in their families.
  • ¨Nearly one-half of parents do not favor a requirement that they return unused pain medicine to the doctor or pharmacy.

The press release is available at: http://www.newswise.com/articles/parents-numb-to-misuse-of-narcotic-pain-meds-by-youth-new-poll-shows

Source: Newswise/University of Michigan Health System – January 23, 2013

U.S. Military Working on Combination Anti-Heroin/HIV Vaccine

A scientist at the Walter Reed Army Institute of Research is developing a vaccine designed to treat heroin addiction while at the same time prevent HIV infection. This project is one of a number of research initiatives around the world that are working toward new vaccines to fight addiction.

The National Institute on Drug Abuse recently pledged $5 million toward Dr. Gary Matyas’ work on the new dual vaccine. The goal of the vaccine is to fight heroin abuse and the high risk of HIV infection among heroin users who inject the drug.

 http://www.drugfree.org/join-together/addiction/u-s-military-working-on-combination-anti-heroinhiv-vaccine

Source:  JoinTogether.org – November 30, 2012

PMPs Need to be More ‘User-Friendly’ for Physicians, Study Finds

There are barriers to prescribers’ use of prescription monitoring programs (PMPs), according to researchers from the American College of Medical Toxicology (ACMT). In a June 21 New England Journal of Medicine Perspective article, Jeanmarie Perrone, MD, and Lewis Nelson, MD, found that PMPs, with some simple improvements, could be much more useful to physicians.

The most frustrating aspect of PMPs is the time it takes to use these programs. “Even if it takes only three minutes per patient, in a busy emergency department or office practice, having to do this multiple times daily amounts to a substantial time investment,” said Dr. Lewis in a press release from the ACMT. Much of the time is spent navigating to the correct web portal, they found. The physicians need to recall the password—and reset it. And many physicians found that once they did gain access, up-to-date information was not available for each patient.

Because time is the major barrier to physician use of PMPs, it would be helpful to have programs be more user-friendly, the researchers found.

Despite the barriers, the potential benefits of PMPs are great, the researchers said, noting that with enhancements to systems, these programs may help reduce prescription drug abuse.

For the research, Drs. Perrone and Lewis looked at opioid prescribing practices of ACMT members, and presented their results at the March national meeting.

For the free full-text article, go to http://www.nejm.org/doi/full/10.1056/NEJMp1204493

Study Finds Methadone Take-homes Reduce Acute Care Hospitalizations

It’s been known that among patients receiving methadone maintenance treatment (MMT) for opioid dependence, take-home privileges and methadone doses of at least 80 mg/day are associated with better treatment outcomes. But what hasn’t been known is whether patients with take-homes also have fewer acute care admissions, and consequently lower health care costs, or whether they have better health to begin with, thus fewer admissions.

Researchers at three leading academic centers designed a study to find out.

They conducted a retrospective medical record review of 138 patients enrolled in the MMT program at Boston Public Health Commission between 2006 and 2008. The study adjusted for differences in age, sex, race/gender, HIV infection, chronic medical illness, mental illness, and polysubstance use at admission. Thus, patients with these conditions were equally represented in the take-home group and the non-take-home group.

The study found that patients with take-homes had one-fourth the odds of hospital admission of those without take-homes. As expected, medical illness was associated with higher odds of hospital admission. Common diagnoses at hospitalization included pneumonia, upper respiratory infection, cardiac conditions, gastrointestinal conditions, infections, asthma, chronic obstructive pulmonary disease, and trauma. Methadone dose of at least 80 mg/day was not associated with decreased hospital admissions.

The authors wrote, “Although this analysis does not determine whether take-home status directly reduces hospitalization or is a marker of other unmeasured factors, it does account for other known predictors of hospital admission . . . ”  So a difference in health status does not account for the fewer admissions of those with take-homes.

Key Finding: Fewer Admissions Are Not Related to Better Health at Study Entry

“By demonstrating an association between take-home status and hospitalization, an important medical and health system cost outcome, this study supports consideration of take-home status as a useful performance measure reflecting direct benefit to individual patients and the wider health care system.”

In other words, they found the answer to their question: patients with take-homes also have fewer acute care admissions, and consequently lower health care costs, and it is not because they have better health to begin with.

The finding of significantly lower odds of hospital admission carried an adjusted odds ratio of 0.26; 95% confidence interval 0.11-0.62 means that the results are considered statistically valid, regardless of the number of patients.

Authors of the study were seven investigators from Boston University, Vanderbilt University, and Brown University. The National Institute on Drug Abuse provided partial funding. The Journal of Addiction Medicine published the study online June 12.

Walley AY, Cheng DM, Pierce CE, et al. Methadone dose, take home status, and hospital admission among methadone maintenance patients. J Addict Med. 2012. June 12. [E pub ahead of print.]

The Abstract is available at: http://www.ncbi.nlm.nih.gov/pubmed/22694929

NIDA Backs Research on Vaccine Against Heroin, HIV

The National Institute on Drug Abuse (NIDA) has issued a $5 million grant to Gary Matyas, PhD, to support his research into a new vaccine that could treat heroin addiction as well as prevent HIV infection in those receiving the vaccine. Matyas, of the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Md., is the 2012 recipient of the NIDA Avant-Garde Award for Medications Development and will receive $1 million a year for five years.

