NEWS NOTES & UPDATES #126
December 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: November 2008
Contents
KEY U.S. GOVERNMENT REPORTS
NDIC National Drug Threat Assessment Report 2009
SAMHSA Releases New Data on Drug-related Hospital Emergency Department Visits
PRESCRIPTION DRUG ABUSE
Painkiller Overdose Deaths Rising in West Virginia, Study Says
NEW RESEARCH
Study: Methadone May Be Effective in Treating Cocaine Addiction
NEW RESOURCES
ASAM Review Courses Now Available Online
HIV/AIDS
CDC HIV Transmission Rates in the United States
AIDSinfo Glossary of HIV/AIDS-Related Terms - 6th Edition Now Available Online
KEY U.S. GOVERNMENT REPORTS
NDIC National Drug Threat Assessment Report 2009
The National Drug Intelligence Center (NDIC), a component of the U.S. Department of Justice, recently released their 2009 National Drug Threat Assessment Report. The report provides a strategic overview
and predictive outlook of drug trafficking and abuse trends within the U.S.
Strategic Findings for Heroin
- Drug demand data show that, nationally, heroin use is stable or decreasing.
- Heroin trafficking and abuse are most prevalent in eastern states. The strong and lucrative heroin markets in these states are attracting Mexican criminal groups.
- Rising Mexican heroin production and purity during a period of decreasing heroin production and purity in Colombia are fueling the expansion of Mexican heroin distribution in the U.S.
- Drug seizure data indicate that traffickers are increasingly relying on smuggling routes through the Southwest Border to supply heroin to U.S. drug markets.
Drug prevalence and treatment data indicate that rates of use for heroin and the number of individuals seeking treatment for heroin addiction have been stable or have declined for most age groups. Although heroin use is stable, it could increase as more prescription narcotics abusers switch to heroin. Officials in treatment facilities throughout the country report that many abusers of prescription opiates such as OxyContin, Percocet, and Vicodin eventually begin abusing heroin because it is typically cheaper and easier to obtain, and it provides a more intense high.
Treatment officials also report that once an individual switches from prescription opiates to heroin, he or she rarely switches back to exclusively abusing prescription opiates. As the number of prescription opioid users rises, the number of individuals switching from prescription opioids to heroin will likely rise as well. In some areas this trend is already apparent. For example, drug treatment providers in Williams, Fulton, and Defiance Counties in Ohio reported a large increase in the number of heroin abusers seeking treatment in the first half of 2008. Prior to 2008 these treatment providers were treating 90 percent of their clients for prescription opioid abuse; however, they are now treating 60 to 70 percent of their clients for heroin abuse.
Strategic Finding Highlights for Controlled Prescription Drugs
- Distributors and abusers of Schedule II controlled prescription drugs usually acquire the drugs through traditional diversion methods such as prescription fraud and doctor-shopping.
- Many abusers of controlled prescription drugs commit insurance fraud to finance the purchase of these drugs, and such activity has an enormous financial impact on society.
- Overdose deaths related to opioid pain relievers have been increasing recently. The number of deaths involving controlled prescription drugs, particularly opioid pain relievers (such as oxycodone, hydrocodone, methadone, morphine, and fentanyl), increased from 2001 through 2005 and outpaced deaths involving illicit drugs in 2005 (the latest year for which data are available). The number of deaths involving prescription opioids increased 66 percent from approximately 3,484 in 2001 to 5,789 in 2005, according to the Centers for Disease Control and Prevention (CDC). Moreover, the number of methadone-related deaths increased 206 percent (1,456 to 4,462) and the number of deaths involving other synthetic narcotics increased 81 percent (962 to 1,744) during that time. For deaths in which multiple controlled prescription drugs were found, opioid pain relievers were the most commonly mentioned and accounted for approximately 38 percent of first-listed drugs on death certificates in 2005; nearly half of those deaths involved methadone.
The 94-page PDF file can be accessed at: http://www.usdoj.gov/ndic/pubs31/31379/31379p.pdf
Source: National Drug Intelligence Center – December 10, 2008.
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SAMHSA Releases New Data on Drug-related Hospital Emergency Department Visits
The latest Drug Abuse Warning Network (DAWN) report - drawn from a sample of hospital emergency departments (ED) across the U.S. - indicates that more than 1.7 million visits for treatment were associated with some form of substance misuse or abuse.
