AT Forum NEWS NOTES & UPDATES #115

January 2008

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: November-December 2007

List of all News/Updates

 

Contents

 

MMT
December 2007 Heroin Addiction and Related Clinical Problems Now Available
NAMA Announces New President Roxanne Baker

GOVERNMENT
Methadone Diversion, Abuse, and Misuses: Deaths Increasing at Alarming Rate
National Drug Threat Assessment 2008 Report
DEA Advisory December 10, 2007 Methadone Hydrochloride Tablets USP 40 mg (Dispersible)
NASADAD Methadone Overdose Report
SAMHSA Releases 2006 Data from National Survey of Substance Abuse Treatment Services
SAMHSA Announces Availability of Substance Abuse Treatment for Persons With Co-Occurring Disorders Inservice Training

SMOKING AND SUBSTANCE ABUSE
Smoking Among Patients With Alcohol or Drug Use Disorders
Feasibility of a Smoking Cessation Intervention in Substance Abuse Treatment Programs

ADDICTION & MENTAL ILLNESS
Amygdala is Link Between Addiction, Mental Illness, Researchers Say

 

MMT

Heroin Addiction and Related Clinical Problems December 2007 Issue

The December 2007 issue of Heroin Addiction and Related Clinical Problems is now available for download at atforum.com. Articles in this issue include:

• Addiction Treatment: When Will Medical Principles Matter?
• Maintenance: How Long?
• Agonist Opioid Treatment in Prisons
• The Need For Patient Education. Opinions And Attitudes On Heroin Addiction
• Motivational Interviewing: Linking Systems and Dancing with Clients

<Click here… > to download the 60 page PDF file.

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NAMA (National Alliance of Methadone Advocates) Announces New President Roxanne Baker

November 26, 2007 - Roxanne (Rokki) Baker, C.M.A. is NAMA's new president. Ms. Baker was elected by the Board of Directors during the AATOD Conference in San Diego this past October. Prior to holding this new office Ms. Baker has served NAMA as Vice President and Chapter Coordinator. She also founded and is the Director of the chapter NAMA Northern California (NAMA NorCal). Joycelyn Woods, M.A., C.M.A. who is stepping down as President has been appointed as the Executive Director of NAMA.

Source: National Alliance of Methadone Advocates

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Government

Methadone Diversion, Abuse, and Misuses: Deaths Increasing at Alarming Rate

December 6, 2007 - Deaths from overdoses on methadone rose 390 percent between 1999 and 2004, and the trend is continuing, according to a new report from the National Drug Intelligence Center.

USA Today reported Dec. 6 that the report attributes the trend mostly to increased use of methadone as a painkiller; the drug is seen as a cheaper alternative to drugs like OxyContin, which also have more potential for abuse and diversion. Doctors prescribed 715 percent more methadone in 2006 than they had in 2001.
The methadone overdose rate was highest among those ages 15 to 24; the rate was lower than that for other narcotic painkillers but is rising faster.

"The larger story is the widespread abuse of prescription painkillers in America," said Tom Riley of the White House Office of National Drug Control Policy. "The abuse and misuse of prescription drugs is far more dangerous and far more widespread than most Americans realize."

<Click here… > to access the 20 page PDF report.

Source: JoinTogether.org and The National Drug Intelligence Center (NDIC)

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National Drug Threat Assessment 2008 Report

This report published online November 11th, provides a strategic overview and predictive outlook of the threat to the US from the illicit trafficking of heroin, pharmaceutical drugs, and other dangerous drugs. The following summarizes key findings on heroin and pharmaceutical drugs:

Heroin
Heroin is readily available in most large metropolitan areas and, increasingly, in some suburban and rural markets throughout the country. Abuse levels are stable at relatively low levels; however, abuse is increasing among young adults in a number of suburban and rural areas. Abuse is generally concentrated in the Northeast, where the drug is most available. Abuse of prescription narcotics as a precursor to heroin among adolescents is an emerging concern to law enforcement and public health officials.

Pharmaceutical Drugs
Over the past several years, pharmaceutical abusers typically acquired the drugs through doctor-shopping, forged prescriptions, or unscrupulous physicians and pharmacists working alone or in association; however, many of these individuals have been dissuaded from using these methods because of prescription monitoring programs (PMPs) and increased law enforcement scrutiny. As a result, more abusers have shifted to other means of obtaining pharmaceuticals such as theft, purchases from Internet pharmacies, or acquisitions from retail distributors.

<Click here… > to access the 89 page PDF assessment report.

