NEWS NOTES & UPDATES #124
October 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: September 2008
Contents
MEDICATION-ASSISTED TREATMENT IN OPIOID TREATMENT PROGRAMS
SURVEYS/RESEARCH
College Freshmen: Pain Killers And Stimulants Less Risky Than Cocaine; More Risky Than Marijuana
Survey Finds Public Has Faith in Addiction Recovery
Effects of Drugs of Abuse on the Aging Brain Explored
HEPATITIS C/HIV
Substance Abuse Treatment among Patients with HIV and Mental Illness
Drug Users Attitudes and Decisions Regarding Hepatitis C (HCV) Treatment
DRUG COURTS
Despite Concerns and Cuts, Drugs Courts Spreading Fast
SAMHSA Awards More Than $17.4 Million to Help Expand Adult Drug Courts
MISCELLANEOUS
Bush Signs Law Cracking Down on Online Pharmacies
MEDICATION-ASSISTED TREATMENT IN OPIOID TREATMENT PROGRAMS
New In-service Training Manual Based on TIP 43 (Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs)
A new in-service training manual is available for TIP 43 (Medication-Assisted Treatment (MAT) for Opioid Addiction in Opioid Treatment Programs. The manual provides a detailed in-service training curricula for introducing substance abuse treatment professionals to MAT for opioid addiction in outpatient treatment programs. It also describes opioid use disorders; assessment and treatment planning; pharmacology and dosing, and evidence-based best practice for treatment.
The training manual which includes 13 modules with PowerPoint slides is available for download at: http://www.kap.samhsa.gov/products/trainingcurriculums/tip43.html
Hard copies of the manual can be ordered online at : http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17932
Source: The Substance Abuse and Mental Health Service Administration – October 1, 2008
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RESEARCH
New National Survey Reveals Cocaine, Methamphetamine Use Drop among Young Adults; Prescription Drug Abuse Increases
Cocaine and methamphetamine use among young adults has dropped significantly over the past year, while abuse of prescription drugs has risen, according to the nation’s largest substance use assessment, the 2007 National Survey on Drug Use and Health (NSDUH). The report also showed a spike in drug use among 55-59 year-olds, as baby boomers entered that age range. See news brief below for the Effects of Drugs of Abuse on the Aging Brain Explored.
Among young adults ages 18 to 25, the level of current nonmedical use of prescription pain relievers has risen 12 percent (to 4.6 percent in 2007). In addition, the level of current illicit drug use among those aged 55 to 59 more than doubled, to 4.1 percent in 2007, confirming concerns that baby boomers have continued their higher levels of substance abuse as they age.
“Our efforts against methamphetamine, cocaine, and other illegal drugs are working,” said John Walters, director of National Drug Control Policy. “The markets for these poisons are shrinking, and the deadly grip they hold on the lives of individuals, families, and communities is being countered. But when it comes to prescription drugs, we can not afford to re-live the painful experiences we’ve had with illegal drugs. We must act quickly to increase awareness of the dangers of prescription drug abuse, decrease the illegal diversion of these products, and shore up safer practices for their prescription and distribution.”
NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country.
The full press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/0809033637.aspx
The complete survey findings are available on the SAMHSA website at http://oas.samhsa.gov/NSDUHlatest.htm
Source: The Substance Abuse & Mental Health Services Administration – September 4, 2008
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Unmet Need for Drug Treatment
According to data from the 2007 National Survey on Drug Use and Health (NSDUH), 82% of the estimated 7.5 million who needed treatment for an illicit drug problem in the past year did not receive it.
While there are many reasons for not receiving treatment, a primary one appears to be a lack of perceived need. Nearly all (91%) of those who were assessed as needing but did not receive treatment for illicit drug problems said that they did not feel that they needed treatment.
A lack of perceived need for treatment may mean that people don’t think they have a problem, they think their problem is not serious enough to warrant treatment, or they think they can handle their substance use problem on their own.
