NEWS NOTES & UPDATES #125
November 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: October 2008
Contents
MEDICATION-ASSISTED TREATMENT (MAT) IN OPIOID TREATMENT PROGRAMS (OTPs)
Methadone Maintenance 4 Decades Later – A Commentary by Herbert D. Kleber, MD
SAMHSA’s OTP Mortality Reporting Form Now Available Online
Study: Extended Suboxone Treatment Improves Outcomes in Young Adults
RESEARCH IN THE NEWS
Boston Medical Center Researchers Educating Chief Residents About Addiction
SBI Program Reduces Heavy Alcohol Use and Illicit Drug Use, Study Says
‘Insight’ Deficit May Explain Denial in Drug Addiction
NEW RESOURCE
NEW EVENTS TO NOTE
Over 35 U.S. and international events have recently been added to the ATForum.com website. The Events page can be accessed at: http://atforum.com/events/index.php
MEDICATION-ASSISTED TREATMENT (MAT) IN OPIOID TREATMENT PROGRAMS (OTPs)
Methadone Maintenance 4 Decades Later – A Commentary by Herbert D. Kleber, MD
As part of the Journal of the American Medical Association (JAMA) classics series of articles celebrating 125 years of publishing, the November 19, 2008 issue provides a commentary on “Methadone Maintenance 4 Decades Later”. The commentary is provided by Herbert D. Kleber, MD, Columbia University College of Physicians and Surgeons, Division on Substance Abuse, The New York State Psychiatric Institute.
Dr. Kleber provides his perspective on the impact of Drs. Dole and Nyswander’s 1965 article on methadone maintenance published in JAMA. His commentary also addresses positive outcomes of methadone maintenance treatment, the safety of methadone, and federal regulations and stigma.
Dr. Kleber’s commentary can be accessed at:
http://jama.ama-assn.org/cgi/content/full/300/19/2303
The complete text of the 1965 Dole/Nyswander article “Medical Treatment for Diacetylmorphine (Heroin) Addiction: A Clinical Trial With Methadone Hydrochloride” can be accessed at:
http://jama.ama-assn.org/cgi/data/300/19/2303/DC1/1
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SAMHSA’s OTP Mortality Reporting Form Now Available Online
The Opioid Treatment Program (OTP) Mortality Reporting Form allows OTPs to voluntarily report mortality data on patients who, at the time of death, were receiving medication-assisted treatment (methadone or buprenorphine) at a SAMHSA-certified OTP.
To date, there has been no means of estimating the number of patients dying while enrolled in OTPs and the causes of those deaths. Under the statutory authority of The Public Health Service Act, SAMHSA is responsible for supporting activities that will improve treatment for substance abuse and coordinating federal policy with respect to methadone. The proposed information gathering relating to mortality is ultimately in adherence to this legislative mandate.
SAMHSA is requesting that this information be voluntarily reported to SAMHSA. They are also welcoming feedback regarding use of the reporting form. Given national concerns over drug poisoning deaths, and the belief that a SAMHSA-certified OTP should represent safe and competent addiction treatment of patients who have become dependent on heroin or prescription opioid drugs, SAMHSA may propose new rules requiring mandatory mortality reporting.
A designated OTP staff member should complete and submit the form to SAMHSA within 48 hours of notification of a patient death. The OTP’s investigation into a patient death should follow the policies and procedures set forth by the state and program. Additional information pertinent to the cause(s) of death discovered after the initial notification should be forwarded to SAMHSA immediately. All subsequent communication should reference the initial report.
The OTP Mortality Report Form can be accessed at: http://dpt.samhsa.gov/pdf/OTPMortalityForm.pdf
Instructions for using the form can be accessed at: http://www.dpt.samhsa.gov/pdf/OTPMortalityForm_Instructions.pdf
For additional information or questions, please contact Alina Walizada, Public Health Advisor, at (240) 276-2755 or by e-mail at Alina.Walizada@samhsa.hhs.gov.
Source: The Substance Abuse Mental Health Service Administration – November 21, 2008.