Source: US Department of Justice National Drug Intelligence Center

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DEA Advisory - Methadone Hydrochloride Tablets USP 40 mg (Dispersible)

December 10, 2007 - As of January 1, 2008, manufacturers of methadone hydrochloride tablets 40 mg (dispersible) have voluntarily agreed to restrict distribution of this formulation to only those facilities authorized for detoxification and maintenance treatment of opioid addiction, and hospitals. Manufacturers will instruct their wholesale distributors to discontinue supplying this formulation to any facility not meeting the above criteria.

Methadone is a long-lasting opioid medication used in the treatment of pain and narcotic addiction. The 5mg and 10 mg formulations indicated for the treatment of pain will continue to be available to all authorized registrants, including retail pharmacies. The 40 mg methadone formulation is indicated for the detoxification and maintenance treatment of opioid addiction. The 40 mg strength is not FDA approved for use in the management of pain. Thus, the distribution and availability of the 40 mg formulation will be limited to registrants in only those settings using the 40 mg formulation for the appropriate indication.

The DEA and pharmaceutical industry agree that the reported increase in methadone-related adverse events merits action and further agree to a united effort to assure that methadone is properly distributed, consistent with its approved uses. Industry and the federal entities involved commit to monitor the progress of this initiative.

Source: US Drug Enforcement Agency (DEA)

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NASADAD State Issue Brief on Methadone Overdose Report

On November 7, 2007 the National Association of State Drug Alcohol State Directors issued a 23 page report on Methadone Overdose. This Issue Brief describes national and State efforts to explore the extent of the problem, the benefits of methadone for addiction treatment and pain management, the risks associated with methadone use, and efforts at a national and State level to better understand the problem and to reduce methadone overdose deaths.

After reviewing data on opioid sales, patterns of prescribing and dispensing and data on drug-associated mortality, National Assessment participants concluded that the available data suggested that methadone tablets and/or diskettes that had become available through channels other than OTPs were most likely the central factor in the recent increases in methadone-associated mortality.

<Click here… > to access the 23 page report.

Source: National Association of State Drug Alcohol State Directors

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SAMHSA Releases 2006 Data from National Survey of Substance Abuse Treatment Services

November 23, 2007 - The Substance Abuse and Mental Health Services Administration (SAMHSA) has released findings from the 2006 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of substance abuse treatment facilities that provides data on the location and characteristics of alcohol and drug abuse treatment services throughout the United States. 

Nearly 13,800 facilities participated in the survey, reporting more than 1.1 million clients in treatment on March 31, 2006.

• In 2006, 1,203 facilities operated Opioid Treatment Programs (certified by SAMHSA) which represents a 12.5% increase compared to 2005.
• A total of 258,752 patients received methadone treatment in 2006…a 9.7% increase compared to 2005.

The report’s findings include:

• Facilities operated by private non-profit organizations made up the bulk of treatment facilities (59 percent).  Private for-profit facilities made up 28 percent of these services in 2006, with the remaining facilities operated by local governments (7 percent), state governments (3 percent), the Federal government (2 percent) and tribal governments (1 percent). The 2006 N-SSATS shows that a growing proportion of patients are being treated in private for-profit facilities (from 26 percent in 2002 to 29 percent on March 31, 2006). 
• Nearly half (46 percent) of all clients were in treatment for both alcohol and drug abuse on March 31, 2006.  Approximately one third (35 percent) of clients were in treatment for drug abuse only, and 18 percent were in treatment for abuse of alcohol only.

<Click here… > to access the 213 page PDF report.

Source: The Substance Abuse and Mental Health Services Administration (SAMHSA)

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SAMHSA Announces Availability of Substance Abuse Treatment for Persons With Co-Occurring Disorders Inservice Training

Substance Abuse Treatment for Persons With Co-Occurring Disorders Inservice Training is based on SAMHSA’s Treatment Improvement Protocol (TIP) 42.
This manual provides a structure for introducing addiction counselors and other practitioners to information on the rapidly advancing field of co-occurring substance use and mental disorders. The material is designed for delivery by clinical supervisors.

The trainer’s manual includes eighteen 45-minute modules to be delivered over time, with one module presented per training session. Each module includes presentation instructions, PowerPoint slides trainer scripts, and participant handouts.

Available for download at www.kap.samhsa.gov or <Click here… > to access the 786 page training manual.

Source: The Substance Abuse and Mental Health Services Administration (SAMHSA)

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Smoking and Substance Abuse

Smoking Among Patients With Alcohol or Drug Use Disorders

The prevalence of smoking is much higher in people with alcohol or drug use disorders.  However, neither the specific relationship between smoking and alcohol or drug use nor the impact of gender on this relationship is clearly understood. Therefore, researchers analyzed data from a nationally representative sample of 42,565 U.S. adults who participated in a survey on alcohol and related conditions.

