AT Forum NEWS NOTES & UPDATES #121
July 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: June 2008
Contents
ADDICTION TREATMENT IN THE CRIMINAL JUSTICE SYSTEM
California Prison Overcrowding Plan Focuses on Alternatives
ADDICTION RESEARCH
Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders
Hopkins Study: Many Hospital Patients Have Addictive Disorders
Treat Pregnant Addicts Early to Prevent Problems, Researchers Say
Drug Tests on Newborns Frequently Wrong, Researchers Say
Impulsivity May Trigger Addiction, Researchers Say
NIDA Research Focuses on Addiction and Exercise
GOVERNMENT RESOURCES
DEA Issues Proposed Regulations to Allow Electronic Prescriptions for Controlled Substances
HEPATITIS/HIV/AIDS
Persistent Hepatitis C Reinfection in Injection Drug Users Who Have Cleared the Virus
MISCELLANEOUS
Effects of Buprenorphine after Accidental Ingestion by Children
Sewage Study Yields Surprising Info About Drug Use
Addiction Treatment in the Criminal Justice System
California Prison Overcrowding Plan Focuses on Alternatives
A settlement plan to reduce chronic overcrowding in California prisons proposes to invest in more addiction treatment programs, as well as offering community service and other alternatives to incarceration, the San Francisco Chronicle reported May 20.
The California corrections system and prisoners, advocates, law enforcement and state officials are working with appointed court referees in an attempt to craft a solution to the overcrowding situation before a federal lawsuit goes to trial. The proposed settlement calls for prison populations to decline over the next three years, according to Los Angeles attorney and former judge Elwood Lui, one of the referees. "The idea is to make use of techniques to divert prisoners," he said.
The plan calls for placing parole violators in treatment programs instead of returning them to prison; having some low-risk offenders serve their time in county jail or on probation; electronic monitoring; and offering reduced sentences to inmates who complete drug treatment, vocational training and educational programs.
"It reduces the prison population by reducing crime -- putting people in programs rather than in prison," said Don Specter, director of the Prison Law Center.
"We're reviewing this as a potential compromise framework for resolving the prison overcrowding crisis and as an effective solution to protecting public safety," said Lisa Page, a spokeswoman for Gov. Arnold Schwarzenegger.
Source: JoinTogether.org – June 18, 2008
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Prerelease Treatment with Buprenorphine-Naloxone Reduces Drug Use in Inmates
Re-Entering the Community
Although around 15 percent of American prisoners have a history of heroin addiction, most inmates with a drug use disorder do not receive treatment, and very few have access to pharmacological treatment programs. Investigators in Puerto Rico and funded by NIDA tested whether treatment with buprenorphine-naloxone (bup-nx) could feasibly be initiated in soon-to-be released opioid-addicted prisoners. They also examined whether the treatment would continue in the community and decrease drug use and criminal activities.
The investigators recruited 45 male prisoners with heroin addiction and approximately 6 months left in their prison sentences to participate. All received a personalized dosing schedule in prison, and before release, an appointment for community treatment. Three participants had to discontinue treatment before release. Of the 42 who continued treatment while in prison, 35 attended their appointment with the community provider and reported continued use of bup-nx (referred to as treatment completers).
Treatment completers had significantly greater reductions in heroin and cocaine use as well as a reduction in criminal activities compared with those who did not complete the program. Although the authors caution that this was a small feasibility study without a control group, and that larger future studies are needed, they believe that “the short-term outcomes of this study suggest that treatment with bup-nx may significantly contribute to reductions in readdiction to heroin and in criminal activities among re-entering male offenders.”
Published in: National Institute on Drug Abuse (NIDA) News Scan – June 9, 2008
Original Source: Albizu-Garcia C, Correa GC, Viver AD, Kinlock TW, Gordon MS, Avila CA, Reyes IC, Schwartz, RP. Buprenorphine-naloxone treatment for pre-release opioid-dependent inmates in Puerto Rico. J Addict Med. 2007;1(3):126-132.
