AATOD Conference Recap, Progress Report, and Future Challenges

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AATOD Conference Recap, Progress Report, and Future Challenges

AATOD ConferenceThe 1,500 attendees of the national conference of the American Association for the Treatment of Opioid Dependence (AATOD) in Atlanta knew that they were part of a unique time in the history of our nation and medication-assisted treatment (MAT). They heard top federal officials speak about the opioid epidemic, something that these officials have been discussing publicly on a regular basis. Treating opioid addiction is not just the province of opioid treatment programs (OTPs)─it has become an essential agenda item for our country’s top public health leaders.

The conference, “Addressing a Public Health Crisis: Opioid Dependence,” was held March 28-April 1 and hosted by the Georgia Department of Behavioral Health and Developmental Disabilities and the Opioid Treatment Providers of Georgia.

AATOD president Mark W. Parrino, MPA, said in his opening statement that there is now an “extraordinary alignment” of federal agencies and Congress to increase access to treatment for opioid addiction.

Plenary Speakers

The plenary speakers presented compelling data proving that the country is in the midst of an opioid epidemic, and that top leaders are on board to do something about it.

Richard Dart, MD, Director, Rocky Mountain Poison and Drug Center, and Executive Director, Researched Abuse, Diversion, and Addiction-Related Surveillance (Radars System) discussed his recently published article in the New England Journal of Medicine on current trends in the use and abuse of prescription opioids and the transition to heroin use. (For an abstract of the article, go to http://www.ncbi.nlm.nih.gov/pubmed/25587948.)

Trends data were also presented by Kimberly Jeffries Leonard, PhD, deputy director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), and Tom Frieden, MD, director of the Centers for Disease Control and Prevention (CDC). This data also clearly confirmed that the opioid epidemic is here, and that heroin is a big part of it.

Reverend Fred Brason II, President/CEO of Project Lazarus, provided examples of his work in preventing opioid overdose deaths in North Carolina; he is leading the way in working with OTPs on getting naloxone kits to patients. In fact, a number of OTPs are already using such opioid overdose prevention kits with newly admitted patients and with patients who have yet to stabilize in maintenance treatment, noted Mr. Parrino. “We expect that this initiative will increase as funding is provided and as OTPs work with state authorities.”

Michael Botticelli, director of the Office of National Drug Control Policy (ONDCP), closed the conference, along with SAMHSA administrator Pam Hyde. He stressed how it’s important to work treatment into discussions about prescription drug monitoring programs (PDMPs) and naloxone, the two top items on the opioid agenda of the federal Department of Health and Human Services and the ONDCP. Mr. Botticelli said the

PDMP data should be used to get treatment to the people who need it instead of just cutting off their supply. There should also be more thoughtful uses of naloxone─when someone has an overdose reversed, that person should be referred to treatment.

It was clear that the federal government agencies represented─the Centers for Disease Control and Prevention, the ONDCP, and SAMHSA─were working together closely. There is a better degree of coordination at the policy-making level than has ever been seen before when it comes to opioid addiction treatment, said Mr. Parrino. “This was a noticeable change for me,” he said. “They were very much on the same page. We need to educate the public.”

Upcoming Policy White Papers

During the policy luncheon, Mr. Parrino discussed three policy white papers AATOD is preparing for SAMHSA. The papers will address:

  • Increasing the referral capability and integration of OTPs with buprenorphine office-based practices, primary mental health care, and primary health care, with the aim of developing models for OTPs to be “hub” sites, as in Vermont;
  • Integrating OTP services in three special population groups: drug courts, correctional facilities, and child protective services; and
  • State innovations, such as the hub-and-spoke system in Vermont and the health homes in Maryland and Rhode Island.

The policy luncheon was devoted to the topic of innovative models of care, which will be growing increasingly over the next five years. The white papers will be finished this year, and will help cast the system into a “forward-thinking” set of models of care, Mr. Parrino said at the luncheon.

International

There were about 40 international participants at the conference, and the international sessions had their best attendance ever, said Mr. Parrino. That means there is an increasing interest in how international colleagues present material, and how relevant the attendees from the United States think the international material is, he noted.

Awards Banquet

The banquet speech by Governor Peter Shumlin of Vermont was passionate and inspiring, and was informative about OTPs and all medication-assisted treatment, including methadone. “Many of my colleagues do not get the chance to hear a governor say such supportive things about their work,” said Mr. Parrino. Governor Shumlin, who won the Friend of the Field Award, spoke with knowledge and compassion, and with an urgency that said, “something must be done, now.”

