Addiction Treatment Forum reports on substance abuse news of interest
to opioid treatment programs and patients in methadone maintenance treatment.

NEWS NOTES & UPDATES #128

February 2009

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: January 2009

List of all News/Updates

 

Contents

MEDICATION-ASSISTED TREATMENT

Clinical Guidelines Published on QTc Screening in Methadone Treatment

NEW SURVEYS & REPORTS

SAMHSA Issues Data on 2007 N-SSATS Report on Substance Abuse Treatment Facilities

New Hazelden Survey Finds Strong Support for Treatment, Recovery

OPIOID PRESCRIPTION DRUGS IN THE NEWS

FDA to Meet with Drug Companies about REMS for Certain Opioid Drugs

New Guidelines For Prescribing Opioid Pain Drugs Published

HARM REDUCTION

Report: Needle Exchange Program Finds Mixed Success in Atlantic City

Study: Heroin Maintenance Cuts Crime, Improves Health

U.S. MILITARY & SUBSTANCE ABUSE TREATMENT

Army's Approach to Drug Treatment Criticized

NEWS FROM NEW YORK

Panel Calls for Overhaul of Drug Laws in NY

Legal Action Center Releases New Drug Law Reform Costs Savings Report for NY

NY State Launches Your Story Matters For Those in Recovery to Share Their Story

(Share Your Story, Inspire Hope. It Matters)



MEDICATION-ASSISTED TREATMENT

Clinical Guidelines Published on QTc Interval Screening in Methadone Treatment

Five members of a Center for Substance Abuse Treatment (CSAT) panel on the cardiac effects of methadone acted hastily in publishing, online, Clinical Guidelines on QTc Screening in Methadone Treatment—even though the document is currently out for CSAT field review. Scheduled to be published in the March 17 print edition of Annals of Internal Medicine, the article is available online (no charge) at: http://www.annals.org/cgi/content/full/0000605-200903170-00103v1

An earlier version of the Annals QTc article, available online this past December, created confusion among OTPs. Some thought the recommendations were final, and should be enacted immediately. Others questioned whether the guidelines had been approved by CSAT.

A related editorial, also in the March 17 issue of Annals, was written by Marc N. Gourevitch, MD, MPH. First Do No Harm… Reduction? The editorial can be accessed at: http://www.annals.org/cgi/content/full/000060520090317000111v1?maxtoshow=&HITS=10&hits=10&
RESULTFORMAT=&fulltext=Gourevitch&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Annals of Internal Medicine also offers a webpage where you can submit responses to the QTc article. The Rapid Response webpage can be accessed at: http://www.annals.org/cgi/eletters/0000605-200903170-00103v1

Note: Addiction Treatment Forum will have a related feature article on QTc screening in our Spring 2009 edition.

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NEW SURVEYS & REPORTS

SAMHSA Issues Data on 2007 N-SSATS Report on Substance Abuse Treatment Facilities

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released findings from the 2007 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of substance abuse treatment facilities that provides data on the location and characteristics of alcohol and drug abuse treatment services throughout the United States.

The report’s findings include:


The 234 page PDF report can be accessed at: http://atforum.com/addiction-resources/documents/nssats2k7web.pdf

Source: The Substance Abuse and Mental Health Services Administration – January 30, 2009

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governmentNew Hazelden Survey Finds Strong Support for Treatment, Recovery

Advocates who say addiction should be treated as a public-health issue and not a criminal problem have broad public support, according to the results of a new survey from Hazelden that also found that about one in three families include members with addiction problems.

Public support alone, however, will not be sufficient to sustain recent victories like addiction parity legislation or to meet the economic and policy challenges now facing the addiction field, said William Cope Moyers, executive director of Hazelden's Center for Public Advocacy, which conducted the survey.

The Public Attitudes Towards Addiction Survey found that more than three-quarters (79 percent) of the 1,000 adults polled called the War on Drugs a failure, and 83 percent said that first-time drug offenders should be sent to addiction-treatment programs, not prison. Moyers said the findings illustrate the disconnect between public perceptions and policymakers who "are still waging the war."

Ethan Nadelmann, director of the Drug Policy Alliance (DPA), said the Hazelden findings are in line with other research on public attitudes toward the drug war and treatment alternatives to incarceration.