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Addiction Research
Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders
This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders. Methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders are presented, as well as practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. This article is featured in the June 2008 issue of NIDA’s Addiction Science and Clinical Practice. The authors include: Seddon R. Savage, M.D., M.S., Kenneth L. Kirsh, Ph.D., and Steven D. Passik, Ph.D.
The article can be accessed at: http://www.nida.nih.gov/ascp/vol4no2.html
Source: National Institute of Drug Abuse (NIDA) – Available online June 5, 2008.
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Hopkins Study: Many Hospital Patients Have Addictive Disorders
A significant number of patients admitted to a major U.S. hospital had alcohol or other drug problems, according to researchers at the Johns Hopkins School of Medicine.
WebMD reported June 25 that researchers Patricia B. Santora, Ph.D., and Heidi E. Hutton, Ph.D., found that 13.7 percent of patients admitted to Johns Hopkins Hospital between 1994 and 2002 had alcohol, tobacco, or other drug addiction disorders (ADAA), and that the cost of caring for these patients rose 134 percent during that time span.
Just one percent of patients were admitted solely for drug problems; the vast majority had other health problems, as well.
"Our results demonstrated the high prevalence of hospital admissions with co-occurring ADAA and the striking financial costs placed on the hospital, government programs, and insurers," according to the researchers.
About half of the patients were polydrug users, while a quarter used only alcohol and the rest used opioids or heroin only. The cost of treating opioid users rose 482 percent between 1994 and 2002.
The study was published in the July 2008 issue of the Journal of Substance Abuse Treatment.
This article summarizes an external report or press release on research published in a scientific journal. When available, links to the sources are provided above.
Source: JoinTogether.org – June 27, 2008
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Treat Pregnant Addicts Early to Prevent Problems, Researchers Say
Being addicted and pregnant isn't an automatic pathway to trouble. Researchers say that negative birth outcomes can be avoided if patients get decent prenatal care and addiction treatment early in their pregnancy, WebMD reported June 26.
Delivering integrated prenatal care and addiction treatment also is cost-effective, according to researcher Nancy C. Goler of Kaiser Permanente and colleagues. The study of more than 49,000 women included 2,000 women enrolled in Kaiser's Early Start program for addicted mothers-to-be.The authors determined that those enrolled in the program had no significantly higher rates of problems like low birth weight, preterm labor or delivery, or stillbirth than non-addicted women.
Researchers also found that perinatal and addiction treatment reduced the number of maternal deaths.
The study was published in the Journal of Perinatology.
Source: JoinTogether.org – June 27, 2008
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Drug Tests on Newborns Frequently Wrong, Researchers Say
Up to 70 percent of drug tests on newborns falsely come up positive for the presence of methamphetamine, and other routine drug tests are often wrong, as well, experts say.
The Los Angeles Daily News reported June 28 that testing of meconium samples -- the first stool produced by a newborn -- is frequently incorrect, according to Brown University's Barry Lester. Experts recommend that hospitals testing for maternal drug use conduct confirmatory or forensic testing to verify results, but many hospitals don't do so.
"It's not the hospital's burden to do a confirmatory test," said James Lott, executive vice president of the Hospital Association of Southern California. "It's up to the agency that investigates child abuse whether a confirmatory test needs to be done. The hospital can choose to do it if it wants to, but it's not obligated to do it."
False positive results on drug tests can be caused by a variety of factors, including use of cold medicines or even consumption of poppy seeds. Research suggests that tests for methamphetamine are incorrect 26 percent of the time, on average, while tests for opiates are wrong in 29 percent of cases, according to a study in the January 2008 issue of the Mayo Clinic Proceedings.
This article summarizes an external report or press release on research published in a scientific journal. When available, links to the sources are provided above.
Source: JoinTogether.org – June 30, 2008
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Impulsivity May Trigger Addiction, Researchers Say
British researchers say that impulsivity seems to trigger addiction and not the other way around, Science magazine reported June 6.
People with addictions are known to be more impulsive and engage in more thrill-seeking behaviors than non-addicts, but it has been unclear whether those behaviors predated drug use or were the result of addiction.
