AT Forum NEWS NOTES & UPDATES #122
August 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: July 2008
Contents
MEDICATION-ASSISTED TREATMENT (MAT)
Adherence to Practice Guidelines Improves Outcomes of Opiate Agonist Treatment
Alkermes Initiates Phase III Opioid Dependence Study on Vivitrol
ADDICTION TREATMENT
States Guide Treatment Services, Study Says
PRESCRIPTION DRUGS
Prescription Drugs Continue to Be Widely Available on the Internet Without a Prescription
Report Underscores Fatal Risk of Combining Prescriptions, Other Substances at Home
HIV/AIDS
Center for Disease Control (CDC) Issues New Findings on HIV Incidence in U.S.
MEDICATION-ASSISTED TREATMENT (MAT)
EUROPAD Journal - Heroin Addiction and Related Clinical Problems. 2008(June), Vol. 10, No.2 Now Available Online
Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction.
Articles in this issue include:
- Evaluation of Therapeutic Alternatives to Imprisonment for Drug-Dependent Offenders. Findings of a Comparative European Multi-country Study
- Motivational Interventions for Methadone-Treated Patients
- Health Care Utilization and Morbidity Associated With Methadone and Buprenorphine Treatment
- GPs’ Office Based Methadone Maintenance Treatment in Trieste, Italy. Therapeutic Efficacy and Predictors of Clinical Response
- Use of Sertraline in Depressed Methadone Maintenance Patients
The PDF file of the June 2008 issue can be accessed at HeroinAdd10-2.pdf
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Adherence to Practice Guidelines Improves Outcomes of Opiate Agonist Treatment
Although treating heroin dependence with high-dose methadone and psychosocial services is well-supported by clinical trial data and practice guidelines, many opioid treatment programs (OTPs) do not follow all evidence-based practices. To determine whether adhering to guidelines improves patient outcomes, researchers analyzed data from 232 patients recruited from OTPs in the U.S. Veterans Administration health system that were selected based on whether they were guideline-concordant or guideline-discordant. OTPs in both the guideline-concordant and guideline-discordant groups were geographically similar, as were baseline measures of heroin use, employment, illegal activities, and mental health among patients. The sample also had a high level of psychiatric impairment.
- In the guideline-concordant OTPs, 79% of patients received doses of methadone in the recommended high-dose range compared with 47% of patients in the guideline-discordant OTPs.
- Guideline-concordant OTPs had more full-time equivalent staff than guideline-discordant clinics, despite similar numbers of patients.
- At 6-month follow-up, patients in guideline-concordant OTPs had greater reductions in heroin use, greater improvements in global mental health, and a higher percentage of opioid-free urine tests.
Comments: These results demonstrate that adherence to practice guidelines (which emphasize clinical practices found efficacious in controlled trials—e.g., high-dose methadone and psychosocial services) improves opioid treatment outcomes in everyday practice with severely impaired patients. Greater effort should be made to increase adherence to clinical practice guidelines for opioid substitution treatment through policy changes.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue May/June 2008. Access checked 8/10/08.
Julia H. Arnsten, MD, MPH
Original Source: Humphreys K, Trafton JA, Oliva EM. Does following research-derived practice guidelines improve opiate-dependent patients’ outcomes under everyday practice conditions? Results of the Multi-site Opiate Substitution Treatment study. J Subst Abuse Treat. 2008;34(2):173–179.
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Mixed Progress For Bupe
Baltimore has doubled the number of people using the medication buprenorphine to shake off heroin addiction but has struggled to keep them in treatment.
As the Baltimore Buprenorphine Initiative has accepted more hard-core drug addicts dealing with complications such as mental illness, more drop out. At the start of the initiative in October 2006, officials had picked mostly highly motivated participants.
The retention rate dropped to 52 percent for the year that ended June 30 compared with 65 percent in fiscal year 2007. That is prompting city health officials to question which patients do best on buprenorphine, sold as Suboxone and widely known as "bupe."
Source: BaltimoreSun.com – July 12, 2008. The article can be accessed at : http://www.baltimoresun.com/news/local/bal-te.md.bupe12jul12,0,1093441.story
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Alkermes Initiates Phase III Opioid Dependence Study on Vivitrol
Alkermes has started a Phase III clinical trial of Vivitrol for the treatment of opioid dependence. The multi-center study is designed to assess the efficacy and safety of Vivitrol in approximately 200 patients diagnosed with opioid dependence. The clinical data from this study will form the basis of a supplemental new drug application (sNDA) to the FDA.
The Phase III randomized, multi-center study is designed to assess the efficacy and safety of Vivitrol compared to placebo treatment in opioid dependent subjects who have been recently detoxified and abstinent from opioids for a minimum of seven days prior to treatment initiation.
Approximately 200 subjects will be randomized to receive once-monthly intramuscular injections of either Vivitrol or placebo in combination with counseling for six months. The primary efficacy endpoint is the response profile based on the rate of positive urine drug test results.
All participants who complete the randomized portion of the study will be eligible to continue in an open-label phase and receive Vivitrol once-monthly in combination with counseling for an additional seven months. The objective of the extension phase of the study is to assess the long-term durability of effect, health economics and quality of life outcomes with once-monthly Vivitrol injections.
Source: Datamonitor via COMTEX - June 26, 2008. The full press release can be accessed at: http://www.tradingmarkets.com/.site/news/StockNews/1716947/ Access checked 8/1/08.
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ADDICTION TREATMENT
States Guide Treatment Services, Study Says
State rules and policies play an important role in determining the type of addiction treatment delivered to patients and could be key to getting more treatment programs to adopt proven interventions, according to a new report.
