AT Forum NEWS NOTES & UPDATES #116

February 2008

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: January 2008

List of all News/Updates

 

Contents

MMT & ADDICTION TREATMENT

Buprenorphine in the News – Misuse of ‘bupe’ is found to be on rise – U.S. could exert controls if matter is deemed serious

How Common Is Comprehensive Addiction Treatment Across the U.S.?

GOVERNMENT

SAMHSA Guidance Letter on Take-Home Medication Issued January 24, 2008

SAMHSA Proposed Project: Opioid Treatment Programs (OTPs) Mortality Reporting Form

NIDA Releases Draft Strategic Plan

SAMHSA Papers Provide Information on Treatment for People with Co-Occurring Disorders

SAMHSA Launches E-Learning Courses

HIV, AIDS, NEEDLE EXCHANGES

Rand Report: HIV and Mental Health

Introduction to the CDC HIV Prevention Strategic Plan: Extended Through 2010

D.C., Freed from Federal Restraints, Funds Needle Exchanges

Medscape® Poll Results on Needle-Exchange Programs

MMT & Addiction Treatment

Buprenorphine in the News – Misuse of ‘bupe’ is found to be on rise – U.S. could exert controls if matter is deemed serious

In December 2007, the Baltimore Sun ran a three part series entitled the ‘bupe fix’. The articles revealed that while buprenorphine has been shown to be highly effective as an addiction treatment, its misuse is increasing. The Sun also identified patterns of illegal sales as well as several deaths caused by taking the drug in combination with other substances. Several articles have been published in the Baltimore Sun since the ‘bupe fix’ series was published, including an article on February 3, 2008, which outlined details of a report provided by Reckitt Benckiser Pharmaceuticals Inc. to the U.S. Food and Drug Administration on January 8th.

The report linked misuse and illicit sales to the federally sanctioned practice of allowing doctors to prescribe large quantities of the drug for patients to take at home. “It was the patients in treatment for opioid abuse - no doubt selling or trading their own supply of buprenorphine - who were seen as major contributors to the street supply," the report stated.

Reckitt Benckiser submitted the reports as part of a "post marketing surveillance" system as a condition of the FDA's 2002 approval of the drug.. The surveillance, conducted by a consultant hired by the company, is intended to alert U.S. regulators to any abuse. A copy of the document was obtained by The Sun.

The report, covering the period from July through September 2007, is based largely on questionnaires to patients seeking drug treatment and to doctors and workers at drug clinics, including three in Baltimore. The consultant also conducts "street-level" interviews, analyzes poisoning and injury data, and reviews postings on Internet sites frequented by drug abusers.

• There was a substantial increase in the numbers of patients entering drug treatment who were aware of abuse and illegal sales of buprenorphine - on par with methadone for the first time. They described street sales in a number of places, including Chicago's West Side, where the drug was "easy to purchase" for $2 to $5 per tablet. Most addicts reported using it on the street to avoid withdrawal sickness.
• At poison control centers across the nation, more than a quarter of 1,876 buprenorphine exposures involved children under 6 years of age from Jan. 1, 2006, to Sept. 30, 2007, the company said. The rate of buprenorphine exposures in children was higher than the rates for methadone and oxycodone, which are far more commonly prescribed, the report said. The children who ingested buprenorphine, whose names and locations were not stated, all recovered.
  
• A major source of illegal Suboxone, according to 17 percent of doctors surveyed, was "lax or inappropriate" prescribing of the drug by their peers. More than half the doctors questioned in New England, where Suboxone is most widely available as an addiction treatment, said they believed it was just as easy to buy illegally as methadone and other widely abused narcotics. Drug abusers who were interviewed generally agreed.
  
• Interviews with drug treatment clients in Lynn, Mass., suggested that growing numbers of drug abusers might be turning to Suboxone to get high. In past reports, company officials have said 90 percent of people abusing Suboxone buy it on the street to ward off symptoms of narcotics withdrawal. But a third of the drug abusers questioned in Massachusetts said they used the drug to get high.