NIDA and WRAIR began a research collaboration on development of the joint vaccine two years ago. At this point, the heroin component of the combination vaccine has been created and is ready for advanced preclinical testing. Matyas noted that “The possibility of creating a combination heroin-HIV vaccine provides an important opportunity to address both a unique treatment for heroin abuse as well as continuing the quest to develop an effective preventive HIV vaccine.”

http://alert.psychiatricnews.org/2012/07/nida-backs-research-on-vaccine-against.html

Source: American Psychiatric Association – July 26, 2012

Take-Home Methadone Maintenance Treatment Associated With Decreased Hospital Admissions

hospital signPatients in methadone maintenance patients that exhibit treatment successes, including regular attendance at clinic and counseling sessions, as well as passing urine screenings for illicit drug use, are rewarded with “take home” methadone doses. Previous studies have shown that receiving “take home” doses and receiving doses of 80 milligrams or more are associated with improved addiction treatment outcomes, but the impact of these factors on hospitalizations was unknown.

To explore these questions, the researchers performed a retrospective analysis of 138 patients enrolled in the Boston Public Health Commission’s MMT program for a period of two years between 2006 and 2008. The results showed that patients receiving “take home” methadone doses were substantially less likely to be admitted to the hospital with 74 percent lower odds of hospitalization. The data also showed no evidence that the dose of methadone was associated with hospitalization.

http://www.medicalnewstoday.com/releases/246641.php

Source: MedicalNewsToday.com – June 18, 2012

Data Suggests Drug Treatment Can Lower U.S. Crime

U.S. crime statistics show illegal drugs play a central role in criminal acts, providing new evidence that tackling drugs as a public health issue could offer a powerful tool for lowering national crime rates, officials said on Thursday.

Based on thousands of arrestee interviews and drug tests, the study showed that on average 71 percent of men arrested in 10 U.S. metropolitan areas last year tested positive for an illegal substance at the time they were taken into custody.

According to Dr. Redonna Chandler of the National Institute on Drug Abuse, 5 million of an estimated 7 million Americans who live under criminal justice supervision would benefit from drug treatment intervention. But only 7.6 percent actually receive treatment.

The 2011 Adam II Annual Report can be accessed at: http://www.whitehouse.gov//sites/default/files/email-files/adam_ii_2011_annual_rpt_web_version_corrected.pdf

http://www.reuters.com/article/2012/05/17/us-usa-drugs-idUSBRE84G06G20120517

Source:  Reuters.com – May 17, 2012

Research Study: Technique Rewrites Addicts’ Memories

 Researchers in China have developed a technique that rewrites the memories of drug addicts to lessen their association with pleasure and help prevent them from relapsing.

The study’s findings may be a useful addition to existing treatments for recovering addicts, who are vulnerable to relapse even after undergoing rehabilitation programs which include “extinction procedures” to help patients control cravings

http://www.healthcare-today.co.uk/news/technique-rewrites-addicts-memories/21665/

Source:  Healthcare Today – April 17, 2012

Insomnia in Methadone Maintenance Patients Does Not Respond to Trazodone – Research Abstract

massage sleepA recent study sought to learn if trazodone (marketed as Desyrel and Oleptro) could help recovering drug abusers sleep better. The study concluded that the trazodone did not help this population of patients.

BACKGROUND: To test whether trazodone, one of the most commonly prescribed medications for treatment of insomnia, improves subjective and/or objective sleep among methadone-maintained persons with sleep complaints, a randomized, double-blind, placebo-controlled trial with 6-month follow-up was performed.

METHODS: From eight methadone maintenance programs in the northeastern U.S., 137 persons receiving methadone for at least 1 month who reported a Pittsburgh Sleep Quality Index (PSQI) score of six or higher were recruited. Two-night home polysomnography (PSG) was completed at baseline and 1 month later, with morning surveys and urine drug toxicologies. Interviews assessed sleep over the past 30 days at baseline and 1-, 3-, and 6-month follow-ups.

RESULTS: Participants averaged 38 years of age, were 47% male, and had a mean PSQI total score of 12.9 (±3.1). At baseline, intervention groups did not significantly differ on 10 PSG-derived objective sleep measures and 11 self-reported measures. Over 88% (n=121) of participants completed the PSG at 1-month. Without adjusting p-values for multiple comparisons, only 1 of 21 sleep measure comparisons was statistically significant (p<.05). The effect of trazodone on mean PSQI scores during the 6-month follow-up was not statistically significant (p=.10). Trazodone neither significantly increased nor decreased illicit drug use relative to placebo.

CONCLUSIONS: Trazodone did not improve subjective or objective sleep in methadone-maintained persons with sleep disturbance. Other pharmacologic and non-pharmacologic treatments should be investigated for this population with high rates of insomnia.

The article abstract is available at: http://www.ncbi.nlm.nih.gov/pubmed/21798674

The article was published in the January 1, 2012 issue of Alcohol and Drug Dependence.

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