Among the report’s findings for 2006:
Over half (55%) of all the drug misuse/abuse ED visits during the year involved an illicit drug either alone or in combination with other types of drugs.
- Cocaine was involved in 548,608 emergency department visits.
- Marijuana was involved in 290,563 emergency department visits.
- Heroin was involved in 189,780 emergency department visits.
For 2006, DAWN estimates that 741,425 ED visits involved nonmedical use of prescription or OTC pharmaceuticals or dietary supplements. The majority of these visits (54%) involved multiple drugs.
Central nervous system (CNS) agents (present in 50% of nonmedical-use visits) and psychotherapeutic agents (44%) were the most frequent drugs reported in the nonmedical-use category of ED visits.
- Among the CNS agents, the most frequent drugs were opiate/opioid analgesics (present in 33% of nonmedical-use visits), including single-ingredient formulations (e.g., oxycodone) and combination forms (e.g., hydrocodone with acetaminophen). Methadone, together with single-ingredient and combination forms of oxycodone and hydrocodone, were the most frequent opioids.
- Hydrocodone/combinations in 57,550 ED visits.
- Oxycodone/combinations in 64,888 ED visits.
- Methadone in 45,130 ED visits.
Note: It is not possible to know, based on the documentation available in ED medical records, the extent to which the source of these drugs is a legitimate prescription, as opposed to other sources, nor is it possible to distinguish methadone used for treatment of opiate addiction from the methadone in tablet form, which is prescribed for pain. In fact, methadone may be one of the most ambiguous drugs to categorize in DAWN. When a patient on opioid replacement therapy presents to an ED, methadone may be routinely documented in the medical record, but without sufficient detail to distinguish whether the methadone specifically was related to the ED visit.
According to DAWN, the total number of ED visits attributable to drug misuse and abuse was stable across 2004, 2005, and 2006. That is, the apparent difference is within the margin of error.
- No significant changes in ED visits from 2004 to 2006, or from 2005 to 2006, were detected for any of the major illicit drugs (cocaine, heroin, marijuana, and stimulants) or for alcohol.
- ED visits related to nonmedical use of pharmaceuticals increased 38% in the period from 2004 to 2006. Among the drugs most frequently implicated in nonmedical use, notable changes from 2004 to 2006 occurred for psychotherapeutic agents (31%) and CNS agents (32%). Within these two categories, visits involving benzodiazepines increased 36%, and visits involving opiate/opioid analgesics increased 43%.
The full DAWN report can be accessed at: http://dawninfo.samhsa.gov/pubs/edpubs/default.asp
Source: Substance Abuse and Mental Health Services Administration (SAMHSA) – December 5, 2008
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PRESCRIPTION DRUG ABUSE
One-Third of Americans Report Sharing Prescription Medications; Allergy, Pain, and Antibiotics Most Commonly Shared
Americans frequently share prescription medications, according to a survey of a sample of 700 people in 10 cities across the U.S. Thirty-four percent of the respondents reported sharing prescription medications in the past year, either by loaning their medications to someone else (7%), borrowing medications from someone else (11%), or both (16%). The types of medications most frequently shared were allergy medications (25%), pain medications (22%), and antibiotics (21%; see figure below). According to the authors, these findings suggest that “a large number of individuals are at risk for loss of warnings and instructions, reduced likelihood of appropriate use and compliance, and numerous related consequences, including reduced care seeking, increased perceptions of ineffective treatment, increased antibiotic resistance, and increased risk of side effects”.
Notes: The authors note that while the relatively small sample size may not be representative of the entire U.S., it is “well distributed across a variety of demographic characteristics.” In addition, the findings may under represent the prevalence of prescription medication sharing since the “participant responses may have been influenced by the belief that medication sharing is an illicit or illegal behavior”.
Source: CESAR Fax – November 24, 2008, Volume 17, Issue #47
Original Source: Goldsworthy, R.C., Schwartz, N.C., and Mayhorn, C.B. “Beyond Abuse and Exposure: Framing the Impact of Prescription-Medication Sharing, ”American Journal of Public Health98(6):1115-1121. For more information, contact Dr. Richard Goldsworthy at rick@academicedge.com.