For details, including data charts, source information and caveats, download the CESAR Fax PDF.
Original Source: 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.
Source: JoinTogether.org - October 7, 2008
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College Freshmen: Pain Killers And Stimulants Less Risky Than Cocaine; More Risky Than Marijuana
'Sensation-Seekers' and students who don't perceive nonmedical use as harmful are prime candidates for nonmedical prescription drug use.
First year college students believe that occasional nonmedical use of prescription pain killers and stimulants is less risky than cocaine, but more risky than marijuana or consuming five or more alcoholic beverages every weekend, according to a new study published in the September issue of Prevention Science.
This is the first study to describe college students' perceptions about the potential harmfulness of nonmedical use of prescription pain killers and stimulants. Previous studies with high school students show that beliefs about harmfulness of illicit drugs are related to drug use.
The study by Amelia Arria, Ph.D., of the Center for Substance Abuse Research at the University of Maryland, also found that college students who can be described as "sensation-seekers" are more likely to use prescription drugs nonmedically; irrespective of how harmful they may perceive the drugs to be. Arria said "sensation-seekers are students who like novel experiences, who want to try something new and a little dangerous, like jumping off the highest diving board or placing themselves in high-risk situations. They are much more likely to use pain killers nonmedically even if they perceive the drugs to be quite harmful."
Arria's study, which was funded by the National Institute on Drug Abuse, also found that students who perceive these drugs as relatively harmless are ten times more likely to use them than those who think that the drugs are extremely harmful.
"This study suggests that educating students about the potential harm that can be caused by nonmedical use of prescription drugs is important in reducing use of these drugs by college students.
Research has shown that sensation-seeking peaks during the late teen years, which raises the possibility that students might become better equipped to make appropriate risk appraisals as they mature into college years.
Source: Society for Prevention Research – September 3, 2008
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RESEARCH
Survey Finds Public Has Faith in Addiction Recovery
Most U.S. adults believe that recovery from addiction is possible, according to a recent national survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The telephone survey of 1,010 Americans ages 18 and older found that 50 percent of adults know someone in recovery from alcohol or other drug addiction.
Furthermore, more than two-thirds of respondents said they believe that treatment for addiction can work and that people in recovery can contribute to society.
The survey revealed some variations in attitudes by age and gender. For example, more young adults (ages 25-34) than older adults said they believe that recovery is possible, and women were more likely than men to say that people in recovery from illicit drugs can contribute to society.
Over 60 percent of respondents said they "would be comfortable" working with or being friends with someone in recovery, and less than 20 percent said they would "think less of a friend or relative" if they discovered he or she was in recovery.
But adults seem to be more comfortable with some addictions than others. When asked if they would be comfortable living next to someone in recovery from alcohol abuse, 57 percent said yes, whereas 46 percent of those polled said they would feel comfortable if the person next door were in recovery from drug abuse.
The 4-page fact sheet can be accessed at : http://www.samhsa.gov/Attitudes/CARAVAN_Factsheet.pdf
The full report can be accessed at: http://www.samhsa.gov/Attitudes/CARAVAN_LongReport.pdf
Publisher’s Note: While SAMHSA put a positive spin on the survey, addiction stigma and negative attitudes still prevail. See the Addiction Inbox point-of-view on the survey results at: http://addiction-dirkh.blogspot.com/2008/10/addiction-stigma-lives-on.html
Original Source: JoinTogether.org - October 3, 2008
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Effects of Drugs of Abuse on the Aging Brain Explored 
While substance abuse affects Americans of all ages, particularly youth and young adults, little focus has been given to substance abuse among older adults. However, the aging of the baby boomer generation may lead to a dramatic increase in the abuse of illicit, prescription, and over-the-counter drugs among older adults, due in part to their larger numbers and their lifetime histories of substance abuse.
