News & Updates – April 27, 2015; Issue 219




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:

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:

Source: – 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:

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:,0,180528.story

Source: – 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:

Source: – 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:

Source: – 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:

Source: Boston University Medical Center via – 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:

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

ASAM Policy Plenary Opens Debate on Buprenorphine Prescribing Limit

ASAM logo“Countering all the positive outcomes of buprenorphine treatment for patients with addiction are the negatives of the drug’s misuse that are frequently cited by critics, including legislators who oppose expanded use of pharmacotherapies to treat addiction. Saturday’s ASAM Policy Plenary opened the door to a passionate discussion of how to address the problem.

The session, “Consequence of Changing the Buprenorphine Prescribing Limit,” featured H. Westley Clark, MD, JD, MPH, CAS, FASAM, reviewing facts about buprenorphine use and misuse. Then, he and session moderators Scott A. Teitelbaum, MD, FAAP, FASAM, and Mark Kraus, MD, FASAM, opened the floor to discussion from attendees, but the session ended with about a dozen people still lined up at microphones waiting to speak.

Opinions ranged from those supporting physicians being allowed to prescribe buprenorphine beyond the 100-patient limit, to those who questioned a need for that expansion, to suggestions for other options. Two themes often cited by speakers were to remember the patients and to remember what caused concerns about drug misuse.”

Read more at:

Source: American Society of Addiction Medicine – April 26, 2015

Categories: 2015-04-27, Buprenorphine, Heroin, Medication-Assisted Treatment (MAT), News Updates, OBOT, Opioid Abuse/Addiction
Tags: Addiction, Buprenorphine, Suboxone, Substance abuse treatment

Senators Urge More Research Funding for Prescription Drug Abuse

prescription-pills“Prescription drug abuse is an epidemic in this country according to the Centers for Disease Control and Prevention. Some U.S. senators are hoping to find room in the budget to help those who are abusing prescription drugs.

The statics are staggering– in 2012 drug overdose caused more deaths than motor vehicle accidents among Americans 25-64 years old. Which is why some senators are saying enough is enough—more research is needed to fight this problem found in our communities.

Here’s what’s in the proposal; 68-million dollars to the CDC for the monitoring of high-risk prescription drugs and identify people who may misuse them. Just over 25-million dollars for a new initiative to expand treatment of opioid use with a focus on heroin and prescription opioids through a combination different therapies.

Also in the proposal is 54-million dollars for medical research through the National Institutes of Health, for clinical research for other approaches to pain management that pose less of a risk for dependency.”

Read more at:

Source: – April 20, 2015

Categories: 2015-04-27, Addiction, Education, Heroin, Medication-Assisted Treatment (MAT), News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Addiction, Government, Methadone Treatment, Prescription Opioids