Recipients of the Nyswander/Dole Award, which recognizes outstanding contributions to opioid treatment, included:

  • Henry Bartlett, MS – New York
  • Donna Boone, MD – Illinois
  • JoAn Brown, LAC – Louisiana
  • Richard Froncillo, LCDS – Pennsylvania
  • Sara Hartman, MSW – Massachusetts
  • Jason Kletter, PhD – California
  • Yngvild Olsen, MD – Maryland
  • Lorenzo Somaini, MD – Italy
  • Rubie Walker, MA – Arizona

The Richard Lane/Robert Holden Patient Advocacy Award was given to Claude Hopkins, CADC.

Progress

While progress may sometimes seem bumpy, in fact there are great strides being made in terms of familiarizing Congress and the federal government in general with medication-assisted treatment, said Mr. Parrino. “What AATOD does, and I say this with pride, was clearly reflected in the five days of the conference─and that is providing the connective tissue to policy makers.”

AATOD is also working with partners─the Legal Action Center, SAMHSA, and the National Association of Drug Court Professionals─to make sure drug court participants have access to MAT, said Mr. Parrino. In addition, communication between AATOD and the Centers for Medicare and Medicaid Services is ongoing, to make sure Medicaid and Medicare cover treatment in OTPs, he said.

BaltimoreThe next AATOD conference will be at the Baltimore Marriott Waterfront, October 29-November 2, 2016.

Categories: 2015-05-17, Addiction, Healthcare Reform, Heroin, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Prescription Drugs
Tags: AATOD, Addiction, Buprenorphine, Heroin, Methadone Treatment, Opioid Treatment Programs, Overdose, Prescription Opioids, Substance abuse treatment

News & Updates – April 27, 2015; Issue 219

MEDICATION-ASSISTED TREATMENT AND OPIOID USE/ADDICTION

MISCELLANEOUS

LINKKS TO MORE NATIONAL NEWS

Categories: 2015-04-27, News Updates, TOC

Dr. Jana Burson Blog: Confusion over Methadone Peak and Trough Levels

jana burson“Recently I’ve had patients write to my blog describing how their opioid treatment program doctors are using methadone blood levels to determine the correct dose. What they described to me was worrisome; patients’ doses rarely need to be checked with methadone peak or trough blood levels. Due to tolerance, a methadone blood level may be adequate for one patient, but far too low for other patients.

A patient’s dose of methadone needs to be determined on clinical grounds. This can include the patient’s description of withdrawal symptoms and their timing related to dosing, physical exam just before the patient is due for a dose, and evaluation of the patient three to four hours after dosing. It may also include an evaluation of ongoing illicit opioid use, other medical issues, and other medication or illicit drug use.”

Read more at: https://janaburson.wordpress.com/2015/04/19/confusion-over-methadone-peak-and-trough-levels/

Categories: 2015-04-27, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs)
Tags: Methadone Dosing, Methadone Treatment, Opioid Treatment Programs, OTP Patient Safety, OTP Patients

Congressman Richard Neal Introduces Bill to Limit Lawsuits in the Administration of Opioid Overdose Drugs

home-featured-naloxone“U.S. Rep. Richard E. Neal has introduced bipartisan legislation into the House of Representatives that would exempt from civil liability the administration of opioid overdose-reversing drugs, like naloxone, on an emergency basis, by people who prescribe or are prescribed them.

“Prescription drug and heroin overdoses have reached epidemic proportions in the United States,” the Massachusetts Democrat said in a release. Sen. Edward J. Markey (D-MA) is among the co-sponsors of a companion bill in the Senate, along with Senators Tim Kaine (D-VA), and Kelly Ayotte (R-NH).”

“In the past 10 years, opioid prescriptions have doubled. Every day, 120 people overdose on illegal drugs and prescription painkillers. Drugs like naloxone provide the means to counteract the effects of opioid overdoses,” Neal said. “This is a life-saving treatment, but many are deterred from providing these medications for fear of litigation. This bipartisan legislation hopes to correct that resistance immediately.”