The present review, written by scientists from NIDA, examines current trends and projected prevalence estimates of substance abuse among older adults as well as how drugs of abuse affect the aging brain. Large knowledge gaps exist of how age-related changes in the brain interact with drugs such as marijuana, cocaine, and heroin and other opiates. While it is known that some of the same brain systems involved in substance abuse are affected by aging, it is unclear whether these changes affect responsiveness to drugs—laboratory studies exploring these changes have shown mixed results as to whether aging may sensitize or dull the brain to the effects of drugs. Research does suggest, however, that susceptibility to neurotoxicity induced by some drugs of abuse may increase with age.
The effects of illicit drugs may also be impacted by the many medical conditions that increase in prevalence with age, such as heart or kidney disease, diabetes, and lung disorders. Additionally, because the body’s metabolism and the rate at which drugs leave the body also decrease with age, “even moderate use of alcohol, many prescription and over-the-counter medications, and illicit drugs may have devastating consequences” in this population, state the authors.
Few screening tools exist to identify older adults with substance abuse problems, compounding the difficulty doctors may have in recognizing this diagnosis. Improvements in diagnosis and outreach for older drug abusers are needed, especially since older adults who do receive treatment for substance abuse have outcomes as good as or better than younger adults. The authors suggest that positive treatment outcomes such as these “suggest that the primary barrier to recovery is diagnosis and treatment entry; however, meeting the challenges will require a better understanding of the scope and effects of drug abuse in this population.”
Source: National Institute of Drug Abuse (NIDA) News Scan - September 29, 2008
Original Source: Dowling GJ, Weiss SR, Condon TP. Drugs of abuse and the aging brain. Neuropsychopharmacology. 2008;33(2):209–218.
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Substance Abuse Treatment among Patients with HIV and Mental Illness
Untreated substance use and mental health conditions are associated with increased HIV transmission risk, decreased adherence to highly active antiretroviral therapy (HAART), and poor response to HAART. Researchers sought to determine the receipt of substance abuse and mental health treatment over a 3-month period in a cohort of 803 HIV infected individuals who met diagnostic criteria for substance use and mental health disorders. Primary findings were as follows:
- Forty-seven percent of subjects had drug and alcohol dependence, 33% had drug dependence, 15% had alcohol dependence, and 5% had drug and/or alcohol abuse but not dependence.
- Only 33 percent had received concurrent treatment for substance abuse and mental illness in the past 3 months; 26 percent had received only mental health services, 15 percent had received only substance abuse services, and 26 percent had received no services.
- Use of concurrent substance abuse and mental health services was lower among nonwhites and Hispanics (p<0.05) but was positively associated with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage (p<0.05).
- African American, Hispanic, and nonwhite subjects were more likely to use self-help groups than white non-Hispanic subjects (p<0.001).
Comments: The low use and racial disparities seen in the receipt of substance-abuse treatment services among patients diagnosed with HIV infection, substance abuse, and mental health disorders is concerning. These findings have implications for the individual and the public. Strategies to make substance-abuse treatment services more attractive, more available, and more effective are needed to address the issues highlighted in this study.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue July/August 2008. Access checked 10/19/08.
David A. Fiellin, MD
Original Source: Weaver MR, Conover CJ, Proescholdbell RJ, et al. Cost Subcommittee of the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study Group. Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders. J Acquir Immune Defic Syndr. 2008;47(4):449–458
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Drug Users Attitudes and Decisions Regarding Hepatitis C (HCV) Treatment
Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programs (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs.
While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications.
Interviews were conducted with 164 patients from 14 drug treatment programs throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment or both.
Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.
Source: NIDA Director's Report to the National Advisory Council on Drug Abuse - September, 2008
Original Source: Munoz-Plaza, C., Strauss, S., Astone-Twerell, J., Des Jarlais, D., Gwadz, M., Hagan, H., Osborne, A., Rosenblum, A., and Rosenblum, A. Exploring Drug Users Attitudes and Decisions Regarding Hepatitis C (HCV) Treatment in the U.S. Int. J. Drug Policy, 19(1), pp. 71-78, 2008.
