News & Updates – September 25, 2014; Issue 206

MEDICATION-ASSISTED TREATMENT AND OPIOID ABUSE/ADDICTION

GOVERNMENT NEWS AND RESOURCES

GENERAL ADDICTION

MORE NATIONAL NEWS

NEWS FROM THE STATES

Categories: 2014-09-24, News Updates, TOC

The Changing Face of Opioid Addiction

“The image of the opioid addict as a young person is fast becoming outdated, a new study suggests. Today, someone abusing opioids could be a working mom, or even a senior, a new review suggests.

According to various sources, Americans aged 50 to 69 years represent the fastest growing population of opioid addicts, and the number of people aged 65 years and over who have at some point abused opioids increased by 34% from 2011 to 2012.

“What this tells us is that there’s some evolving demographics for opioid addiction and guess what, it’s not just that young college student who is the addict; it’s actually also working people and it’s more mature adults,” said Joseph V. Pergolizzi Jr., MD, assistant professor, medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

“Practitioners should employ universal precautions because we don’t have any verifiable biomarker for who’s addicted, who’s abusing, missing or diverting drugs.”

The statistics come from a report based on recently released data from the medical literature, government sources, authoritative Web sites, and financial analyses. The report was compiled by NEMA Research, a clinical research network.”

Read more at: http://www.medscape.com/viewarticle/831319

Source: Medscape.com – September 8, 2014

Categories: 2014-09-24, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Addiction, Heroin, Illicit Drugs, Prescription Opioids

Research Report: Methadone Suppresses Sex Hormones in Men, but Not Women

male Symbol“Methadone used to treat opioid addiction reduces and suppresses testosterone levels in men, but women are not affected, a new Canadian study has found.

According to the researchers, “emerging research on sex hormones in addiction has shed light on the association between testosterone and specific addictive behaviors in men and women, including impulsivity, aggression, risk-taking and sensation-seeking,” but the extent of this effect is unclear. The researchers conducted a cross-sectional study of 231 patients with opioid dependence (100 women) and a control group of 783 non-opioid users (297 women) to investigate the overall effect that opioids have on serum testosterone levels in both sexes, and testosterone levels across menstrual cycle phases in women.”

Read more at: http://www.painmedicinenews.com/ViewArticle.aspx?d=Web%2BExclusives&d_id=244&i=September+2014&i_id=1100&a_id=28282

Source: PainMedicineNews.com – September 22, 2014

Categories: 2014-09-24, Methadone, News Updates
Tags: Methadone Treatment, Opioid Treatment Programs, Research

Jana Burson Blog: Neonatal Abstinence Syndrome: Genetically Influenced

baby“As you can see from my blog post of July 27th of this year, we know genetics influences the risk of developing opioid addiction. Now, according to a 2013 study, we know that certain genes are associated with less severe neonatal abstinence syndrome.

This prospective cohort study, conducted in Maine and Massachusetts from July 2011 to July 2012, looked at eighty-six pairs of mothers and infants. The study only included mothers in addiction treatment on methadone or buprenorphine. It looked at length of hospital stay for the infants and the need for medical treatment for NAS in those infants. The study found that babies with certain genetic variants of the OPRM1 gene and the COMT gene had significantly shorter hospital stays and needed significantly less medication to treat withdrawal symptoms.

Of course, we can’t change genetic makeup, but we may be able to use this information someday to help predict which babies need longer hospital stays and more medication for their NAS. Ultimately, these studies may help us better understand NAS and how to treat it.”

Read more at: http://janaburson.wordpress.com/2014/09/

Source: Jana Burson – September 21, 2014

Categories: 2014-09-24, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Neonatal Abstinence Syndrome, Pregnancy, Prescription Opioids

Research Report: Even After Training, Many Primary Care Physicians are Reluctant to Prescribe Buprenorphine

pg6_doctor“Buprenorphine has been shown to be an effective treatment for opioid use disorder, even when prescribed by primary care physicians without additional psychosocial services. In 2009, the Rural Opioid Management Project was established to train physicians to prescribe buprenorphine in rural areas of Washington State with high opioid death rates and few waivered physicians. Of 120 physicians who completed the training, 92 were interviewed at least 7 months following their training and 78 were included in this study.

Of the 78 physicians, 50 (64%) had obtained the requisite DEA waiver to prescribe buprenorphine, but only 22 (28%) had since prescribed the medication.

Family physicians were more likely than other specialties to prescribe buprenorphine (33% versus 7%). Having another physician with a waiver in the practice was associated with prescribing buprenorphine.

Perceived barriers to prescribing buprenorphine included: lack of mental health and psychosocial support, time constraints, lack of confidence, resistance from practice partners, and lack of institutional support.

