News & Updates – September 16, 2014; Issue 205




Categories: 2014-09-16, TOC

Letter to the Editor: Methadone Maintenance: “Interim Treatment” Compared to Waiting Lists by Robert G. Newman, MD

waiting line“In a recent publication, Schwartz et al (2013) present a cost-benefit analysis of “interim treatment” (IM). They confirmed their earlier outcomes-oriented findings (Schwartz et al., 2012), including the similarity in retention. The retention rate of IM patients is especially remarkable since unlike standard methadone patients they “were not eligible for the motivational incentive of obtaining a take-home dose … after the first 90 days of treatment.

Surely this study should lead to an immediate radical change in governmental regulations and in self-imposed program policies as they relate to waiting lists. More generally, however, there should be open-minded reconsideration of imposing on both programs and patients a host of psychosocial services that in many instances neither can afford, and that both might believe are unnecessary.”

Journal of Addiction Medicine: July/August 2014 – Volume 8 – Issue 4 – p 295-296

Categories: 2014-09-16, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs)
Tags: Methadone Treatment, Opioid Treatment Programs

Jana Burson Blog: Opioids and Benzodiazepines Prescribed More Frequently in the South

The South“Last month, the CDC released information comparing rates of opioid and benzodiazepine prescriptions by state and by region. It did not surprise me to learn the South had the highest rates of benzodiazepine and opioid prescribing of the entire nation.

The CDC authors of this report admit it’s unlikely there’s much difference in rates of disorders needing treatment with opioids or benzodiazepines. My interpretation of this statement is that it’s an indirect way of saying doctors in the South are overprescribing opioids and benzodiazepines. The authors allude to the problem of overprescribing in the South, mentioning that the South also has higher rates of prescribing for antibiotics, stimulants in children, and medications known to be high risk for the elderly.

This supports what I’ve long suspected: the treatment of opioid addicts with MAT is different in the South than in the West. My colleagues in California, inferring from the CDC’s report, don’t have to deal with benzodiazepine co-addiction as often as I do in the mountains of North Carolina. That co-occurring addiction changes the clinical picture, and makes induction onto methadone particularly more risky.”

Source: – August 25, 2014


Categories: 2014-09-16, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs), Prescription Drugs
Tags: Benzodiazepines, Opioid Treatment Programs, Prescription Opioids

ASAM State Medicaid Coverage of Addiction Treatment in the US

medicaidAs part of ASAM’s “Advancing Access to Addiction Medications” project, the Treatment Research Institute was contracted to create “Medicaid Coverage of Medications for the Treatment of Opioid Use Disorder” state fact sheets. These two-page fact sheets summarize state Medicaid coverage of addiction treatment, both medication and counseling, and serve as an update to the June 2013 Patient Advocacy Task Force survey and research report on insurance coverage of addiction medications. In order to gather the most current nationwide coverage information, each state and the District of Columbia was surveyed to see if their Medicaid program covered methadone, Suboxone, buprenorphine/naloxone tablets (Zubsolv and generic), buprenorphine tablets, and injectable naltrexone (Vivitrol) under Fee-For-Service (FFS) or Managed Care (MC) plans.

The state fact sheets are currently available on the ASAM website, along with an interactive map of the United States. The purpose of this project is to improve access to addiction treatment by increasing knowledge and understanding of Medicaid coverage currently available and encouraging states to improve their program’s coverage of addiction treatment.

Source: American Society of Addiction Medicine – August 15, 2014

Categories: 2014-09-16, Medication-Assisted Treatment (MAT), Methadone, News Updates, Opioid Abuse/Addiction, Opioid Treatment Programs (OTPs)
Tags: Buprenorphine, Medicaid, Methadone Treatment, Opioid Treatment Programs

Clinical Assessment May Benefit Postpartum Women with Methadone Treatment Changes

“A recent study led by researchers at Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) found that women may not need significant methadone dose reductions in the first three months after pregnancy.

Researchers reviewed the charts of 101 women who received care at a methadone maintenance treatment program between 2006 and 2010 after giving birth. They discovered that under the clinical assessment model—in which clinicians estimate patients’ methadone dose based on their individual physiologic parameters, rather than using a standard formula to reduce doses—women experienced on average only a small reduction in methadone dose. This suggests that, contrary to prior belief, changes in the physiology of women’s bodies from delivery to 12 weeks postpartum did not significantly affect their response to methadone.”

Source: – August 24, 2014

Categories: 2014-09-16, Medication-Assisted Treatment (MAT), Methadone, News Updates
Tags: Methadone Treatment, Pregnancy

Blog: Why Opioid Substitution Therapy is Not Just Replacing One Addiction for Another

“Substance addiction is a behavioral disorder characterized by a compulsive drive for the reinforcing euphoria, loss of control over it, and substance use despite adverse consequences leading to the sacrifice of normative life goals, values, coping mechanisms and functioning (including health, family, work, etc.) at the altar of the substance.

People often confuse physical dependence (tolerance and withdrawal) with addiction (partly because the confusing DSM-IV and earlier definition of substance dependence was synonymous with addiction).  The oral, long-acting opioid agonists currently FDA approved to treat opioid use disorders produce physical dependence, but by diminishing the reinforcing effects of short-acting opioids they function to extinguish addictive behavior.”