In Vermont, a researcher reported that 14 percent of prescription opioid abusers reported that buprenorphine was their "primary opioid of abuse."

"There is evidence that there is experimental use and illegal diversion of buprenorphine, especially the most frequently prescribed product - Suboxone," the report said.

<Click here… > to read the complete article.

Source: Baltimore Sun February 3, 2008. Article written by Fred Schulte and Doug Donovan - Sun reporters. Used by permission of Fred Schulte (2/5/08)

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How Common Is Comprehensive Addiction Treatment Across the U.S.?

The National Institute on Drug Abuse (NIDA) has specified a research-based set of core and wraparound services that should be provided in addiction treatment to enhance retention and outcomes. This study examined the extent to which 754 treatment centers across the United States made these services available to people they treated.

• The average organization provided only 6.6 of the 14 services examined: 3.2 of the 5 core services (intake/assessment, random drug testing, self-help groups, pharmacotherapy, and continuing care services) and 3.4 of the 9 wraparound services (childcare, transportation assistance, treatment for HIV/AIDS, integrated care for dual diagnoses, and linkage with medical, employment, financial, family, and legal services).
• None of the organizations provided all 14 services examined.
• Government-operated and publicly funded nonprofits provided significantly more core and wraparound services than did privately funded nonprofits.

Comments by Mike Boyle, MA:
Claims of comprehensive addiction treatment services in the United States are far from reality. Since core and wraparound services increase retention and outcomes, clients, their families, and funding bodies (most importantly) should demand these services be provided. To increase receipt of these services, payors may need to add billing codes or change rate structures to cover the cost of providing wraparound services, and treatment organizations may need to strengthen collaboration with other providers of these services in their communities.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue January/February/March 2008. Article accessed 1/28/08.
Mike Boyle, MA.

Original Source: Ducharme LJ, Mello HL, Roman PM, et al. Service delivery in substance abuse treatment: reexamining “comprehensive” care. J Behav Health Serv Res. 2007;34(2):121–137.

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Government

SAMHSA Guidance Letter on Take-Home Medication Issued

On January 24, 2008, H. Westley Clark Director of CSAT issued a reminder letter to the field concerning “SAMHSA policy for unsupervised medication take-home doses when the Opioid Treatment Program is closed for business, including Sundays and Federal and State holidays.”  CSAT is reminding programs that if they are closing their operations and if they are treating clinically unstable patients, who do not meet the longstanding 8 criteria, which should be used by the physician and program clinical staff in determining take-home dosage schedules, then the program is expected to make “alternative arrangements” for such patients.

<Click here… > to view the correspondence.

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SAMHSA Proposed Project: Opioid Treatment Programs (OTPs) Mortality Reporting
Form

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT), has developed a voluntary reporting form for Opioid Treatment Programs (OTPs) to report mortality data on patients who at the time of death, were enrolled in the Programs that were certified to operate by SAMHSA.

Currently, there is no national database that tracks mortality among patients receiving methadone in OTPs and as a result, it is not clear whether and to what extent the increase in methadone-associated deaths may be related to treatment in OTPs. MedWatch, a voluntary reporting system maintained by FDA, provides information relevant to its role in its more general oversight of medication and device safety. A similar system is needed within SAMHSA to gather information directly relevant to the agency's mission of overseeing and ensuring safe and effective treatment for patients with opioid dependence.

In order to more accurately understand potential methadone-associated deaths at the OTP level, it is necessary to examine all patient deaths, including those related to buprenorphine. Understanding the actual cause of death of patients enrolled in OTPs can be a challenging task for many reasons, including inconsistencies in methods of reporting causes of deaths across different localities and officials; patients' use of other drugs, including illicit, over-the-counter, and prescription products; and other aspects of the patient's physical and mental condition. The standardized terminology to be used for reporting in the proposed system will contribute to a more precise and relevant analysis of individual cases and higher-level trends. The data will be used by SAMHSA to increase understanding of the factors contributing to these deaths, identify preventable causes of deaths, and ultimately, take appropriate action to minimize risk and help improve the quality of care. Importantly, better data will enable the agency to more proactively manage the oversight of treatment.