Comments:

This study shows that simply providing the required waiver training is not sufficient to overcome barriers to increasing access to buprenorphine treatment. Physicians need institutional support and encouragement. Moreover, the widespread expectation that all patients who are prescribed buprenorphine must also receive psychosocial support beyond standard physician counseling presents another barrier to treatment. Including experience with prescribing buprenorphine in residency training programs may also help.” Darius A. Rastegar, MD

Reference:

Hutchinson E, Catlin M, Andrilla CH, et al. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12:128–133.

http://www.bu.edu/aodhealth/issues/issue_july14/rastegar_hutchinson.html

Source: Alcohol, Other Drugs, and Health: Current Evidence – July/August 2014

Categories: 2014-09-24, Buprenorphine, Medication-Assisted Treatment (MAT), News Updates
Tags: Buprenorphine, OBOT, Prescription Opioids, Research

Research Report: Among People with Opioid Use Disorder, Buprenorphine and Methadone Treatment Lead to Decreases in Injection-Related HIV Risk

heroin and injectionMethadone and buprenorphine treatment can reduce the risk of HIV infection among people with injection drug use but few studies have directly compared the efficacy of the two medications on injection and sexual risk. Researchers performed a secondary analysis of data from a 24-week randomized trial that assessed differences in hepatotoxicity between buprenorphine and methadone among 731 adults with opioid dependence. For this study, the HIV Risk Behavior Survey was used to assess participants’ injection and sexual risk behaviors to determine differences between those treated with methadone and those receiving buprenorphine. Randomization was 2:1 in favor of buprenorphine due to higher rates of dropout in that group.

Injecting risk decreased with treatment in most ways measured, and did not differ between groups. The mean number of times a participant injected any substance in the last 30 days decreased from 74 at baseline to 6 at 24 weeks among participants receiving methadone, and from 70 to 6 among those treated with buprenorphine. High-risk injecting practices (e.g., sharing needles) also decreased.

Overall, sexual risk decreased slightly or stayed the same over time for both the methadone and buprenorphine groups. However, males receiving buprenorphine had a modest increase (41% to 47% at 24 weeks) in their sexual risk composite, whereas males receiving methadone had a small decrease in their sexual risk composite (46% to 44% at 24 weeks).

Comments:

This study suggests that both buprenorphine and methadone decrease HIV transmission risk primarily through decreased injection-related activities. Strategies to address sexual risk among patients treated with both medications are needed. Clinicians should screen for HIV transmission risk behaviors in their opioid-dependent patients and promote the use of methadone or buprenorphine among those at risk. Jessica S. Merlin, MD, MBA

Reference:

Woody G, Bruce D, Korthuis PT, et al. HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. J Acquir Immune Defic Syndr. 2014;66(3):288–293.

http://www.bu.edu/aodhealth/issues/issue_july14/merlin_woody.html

Source: Alcohol, Other Drugs, and Health: Current Evidence – July/August 2014

Categories: 2014-09-24, Buprenorphine, Heroin, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction
Tags: Buprenorphine, HIV/AIDS, Methadone Treatment, OTP Patient Safety, Substance abuse treatment

SAMHSA Blog H. Westley Clark: Even Non-Fatal Overdoses Can Lead to Severe Consequences

Clark“Heroin use and deaths related to prescription opioid use are on the rise in the U.S. As a result, overdose treatments like naloxone, which can help revive people in the throes of an opioid overdose, are attracting increased interest.  A number of community-based harm reduction organizations are working to prevent overdose deaths through public education and naloxone distribution programs.  SAMHSA has also released an overdose prevention toolkit (see related article below), which includes prevention strategies and rescue steps to take when an overdose occurs.

However, it’s important to remember that naloxone is not a free pass—there can be severe costs, even for those who survive an overdose.  The New York Times recently ran a story about a young man who suffered a non-fatal, but ultimately debilitating overdose of heroin.  As a consequence of his overdose, he has spent the last 13 years dealing with multiple neurologic challenges.  This case represents the “other side” of non-fatal overdoses, and provides a cautionary tale.

Complications from non-fatal overdoses, although infrequent, can include a wide range of conditions such as muscle tissue breakdown, kidney failure, heart problems, seizures, nerve damage, temporary motor paralysis, fluid buildup in the lungs, pneumonia from inhaling vomitus, stroke, and other neurologic consequences.  Multiple non-fatal overdoses also subject the brain to low oxygen, which can cause damage to the white matter of the brain.  In addition, falls while overdosing can cause head injuries and broken limbs.   Most individuals recover from the effects of an opioid overdose, with the less serious consequences of a non-fatal overdose lasting from minutes to hours.  The more serious consequences can persist, as the New York Times article succinctly captured in its singular case study.

