AT Forum NEWS NOTES & UPDATES #118
April 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: March 2008
Contents
ADDICTION TREATMENT
Study: Improve Public Addiction Treatment through Performance Contracting
JOURNALS
Now Available Online: Europad March 2008 Issue
PRESCRIPTION DRUG USE
Early Non-Medical Prescription Drug Use
GOVERNMENT
FY2009 Proposed Federal Drug Control Budget
NIDA’s Director Addresses Senate on Prescription Drug Abuse
HIV/AIDS
Updated CDC Fact Sheet "HIV/AIDS in the United States"
CDC Fact Sheet: HIV/AIDS among Persons Aged 50 and Over
ADDICTION TREATMENT
Study: Improve Public Addiction Treatment through Performance Contracting
Paying substance abuse treatment providers for results, not services, may lead to improved quality of care, according to the first published study of a novel performance-based contracting system implemented by the State of Delaware in 2002.
Providers who stood to gain or lose financially under the new system may have taken steps to make their services more appealing to patients and do more to integrate evidence-based practices, improving their ability to attract patients and keep them engaged in treatment longer, the study suggested.
The unusual pay-for-performance system was undertaken in fiscal year 2002 by the Delaware Division of Substance Abuse and Mental Health when it replaced its cost-reimbursement contracts with performance-based contracts with all outpatient addiction treatment programs. Rather than reimbursing providers on a fixed basis (regardless of the number of patients treated), or for the number of treatment services delivered (regardless of the results), the new model included financial rewards and penalties based on success or failure to achieve agreed-upon incentive targets: 80% and later 90% capacity utilization and active patient participation in treatment.
The study, evaluating this incentive-based contracting system, is published in an upcoming issue of Health Policy by A. Thomas McLellan, PhD and a team of investigators from the Treatment Research Institute; as well as Jack Kemp, now-retired Director of Substance Abuse Services in Delaware. The project demonstrated marked increases in two indicators experts agree are predictive of accountability and effectiveness of clinical services. Comparing 2001 - the year before the performance contracting - and 2006, average rates of patient capacity utilization increased from 54% to 95%; and the average proportion of patients who were actively engaged in more than 30 days of treatment went from 53% to 70%.
Source: Treatment Research Institute Press Release (March 14, 2008).
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JOURNALS
Europad March 2008 issue
The March 2008 issue of Europad’s Heroin Addiction and Related Clinical Problems journal is now available online at www.ATForum.com. Articles in this issue include:
- Sexual Behaviour of Heroin Addicts in Treatment
- Evidence of Reliability and Validity of the Opiate Dosage Adequacy Scale (ODAS) in a Sample of Methadone Maintenance Patients
- Improvement in the Quality of Life in Heroin Addicts: Differences Between Methadone and Buprenorphine Treatment
- Methadone: A Fast and Powerful Anti-anxiety, Anti-depressant and Anti-psychotic Treatment
The current 60-page issue can be accessed at : http://www.atforum.com/pdf/europad/HeroinAdd10-1.pdf
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NIDA Notes Volume #21, #5 Now Available Online
Articles include:
- Alcohol Abuse Makes Prescription Drug Abuse More Likely
- HIV Patients Show Better Immune Recovery With Early Initiation of HAART
The 16-page PDF file is available for download at: http://www.drugabuse.gov/PDF/nidanotes/NNvol21N5.pdf
Source: NIDA (National Institute of Drug Abuse) available online 3/28/08.
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PRESCRIPTION DRUG USE
Early Non-Medical Prescription Drug Use
Persons who begin using prescription drugs non-medically at an early age are more likely to be diagnosed with lifetime prescription drug abuse and dependence, according to an analysis of data from a national household survey.
An estimated 42% of those who reported that their first non-medical use of prescription drugs was at age 13 or younger also had a lifetime diagnosis of prescription drug abuse, compared to 17% of those who first used prescription drugs non-medically at age 21 or older. Similar results were found for lifetime prescription drug dependence.