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Painkiller Overdose Deaths Rising in West Virginia, Study Says
A new study suggests that deaths from accidental overdoses of prescription medications in the U.S. are on the rise, U.S. News and World Report reported Dec. 9.
The study, which focused on accidental deaths in the state of West Virginia, also reported a pattern of "doctor shopping" for painkillers, as well as deaths from medications that were not used as prescribed.
"This epidemic of prescription drug overdose involves a substantial amount of substance abuse, and it affects not just West Virginia, but particularly rural areas of the country," said lead study author Aron Hall of the U.S. Centers for Disease Control and Prevention, who called West Virginia "just the tip of the iceberg."
The study reported that 67.1 percent of West Virginia's 295 fatal overdose victims in 2006 were men, and 91.9 percent were between the ages of 18 and 54. About 63 percent of the victims did not have a prescription for painkillers.
The researchers noted that women doctor-shopped more than men and said that younger people were more likely to use painkillers for non-medical reasons. Opioids accounted for 93.2 percent of the deaths, with methadone responsible for 40 percent of these fatalities.
"Opiates are generally very safe if used appropriately, but opiate abuse and dependence is an illness with high mortality rates," said Adam Bisaga, an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. "So the issue is not with the medication, but rather the detection and treatment of those who abuse and become addicted to opiates."
The report is published in the Dec. 10, 2008 issue of the Journal of the American Medical Association.
Source: JoinTogether.org – December 11, 2008
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Related Editorial: More Vigilance, Better Electronic Records Needed, Not Less Use of Opioids to Control Pain
CDC Study of West Virginia Overdoses Suggests Need for Better Compliance Monitoring, Contend McLellan and Turner in Special JAMA Editorial
Physicians who prescribe opioids should be more vigilant and step up monitoring, but not avoid prescribing these drugs when needed for pain management, according to A. Thomas McLellan, Ph.D. and Barbara J. Turner, M.D., MSED in an editorial appearing in the December 10, 2008 Journal of the American Medical Association (JAMA).
The findings, which McLellan and Turner called "disturbing," suggest that diversion of expensive and potent pain medications (sold or stolen) can lead to lethal outcomes." These findings provide further evidence of how significant abuse and misuse of prescription medications has become to America's drug problem," McLellan said. "We know that legitimate, doctor prescribed and managed opioid use is on the rise because of the high prevalence of chronic pain-causing diseases like arthritis. Very disturbing, however, is the rapid increase in accidental drug overdoses, most from opioid use," he said.
"The real message - from this and other studies - is that physicians should increase monitoring, particularly for patients who admit to a history of substance use/abuse when formally queried," he said, "and they should be queried."
In addition to asking patients about past drug, alcohol, and possibly tobacco use, McLellan and Turner recommended executing agreements where patients assent to: receiving opioid drugs from one physician and one pharmacy; limits on timing of refills; taking the medications as prescribed; and adhering to doctor visits for urine screens and other safety checks. Another necessary monitoring tool, they said, is through statewide or even multi-state prescription monitoring databases that physicians can easily access from their offices. "For 20% of the West Virginia deaths, patients appeared to be 'doctor shopping' (obtaining prescriptions from multiple physicians, sometimes based on fraudulent claims of pain or other symptoms). This makes a compelling case for prescription monitoring programs that span multiple states - but such databases are not widely available," they said.
Copies of the editorial and the CDC study can be obtained from the JAMA website.
Source: JoinTogether.org – December 12, 2008
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NEW RESEARCH
Study: Methadone May Be Effective in Treating Cocaine Addiction
New research out of the University of Guelph in Canada suggests that methadone, normally used to treat opiate dependence, may also be effective in treating cocaine addiction, the Ottawa Citizen reported Nov. 24.
Researcher Francesco Leri and colleagues tested the effects of methadone on cocaine-dependent rats and found that the rats did not experience cocaine highs after getting methadone.
The researchers also found that methadone appeared to have a "resetting" effect on portions of the rats' brains responsible for addictive behavior. "What's interesting is that, among the rats given cocaine and then methadone, these regions of the brain looked similar to how they appeared in the rats that were never exposed to cocaine," Leri said.
"We feel we may have the hope of resetting the brains of some individuals to a type of normality," he said. "I think it should be tried and I guarantee you there will be some individuals -- not everybody -- who will do better on methadone, who will be stabilized on methadone."
