AT Forum NEWS NOTES & UPDATES #119
May 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: April 2008
Contents
Opioid Treatment Programs (OTPs) in the News
First methadone clinic in Idaho opens
NY Methadone Clinic Fits Well in Health Network
Addiction Treatment
Addiction Treatment Needed for Traumatized Returning War Veterans
Prescription Drugs
User Registry for Prescription Painkiller Abuse
Research
A Brief Screen for Classifying Pain Severity in Patients with Opioid Dependence
Substance Use and Dependence in First Year After Initiation
Personality Disorders Cause Emotional Reactions In Staff
Limbic System Activated by Drug and Sexual Cues Even Before Conscious Recognition
Meeting Highlights
ASAM Opening Plenary Medical-Scientific Session Highlights
Opioid Treatment Programs (OTPs) in the News
First Methadone Clinic in Idaho Opens
Idaho’s first methadone clinic (private, for-profit) opened last month in Meridian with 10 patients. Before the clinic opened, patients had to drive to Ontario, OR and Ogden, UT, which are approximately 50 and 300 miles away respectively. There are four states remaining that do not have any methadone clinics: Montana, North Dakota, South Dakota, and Wyoming.
Source: Idahostatesman.com – April 23, 2008
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NY Methadone Clinic Incorporated into Health Network
Once set to close, a Newburgh, NY methadone clinic has become the type of place the state wants to see across New York's health-care system. What makes it interesting isn't so much the clinic itself but its place in a larger network of doctors, dentists, mental health workers and therapists.
The article can be accessed at: http://www.recordonline.com/apps/pbcs.dll/article?AID=/20080423/NEWS/804230359
Source: Times Herald-Record – Doyle Murphy – April 23, 2008
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ADDICTION TREATMENT
Addiction Treatment Needed for Traumatized Returning War Veterans
Many veterans suffering from post-traumatic stress disorder and other combat-related trauma self-medicate with alcohol and other drugs, so therapists need to be aware of the need to treat both addiction and trauma simultaneously, addiction specialists say.
The Newport News Daily Press reported March 31 that self-medication is especially prevalent among active military because soldiers are reluctant to seek mental-health counseling, fearing that it could hurt their careers.
Addiction specialist Larry Ashley, a Vietnam War veteran, said that combat veterans have unique needs that civilian counselors often are unequipped to deal with. Veterans "give out the trauma, by the very nature of what they do, and receive the trauma," said Ashley at a recent meeting of the Virginia Association of Alcoholism and Drug Abuse Counselors. "In combat, your job is to kill. Knowing you've inflicted trauma, or killed someone, can be just as damaging as facing a life-threatening event."
Community-based addiction specialists expect to encounter more war veterans in their work; Newport News Drug Court administrator John Haywood said it typically takes about two years before returning veterans seek help dealing with trauma, either by choice or because they are forced to do so.
Patricia Greer, president of the National Association of Alcoholism and Drug Abuse Counselors, warned Congress about the problem in recent testimony. "Some experts estimate that about 40 percent of veterans who have served in Iraq or Afghanistan will experience a mental health problem and that of those ... 60 percent will have a substance use disorder," she said.
Source: JoinTogether.org – April 9, 2008
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PRESCRIPTION DRUGS
User Registry for Prescription Painkiller Abuse
New research suggests that stricter monitoring by physician offices and clinics, including user testing, implementation of a user registry, and stronger staff training, can help prevent the abuse of prescription painkillers like OxyContin and Vicodin.
Health Day News reported April 10 that researchers at the University of Michigan and Ohio State University found that a strictly defined policy helps to identify patients using illicit drugs, allowing staff to be more aware of potential painkiller abusers who could be directed to treatment and counseling.
The study found that patients receiving OxyContin or other medications containing oxycodone were twice as likely as other opioid registry patients to violate the clinic policy. The new policy called for a registry of all patients receiving opioid prescriptions, screening of patients from the moment they called for an appointment, and annual and random urine screening.
"Many of us in the clinic were surprised at what we found, because a doctor's job is first and foremost to trust the patient as they tell us about their pain," study author Jennifer Meddings of the University of Michigan Medical School said. "But in order to confront this issue, and protect our ability to prescribe these drugs to the patients who truly need them, we need to have a uniform approach for all patients."
The study was conducted by the University of Michigan/Ohio State University, and was presented April 10 at the Society for General Internal Medicine annual meeting in Pittsburgh.