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Extended Suboxone Treatment Improves Outcomes in Young Adults
A new study concludes that opioid-addicted young adults who underwent 12 weeks of treatment with the anti-addiction medication Suboxone and counseling had substantially better outcomes than those receiving standard, short-term detoxification and counseling.
Study participants who received the extended Suboxone treatment were less likely to use opioids, cocaine and marijuana, to inject drugs, or drop out of treatment than those who receiving short-term treatment.
The study included 154 patients aged 15 to 21 who were addicted to opioids for an average of 1.5 years and were recruited from six outpatient treatment programs around the country. All were offered group and individual counseling for 12 weeks. Participants were randomly given either two weeks of detoxification using Suboxone or 12 weeks of extended Suboxone treatment. Starting at week 9 the dose of Suboxone for the extended treatment group was tapered downward and was discontinued at week 12.
The researchers found that patients receiving extended Suboxone treatment were much less likely to provide opioid-positive urine samples at weeks 4 and 8 than those in the standard detoxification group, but not when the dose had tapered off at week 12. Evaluations at months 6, 9 and 12 showed increased rates of opioid use in both groups compared to the end of the treatment period. Both groups showed lower rates of opioid use than they did prior to treatment, particularly in the extended treatment group.
"We saw a marked reduction in opioid and other drug use; less injecting behavior, and better treatment retention in the patients assigned to longer-term Suboxone treatment," said George Woody of the University of Pennsylvania and Treatment Research Institute, the study's chief investigator. "The teens and young adults readily accepted Suboxone and tolerated it well."
The study was conducted through the National Drug Abuse Treatment Clinical Trials Network and supported by the National Institute on Drug Abuse (NIDA).
The research was published in the November. 5, 2008 issue of the Journal of the American Medical Association.
Source: JoinTogether.org – November 5, 2008
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RESEARCH IN THE NEWS
Nearly One-Half of Youths Who Have Ever Misused Prescription Pain Relievers Have Also Used Two or More Illicit Drugs
Approximately one-tenth of U.S. youths ages 12 to 17 reported using non-prescribed pain relievers at least once in their lifetime, according to an analysis of data from the National Survey on Drug Use and Health. These youths were significantly more likely than those who did not use non-prescribed pain relievers to also report poly-drug use. For example, 49% of youths who used non-prescribed pain relievers also reported using two or more illicit drugs at least once in their lifetime, compared to 4% of youths who did not use non-prescribed pain relievers (see figure below). Previous research has found a similar relationship between nonmedical use of prescription stimulants and use of other illicit drugs.
Source: CESAR Fax – October 20, 2008, Volume 17, Issue #42
Original Source: Wu, L-T, Pilowsky, D.J., and Patkar, A.A. “Non-prescribed use of pain relievers among adolescents in the United States,”Drug and Alcohol Dependence94(1-3):1-11, 2008.
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Boston Medical Center Researchers Educating Chief Residents About Addiction
Researchers from Boston Medical Center (BMC) have found that education on addiction is inadequate during medical training, resulting in suboptimal medical care for those at risk. However, the research also found that a Chief Resident Immersion Training (CRIT) program in addiction medicine is an effective "train the trainers" model for dissemination of addiction knowledge and skills to generalist physician trainees. These findings appear in the Journal of General Internal Medicine.
The goal of the CRIT program is to provide incoming generalist chief residents from internal medicine, family medicine and emergency medicine with the scientific foundation of addiction medicine and state-of-the-art diagnosis and management skills of addiction medicine. The goal is to facilitate the integration of addiction medicine content into residency program curricula and chief resident teaching.
"Training chief residents who have a primary responsibility for educating medical trainees, appears to be one important pragmatic strategy to address the compelling need for better physician training in the identification and management of patients with addiction," explains lead author of the study Daniel P. Alford, MD, MPH, FACP, Associate Professor of Medicine at Boston University School of Medicine and director of Chief Resident Immersion Training in Addiction Medicine Section of General Internal Medicine at BMC. "This program effectively transferred evidence-based addiction knowledge and practice to 64 chief residents in generalist disciplines and more importantly, enhanced the addiction curriculum in 47 residency programs," said Alford.