Read more at: http://www.masslive.com/news/index.ssf/2015/04/congressman_richard_neal_intro.html

Source: MassLive.com – April 17, 2015

Categories: 2015-04-27, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Addiction, Heroin, OTP Patient Safety, Overdose, Prescription Opioids

American Medical Association (AMA) Statement to the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations Hearing on “Combatting the Opioid Abuse Epidemic: Professional and Academic Perspectives” Summary

  • “There is no question that we are in the midst of an epidemic of prescription drug opioid misuse, abuse, overdose, and deaths from such drugs. At the same time, we are seeing an alarming related trend, with patients turning to illicit drugs such as heroin as the supply of prescription drugs decreases.
  • The issues are complex and there is no one answer or solution, but we must approach the problems with a public health focus.
  • As physicians, we need to take ownership and responsibility for prevention. We need to ensure that patients experiencing pain are appropriately treated, and that patients who abuse or misuse opioids are referred to and have access to treatment programs.
  • The American Medical Association is providing leadership and working on a number of fronts to offer and implement specific strategies to deal with this epidemic. We are working with a diverse array of stakeholders at the federal and state levels to effect change.
  • We have specific recommendations to address solutions. First, we support enhancing education and training of physicians, prescribers, and patients to ensure informed prescribing decisions to prevent and reduce the risks of opioid abuse. We are developing new training materials on responsible opioid prescribing through a SAMHSA grant.
  • We need to ensure that patients in pain receive the care they need and reduce the stigma associated with many such patients. We must change the tone of the debate to pay more attention to multi-disciplinary, patient-centered approaches to pain management, including ensuring insurance coverage for evidence-based alternative pain management treatments.
  • We need to recognize that opioid use disorder is a medical condition and increase coverage for and access to medication assisted treatment and other treatment programs. We need more resources devoted to ensure that evidence-based treatment is available and accessible.
  • We need to increase access to naloxone and other overdose prevention measures, and enact Good Samaritan laws to provide protection from liability for bystanders who witness overdoses.
  • We need to modernize and fully fund prescription drug monitoring programs. PDMPs can serve as a helpful clinical tool, but to increase their use, they need to be real-time, interoperable, and available at the point-of-care as part of a physician’s workflow.
  • Physicians want to be engaged and be part of the

The statement is available at: http://docs.house.gov/meetings/IF/IF02/20150423/103367/HHRG-114-IF02-Wstate-HarrisP-20150423.pdf

Source: American Medical Association – April 24, 2015

Categories: 2015-04-27, Addiction, Heroin, Medication-Assisted Treatment (MAT), News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Prescription Drugs
Tags: Addiction, Heroin, Overdose, Prescription Opioids, Substance abuse treatment

Our Say: Survey Indicates Reach of Heroin Problem

“The number of heroin overdose deaths in Anne Arundel County in Maryland is more than enough reason for County Executive Steve Schuh to declare a public health emergency. But does this concern extend beyond politicians and public health officials? How many county residents have firsthand experience? An attempt to measure this was part of the latest survey by Anne Arundel Community College’s Center for the Study of Local Issues.

The center’s director, Dan Nataf, found the result striking: Eleven percent of respondents — more than 1 in 10 — answered “yes” when asked if they knew any friends or family members who had a health concern involving “heroin consumption or overdose.”

As of April 26th, when asked If a methadone clinic wanted to move in two blocks from your house, would you be opposed? Two-thirds said they would be opposed.

Read more at: http://www.capitalgazette.com/opinion/our_say/ph-ac-ce-our-say-20150423,0,180528.story

Source: CapitalGazette.com – April 23, 2015

Categories: 2015-04-27, Addiction, Heroin, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs)
Tags: Addiction, Methadone Treatment, NIMBY, Opioid Treatment Programs, Stigma, Substance abuse treatment

Heroin Relapse Study Attracts Attention, Concerns

prison“An NYU Langone Medical Center study testing the use of a controversial heroin addiction treatment to prevent relapses in Rikers Island inmates has prompted concern from some advocates and analysts who worry that use of the drug could in some cases have fatal consequences.

The study examined the effectiveness of Vivitrol, or naltrexone—a drug already approved for use in the general population—in treating inmates who were about to be released. It involved 34 inmates, half of whom were given a combination of Vivitrol and counseling. The other half was given no treatment. After eight weeks, 88 percent of the inmates who received no treatment relapsed, compared to 38 percent of those given Vivitrol and counseling.