The original press release can be accessed at: http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=155
Source: JoinTogether.org – April 14, 2008
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RESEARCH
A Brief Screen for Classifying Pain Severity in Patients with Opioid Dependence
Pain is prevalent among people with opioid dependence, and its association with psychosocial stressors (e.g., depression) may threaten clinical gains achieved through substance abuse treatment. A rationale exists, therefore, for screening treatment-seeking patients with opioid dependence for potentially destabilizing pain.
Researchers in this study examined the effectiveness of a streamlined pain screening instrument among people with opioid dependence who sought inpatient opioid detoxification in Massachusetts. Following admission, 110 adults completed a brief questionnaire, including the Brief Pain Inventory–Short Form, to assess physical pain during the last week.
- Ninety-one percent of patients reported some pain during the previous week. Forty-three percent reported chronic pain (lasting ≥6 months), and 70% of those with chronic pain rated their pain as “severe” (≥7 on a scale of 1 to 10).
- Patients with severe chronic pain, versus patients with less severe or no pain, had worse depressive symptoms and were more likely to be receiving occupational disability benefits.
Comments: Severe chronic pain was common among people with opioid dependence seeking inpatient detoxification and was associated with conditions (depressive symptoms, disability) that complicate recovery from drug dependence.
Limitations of this study include the high-acuity patient population (seeking inpatient treatment) and lack of detail about the timing of pain assessment, sequencing of screening steps, and potential for opioid withdrawal symptoms to be reported as pain. Nonetheless, this study suggests that assessing pain severity among patients in opioid dependence treatment could help clinicians identify which of their patients might benefit from pain-related intervention. Additional research is needed to define the impact of simple pain screening algorithms on clinical outcomes among people in treatment for opioid dependence.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue April 2008. Article accessed 4/29/08
Marc N. Gourevitch, MD, MPH
Original Source: Potter JS, Shiffman SJ, Weiss RD. Chronic pain severity in opioid-dependent patients. Am J Drug Alcohol Abuse. 2008;34(1):101–107.
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Substance Use and Dependence in First Year After Initiation
Substance use trajectories in the year after initiation vary greatly by substance, according to a recent analysis of data from the National Survey on Drug Use and Health. For most drugs, more than half of initiates did not continue to use the drug in the year after their first use. In fact, alcohol and marijuana were the only substances for which the majority of initiates continued to use the substance one year after initiating use.
The highest rates of dependence in the year after initiation were for heroin and crack cocaine, followed by marijuana. All other substances had year-after-initiation dependence rates of 5% or less.
Interestingly, the drugs with the highest dependence rates (heroin and crack cocaine) also had the highest rates of nonuse in the year after initiation, indicating that while very few go on to continue using these drugs in the year after initiation, those that do have a greater chance of developing dependence.
The PDF file including data charts, source information and caveats can be accessed at: http://www.cesar.umd.edu/cesar/cesarfax/vol17/17-15.Pdf
Source: JoinTogether.org – April 16, 2008
Reprinted from CESAR Fax, a weekly, one-page overview of timely substance abuse trends or issues, from the Center for Substance Abuse Research (CESAR) at the University of Maryland.
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Genetics of Addiction
Genetics: the blueprint of health and disease
Why do some people become addicted, while others do not? Studies of identical twins indicate that as much as half of an individual’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genes. Pinning down the biological basis for this risk is an important avenue of research for scientists trying to solve the problem of drug abuse. Genes – functional units that make up our DNA – provide the information that directs our bodies’ basic cellular activities. Research on the human genome has shown that the DNA sequences of any two individuals are 99.9% identical. However, that 0.1% variation is profoundly important, contributing to visible differences, like height and hair color, and to invisible differences, such as increased risks for, or protection from, heart attack, stroke, diabetes, and addiction.
Medical research has been strikingly successful at unraveling the mechanisms of these single-gene disorders. However, most diseases, including addiction, are more complicated: variations in many different genes contribute to an individual’s overall level of risk or resistance.
The promise of personalized medicine
The emerging science of pharmacogenomics promises to harness the power of genomic information to improve treatments for addiction. Clinicians often find substantial variability in how individual patients respond to treatment. Part of that variability is due to genetics. Genes influence the numbers and types of receptors in our brains, how quickly our bodies metabolize drugs, and how well we respond to different medications. Armed with an understanding of genetics, health providers will be better equipped to match patients with the most suitable treatments, adjust medication dosages, and avoid or minimize adverse reactions.