<Click here… > to view the complete article.

Source: Federal Register: January 2, 2008 (Volume 73, Number 1)] [Notices] [Page 200]

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NIDA Releases Draft Strategic Plan

HIV/AIDS and "crosscutting priorities" join prevention and treatment as the four major goals outlined in the National Institute on Drug Abuse's (NIDA) new strategic plan, recently released in draft form.

Citing "recent revolutionary advances in drug abuse research," NIDA has been working with its national advisory council and others in the addiction research field to develop the plan, the agency's first major new outline of goals and objectives since former director Alan Leshner, Ph.D., published a five-year strategic plan in 2000.

The new strategic plan for NIDA, which spends more than $1 billion annually on research into illicit drugs, includes:

Prevention: to prevent the initiation of drug use and the escalation to addiction in those who have already initiated use. "A major focus of our efforts will be the determined pursuit of why some people get addicted while others do not," according to NIDA. "To that end, we will support research that strives to identify the factors that put people at increased risk of drug abuse or protect them from it." 

Treatment: to support research to develop successful treatments for drug abuse and addiction, and to improve their accessibility and implementation, using a "whole systems" approach.

HIV/AIDS: to support research that seeks to diminish the spread of HIV among drug abusers and their partners, and minimize the associated health and social consequences of the disease. "We plan to continue to support primary prevention research to find the most effective HIV risk-reduction interventions for different populations," according to the draft strategic plan. "Young people are a major focus for these efforts, calling for strategies that start early and can adapt with age."

Under the catchall of "crosscutting priorities" outlined in the draft, NIDA intends to work toward:

• Decreasing health disparities related to drug addiction and its consequences
• Ensuring a diverse and highly trained workforce able to assume leadership roles in the research agenda on substance abuse and related disorders
• Promoting collaborative international research activities, including training and dissemination of science-based information on drug abuse
• Promoting a more rapid translation of research findings into clinical application and practice
• Educating a variety of audiences (e.g., children, parents, teachers, media, legislators, and others) about the science underlying drug abuse
• Leveraging NIDA resources across the entire National Institutes of Health research community to expand our knowledge base and increase awareness of the import of drug abuse on other health issues

To access the 39 PDF file <click here… >

Source: Join Together – January 11, 2008

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SAMHSA Overview Papers Provide Information on Treatment for People with Co-Occurring Disorders

Three new short overview papers from the Substance Abuse and Mental Health Services Administration (SAMHSA) provide information about how epidemiology, services integration and systems integration research and practices can be best utilized in helping people with co-occurring substance use and mental disorders.

• Services Integration: Overview Paper 6 defines and explains how services integration practices can help merge previously separate substance abuse treatment and mental health clinical services provided at the individual level to people with co-occurring disorders.  <Click here … > to access the PDF file.
• Systems Integration: Overview Paper 7 outlines the benefits of developing public health infrastructures that systematically integrate mental health and substance abuse treatment programs to better meet the full needs of people with these disorders. <Click here… > to access the PDF file. 
• The Epidemiology of Co-Occurring Substance Use and Mental Disorders: Overview Paper 8 is presented in two parts. Part 1 provides the general public with a basic understanding of the field of epidemiology and how it has been used to shed light on the problem of co-occurring disorders. In particular, it focuses on three major studies that are regularly referenced as prime sources of information on the nature and scope of this problem. Part 2 is geared more to the scientific community and provides more detailed technical information on these three studies. <Click here… > to access the PDF file.

