AT Forum NEWS NOTES & UPDATES #123
September 2008
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: August 2008
Contents
GOVERNMENT
SAMHSA Awards Funds to Educate Physicians about Methadone Prescribing
SAMHSA Awards Almost $3 Million to Fund Opioid Treatment Program Accreditation Grants
FDA Considers Training Docs to Prescribe Narcotics
RESEARCH
Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling
Intervention Improves Employment Outlook For Methadone Patients
Abuse Of Opioid Painkillers Can Predispose Adolescents To Lifelong Addiction
NEWS FROM THE STATES
New Program Lets Baltimore Jail Inmates Continue Methadone Treatment While They Await Trial
Heroin Abuse Up for Many Ohio Youth
New West Virginia Hotline To Help Prescription Drug Abusers
GOVERNMENT
Appropriate Use of Methadone Provides Valuable Treatment for Pain and Addiction - Message from NIDA Director Nora D. Volkow, MD
Recent reports have highlighted the potential dangers, including death, of the improper use (or abuse) of methadone. Growing accounts of this medication's adverse effects - which likely stem from its increased use for treating pain, along with physician inexperience in prescribing it - should not overshadow methadone's proven benefits. For more than 30 years, methadone has been used safely and effectively to treat people with opioid addiction, particularly heroin.
Methadone is a long-acting synthetic opiate that works at the same receptors in the brain as heroin (the mu opioid receptors). However, unlike heroin, it has a slow onset and long duration of action when taken orally as directed. Properly prescribed, methadone is not intoxicating or sedating and does not interfere with ordinary activities like driving a car. It does effectively suppress opiate withdrawal and relieve the debilitating craving that typically causes people to relapse.
Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives. Methadone has also been shown to reduce addiction-related death, criminal recidivism, and the spread of HIV. The increased incidence of adverse methadone-related consequences demands that we intensify our efforts to mitigate its potential misuse or abuse, starting with physician and patient education. That said, we must not lose sight of methadone's powerful benefits as a therapeutic medication for both pain and addiction.
Source: National Institute of Drug Abuse – August 2008
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SAMHSA Awards Funds to Educate Physicians about Methadone Prescribing
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced a three-year cooperative agreement grant award totaling $1.5 million to the American Society of Addiction Medicine (ASAM). The grant will be used to train physicians and other health professionals on the appropriate use of methadone in the treatment of pain and opioid addiction.
The cooperative agreement is to establish a national mentoring network offering support (clinical updates, evidence-based outcomes and education) free of charge to opioid addiction treatment center medical staff, prescribing physicians and other medical professionals in the appropriate use of methadone for the treatment of pain and opioid addiction.
“According to SAMHSA Administrator Terry Cline, Ph.D. “Medical education and training are critical and warranted to reduce methadone-associated deaths. This initiative will provide necessary support to help prescribing medical professionals better understand the benefits and risks associated with methadone.”
The full press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/0808154000.aspx
Source: The Substance Abuse and Mental Health Services Administration – August 18, 2008
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SAMHSA Awards Almost $3 Million to Fund Opioid Treatment Program Accreditation Grants
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced on September 9, 2008, the award of three grants, totaling approximately $3 million over three years, to help Opioid Treatment Programs (OTPs) reduce the costs of basic accreditation education and accreditation/reaccreditation surveys, or site visits.
“Accreditation is the peer review process by which SAMHSA-approved accreditation bodies make site visits and review the policies, procedures, practices and patient services of an organization providing opioid treatment,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “The purpose of these accreditation site visits is to ensure that OTPs meet specific, nationally accepted standards regarding organizational functioning and patient care.”.
Grants were made to:
- The Joint Commission, Oakbrook Terrace, Ill. -- $435,000 in first-year funding to provide accreditation and re-accreditation services and education to more than 300 OTPs nationwide. Accreditation services include the provision of written and electronic materials to assist OTPs with accreditation preparation, surveys, accreditation decision reports and periodic performance reviews.
- The Commission on Accreditation of Rehabilitation, Tucson, Ariz. -- $500,000 in first-year funding to continue to publish and maintain accreditation standards of quality; recruit, train and retain a cadre of experienced surveyors; conduct on-site accreditation surveys of OTPs to determine conformance to the commission’s standards and to provide consultation; and provide technical assistance, and regional training on standards and the accreditation process.
- The National Commission on Correctional Health Care, Chicago -- $39,500 in first-year funding to provide quality accreditation services that will help promote improved health access and services to incarcerated populations and will promote a plan for OTPs to be self-sufficient in maintaining their accreditation status. Quality of care and expansion of services will remain priorities among accredited OTPs.