The 2-page PDF file can be accessed at: http://www.nida.nih.gov/pdf/tib/genetics.pdf
Source: NIDA – April 2008
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Personality Disorders Cause Emotional Reactions In Staff
A study published in BMC Psychiatry suggests that the way in which professional care workers respond emotionally to substance abuse patients with personality disorders depends on the type of disorder.
While previous research has shown that antisocial and aggressive behavior in patients can affect how professionals manage them, no previous studies have investigated the distinction between the full range of different personality disorders and their effects on professional health care workers.
The idea that the emotional reactions of a professional to his or her patient may play an important part in psychotherapeutic treatment dates back to the work of Sigmund Freud. He coined the term ‘countertransferance’ to describe the observation that a patient’s influence on the analyst’s unconscious feelings may interfere with the patient’s treatment.
In order to test whether this hypothesis holds for the interaction between health professionals and substance abuse patients, the researchers asked staff members to complete an inventory of emotional reactions to their patients. Concomitantly, the patients, most commonly men in their thirties, were asked to complete a personality disorder questionnaire.
The researchers then sought to determine if there were any correlations between the emotional reactions reported by staff and the type of personality disorder in the patient.
Not unexpectedly, they found that patients with features of antisocial personality disorder induced feelings of distance in their carers. Interestingly, feelings of helpfulness were induced by those with features of avoidant personality disorder.
“The patient with antisocial personality disorder tends to be manipulative and aggressive. It is natural for staff members to react to such behavior with some negative reactions, and this is not a sign of unprofessional conduct”, says Morten Hesse. “On the other hand, the patient with avoidant personality disorder is often cautious and appears vulnerable and needy. In that context, many clinicians feel that they can be useful to the patient, and feel secure in their role as treatment providers.”
The researchers point out that by using self-reporting, rather than disorders assessed by the staff, they have, for the first time, avoided the problem of a confounding diagnosis. "Staff reactions should be considered in supervision of staff, and in treatment models for substance abuse patients with personality disorders," the researchers conclude.
The article can be accessed at: http://www.biomedcentral.com/imedia/9854279541613402_article.pdf?random=390405
Source: Biomedcentral.com - Substance abusers' personality disorders and staff members' emotional reactions Birgitte Thylstrup and Morten Hesse BMC Psychiatry (in press)
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Limbic System Activated by Drug and Sexual Cues Even Before Conscious Recognition
The human brain responds to recognizable signals for sex and drugs of addiction by activating the limbic reward circuitry. To determine whether the brain responds in similar ways to these signals even when they are "unseen" -- i.e., presented in a way that prevents their conscious recognition -- researchers in an NIDA-funded study tested the brain response to cocaine, sexual, aversive, and neutral cues (33 milliseconds duration each) in 22 male patients with cocaine dependence. Brain response to each visual cue was measured by magnetic resonance imaging (MRI).
- Cocaine-related images triggered the emotional centers of the brains of patients, even when subjects were unaware they had seen anything.
- Greater brain activity to “unseen” cocaine cues predicted a stronger positive response to visible versions of the same stimuli in later testing.
Comments by Tommie Ann Bower, MA: Results of this study supports years of anecdotal evidence that relapse can be triggered outside of awareness. As with any new finding, the generalizability of these results will depend on additional studies. In the long run, the complicated nature of craving in the brain must be further understood. In the short run, clinicians must redouble efforts to educate patients about the specific triggers for craving, to activate awareness, and to redirect impulses to use.
Source: JoinTogether.org – April,2008
Original Source: Childress AR, Ehrman RN, Wang Z, et al. Prelude to passion: limbic activation by "unseen" drug and sexual cues. PLoS ONE. 2008;3(1):e1506.
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Meeting Highlights
ASAM Opening Plenary Medical-Scientific Session Highlights
Experts Discuss Progress and New Initiatives in Addiction Medicine
April 24, 2008 (Toronto, Ontario) — At the opening plenary session of the American Society of Addiction Medicine 39th Annual Medical-Scientific speakers from the substance abuse field described positive progress and new initiatives in this field including:
- An update on National Institute of Drug Abuse (NIDA) Addiction Research - Jag H. Khalsa, PhD, chief of the medical consequences branch in the division of pharmacotherapies and medical consequences of drug abuse, at NIDA.
- Centers for Disease Control and Prevention (CDC) Finds Decline in HIV From Drug Injections - H. Westley Clark, MD, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA).
Highlights of the opening plenary session can be accessed at: http://www.medscape.com/viewarticle/573441?src=rss
Source: Medscape Medical News - Marlene Busko
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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.