The U.S. National Institute for Drug Abuse also is researching the effects of methadone and similar addiction medication, such as buprenorphine on cocaine-dependency.
The findings were published online Nov. 6, 2008 in the journal European Neuropsychopharmacology.
Source: JoinTogether.org - November 25, 2008
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ASAM Review Courses Now Available Online
If you could not attend the American Society of Addiction Medicine review courses held in Chicago this past October, over 20 presentations are available to view free-of-charge online at: http://www.asam.org/ReviewCourse.html
Presentations include: Psychiatric and Medical Comorbidites, Maternal/Child Issues in Addiction Including Pregnancy, Clinical Challenges In Prescribing Controlled Drugs, Understanding Addiction: Translating Science to Practice, and Opioid Agonist Therapy
Source: American Society of Addiction Medicine
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NEW RESOURCES
A Guide for Addiction Professionals and Treatment Providers - A Legislative Summary: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
This easy to read legislative summary provides an overview of the act that was signed into law on October 3, 2008. Plans that choose to offer mental health and substance use disorder benefits (there is no mandate that they do so) must offer them at the same level that they offer medical/surgical benefits. Discrimination against mental health and addiction in the form of sub-standard benefits can no longer be written into health insurance plans. Plans are still allowed to use medical management tools (including medical necessity criteria) to manage benefits.
The summary provides a history of the act, frequency asked questions, and case studies of parity in individual states.
The 6-page PDF file can be accessed at: http://www.naatp.org/pdf/newsletters/08novembersi.pdf
Source: National Association of Addiction Treatment Providers (NAATP) Visions November 2008 Newsletter
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HIV/AIDS
CDC HIV Transmission Rates in the United States
The Centers for Disease Control and Prevention (CDC) estimates that approximately 1.1 million persons are living with HIV in the United States. This number is expected to continue to increase over time, as antiretroviral treatments prolong the lives of those who are infected and more people become infected with HIV than die from the disease each year. As the number of people living with HIV—or HIV prevalence—grows, so does the opportunity for HIV transmission to others. Therefore, it is critical to have not only a clear understanding of the number of new infections that occur annually—or HIV incidence—it is also important to know the rate of HIV transmission in order to accurately gauge the impact of HIV prevention efforts on the US epidemic.
Since the peak level of new infections in the mid-1980s, just prior to the introduction of HIV testing, the transmission rate has declined by approximately 89 percent (from 44 transmissions per 100 persons living with HIV in 1984 to five transmissions per 100 persons living with HIV in 2006). Five transmissions per 100 persons living with HIV in 2006 means more than 95 percent of persons living with HIV did not transmit the infection that year.
These data underscore the importance of reaching all infected individuals with HIV testing and prevention services. Previous research has shown that the majority of people who know they are infected take steps to prevent transmission to their partners. CDC currently estimates that approximately one in five persons living with HIV in the US is unaware of their infection and may be unknowingly transmitting the virus to others.
Implications of the Findings
Despite these successes, we must remember that the fight against HIV is far from over. As the number of people living with HIV in the US continues to grow, opportunities for HIV transmission and the burden on the health care system also grow. Additionally, too many people—both HIV-infected and uninfected individuals—are not yet reached by the prevention efforts that we know to be most effective.
HIV continues to take a severe toll on multiple communities in the US, with gay and bisexual men of all races, African Americans, and Latinos bearing the heaviest burden. Waging a continued battle against HIV will take a continued commitment across the country to address HIV among these populations. We all must do more—as individuals, communities, and as a nation—to expand the reach of effective prevention efforts to those at risk and stop the spread of HIV.
The article can be accessed at: http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/transmission.htm
Source: Center for Disease Controls – December 2008.
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AIDSinfo Glossary of HIV/AIDS-Related Terms - 6th Edition Now Available Online
The updated glossary which became available this month, contains 170 new and updated terms, definitions, and abbreviations related to HIV/AIDS. AIDSinfo is a service of the U.S. Department of Health and Human Services (HHS). The 180-page PDF file can be accessed at: http://atforum.com/addiction-resources/documents/GlossaryHIVrelatedTerms.pdf
Source: AIDSinfo - a service of the U.S. Department of Health and Human Services (HHS) - Released December 2008.
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 unrestricted educational grant from Covidien Mallinckrodt a manufacturer 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.