Similar majorities of Americans said that addiction treatment benefits should be included in healthcare insurance plans (71 percent) and in national healthcare reform plans (77 percent). Congress last year passed legislation requiring that most health-insurance plans cover addiction and mental health services on par with other health conditions, but only if such benefits are included in their plans.

Moyers warned that the hard-earned gains of more than a decade of parity advocacy could be wiped out amid the current economic crisis and the drive for healthcare reform, despite the high levels of public support indicated by the survey findings.

He expressed particular concern that addiction treatment providers struggling with internal financial crises, such as cutbacks in public funding coupled with rising demand for services, will fail to fight the broader policy battles on issues like inclusion in healthcare reform. Hazelden plans to use the survey findings to support a new national advocacy campaign aimed at increasing public understanding of addictive diseases and increasing access to treatment.

The Hazelden survey yielded mixed results when it came to public attitudes about individuals with addictions. On the one hand, 77 percent of those polled said that people who complete addiction treatment can go on to live productive lives, and 78 percent said that addiction is a chronic disease, not a moral failing.

Yet discrimination against people with addictions persists, with stigma cited as the most common negative consequence of having a family member with addiction problems.

Source: JoinTogether.org – News Feature by Bob Curley - February 6, 2009

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OPIOID PRESCRIPTION DRUGS IN THE NEWS

FDA to Meet with Drug Companies about REMS for Certain Opioid Drugs

On February 6, 2009, the Food and Drug Administration (FDA) sent letters to manufacturers of certain opioid drug products, indicating that these drugs will be required to have a Risk Evaluation and Mitigation Strategy (REMS) to ensure that the benefits of the drugs continue to outweigh the risks. The affected opioid drugs include brand name and generic products and are formulated with the active ingredients fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone.

In the first of a series of meetings with stakeholders, the FDA has invited those companies that market the affected opioid drugs to a meeting with the agency on March 3 to discuss REMS development. Additional steps will include discussions with other federal agencies and non-government institutions, including patient and consumer advocates, representatives of the pain and addiction treatment communities, other health care professionals, and other interested parties. FDA is planning a public meeting in late spring or early summer to allow for broader public input and participation.

Note: The liquid formulation of methadone is not included in the Risk Evaluation and Mitigation Strategy.

Source: The Federal Drug Administration – February 9, 2009

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New Guidelines For Prescribing Opioid Pain Drugs Published

A panel of pain-management experts representing the American Pain Society (APS) www.ampainsoc.org and the American Academy of Pain Medicine (AAPM) has published a comprehensive clinical practice guideline to assist clinicians in prescribing potent opioid pain medications for patients with chronic non-cancer pain. The guideline appears in the current issue of The Journal of Pain, www.jpain.org, the APS peer-reviewed publication.

"The expert panel concluded that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic non-cancer pain," said Gilbert J. Fanciullo, MD, a panel co-chair and director, Section of Pain Medicine, Dartmouth Hitchcock Medical Center.

The panel made 25 specific recommendations and achieved unanimous consensus on nearly all. "The guidelines are based on the available evidence and also rely on an underlying assumption that chronic opioid therapy requires prescribers to have clinical skills and knowledge in both the principles of opioid treatment and the assessment and management of risks associated with opioid abuse, addiction and diversion," said Fanciullo.

"Decisions about chronic opioid therapy must weigh the benefits of these medications against the risks, which include side effects and adverse outcomes associated with abuse," said Perry Fine, MD, panel co-chair and professor of anesthesiology, University of Utah Medical Center.

Prior to initiating chronic opioid therapy, the guideline advises clinicians to determine if the pain can be treated with other medications. If opioids are appropriate, the clinician should conduct a thorough medical history and examination and assess potential risk for substance abuse, misuse or addiction.

Fanciullo noted the strongest predictor of possible drug misuse is a personal or family history of alcohol and drug abuse. "For patients at higher risk for misuse of opioids, the guideline advises giving patients clear written rules, such as filling prescriptions at one pharmacy only, taking random drug tests, making regular physician visits, and locking their medications at home," he said.

A key recommendation urges clinicians to continuously assess patients on chronic opioid therapy by monitoring pain intensity, level of functioning and adherence to prescribed treatments. Periodic drug screens should be ordered for patients at risk for aberrant drug behavior.