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) – September 9, 2008
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FDA Considers Training Docs to Prescribe Narcotics
Amid growing reports of patient deaths and complications caused by problems with legally prescribed pain medication, the Food and Drug Administration (FDA) is discussing the possibility of requiring doctors to receive specialized training before prescribing narcotics, the New York Times reported Aug. 16.
The imposition of license requirements such as continuing education on physicians is generally the responsibility of state medical boards, but the FDA is looking into this area because state boards have done little to require training in prescribing pain medication. The federal agency is expected by early next year to release some recommendations, which also may include requiring drug makers to engage in more monitoring of how their products are prescribed.
Federal officials have been frustrated that advisories they have sent to physicians about prescribing dangers associated with the drugs methadone and fentanyl do not appear to be lowering the number of adverse incidents resulting from improper prescribing.
"We are putting out communications," said Gerald Dal Pan, M.D., director of the FDA's office of surveillance and epidemiology. "We don't know why they are failing."
Physicians generally are required only to demonstrate proof of their license in order to receive federal authorization to prescribe narcotics. Some pain management experts fear that if these requirements were made significantly more stringent, some physicians would stop prescribing altogether and consumers would have fewer options for pain management treatment.
Source: JoinTogether.org – August 20, 2008
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RESEARCH
Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling
No controlled studies have compared short-term methadone maintenance (MM) to methadone detoxification (MD), although it is known that open-ended MM is more effective than MD. Gruber et al. took advantage of a randomized controlled trial (RCT) assessing the effect of 6-month MM on adherence to latent tuberculosis therapy to compare 21-day MD to 6-month MM with either minimal or standard counseling.
In this RCT (n=111), outcomes were substance use and depressive symptoms. Doses of methadone were between 60 and 90 mg per day. Minimal counseling involved a single 15-minute session per month with no contingencies (e.g., take-home medication). Standard counseling involved 2 sessions per month (more, if needed, as determined by the counselor) with the opportunity to earn take-home medications. The majority of subjects were male, nonwhite, poor, and not interested in stopping heroin but rather in cutting down on use.
- Compared with 6-week MD, 6-month MM resulted in a greater decrease from baseline in self-reported opiate use, opiate positive urines, and days of alcohol use.
- No difference between groups was found for cocaine use or depressive symptoms.
- Results for MM with standard counseling did not differ from those for MM with minimal counseling.
Comments: These findings show once again that the duration of time on methadone therapy is key to the benefits received, mainly with regard to opiate-related outcomes. As the treatment groups were quite small, few conclusions can be drawn concerning the lack of differences noted between counseling intensity in the 6-month MM groups.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue July/August 2008. Access checked 9/10/08.
Jeffrey H. Samet, MD, MA, MPH
Original Source: Gruber VA, Delucchi KL, Kielstein A, et al. A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug Alcohol Depend. 2008;94(1–3):199–206.
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Intervention Improves Employment Outlook For Methadone Patients
Assertive outreach and motivational techniques can enhance methadone patients' participation in vocational counseling and increase subsequent employment. In a study of 211 unemployed methadone patients at two facilities in New York City, Dr. Stephen Magura and colleagues at the National Development and Research Institutes found that 47 percent of participants assigned to the Customized Employment Supports (CES) intervention attended five or more vocational counseling sessions within 6 months of beginning the study. In contrast, only 12 percent of those in the clinic's standard vocational programs were as diligent.
CES counselors engaged patients in the program with tactics such as checking their clinic schedules and arranging impromptu visits; spent more time with patients in counseling sessions than counselors in the standard program; responded promptly to requests for help; accompanied patients in their job searches; and helped patients overcome barriers to employment. Among 168 participants interviewed 6 and 12 months after beginning the study, 41 percent in the CES group, compared with 26 percent of those who received standard counseling, reported paid employment at both follow up assessments.
Source: National Institute of Drug Abuse - NIDA NOTES Volume 21, Number 6 (June 2008).
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Abuse Of Opioid Painkillers Can Predispose Adolescents To Lifelong Addiction
No child aspires to a lifetime of addiction. But their brains might. In new research to appear online in the journal Neuropsychopharmacology this week, Rockefeller University researchers reveal that adolescent brains exposed to the painkiller Oxycontin can sustain lifelong and permanent changes in their reward system – changes that increase the drug's euphoric properties and make such adolescents more vulnerable to the drug's effects later in adulthood.
The research, led by Mary Jeanne Kreek, head of the Laboratory of the Biology of Addictive Diseases, is the first to directly compare levels of the chemical dopamine in adolescent and adult mice in response to increasing doses of the painkiller.