Interestingly, "early non-medical users of prescription sedatives, tranquilizers, and opioids were generally more likely to become non-medical users of other prescription drug classes than to develop sedative, tranquilizer or opioid use disorders." For example, persons who initiated non-medical use of prescription sedatives at age 13 or younger were more likely to eventually report non-medical use of prescription tranquilizers, opioids or stimulants than to be diagnosed with a sedative use disorder.
The exception was for non-medical users of prescription stimulants, who were more likely to develop stimulant use disorders than to become non-medical users of other prescription drugs.
For details, including data charts, source information and caveats visit: http://www.cesar.umd.edu/cesar/cesarfax/vol17/17-08.pdf.
Source: JoinTogether.org – March 28, 2008 Reprinted from CESAR Fax, a weekly, one-page overview of timely substance abuse trends or issues, from the Center for Substance Abuse Research (CESAR) at the University of Maryland.
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Government
FY2009 Proposed Federal Drug Control Budget
The $14.1 billion proposed federal drug control budget for fiscal year 2009 increases funding for the National Youth Anti-Drug Media Campaign, drug treatment courts, and screening, brief intervention, referral, and treatment activities. At the same time, however, federal support for many state and local drug programs are recommended to be reduced, eliminated, or consolidated into a new competitive grant program, the Byrne Public Safety and Protection Program, with a lower funding level. 
Highlights of some of the changes proposed by the FY2009 drug control budget can be accessed at: http://www.cesar.umd.edu/cesar/cesarfax/vol17/17-11.pdf.
The 180-page National Drug Control Budget Summary PDF report can be accessed at : http://www.whitehousedrugpolicy.org/publications/policy/09budget/fy09budget.pdf
Comment: It should be noted that this proposed budget is not binding and may differ significantly from the final budget developed by Congress and signed into law by the President.
Source: Adapted by CESAR from Office of National Drug Control Policy (ONDCP), National Drug Control Strategy FY2009 Budget Summary, 2008. NIDA’s Director Addresses Senate on Prescription Drug Abuse On March 12th, Nora D. Volkow, MD, Director of the National Institute of Drug Abuse, addressed the Senate about the growing problem of prescription drug abuse in the US. Highlights of the testimony include:
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NIDA’s Director Addresses Senate on Prescription Drug Abuse
On March 12th, Nora D. Volkow, MD, Director of the National Institute of Drug Abuse, addressed the Senate about the growing problem of prescription drug abuse in the U.S. Highlights of the testimony include:
What is the scope of the prescription drug problem in this country?
Several indicators show that prescription drug abuse is a significant problem in the United States. According to the National Survey on Drug Use and Health (NSDUH), conducted by HHS's Substance Abuse and Mental Health Services Administration (SAMHSA), in 2006 approximately 7 million persons 12 and older took a psychotherapeutic drug for non-medical purposes in the 30 days before the survey. Most reported abusing opiate pain relievers in particular. In fact, 2.2 million persons aged 12 and over initiated abuse of pain relievers in the past year. Young adults (ages 18-25) by far showed the greatest use overall and the largest increases in past month, past year, and lifetime use between 2002 and 2006, compared to all other age groups (NSDUH, 2007). Still, even by the time they graduate from high school, roughly a quarter of 12th graders report having abused a prescription drug (MTF, 2007).
What factors are driving abuse of prescription drugs?
The far-ranging scope of prescription drug abuse in this country stems not only from the greater prescribing of medications, but also from misperceptions of their safety.
Older adults represent an area for particular concern. Although this group currently comprises just 13 percent of the U.S. population, they receive approximately one-third of all medications prescribed in the Nation. In a culture in which medications are considered a "quick fix" for whatever ails you, combined with the greater rates of lifetime drug abuse among the "baby boom" generation as compared to those in the current older generation relative to its size, it is possible that the number of persons aged 50 or older abusing prescription drugs could increase 190 percent over the next two decades, from 911,000 in 2001 to almost 2.7 million in 2020. Because older adults also experience higher rates of other illness as well as normal changes in drug metabolism, it makes sense that even moderate abuse or unintentional misuse of prescription drugs by elderly persons could lead to more severe health consequences. Therefore, physicians need to be aware of the possibility of abuse and to discuss the health implications with their patients.