Use of methadone for pain management has increased dramatically but few trials have evaluated its benefits and harms for treatment of chronic non-cancer pain. Methadone, therefore, should be started at low doses and titrated slowly. Because of its long half-life and variable pharmacokinetics, the panel recommends methadone not be used to treat breakthrough pain or as an as-needed medication.

Source: The American Pain Society - February 10, 2009

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HARM REDUCTION

Study: Heroin Maintenance Cuts Crime, Improves Health

Heroin addicts enrolled in programs that provide them with the drug for free may commit fewer crimes and be more likely to enroll in addiction treatment programs, according to a new study by researcher Peter Reuter.

The Baltimore Sun reported Feb. 8 that Reuter, a drug-policy researcher at the University of Maryland at College Park, studied heroin-maintenance programs in Switzerland, the Netherlands, Germany, and Vancouver, B.C. Program costs were high, participation low, and outcomes were mixed, Reuter found. But in some cases results were impressive.

In Switzerland, for example, 60 percent of those who left a heroin maintenance program sought addiction treatment, and crime involvement among participants in a German program fell from an average of 15.6 days to 2.5 days at the end of a 12-month period.

The study was funded by Baltimore's Abell Foundation. Reuter said that Baltimore, with its large population of heroin users, might be a good location for a U.S. pilot heroin-maintenance program. Baltimore officials, however, dismissed the suggestion. "I think it would be a mistake to pursue an expensive and unproven idea when we need more resources for effective drug treatment," said city health commissioner Joshua M. Sharfstein.

Former Baltimore Mayor Kurt L. Schmoke once opposed heroin maintenance, but now says that the idea should at least be discussed. "Without the kind of discussion that the Abell Foundation is trying to encourage, it would simply be too shocking to the public to get approved," he said.

Source: JoinTogether.org – February 10, 2009

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Report: Needle Exchange Program Finds Mixed Success in Atlantic City

Atlantic City, N.J.'s needle-exchange program -- the state's first -- has succeeded in its primary mission of collecting dirty needles from drug addicts in exchange for clean ones but has had less success getting addicted individuals into drug treatment, a new report concludes.

The review of the first year of the program showed that the program gave out more than 60,000 needles, far more than other needle exchanges in Camden, Paterson and Newark, the Press of Atlantic City reported Jan. 19. About half of the used needles were later returned in exchange for clean ones.

However, the Atlantic City program ranked last among the state's four needle exchanges in terms of referrals to drug treatment, with only 74 referrals made. Program coordinator Therese Wilkerson said that staff must walk a fine line between wanting to get clients into treatment and scaring them off by pushing too hard.

However, referrals seem to have gotten less frequent as time has gone on, dropping to just one or two a week, according to Alan Oberman, CEO of the John Brooks Recovery Center.

Still, said Oberman, "I think they've done a terrific job. It also hasn't been a disturbance to the area. That's important regarding perception in the community and all the fear attached to the program. Maybe people can see there's nothing to be afraid of."

Source: JoinTogether.org – January 22, 2009

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U.S. MilitaryU.S. MILITARY & SUBSTANCE ABUSE TREATMENT

Army's Approach to Drug Treatment Criticized

While more returning U.S. soldiers struggle with addiction to painkillers prescribed by Army doctors to treat their combat injuries, the U.S. Army's approach to treating addicted soldiers is drawing increasing criticism, the Associated Press reported Jan. 21.

In the six years since the start of the war in Iraq, use of legal painkillers like Percocet, Vicodin, and OxyContin by injured troops has increased nearly 70 percent. Surveys reveal that more soldiers are struggling with prescription drug addiction and are seeking help from Army doctors and counselors.

But some critics say that the military system that historically relies on discipline as well as treatment is mishandling their charge. Barbara McDonald, a civilian social worker and Army drug abuse counselor, described the Army's handling of the recent surge in prescription drug abuse as "a terrible problem," calling the military's approach a broken system, as likely to punish or denigrate troops as to treat their addictions.

A recent court martial and subsequent imprisonment of a soldier in Fort Leonard Wood, Missouri, for illegally buying prescription drugs and selling the pills to eight other soldiers, along with allegations of misconduct and staffing shortages in the Army Substance Abuse Program (ASAP), induced Sen. Claire McCaskill, (D-Mo.) to ask the Secretary of the Army to investigate.

"Clearly, at Fort Leonard Wood and potentially across the military, they have not prioritized this as a health issue," McCaskill said. "The culture has traditionally looked at this as a discipline issue."