The concerns about the study stem from the idea that Vivitrol increases the potential for overdose because, unlike methadone or buprenorphine, it makes it impossible for a user to feel the effects of heroin, drastically lowering their tolerance. As a result, if addicts do relapse, they are more likely to take a dose of heroin their system cannot handle.”

Read more at: http://www.capitalnewyork.com/article/albany/2015/04/8566364/heroin-relapse-study-attracts-attention-concerns

Source: CapitalNewYork.com – April 21, 2015

Categories: 2015-04-27, Addiction, Drug Courts & Criminal Justice, Medication-Assisted Treatment (MAT), News Updates, Opioid Abuse/Addiction
Tags: Criminal Justice, Vivitrol

New York Times Opinion by Sam Quinones: Serving All Your Heroin Needs

“Fatal heroin overdoses in America have almost tripled in three years. More than 8,250 people a year now die from heroin. At the same time, roughly double that number are dying from prescription opioid painkillers, which are molecularly similar. Heroin has become the fallback dope when an addict can’t afford, or find, pills. Total overdose deaths, most often from pills and heroin, now surpass traffic fatalities.

If these deaths are the measure, we are arguably in the middle of our worst drug plague ever, apart from cigarettes and alcohol.

And yet this is also our quietest drug plague. Strikingly little public violence accompanies it. This has muted public outrage. Meanwhile, the victims — mostly white, well-off and often young — are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.”

Read more at: http://www.nytimes.com/2015/04/19/opinion/sunday/serving-all-your-heroin-needs.html

Source: NewYorkTimes.com – April 19, 2015

Categories: 2015-04-27, Addiction, Blog, Heroin, News Updates, Opioid Abuse/Addiction
Tags: Addiction, Heroin, Injecting Drug Users, Substance abuse treatment

Study Finds Emergency Departments May Be High-Yield Venues to Address Opioid Overdose, Education

hospital-sign-purchasedshutterstock_33280960“Emergency departments (ED) provide a promising venue to address opioid deaths with education on both overdose prevention and appropriate actions in a witnessed overdose. In addition, ED’s have the potential to equip patients with nasal naloxone rescue kits as part of this effort.

This finding are from a study published in the Western Journal of Emergency Medicine, and is the first study to demonstrate the feasibility of ED-based opioid overdose prevention education and naloxone distribution to trained laypersons, patients and their social network.
Read more at: http://www.eurekalert.org/pub_releases/2015-04/bumc-sfe041315.php

Source: Boston University Medical Center via Eurekalert.org – April 13, 2015

Categories: 2015-04-27, Addiction, Heroin, News Updates, Prescription Drugs
Tags: Addiction, Heroin, naloxone, OTP Patient Safety, Overdose, Prescription Opioids

Expanding Naloxone Use Could Reduce Drug Overdose Deaths and Save Lives

“Allowing more basic emergency medical service (EMS) staff to administer naloxone could reduce drug overdose deaths that involve opioids, according to a Centers for Disease Control and Prevention (CDC) study, “Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in Rural Communities,” published in the American Journal of Public Health.

According to the study findings, advanced EMS staff were more likely than basic EMS staff to administer naloxone.  A majority of states have adopted national guidelines that prohibit basic EMS staff from administering the drug as an injection. As of 2014, only 12 states allowed basic EMS staff to administer naloxone for a suspected opioid overdose; all 50 states allow advanced EMS staff to administer the overdose reversal treatment.

“Opioid overdose deaths are devastating families and communities, especially in rural areas,” said CDC Director Tom Frieden, M.D., M.P.H.  “Many of these deaths can be prevented by improving prescribing practices to prevent opioid addiction, expanding the use of medication-assisted treatment, and increasing use of naloxone for suspected overdoses. Having trained EMS staff to administer naloxone in rural areas will save lives.”

To reduce opioid overdose deaths, particularly in rural areas, CDC recommends expanding training on the administration of naloxone to all emergency service staff, and helping basic EMS personnel meet the advanced certification requirements.”

Read more at: http://www.prnewswire.com/news-releases/expanding-naloxone-use-could-reduce-drug-overdose-deaths-and-save-lives-300071852.html

Source: Centers for Disease Control and Prevention – April 24, 2015

Categories: 2015-04-27, Addiction, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Addiction, Heroin, naloxone, Overdose, Prescription Opioids, Research