The longer a person is in a comatose state, the greater the chance of consequences.  Therefore, it is important to administer naloxone as soon as possible. Also, because medical issues caused by the overdose might not be obvious to a casual observer, those administering naloxone to someone who has overdosed from an opioid should encourage that rescued person to get checked out by medical personnel.

In short, non-fatal opioid overdoses can have infrequent but significant consequences.  Such efforts as naloxone rescues create a teachable moment opportunity for first responders, clinicians, friends and families.”

Source: Substance Abuse Mental Health and Services Administration – September 16, 2014

Categories: 2014-09-24, Addiction, Blog, Heroin, News Updates, Opioid Abuse/Addiction
Tags: Addiction, Heroin, Overdose, Prescription Opioids

SAMHSA Updated 'Tool Kit' to Prevent Opioid Overdose Released

SAMHSA tool kitThe SAMHSA update overdose tool kit’ was updated in August to equip communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. The kit addresses issues for first responders, treatment providers, and those recovering from opioid overdose. The kit provides the following information:

  • Facts for Community Members
  • Essentials for First Responders
  • Safety Advice for Patients
  • Information for Prescribers
  • Resources for Overdose Survivors and Family Members

The tool kit is available for download at:

http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit-Updated-2014/SMA14-4742

Source: Substance Abuse Mental Health and Services Administration – August 2014

Categories: 2014-09-24, Education, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Heroin, Overdose, Prescription Opioids

New SAMHSA Resource Guide: Adult Drug Courts and Medication-Assisted Treatment for Opioid Dependence

criminal justice imageA new resource guide issued in September by the Substance Abuse Mental Health and Services Administration (SAMHSA) is an 8-page document developed to encourage drug court personnel to increase their knowledge about the effectiveness of medication-assisted treatment (MAT) for opioid dependence.

The publication reviews effective medications, including methadone, buprenorphine, and naltrexone, and provides strategies to increase the use of MAT in drug court programs.

http://store.samhsa.gov/product/SMA14-4852

Source: Substance Abuse Mental Health and Services Administration – September 2014

Categories: 2014-09-24, Buprenorphine, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction
Tags: Buprenorphine, Drug Courts, Methadone Treatment, Opioid Treatment Programs, Substance abuse treatment

SAMHSA Report Reveals the Scope of Substance Use and Mental Illness Affecting the Nation

A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides insight into the nature and scope of substance use and mental illness issues affecting America. Today, 2013 national survey data as well as information on the efforts and resources being taken to address these problems were released in conjunction with the 25th  annual observance of National Recovery Month.

The report shows that 24.6 million Americans aged 12 or older were current (past month) illicit drug users – 9.4 percent of this age group.

Marijuana was by far the most commonly used illicit drug with approximately 19.8 million current users aged 12 and older.

In terms of other illicit drugs, the report indicates that among those aged 12 and older, there were 4.5 million current nonmedical users of prescription pain relievers (1.7 percent), 1.5 million current cocaine users (0.6 percent), 595,000 methamphetamine users (0.2 percent), and 289,000 current heroin users (0.1 percent). Although an estimated 22.7 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem, only 2.5 million persons received treatment at a specialty facility.

The Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings 8-page report can be accessed at: http://www.samhsa.gov/data/2k14/NSDUH200/sr200-findings-overview-2014.pdf

http://www.samhsa.gov/newsroom/advisories/1409032750.aspx

Source: Substance Abuse Mental Health and Services Administration – September 4, 2014

Categories: 2014-09-24, Addiction, Heroin, News Updates, Prescription Drugs, Research/Surveys
Tags: Addiction, Government, Heroin, Injecting Drug Users, Prescription Opioids, Substance abuse treatment

New Research Study: Former Addicts May Be At Lower Risk of New Addictions

addiction-shutterstock“People who manage to get clean after being addicted to drugs are at lower risk of becoming addicted to something else in the future than people who never overcame the first substance use disorder, according to a new study. “The results are surprising, they cut against conventional clinical lore which holds that people who stop one addiction are at increased risk of picking up a new one,” said senior author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center in New York. “The results challenge the old stereotype that people switch or substitute addictions but never truly overcome them,” Olfson told Reuters Health by email.

Getting over substance addiction reduces criminal activity, improves health and social functioning, as well as overall quality of life, Olfson’s team writes in JAMA Psychiatry.

But research into the assumption that former addicts are vulnerable to becoming addicted again has produced mixed results, they point out.”

http://www.reuters.com/article/2014/09/18/us-health-psychiatry-substance-abuse-idUSKBN0HD20920140918

Source: Reuters.com– September 18, 2014

Categories: 2014-09-24, Addiction, News Updates
Tags: Addiction, Substance abuse treatment