Army officials have defended their treatment approach, even while acknowledging treatment staffing shortages nationally; ASAP is 90 counselors short of required employment levels.

Chuck Ashbrook, who oversees ASAP prevention and education efforts at Fort Leonard Wood, said counselors pay close attention to links between substance abuse, post-traumatic stress disorder and combat injuries, noting that medical advances have allowed soldiers who might have returned from previous conflicts as casualties to survive with injuries that require stronger pain management.

Ashbrook also cited historical increases in drug dependency among soldiers during wartime. "We've always seen these kinds of problems," Ashbrook said. "This is not unique."

Source: JoinTogether.org – January 23, 2009

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addictionNEWS FROM NEW YORK

Panel Calls for Overhaul of Drug Laws in NY

New York's Commission on Sentencing Reform has issued a report calling for uniform drug-sentencing guidelines and giving judges greater authority to order offenders into addiction treatment programs as

an alternative to incarceration, the New York Times reported Feb. 4.

The commission said that standards on what constitutes a drug-addicted offender need to be established. Current restrictions on the types of sentences judges can impose on drug offenders also should be eased, the panel said. Other recommendations included doubling the drug-weight requirements that trigger felony sales and possession charges, making more low-level felony offenders eligible for probation or jail term rather than prison time, and expanding the use of parole.

"New York must continue to reserve costly prison resources for high-risk, violent offenders while making greater use of community-based alternatives to incarceration," the report said. However, the panel added, "such reforms should be carefully tailored so that the state's significant gains in public safety are not lost."

The recommendations are expected to spur action by the Democrat-led state legislature; Gov. David A. Patterson was a major backer of reforming the state's harsh, Rockefeller-era drug laws as a legislator and said the issue would be one of his top priorities as governor. Legislation based on the recommendations would be drafted immediately, officials said.

The 326-page New York State Commission on Sentencing Reform report can be accessed at:
http://criminaljustice.state.ny.us/pio/csr_report2-2009.pdf

Source: JoinTogether.org – February 5, 2009

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Legal Action Center Releases New Drug Law Reform Costs Savings Report for NY

The Legal Action Center has completed a new study, Drug Law Reform 2009 - Dramatic Costs Savings For New York State, which finds that New York would save over a quarter billion dollars a year by reforming the Rockefeller-Era Drug Laws. When drug law reform is fully operational, it is estimated that New York would save $267,660,000 a year.

Even in the first year, estimates show that New York would realize tens of millions of dollars in savings. The study calculated the cost savings that would accrue to New York State by diverting addicted individuals charged with second, non-violent, non-sex felony offenses from prison to community-based treatment, as they comprise the vast majority of individuals who are mandated into prison under current law. LAC believes such individuals should be diverted into mandated treatment if the laws are reformed. The study excludes people charged with Class A felonies.

The findings take into account savings generated by the elimination of costs associated with incarceration; savings related to reduced foster care, health care and welfare costs; and increased tax contributions.

The 11-page PDF report can be accessed at: http://www.lac.org/pdf/DLR%20Cost%20Savings%20Report%202009.pdf

Source: The Legal Action Center – December 11, 2009

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NY State Launches Your Story Matters For Those in Recovery to Share Their Story (Share Your Story. Inspire Hope. It Matters)  

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) launched a new web campaign called Your Story Matters at www.iamrecovery.com to highlight stories of recovery from alcoholism, drugs or problem gambling.

Through the online Your Story Matters initiative, the state will support its growing movement of recovery advocates. By sharing the stories of strength and dedication to breaking the cycle of addiction, OASAS anticipates inspiring hope in the lives of those still suffering from this disease and encourage others in recovery to join in the celebration.

Individuals can share their stories at www.iamrecovery.com. The stories will be posted on the website and searchable by viewers. The stories submissions do not require any identification, other than a first name and last initial, in order to respect those who wish to remain anonymous.

OASAS oversees one of the nation's largest addiction services programs, with 1,550 prevention and treatment providers throughout New York State. Through efforts such as Your Story Matters, the agency hopes to continue to strengthen New York’s recovery movement, catalyze a change in the way we talk about recovery from addiction, and promote a life of health and wellness for the 110,000 New Yorkers it serves each day.

 

Source: State of New York Office of Alcoholism and Substance Abuse Services - January 26, 2009

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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.