Source: Boston University– October 24, 2008
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SBI Program Reduces Heavy Alcohol Use and Illicit Drug Use, Study Says
A new report concludes that Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs decrease illicit-drug use rates by 67.7 percent and heavy alcohol use rates by 38.6 percent.
Researchers from the Office of National Drug Control Policy, National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from 459,599 patients who were screened for alcohol and other drug use at a variety of health-care facilities, and followed up with subjects six months later to track changes in drug-use rates. The report showed that of the illicit-drug users participating in SBIRT programs, 64.3 percent reported fewer arrests, 45.8 percent who were homeless said they were no longer homeless, and 31.2 percent reported fewer emotional problems.
The SBIRT program can be used in health-care facilities like primary care centers, hospital emergency rooms, and trauma centers to screen patients for signs of substance abuse and refer them to treatment, as needed.
The report includes data from six organizations running SBIRT programs funded by SAMHSA.
The research was published online in the October 16, 2008 issue of the journal Drug and Alcohol Dependence.
Source: JoinTogether.org – November 5, 2008
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‘Insight’ Deficit May Explain Denial in Drug Addiction
WASHINGTON, D.C. — Drug abusers are often characterized as being in “denial” — not recognizing the severity of their disorder. Although “denial” is often considered to be a form of deception, emerging research suggests that it may be due to a specific brain dysfunction similar to that observed in other neuropsychiatric illnesses.
“The more we understand about the brain mechanisms affected by drugs of abuse and that underlie addiction, the better equipped we will be to address its complex and difficult-to-treat symptoms, including relapse triggered by exposure to cues outside of conscious awareness, and altered perceptions of internal responses and cognitive performance,” said Nora D. Volkow, Director of NIDA. “This knowledge will lead to the development of more responsive, integrated treatments.”
Scientists from a variety of fields presented relevant research during a November symposium on "Impaired Insight into Illness in Drug Addiction" at the Society for Neuroscience annual meeting in Washington, D.C. Rita Z. Goldstein, a psychologist who leads the neuropsychoimaging group at the U.S. Department of Energy's (DOE) Brookhaven National Laboratory, was chair of this symposium.
Ms. Goldstein explained the idea of impaired insight and how it might relate to drug addiction: “Patients suffering from mental illnesses such as schizophrenia often have compromised awareness of their own symptoms and the severity of their disorder. This compromise can exacerbate symptoms and reduce responsiveness to or compliance with treatment,” she said. This “insight deficit” appears to originate from impairments in many of the same brain regions that underlie addiction symptoms — such as continued drug use despite catastrophic consequences, even when the drug is no longer pleasurable.
“It is therefore possible that these core clinical addiction symptoms — craving and compulsion and the chronic relapsing nature of addiction — may be a consequence of compromised insight,” Goldstein said. Such impaired insight might help explain why drug-addicted patients often have a hard time recognizing, accepting, and/or acknowledging their own signs and symptoms of addiction, as well as the need for treatment. It could also help explain these patients’ failure to comply fully with treatment regimens — and their tendency to relapse.
The press release can be accessed at: http://www.bnl.gov/bnlweb/pubaf/pr/PR_display.asp?prID=855
Source: Brookhaven National Laboratory News – November 16, 2008
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NEW RESOURCE
Guidance to States: Treatment Standards for Women With Substance Use Disorders Including Guidance on Medication-Assisted Treatment
The National Association of State Alcohol/Drug Abuse Directors (NASADAD) and the Women’s Services Network (WSN) released Guidance to States in September, 2008, to provide guidance and implementation strategies that can assist individual states as they develop their own treatment standards for women with substance use disorders.
Staring on page 37, there is a section that specifically addresses Medication-Assisted Treatment (MAT) for women including:
- Key standards of care
- Pregnancy/perionatal considerations
- Special considerations for women in the criminal justice system
The 96-page document can be accessed at: http://nasadad.org/index.php?doc_id=1379
Source: The National Association of State Alcohol/Drug Abuse Directors - September, 2008
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NEW EVENTS TO NOTE
More than 35 U.S. and international events have been added to the ATForum.com. website during the past month. The Events page can be accessed at: http://atforum.com/events/index.php
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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 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.