• Prevalence of daily smoking was 21% among the total sample, 40% among people with a current alcohol use disorder (abuse or dependence), and 55% among people with a current drug use disorder.
  
• Ex-smokers composed about 20% of the total sample, 13% of people with a current alcohol use disorder, and 8% of people with a current drug use disorder.
• The likelihood of daily smoking, versus never smoking, was highest among women with a current drug use disorder (odds ratio [OR], 6.5), followed by men with a current drug use disorder (OR, 4.6), women with a current alcohol use disorder (OR, 3.5), and men with a current alcohol use disorder (OR, 2.9). These results were statistically significant.

Comments: Smoking is highly prevalent among people with alcohol or drug use disorders, and quitting smoking is difficult for such patients. Regardless, to help prevent additional smoking-associated morbidity, clinicians should conduct screening and offer appropriate treatment for nicotine dependence for patients with substance use disorders.
Julia H. Arnsten, MD, MPH

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2007. Article accessed 1/2/08.
Julia H. Arnsten, MD, MPH.

Original Source: Husky MH, Paliwal P, Mazure CM, et al. Gender differences in association with substance use diagnoses and smoking. J Addict Med. 2007;1(3):161-164.

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Feasibility of a Smoking Cessation Intervention in Substance Abuse Treatment Programs

Patients in treatment for substance use disorders have a high prevalence of smoking. Treating nicotine dependence in substance abuse treatment settings, however, is uncommon. 

Researchers in this study evaluated the feasibility of implementing a smoking cessation intervention in substance abuse treatment programs. They surveyed, as part of a randomized trial, the program directors, research directors, and 1442 patients from 13 different sites.

Smoking prevalence was 76%. It was higher at sites that provided methadone (87% versus 66% at sites without methadone) and at sites located in a setting with medical services (85% versus 63% at sites without medical services).

Most (78%) smokers were interested in quitting, and 64% were willing to enroll in smoking cessation treatment. Interest in quitting and willingness to enroll in smoking cessation treatment were both more common at the sites that provided methadone (e.g., 77% versus 48% willing to enroll) and at sites located in a setting with medical services (e.g., 73% versus 45% willing to enroll).

Obstacles to performing a smoking cessation intervention identified by sites included the time commitment by staff and scheduling conflicts and low motivation among patients.

Comments: Smoking is highly prevalent among patients in substance abuse treatment. Although barriers to implementing smoking cessation interventions may exist, these patients, particularly those receiving methadone, are very interested in quitting smoking.  Methadone maintenance programs may offer a unique means of integrating nicotine dependence treatment with substance abuse treatment.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2007. Article accessed 1/2/08.
Julia H. Arnsten, MD, MPH.

Original Source: Reid MS, Fallon B, Sonne S, et al. Implementation of a smoking cessation treatment study at substance abuse rehabilitation programs: smoking behavior and treatment feasibility across varied community-based outpatient programs. J Addict Med. 2007;1(3):154–160.

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Addiction & Mental Illness

Amygdala is Link Between Addiction, Mental Illness, Researchers Say

December 10, 2007 - Addiction and mental illness may be so closely related because both affect the brain region called the amygdala, Science Daily reported Dec. 3.

About half of people seeking treatment for addiction or mental-health problems are dually diagnosed. Researcher Andrew Chambers, M.D., of Indiana University and colleagues, seeking to understand the roots of this linkage, studied two groups of lab rats: one with damaged amygdalas, and one with normal amygdalas. The amygdala is involved in fear, anxiety and other emotions.

The rats with the damaged amygdalas were less responsive to dangerous stimuli and were more responsive to novelty. They showed less fear when placed in an elevated maze, for example, and continued to socialize with each other even when exposed to the scent of a predator. Moreover, they were significantly more sensitive to cocaine and seemed more prone to addiction.

The researchers concluded that the damage to the rats' amygdala was the cause of the heightened drug response and their impaired fear response. "Brain conditions may alter addiction vulnerability independently of drug history," said Chambers, who concluded that heightened vulnerability to drugs could explain high rates of dual diagnosis and why such patients tend to respond less to psychiatric medications.

Chambers said that early emotional trauma and genetics may alter the development of the amygdala, "resulting in a cascade of brain effects and functional changes that present in adulthood as a dual-diagnosis disorder."

The study was published in the December 2007 issue of the journal Behavioral Neuroscience.

Source: JoinTogether.org Research Summary

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Updated July 25, 2008