Researchers led by Jamie F. Chriqui, Ph.D., of the University of Chicago looked at the impact of state policy requirements on outpatient care at 9,000 addiction-treatment programs nationwide. They found that most services delivered were closely related to research recommendations from the states, and that programs located in states that required more comprehensive services were more likely to deliver them than programs in states without such mandates.
"The states are uniquely positioned to institute specific policy proscriptions emanating from scientific research in the substance abuse treatment arena, indicating that a comprehensive approach…[is] associated with positive treatment outcomes and reduced recidivism," the authors concluded.
Most of the programs were located in states that required some type of assessment for addiction treatment, but typically did not require the use of comprehensive diagnostic criteria. Few states required drug testing or HIV testing of patients, and a minority of states required programs to provide relapse-prevention services or aftercare.
The study was published in the July 2008 issue of the Journal of Substance Abuse Treatment.
Source: JoinTogether.org – June 27, 2008
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PERSCRIPTION DRUGS
Prescription Drugs Continue to Be Widely Available on the Internet Without a Prescription
The majority of websites selling controlled prescription drugs still do not require a prescription, according to a recent study from the National Center on Addiction and Substance Abuse at Columbia University (CASA). The study identified 159 internet sites selling such drugs during a one-week period in 2008, down from 187 the previous year.
Of these sites, 85% did not require a valid prescription, either by explicitly stating that no prescription was needed/making no mention of a prescription (47%) or by offering an “online consultation” in lieu of a prescription (38%). Only 24 sites (15%) required that a prescription be faxed or mailed or that the patient’s doctor be contacted for the prescription
The authors recommend clarifying federal law to prohibit the internet sale or purchase of a controlled prescription drug without a prescription, requiring internet sites that advertise or sell controlled prescription drugs to be certified, encouraging internet search engines to block advertisements and sites from search results, and creating public service announcements that would appear automatically when conducting internet searches for prescription drugs.
Source: Adapted by CESAR from The National Center on Addiction and Substance Abuse at Columbia University, “You’ve Got Drugs!”V: Prescription Drug Pushers on the Internet, July 2008. Available online at http://www.casacolumbia.org – July 21, 2008.
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Report Underscores Fatal Risk of Combining Prescriptions, Other Substances at Home
While medication-related fatalities in clinical settings have long captured the attention of researchers and health authorities, skyrocketing rates of deaths at home from combining medications and other substances have gone largely unnoticed, ScienceDaily reported July 29.
Researchers at the University of California, San Diego examined records on 200,000 U.S. deaths from medication errors from 1983 to 2004 and found that the highest rate of increase in these deaths -- a staggering 3,196 percent -- was for deaths at home from combining prescription drugs with alcohol and/or street drugs. This issue received national attention in January after the accidental prescription overdose death of actor Heath Ledger at age 28.
By contrast with the numbers for these domestic deaths, fatal medication errors in clinical settings such as hospitals where alcohol or street drugs were not involved showed the smallest rate of increase among the types of deaths studied: 5 percent.
"The decades-long shift in the location of medication consumption from clinical to domestic settings is linked to a dramatic increase in fatal medication errors," the researchers state in their study.
Besides calling for possible changes in policy and clinical practice as a result of the trend, the researchers believe research on medication errors needs an expanded scope to focus on domestic settings and younger patients in addition to clinical settings and elderly populations.
The research, supported in part by a grant from the Marian E. Smith Foundation, is published in the July 28 issue of the Archives of Internal Medicine.
Source: JoinTogether.org – July 30, 2008
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HIV/AIDS
Center for Disease Control (CDC) Issues New Findings on HIV Incidence in U.S.
New technology and methodology developed by CDC show that the incidence of HIV in the U.S. is higher than was previously known. However, the incidence has been stable at that higher level for most of this decade. HIV incidence is the number of new HIV infections occurring during a certain time period, in this case, the year 2006.
These findings, published by in a special HIV/AIDS issue of the Journal of the American Medical Association (JAMA) that was released August 3, 2008, show that in 2006, an estimated 56,300 new HIV infections occurred – a number that is substantially higher than the previous estimate of 40,000 annual new infections. It should be noted that the new incidence estimate does not represent an actual increase in the numbers of HIV infections. Rather, a separate CDC historical trend analysis published as part of this study suggests that the annual number of new infections was never as low as 40,000 and that it has been roughly stable since the late 1990s (with estimates ranging between 55,000 and 58,500 during the three most recent time periods analyzed).
The new estimates highlight the need for expanded HIV prevention services and should serve as a wake-up call that the US HIV/AIDS epidemic is far from over.
The report can be accessed at: http://www.cdc.gov/hiv/topics/surveillance/incidence.htm
Source: Center for Disease Control – August 3, 2008
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Anti-HIV ‘Drug Cocktails’ Equally Effective in Patients with or without History of Injection Drug Use
Highly active antiretroviral therapy (HAART) has been extremely effective at slowing the progression of HIV infection to AIDS as well as extending the lives and improving the quality of life for those with HIV. However, some doctors have been reluctant to prescribe HAART to HIV-infected injection drug users because of concern that they may not fully benefit from the therapy.
A new study by investigators funded by the National Institute on Drug Abuse (NIDA), and led by the British Columbia Centre for Excellence in HIV/AIDS in Canada, suggests that this is not the case: in their large, community-based study of HIV-infected people, injection drug users and people who did not inject drugs had equivalent survival rates seven years after initiating HAART.
HAART consists of a ‘cocktail’ of at least three medications that can decrease HIV viral load. HAART cannot cure a person of HIV infection, which without treatment will almost always progress to AIDS.
The full press release can be accessed at: http://www.nih.gov/news/health/aug2008/nida-06.htm
Source: National Institutes of Health (NIH) – August 6, 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.