The testimony can be accessed at: http://www.nida.nih.gov/Testimony/3-12-08Testimony.html
Source: National Institute of Drug Abuse – March 12, 2008.
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New Report Provides Substance Use and Mental Health Information By State
A new report (State Estimates of Substance Use) issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), shows that although there are some differences in the patterns of substance use and mental health problems experienced among states and regions, all parts of the country are seriously affected by these problems.
The survey is based on the 2005-2006 National Survey on Drug Use and Health (NSDUH) and provides state-level estimates for 23 measures of substance use and mental health problems, including underage drinking, use of illicit drugs, serious psychological distress, major depression, and tobacco use. These estimates are based on combined data collected from 136,110 respondents surveyed in 2005 and 2006 (the most recent data available). The report also reveals statistically significant changes that have occurred within each state between 2004-2005 and 2005-2006.
The 64-page report is available at: http://www.oas.samhsa.gov/2k6state/2k6state.pdf
Source: Substance Abuse and Mental Health Services Administration (SAMHSA) - March 7, 2008.
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HIV/AIDS
Updated CDC Fact Sheet "HIV/AIDS in the United States"
According to the Centers for Disease Control and Prevention (CDC), during the mid-to-late 1990s, advances in HIV treatments slowed the progression of HIV infection to AIDS and led to dramatic decreases in deaths among persons with AIDS living in the 50 states and the District of Columbia. In general, the trend in the estimated numbers of AIDS cases and deaths remained stable from 2002 through 2005. Estimates for 2006 suggest that the number of AIDS cases remained stable and that the number of deaths decreased; however, it is too early to determine whether this trend will hold. Better treatments have also led to an increase in the number of persons who are living with AIDS.
Other findings include:
- In 2006, almost three quarters of HIV/AIDS diagnoses among adolescents and adults were for males.
- In 2006, the largest estimated proportion of HIV/AIDS diagnoses among adults and adolescents were for men who have sex with men (MSM) at 50%, followed by persons infected through high-risk heterosexual contact (33%).
- Although blacks, or African Americans, made up only 13% of the population in the 33 states, they accounted for almost half of the estimated number of HIV/AIDS diagnoses made during 2006.
- In 2006, persons aged 25–34 (26%) and persons aged 35–44 (32%) accounted for the largest proportions of newly diagnosed HIV/ AIDS cases.
This 2-page fact sheet is available at: http://www.cdc.gov/hiv/resources/factsheets/PDF/us.pdf
Source: Centers for Disease Control & Prevention – March 26, 2008.
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CDC Fact Sheet: HIV/AIDS among Persons Aged 50 and Over
The number of persons aged 50 years and older living with HIV/AIDS has been increasing in recent years. This increase is partly due to highly active antiretroviral therapy (HAART), which has made it possible for many HIV-infected persons to live longer, and partly due to newly diagnosed infections in persons over the age of 50. As the U.S. population continues to age, it is important to be aware of specific challenges faced by older Americans and to ensure that they get information and services to help protect them from infection.
This 2-page fact sheet is available at : http://www.cdc.gov/hiv/topics/over50/resources/factsheets/pdf/over50.pdf
Source: Centers for Disease Control & Prevention – February 28, 2008.
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Notice:
All facts and opinions are those of the sources cited. News reports may have been edited for length and/or modified for clarity without altering essential data as originally published.
Addiction Treatment Forum and its associates do not endorse any medications, products, or treatments described, mentioned, or discussed in any of the sources referenced. Nor are any representations made concerning efficacy, appropriateness, or suitability of any such products or treatments. This News Update is made possible by an educational grant from Mallinckrodt Inc., distributors of methadone and naltrexone.
In view of the possibility of human error or advances in medical knowledge, Addiction Treatment Forum and its associates do not warrant the information contained in the above news updates is in every respect accurate or complete, and they are not responsible nor liable for any errors or omissions that may be found in such information or for results obtained from use of such information.