DEA – Addiction Treatment Forum

Mobile Vans for OTPs: Getting Closer to Reality

August 11, 2017

By Alison Knopf

The Drug Enforcement Administration (DEA) is not yet ready to talk about mobile vans. The agency is likely to release new licensing regulations, which will open the door to more mobile vans to provide medication-assisted treatment for opioid use disorders—most likely in conjunction with brick-and-mortar opioid treatment programs (OTPs)—sometime this fall.

Demetra Ashley, associate deputy assistant administrator of the Office of Diversion Control of the DEA, told the board of the American Association for the Treatment of Opioid Dependence (AATOD) that the project was underway last year. However, it was last fall that she said that, and the situation hasn’t changed yet.

New Mobile Vans Need New Regulations

Existing mobile vans can still operate, but new ones need new regulations.

This affects many programs. For example, Washington State, as part of its CURES State Targeted Response to the Opioid Crisis (STR) grant, wants mobile vans. Evergreen Services in Seattle would buy two vans. “They have the CURES money, they have a designated provider, now they’re just waiting for the vans,” said Mark Parrino, MPA, AATOD president, in an interview. “But they can’t buy the vans until the DEA releases its new licensure standards. They’re ready to go, but they can’t.”

About four years ago the DEA decided not to license any new vans, but they did not de-license any existing vans. Once the new regulations are released, more mobile vans are expected to provide more treatment to more patients.

States Linked to OTPs via Mobile Methadone Vans

The following states have mobile methadone vans connected to OTPs (all data as of 2014):

California (3 vans/206 patients)
Massachusetts (3 vans, 2 being used on an active basis/150 patients)
Maryland (2 vans)
New Jersey (5 vans/1,000 patients)
Puerto Rico (2 vans)
Washington (1 van/175 patients)

Importantly, federal authorities need to be ready with a team of consultants who can help state authorities and providers comply with the new regulations.

Mr. Parrino doubts that the DEA would allow methadone to be dispensed from mobile vans that are not associated with brick-and-mortar OTPs. The reason is the storage rules for the medication.

The DEA’s proposal needs to be vetted through its main agency, the Department of Justice. In addition, every regulation must go through the Office of Management and Budget.

Number of OTPs Tops 1,500 For First Time Ever

June 2, 2017

By Alison Knopf

For the first time in the history of opioid treatment programs (OTPs)–federally regulated clinics that dispense methadone and other medications to treat opioid use disorders—there were more than 1,500 as of March, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

“This is the first time it has gone past 1,500,” said Mark W. Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD). “I believe there will be a steady rise in OTP numbers and patients in treatment, over the next several years,” Mr. Parrino told AT Forum. “SAMHSA is doing a great job in managing new OTP applications.”

AATOD has an ambitious plan—to reach 2,800 OTPs by 2020—announced at last fall’s meeting in Baltimore (see http://atforum.com/2016/12/aatod-conference-recap/).

As of December 23, 2016, there were 1,482 OTPs—up 66 from a year earlier (1,416), which was up 53 from December of 2014 (1,363) (see http://atforum.com/2017/02/aatods-goal-doubling-number-otps-strong-samhsa-support/).

Still, SAMHSA isn’t the only player. It’s up to other agencies—the state, the Drug Enforcement Administration (DEA), and of course local communities—to complete the process of certifying OTPs. This process can be long and time-consuming—and costly (see http://atforum.com/2016/04/success-story-advocate-opens-first-otp-second-opens-spring/). But in the end, communities benefit.

And that may be another reason that the OTPs are increasing in number: communities may finally be overcoming their NIMBY (“not in my backyard”) fears. “The rate of growth of opioid treatment programs has traditionally been slow,” Melinda Campopiano, MD, chief of SAMHA’s Division of Pharmacological Therapies, told AT Forum. “This expansion in programs, approximately 100 in the last year, may indicate that communities and providers are recognizing the utility of the model, and acceptance of pharmacotherapy for opioid use disorders is increasing.”

Kratom: What We Know

February 7, 2017

“The US Drug Enforcement Administration (DEA) recently declared that it will hold off on a previously announced ban of the herbal drug kratom, as there was a need for additional input regarding this decision from the public and the US Food and Drug Administration (FDA). In August 2016, the DEA had suggested that it planned to add the psychoactive compounds found in the herbal agent kratom to the list of Schedule I drugs banned under the Controlled Substances Act. This led to significant outrage and clamor from individuals who believe that the herbal supplement, which is derived from trees indigenous to Southeast Asia, can help individuals struggling with a number of different medical issues, including opioid addiction.

Since publishing that notice, the DEA has heard from many concerned members of the public challenging the Schedule I action and requesting that they strongly consider their comments. Many people reported how helpful this particular herbal remedy has been. A decision was made to hold off on imposing the ban on a temporary basis while the DEA awaits further analysis by the FDA. This does not mean, of course, that kratom will not eventually be made illegal.”

See related article: DEA Asked Public To Comment On Its Proposed Kratom Ban And 99 Percent Opposed It available at: http://www.huffingtonpost.com/entry/dea-kratom-ban-comments_us_589374f1e4b06f344e4074fa

Source: Medscape.com – January 23, 2017

Dr. Jana Burson Blog: U-47700 – Also Known as Pink or Pinky

February 7, 2017

“My patients are sometimes my best teachers, so when one of them mentioned a new opioid drug, I searched for information online. This new drug is called Pink, or Pinky, but its chemical name is U-47700.

This drug was first developed in the 1970’s by a scientist at Upjohn, a pharmaceutical company. This drug has never been studied in humans, but produces a strong opioid-type effect due to its action at the mu opioid receptor. It’s quite powerful, with estimated potency at seven or eight times that of morphine.