Source: – August 14, 2014

Categories: 2014-09-16, Blog, Medication-Assisted Treatment (MAT), Methadone, News Updates
Tags: Addiction, Methadone Treatment, Opioid Treatment Programs

Jana Burson Blog: Opioid Physical Dependence versus Opioid Addiction: What’s the Difference?

“Many people, including doctors, are confused about the difference between physical opioid dependence and opioid addiction.

The presence of physical withdrawal symptoms alone is NOT the same thing as opioid addiction.

For addiction to exist, the person taking opioids must have psychological manifestations. Such a person suffers from the obsession and compulsion to use more opioids, even knowing bad things happen with opioid use. A person with addiction neglects other important parts of life in order to focus on the use of opioids. She may use the drug in ways it’s not meant to be use – injecting, snorting, or chewing for faster onset. She may start using opioids to treat negative emotion, and mix them with other drugs for different effects. She may use opioids even when not in pain, for the effect the drug has on her.”

Source: – August 18, 2014

Categories: 2014-09-16, Addiction, Blog, Heroin, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Addiction, Heroin, Prescription Opioids

Key To Prescription Drug Misuse Among Young Adults Is Likely Peers, But Not Peer Pressure

“Current efforts to prevent prescription drug misuse among young adults need to consider peers – but not peer pressure – according to a Purdue University study.

“With the 18-29 age group we may be spending unnecessary effort working a peer pressure angle in prevention and intervention efforts. That does not appear to be an issue for this age group,” said study co-author Brian Kelly, a professor of sociology and anthropology who studies drug use and youth cultures. “Rather, we found more subtle components of the peer context as influential. These include peer drug associations, peers as points of drug access, and the motivation to misuse prescription drugs to have pleasant times with friends.”

Source: Medical – August 18, 2014

Categories: 2014-09-16, News Updates, Opioid Abuse/Addiction, Prescription Drugs
Tags: Prescription Opioids

New Legislation Supports Opioid Overdose Prevention and Treatment

prescription drugs“Legislation recently introduced in the Senate would authorize millions of dollars in overdose prevention programming and research in an effort to curb the growing trend of opioid overdose deaths. The Overdose Prevention Act (S. 2755), introduced by Senator Jack Reed (D-RI) with four cosponsors, would support prevention programs to reduce drug overdose deaths, create a task force to recommend a national public health campaign to Congress and authorize funding to research and test new treatment and prevention methods.

The Overdose Prevention Act would authorize $20 million per year for four years to the CDC to enter into cooperative agreements with eligible organizations engaging in overdose prevention activities. Such eligible organizations include: state and local governments, law enforcement agencies, community agencies, and private nonprofit organizations.

Source: – August 20, 2014

Categories: 2014-09-16, News Updates, Opioid Abuse/Addiction
Tags: Heroin, Overdose, Prescription Opioids

Emerging Street Drug Fifteen Times Stronger Than Heroin

“Emergency physicians should expect” an upswing in what on the surface appear to be heroin overdoses,” but are actually overdoses tied to acetyl fentanyl, an opiate that is mixed into street drugs marketed as heroin. The looming threat of another unregulated quasi-legal drug is detailed online in Annals of Emergency Medicine (“The Potential Threat of Acetyl Fentanyl: Legal Issues, Contaminated Heroin, and Acetyl Fentanyl ‘Disguised’ as Other Opiates”).

“What’s frightening about this emerging street drug is that users themselves may not be aware that they are ingesting it,” said lead study author John Stogner, Ph.D. of the Department of Criminal Justice and Criminology at the University of North Carolina at Charlotte, N.C. “A patient may report heroin use and have symptoms consistent with heroin overdose, but an emergency physician may find that the standard dose of antidote (naloxone) doesn’t work. Larger or additional doses are necessary when acetyl fentanyl is responsible. It’s never good to lose time between overdose and treatment.”

Acetyl fentanyl is an opiate analgesic with no recognized medical use. It is five to 15 times stronger than heroin. Users typically use it intravenously as a direct substitute for heroin or pharmaceutical-grade opioids, though many are unaware that what they are consuming is not plain heroin. A user who injects pure acetyl fentanyl may suffer severe consequences because of its extraordinary potency.”

Source: August 21, 2014

Categories: 2014-09-16, Addiction, News Updates, News Updates, Opioid Abuse/Addiction, Other Drugs of Abuse, Prescription Drugs
Tags: Heroin, Overdose, Prescription Opioids

In Move to Curb Drug Abuse, D.E.A. Tightens Rule on Widely Prescribed Painkiller

“The federal government tightened the prescribing for the most common form of painkiller in the country on Thursday, the final step in a policy shift that has been years in the making.

The rule places all hydrocodone combination drugs, which come together with other ingredients like aspirin, in a tougher, more restrictive category, and the changes it requires are sweeping. Such drugs make up nearly all hydrocodone drugs approved for use today. Doctors will no longer be able to call in prescriptions by telephone, and patients will not be allowed to get refills on the same prescription, but will have to return to a health care professional to get a new one. The drug will have to be kept in special vaults in pharmacies. The Drug Enforcement Administration published the rule Thursday; it will take effect in 45 days.”

Source: – August 21, 2014

Categories: 2014-09-16, News Updates, Prescription Drugs
Tags: DEA, Government, Prescription Opioids