Researchers David Belin and Barry Everitt of the University of Cambridge attempted to answer the question by studying rats known to have thrill-seeking or impulsive personalities. The researchers connected the rats to a device that delivered cocaine directly to their brains and then gave the rats control over their drug use. They found that the thrill-seeking rats tried the drug immediately and in high doses, while the impulsive rats used the drug less quickly and in greater moderation.
However, the authors found that after 40 days of access to the drug the impulsive rats had become addicted and could not stop using cocaine even when punished with an electric shock, while the thrill-seeking rats had grown tired of the drug and stopped using.
Source: JoinTogether.org – June 11, 2008
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NIDA Research Focuses on Addiction and Exercise
Spurred by a study showing that adolescents who exercise daily are far less likely to smoke cigarettes or experiment with marijuana, the National Institute on Drug Abuse (NIDA) is funding research into the role that physical activity can play in prevention, the Associated Press reported June 10.
NIDA recently convened a meeting of 100 exercise and neurobiology experts to discuss how exercise affects mood and the reward system in the brain related to addiction. The agency also announced $4 million for new research studies on the subject.
Addiction treatment programs sometimes have an exercise component, but there has been little research into its effect on recovery. One Brown University study suggested that taking female smokers to the gym three times per week doubled their odds of quitting, as well as limiting their weight gain.
On the other hand, research also suggests that athletes are more likely to be binge drinkers.
Source: JoinTogether.org – June 10, 2008
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Government News & Resources
DEA Issues Proposed Regulations to Allow Electronic Prescriptions for
Controlled 
Substances
On June 27, 2008, the Drug Enforcement Agency (DEA) published proposed regulations that would provide physicians and other authorized prescribers with the option of issuing electronic prescriptions for controlled substances. These regulations would also permit pharmacies to receive, dispense, and archive these electronic prescriptions. The agency is seeking public comment on the proposed regulations. Any member of the public wishing to submit comments may do so by mail or electronically on or before September 25, 2008.
These regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances dispensing; additionally, the proposed regulations would reduce paperwork for DEA registrants who prescribe or dispense controlled substances and have the potential to reduce prescription forgery.
The proposed regulations would also have the potential to reduce the number of prescription errors caused by illegible handwriting and misunderstood oral prescriptions. Moreover, they would help both pharmacies and hospitals to integrate prescription records into other medical records more directly, which would increase efficiency, and would reduce the amount of time patients spend waiting to have their prescriptions filled. Further, with these regulations DEA seeks to ensure that patients, prescribers, and pharmacists know that the person who wrote the prescription is who that person claims to be, and that the medication being dispensed by the pharmacist and received by the patient is the medication that was prescribed.
The text of the Federal Register Notice can be found at http://www.gpoaccess.gov/fr/index.html
Source: Drug Enforcement Agency Press Release – June 27, 2008
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SAMHSA Study Reveals Local Patterns of Addiction, Mental Illness
Thanks to its large Mormon population Utah has long been considered the nation's most sober state -- the church bars members from alcohol and tobacco use -- but a new study shows that the Salt Lake City area has one of the highest rates of prescription-drug abuse in the U.S.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reported that up to 7.92 percent of residents over age 12 in Salt Lake and Weber-Morgan counties in Utah used prescription painkillers for non-medical reasons. However, the same counties had some of the lowest rates of underage binge drinking in the nation.
The report, Substate Estimates from the 2004-2006 National Surveys on Drug Use and Health, provides data on addiction and mental health in 345 localities across the U.S., down to the county and, in some cases, census-tract level.
"The findings reveal that the nation's substance-abuse and mental-health problems are fundamentally local in character and might be addressed directly most effectively at that level," said SAMHSA Administrator Terry Cline, Ph.D. "This report provides local public-health authorities sharper insight into the nature and scope of the substance-abuse and mental-health problems affecting their communities."
Source: JoinTogether.org - June 26, 2008
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Hepatitis/HIV/AIDS
Persistent Hepatitis C Reinfection in Injection Drug Users Who Have Cleared the Virus
Previous retrospective studies of injection drug users who resolved their hepatitis C infection (HCV) have reported high rates of acute reinfection. But the rate of clinically relevant persistent reinfection (i.e., more than one consecutive positive test for HCV RNA in people with resolved HCV) has not been measured prospectively.