Last year, forty to eighty overdose deaths in the U.S. were attributed to this drug, depending on which source you read. As a man-made research drug, it was legal to obtain until late last year, when the DEA placed U-47700 on Schedule 1 status. This means it is no longer legal to buy online, and that it has a high potential for causing addiction and harm.”

Source: Dr. Jana Burson – February 5, 2017

Trump Push to Combat Drug Trade May Mean Starting with China, Not Mexico

November 29, 2016

“If President-elect Donald Trump wants to fulfill his campaign promise of stemming the flow of drugs coming across the United States’ border with Mexico, he may want to start by looking at China.

Manufacturers and organized crime groups in the world’s most populous country are responsible for the majority of fentanyl — the synthetic opioid that is 50 times more potent than heroin — that ends up in the U.S. and the majority of precursor chemicals used by Mexican drug cartels to make methamphetamine, according to numerous published U.S. government reports.

“The Mexican cartels are buying large quantities of fentanyl from China,” Barbara Carreno, a spokesperson with the U.S. Drug Enforcement Administration (DEA), told FoxNews.com. “It’s much easier to produce than waiting around to grow poppies for heroin and it’s incredibly profitable.”

Source: FoxNews.com – November 16, 2016

There’s an Effort to Save the Drug Kratom from DEA Extinction

September 30, 2016

“Users and advocates of the Southeast Asian drug have been fighting, so far unsuccessfully, to save it from full prohibition. They say it can be used as an opioid and heroin substitute, a claim that can be especially appealing in an age when overdoses, often fueled by legit gateway drugs like Oxycodone, have become the leading cause of accidental deaths in the nation.

This week 51 members of Congress sent a letter to DEA administrator Chuck Rosenberg, asking him to delay the emergency scheduling so that research into kratom’s possible uses as an opioid substitute can continue.”

Source: LAWeekly.com – September 28, 2016

D.E.A. to Consider Opioid Substitute More Dangerous Than Drugs That Kill 14,000 Annually

September 13, 2016

“The Drug Enforcement Administration said that it is going to ban the use of a substance that has been shown to be a safer alternative to opioids–one that can be used to help recovering addicts.

Kratom will be listed under Schedule I by the DEA, the agency announced on Monday. The move, which is set to take effect on Sept. 30., means the plant-derivative will be considered by the federal government to have zero medicinal value.”

Source: DistrictSentinel.com – August 31, 2016

DEA Releases 2016 National Heroin Threat Assessment Summary

July 11, 2016

The United States Drug Enforcement Administration (DEA) released the 2016 National Heroin Threat Assessment Summary – Updated (NHTA) on June 27. The report outlines the expanding public health crisis afflicting America due to the use and abuse of heroin and other opioid drugs. Some key facts:

The number of people reporting current heroin use nearly tripled between 2007 (161,000) and 2014 (435,000).
Deaths due to synthetic opioids, such as fentanyl and its analogues, increased 79 percent from 2013 to 2014.
Deaths involving heroin more than tripled between 2010 (3,036) and 2014 (10,574) – a rate faster than other illicit drugs.

Source: United States Drug Enforcement Administration – June 27, 2016

See related article: Heroin overdose deaths in America tripled over four years available at: https://news.vice.com/article/heroin-deaths-in-america-tripled-over-four-years

DEA Warning to Police and Public: Fentanyl Exposure Kills

June 22, 2016

DEA has released a Roll Call video to all law enforcement nationwide about the dangers of improperly handling fentanyl and its deadly consequences. Acting Deputy Administrator Jack Riley and two local police detectives from New Jersey appear on the video to urge any law enforcement personnel who come in contact with fentanyl or fentanyl compounds to take the drugs directly to a lab.

“Fentanyl can kill you,” Riley said. “Fentanyl is being sold as heroin in virtually every corner of our country. It’s produced clandestinely in Mexico, and (also) comes directly from China. It is 40 to 50 times stronger than street-level heroin. A very small amount ingested, or absorbed through your skin, can kill you.”

Two Atlantic County, NJ detectives were recently exposed to a very small amount of fentanyl, and appeared on the video. Said one detective: “I thought that was it. I thought I was dying. It felt like my body was shutting down.” Riley also admonished police to skip testing on the scene, and encouraged them to also remember potential harm to police canines during the course of duties. “Don’t field test it in your car, or on the street, or take if back to the office. Transport it directly to a laboratory, where it can be safely handled and tested.”

Source: DEA.gov – June 10, 2016

DEA Announces “360 Strategy” to Address Heroin, Prescription Drugs and Violent Crime

November 16, 2015

The United States Drug Enforcement Administration (DEA) announced Pittsburgh as the pilot city for a comprehensive law enforcement and prevention “360 Strategy” to help cities dealing with a heroin and prescription drug abuse epidemic, and its associated violent crime.

The DEA 360 Strategy comprises a three-fold approach to fighting drug traffickers:

Provide DEA leadership with coordinated DEA enforcement actions targeting all levels of drug trafficking organizations and violent gangs supplying drugs in our neighborhoods, as we have been doing with ongoing law enforcement operations.
Have a long-lasting impact by engaging drug manufacturers, wholesalers, practitioners and pharmacists to increase awareness of the heroin and prescription drug problem and push for responsible prescribing and use of these medications throughout the medical community.
Change attitudes through community outreach and partnership with local organizations following DEA enforcement actions to equip and empower communities with the tools to fight the heroin and prescription drug epidemic.

Source: DEA.gov – November 10, 2015