Source: SAMHSA - January 4, 2008

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SAMHSA Launches E-Learning Courses

The Substance Abuse and Mental Health Services Administration's (SAMHSA's) Knowledge Application Program (KAP) is offering its first online e-learning course, Acamprosate: A New Medication for Alcohol Use Disorders. This is the first in a series of courses which will also include the following topics:

• Prescription Medications: Misuse, Abuse, Dependence, and Addiction
• Organizational Development: Marketing for Referral Development
• Organizational Development: Finance
• Organizational Development: Governance
• Anger Management

The online e-learning courses are self-paced so that users can log out of the course and return at a later time to continue where they left off. If unsuccessful, users can take the course again. NAADAC credits are offered.

<Click here… > to access the e-learning course.

Source: SAMHSA – January 14, 2008

 

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HIV/AIDS

Rand Report: HIV, Substance Abuse and Mental Health

Rand Corporation has recently issued a research brief entitled Mental Health and Substance Abuse Issues Among People with HIV. The HIV Costs and Services Utilization Study (HCSUS) gathered information to estimate the prevalence of these problems among persons with HIV, to assess those persons’ access to appropriate care, and to measure how these problems affected their ability to adhere to treatment. A special follow-up survey was conducted on the segment of participants who initially screened positive for mental health problems or substance abuse, and another follow-up survey focused on issues related to the sexual behavior of people living with HIV.

Key findings include:

• People with HIV are much more likely to experience mental health or substance abuse problems than individuals in the general population.
• Most individuals with HIV who have mental health or substance abuse problems receive the treatment they need, but earlier detection and intervention would likely offset the increased medical costs they often incur.
• More than half of those receiving highly active antiretroviral therapy (HAART), the most effective treatment for HIV, did not take the medications as directed; those struggling with mental health or substance abuse problems were the least likely to comply. Screening and special interventions may help.
• Violence is common in the intimate relationships of people with HIV: A combination of substance use and violence increases the likelihood of engaging in unsafe sex.

<Click here… > to access the research brief.

Source: Rand Corporation – December 17, 2007

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CDC HIV Prevention Strategic Plan: Extended Through 2010

This plan extends the HIV Prevention Strategic Plan Through 2005 (2001 Plan) published by the Centers for Disease Control and Prevention (CDC) in January 2001. The HIV Prevention Strategic Plan: Extended Through 2010 ( Extended Plan), which will serve as CDC’s strategic guide for HIV prevention through 2010, includes a short-term goal of reducing new HIV infections by 5 percent per year or at least 10 percent by the end of 2010.

To access the 157 page PDF Strategic Plan <click here… >

Source: JoinTogether.org Treatment Practitioners Research Bulletin Jan 2008

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D.C., Freed from Federal Restraints, Funds Needle Exchanges

With a Congressional funding ban finally lifted, the District of Columbia government announced that it will spend $650,000 of local taxpayers' money to establish needle-exchange programs aimed at cutting HIV/AIDS transmission among drug users, the Washington Post reported Jan. 3.

In its FY2008 budget plan, Congress ended a ban on D.C. using public funds to fund needle exchanges, although a ban on federal funding for the harm-reduction programs remains in place. D.C. Mayor Adrian M. Fenty said the clean-needle programs are needed to help reduce the HIV/AIDS rate in the city, which is among the highest in the nation.

"This program goes to best practices to combat one of our greatest health problems," Fenty said. PreventionWorks, which operates a needle exchange program in D.C. using private donations, will receive a $300,000 city grant, while the rest of the money will be used to launch other needle-exchange programs in D.C.

"The cost of infection is immeasurably higher in terms of dollars and lives," said D.C. City Council member David A. Catania.

Prevention Works is already exchanging about 200,000 needles annually in D.C.

Source: JoinTogether.org – January 3, 2008

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Medscape Poll Results on Needle-Exchange Programs

Last month, Medscape® conducted a one week online poll asking respondents if they approve or disapprove of needle-exchange programs. There was a total of 2,636 respondents including physicians, nurses and pharmacists.

As the following graph illustrates, over 70% of respondents somewhat or strongly approve of needle-exchange programs. Pharmacists were most likely to strongly approve at 58%.

<Click here… > to view the complete poll results.

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Updated July 25, 2008