The results suggest that adolescents who abuse prescription pain killers may be tuning their brain to a lifelong battle with opiate addiction if they re-exposed themselves to the drug as adults," says Kreek. During adolescence, the brain undergoes marked changes. For example, the brain's reward pathway increases production of dopamine receptors until mid-adolescence and then either production declines or numbers of receptors decline. By abusing Oxycontin during this developmental period, adolescents may inadvertently trick the brain to keep more of those receptors than it really needs. If these receptors stick around and the adolescent is re-exposed to the drug as an adult, the rush of euphoria may be more addictive than the feeling experienced by adults who had never before tried the drug.
"Despite the early use of these drugs in young people, little is known about how they differentially affect adolescent brains undergoing developmental change," says Kreek. "These findings give us a new perspective from which to develop better strategies for prevention and therapy."
The press release can be accessed at: http://www.eurekalert.org/pub_releases/2008-09/ru-aop090908.php
Source: Rockefeller University – September 10, 2008
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NEWS FROM THE CITIES/STATES
New Program Lets Baltimore Jail Inmates Continue Methadone Treatment While They Await Trial
Maryland has implemented a new program to dispense methadone to heroin addicted inmates who are held at the Baltimore jail awaiting trial. The Maryland Department of Public Safety and Correctional Services launched the effort in January 2008, and dispensed methadone to nearly 2,800 people by June 30. Only the New York City jail on Rikers Island provides the medication to a greater number, a federal official said.
A total of 2,478 inmates received methadone to treat their withdrawal from active heroin addiction. An additional 288 people received it to continue the daily doses they had been getting at methadone clinics before their arrests.
The program is scheduled to treat about 4,500 heroin addicts by the end of the year. The estimated 7,500 others are released too quickly to obtain the treatment, or they refuse medication.
Source: Baltimore Sun – August 17, 2008
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Heroin Abuse Up for Many Ohio Youth
An increase in treatment admissions for heroin abuse among young people in Ohio is being attributed to problems that often start with prescription drug abuse, the Akron Beacon Journal reported Aug. 13.
A report from the Ohio Substance Abuse Monitoring Network covering the period from June 2007 to January 2008 found increasing amounts of "black tar" heroin use in several reporting areas and a higher rate of treatment admissions among young whites, as well as among young adults in suburban communities. A spokeswoman for the state Department of
Alcohol and Drug Addiction Services said many young people are turning to heroin after not finding a sufficient opiate effect from prescription pain medication.
The report's overall findings, culled from interviews with treatment providers, law enforcement officials and consumers, generally found few changes in drug use patterns in the state. Both heroin use and prescription drug abuse continue to hold steady, as do marijuana and cocaine use. Limited street availability of methamphetamine and OxyContin has led to a decline in use of those substances.
Other drug trend patterns that have remained consistent in recent years include young people's inappropriate use of prescription drugs in combination with alcohol, and substantial use of this combination of drugs among the state's elderly population as well.
Source: JoinTogether.org – August 18, 2008
Publisher’s Note: Other states including Wisconsin are keeping an eye on the increased use of heroin, which is often used as a less expensive alternative to prescription painkillers.
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New West Virginia Hotline To Help Prescription Drug Abusers
To stem the prescription drug abuse epidemic in the state, the West Virginia University School of Medicine launched the West Virginia Prescription Drug Abuse Quitline today. The Quitline, 1-866-WVQUITT, aims to educate prescription drug abusers and their families about the problem and services in their areas.
Health information specialists – taking calls 24 hours a day, seven days a week – can give referrals to treatment centers, provide information about Narcotics Anonymous meetings and mail self-help materials. They will also make up to four follow-up calls over the course of several months.
“Prescription drug abuse in West Virginia is a silent epidemic that is wreaking havoc on communities throughout state,” Carl R. “Rolly” Sullivan, M.D., co-principal investigator for the Quitline project and medical director of addiction services at WVU, said. The greatest increases of deaths from drug overdoses are not in urban areas but in rural areas. In five years (1999-2004), deaths resulting from drug overdose in West Virginia rose 550 percent. This was the largest increase of any state in the country.
Sullivan attributed the rise to a national shift in the mid-1990s toward adequately treating pain, which occurred at about the same time opioid pain medications such as OxyContin became popular. In West Virginia, workers in blue-collar industries such as mining and timbering where accidents occur more frequently were increasingly prescribed such painkillers.
As the problem grew, OxyContin became known as “Hillbilly Heroin” in West Virginia. “Many addicts say they prefer OxyContin to heroin because they know what they’re getting when they take it,” Sullivan said.
The line is funded by a $1 million grant WVU received from the state’s multimillion dollar OxyContin settlement with Purdue Pharma.
For more information on the West Virginia Prescription Drug Abuse Quitline, visit www.wvrxabuse.org.
Source: West Virginia University – September 11, 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.