To determine this rate, researchers in this study prospectively examined 224 people with hepatitis C infection, a history of injection drug use, and serial hepatitis C viral loads.
- Of 224 subjects followed for 1391 person-years, 38 resolved their infection.
- Of these 38 subjects, 29 resolved their infection spontaneously, and 9 resolved their infection after receiving HCV treatment.
- Fourteen of the spontaneous resolvers and 2 of the treatment-associated resolvers continued to inject drugs during follow-up.
- Only 1 of the 38 subjects with a resolved infection (a subject who had spontaneous resolution, continued to inject drugs, and also had HIV) had persistent hepatitis C reinfection.
Comments: Persistent reinfection with hepatitis C in people who have resolved the infection, even in those with ongoing injection drug use, appears to be less common than suggested by previously published reports. However, determining a more certain rate of hepatitis C reinfection among injection drug users will require larger studies.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue April 2008. Article accessed 6/30/08
Alexander Y. Walley, MD, MSc
Original Source: Currie SL, Ryan JC, Tracy D, et al. A prospective study to examine persistent HCV reinfection in injection drug users who have previously cleared the virus. Drug Alcohol Depend. 2008:93:(1-2):148–154.
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Miscellaneous
Effects of Buprenorphine after Accidental Ingestion by Children
Researchers sought to identify and analyze all exposures to buprenorphine in children <6 years of age as reported in a national monitoring system over a 3-year period. Primary findings included the following:
- Of the 86 events identified, 77% involved buprenorphine/naloxone tablets.
- The mean dose of buprenorphine ingested was 3 mg with a range of 0.03 to 24 mg. No child who ingested <4 mg experienced a severe effect, while all of the children who ingested >4 mg experienced some effect.
- In the 54 children who developed toxicity, clinical effects included lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%), irritability (5%), pallor (3%), and coma (2%). There were no fatalities.
Comments: This study provides useful information and guidance regarding the likely effects of buprenorphine after accidental ingestion by young children. The author’s conclusions that “any child ingesting >2 mg and children >2 years of age ingesting more than a lick or taste should be referred to the emergency department” for a minimum of 6 hours of observation are prudent. Patients receiving buprenorphine products should be instructed about safe storage to avoid accidental exposures.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue April 2008. Article accessed 6/30/08.
David A. Fiellin, MD
Original Source: Hayes BD, Klein-Schwartz W, Doyon S. Toxicity of buprenorphine overdoses in children. Pediatrics. 2008;121(4);e782–e786.
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Sewage Study Yields Surprising Info About Drug Use
Scientists analyzing the chemical composition of raw sewage in cities in the U.S. and Europe have made some surprising discoveries about drug-use patterns, the Los Angeles Times reported June 23.
Likened to a citywide drug test, the studies estimate drug use based on the chemicals excreted in feces and urine by community residents. Researchers have found, for example, that Los Angeles has more cocaine in its sewage than many European cities, and that London's heroin usage may be higher than in cities in Italy and Switzerland. More methamphetamine apparently is used in Las Vegas than in Omaha, Neb., or Oklahoma City, Okla., the studies suggest.
"Every sample has one illicit drug or another, regardless of location," said researcher Jennifer Field of Oregon State University. "You may see differences from place to place, but there's always something."
The sewage testing is seen as an adjunct to other types of drug-use assessments, such as surveys. Sewage research has shown that cocaine use seems to peak on Saturdays, for example, while heroin and marijuana use appears to be steady throughout the week.
However, there are complications to measuring drug use with sewage: concentration of chemicals can vary based on sewage flow, time of day, and how long it takes waste to flow through the pipes. "This has caught on only recently, and people are still trying to understand the uncertainties," said Field.
Some communities also are resistant to the studies, wary that the results could put them in a bad light. San Diego, for examples, has barred researchers from studying the drug contents of its sewage.
Researchers also have begun checking the environment for traces of illicit drugs.
Source: JoinTogether.org – June 24, 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.