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DRUG COURTS
Despite Concerns and Cuts, Drugs Courts Spreading Fast
As drug courts spread to thousands of communities all over the country, they raise hopes about a new way to address drug crime but also face criticism and cuts in funding, the New York Times reported Oct. 15.
New research shows that drug courts reduce recidivism on average from eight to 10 percent nationally and up to 26 percent in New York State, reinforcing the belief that the courts are among the few programs available that actually reduce recidivism.
However, with 70,000 offenders participating throughout the U.S., the surge in drug courts has some lawyers and scholars questioning their benefits. Some are doubtful that drug courts will actually have a significant impact on the prison population due to high up-front costs, limited success of drug treatment, and a scarcity of qualified judges. Others worry that drug courts will take away from the limited number of spots at treatment centers.
Mark Kleiman, director of the Drug Policy Analysis Program at the University of California, Los Angeles suggests that success rates reported by some courts could be inflated because drug courts take in offenders who want to avoid prison and are not actually addicted. Some drug court participants, however, maintain that drug court is tougher than prison.
Kleiman offered an alternative approach to drug courts that he said could reach more offenders because it doesn't include the costs of treatment at first. He suggested that courts demand offenders stop using drugs, with the threat of short stays in jail if they fail urine tests. The approach has been successful with methamphetamine users in Hawaii, he said.
However, many drug court graduates maintain that they would not have been able to kick their habits without supervision from a judge.
Source: JoinTogether.org - October 17, 2008
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SAMHSA Awards More Than $17.4 Million to Help Expand Adult Drug Courts
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the award of 20 new grants for $17.4 million over the next three years to expand the treatment capability of drug courts – special dockets designed to deal with the treatment needs of people who find themselves in the criminal justice system largely because of underlying substance abuse problems.
The grants will be used to expand and/or enhance substance abuse treatment services in “problem solving” courts, which use the treatment drug court model in order to provide alcohol and drug treatment, recovery support services supporting substance abuse treatment, screening, assessment, case management, and program coordination to adult defendants/offenders.
The selected drug court grantees can receive up to $300,000 each year, over the course of the next three years. The actual award amounts may vary and continuation awards are subject to availability of funds and progress achieved by awardees. The program will be administered by SAMHSA’s Center for Substance Abuse Treatment.
Source: The Substance Abuse and Mental Health Services Administration – October 8, 2008
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MISCELLANEOUS
Bush Signs Law Cracking Down on Online Pharmacies
A new law intended to crack down on shady online prescriptions bans pharmacies from dispensing drugs unless a doctor has examined the patient in person before writing a scrip.
The Wall Street Journal reported Oct. 9 that the measure signed into law by President George W. Bush is intended to make it easier to prosecute rogue online pharmacies that accept prescriptions for controlled drugs written by affiliated physicians who only consult with patients over the Internet or phone, if at all. Some shady pharmacies only require patients to fill out an online form to get drugs, and employ doctors to approve hundreds of prescriptions daily.
Legitimate online pharmacies, like those run by CVS and Walgreen, already require in-person exams to fill prescriptions.
"This is really making explicit what has been implicit," said Sen. Dianne Feinstein (D-Calif.), the bill's lead sponsor. "We've tried to close this loophole by essentially addressing this problem of controlled substances being sold without any medical oversight or prescription."
The measure won't have any impact on overseas pharmacies, however, and also does not apply to non-controlled drugs.
Relatively few patients get controlled drugs online, but those who do use Internet pharmacies often obtain large quantities of drugs, sometimes so they can resell them on the black market.
The legislation also requires online pharmacies to report their practices to the DEA, provide information on doctors and pharmacy locations, and calls for prison terms for illegally distributing controlled drugs.
Source: JoinTogether.org - October 14, 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 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.