AT Forum NEWS NOTES & UPDATES #132
June/July 2009
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: May 2009
Contents
MEDICATION-ASSISTED TREATMENT
SAMHSA Issues Advisory on Emerging Issues in the Use of Methadone
CAP Offers Comprehensive Services for Pregnant Patients on Methadone Maintenance
GOVERNMENT REPORTS & NEWS
Drug Overdose Reduction Act of 2009 Introduced into U.S. House
Drug Use Widespread Among Arrestees, ONDCP Says
NIH Panel to Consider NIDA/NIAAA Merger
NEWS TO NOTE
Wounds of War: Drug Problems Among Iraq, Afghan Vets Could Dwarf Vietnam
States Waste Billions Dealing with Consequences of Addiction, CASA Study Says
RESEARCH
WEBINARS OF INTEREST
Legal Action Center Schedules Webinars on Addiction Treatment Issues
MEDICATION-ASSISTED TREATMENT
SAMHSA Issues Advisory on Emerging Issues in the Use of Methadone
This Spring, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued an 8-page advisory related to the increase in deaths linked to methadone. The advisory discusses:
- Clinical issues related to risk factors in the treatment of opioid dependence.
- Simultaneous patient abuse of substances such as benzodiazepines, other opioids, cocaine, or alcohol.
- Interactions between prescribed medications.
- Methadone accumulation in the body that can result in harmful or toxic levels.
- Methadone’s peak respiratory depressant effect.
- Poor clinical practice during the induction dosing phase.
- Cardiac screening.
- Poisoning that occurs when methadone is diverted for nonmedical use.
- Improving patient safety in opioid addiction treatment. The advisory identified several measures including:
- Updating induction protocols.
- Educating medical and other staff members.
- Monitoring patients’ health while in treatment.
- Improving procedures for take-home medications.
- Carefully assessing each patient for the use of other drugs or medications.
- Reevaluating patient education procedures.
- Updating induction protocols.
The 8-page PDF can be accessed at: http://atforum.com/documents/methadoneadvisory.pdf
Source: Substance Abuse and Mental Health Services Administration – Spring 2009
< Back to top >
CAP Offers Comprehensive Services for Pregnant Patients on Methadone Maintenance
On June 22, the Baltimore Sun ran an article “Pregnant, addicted: Mothers battling heroin”. The article profiled the Center for Addiction and Pregnancy (CAP) at John Hopkins Bayview Medical Center. CAP was originally a methadone clinic that now offers comprehensive services for pregnant patients. Services include: methadone dispensing, individual and group counseling, nutrition counseling, in addition to having an obstetric and a pediatric clinic.
The article can be accessed at:
http://www.baltimoresun.com/health/bal-to.hs.addiction22jun22,0,4930256.story?page=1
Source: BaltimoreSun.com – June 22, 2009
< Back to top >
EUROPAD Journal – Heroin Addiction and Related Clinical Problems. 2009(June), Vol. 11, No. 2 Now Available Online
Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction.
Articles in this issue include:
- Swedish Use and Misuse of the Dole & Nyswander Treatment.
- Methadone-treated Patients After Switching to Buprenorphine in Residential Therapeutic Communities: An Addiction-specific Assessment of Quality of Life.
- Clinical Trial on the Use of Olanzapine in Reducing the Consumption of Cocaine in Methadone Maintenance Programmes.
- Voices of Experience: Attitudes and Opinions of Recipients of Unsupervised Injectable Opiate Treatment in the Northwest of England.
- Substitution Therapy. A New Problem of Biomedical Ethics and Medical Law.
- New Approaches in the Treatment of Opioid Dependency During the Pregnancy.
- QTc Interval Screening. American Association for the Treatment of Opioid Dependence (AATOD) Policy and Guidance Statement.
The PDF file can be downloaded from ATForum.com at: <HeroinAdd11-2pdf>
< Back to top >
GOVERNMENT REPORTS & NEWS
Drug Overdose Reduction Act of 2009 Introduced into U.S. House
Congresswoman Donna F. Edwards (D-MD) introduced the Drug Overdose Reduction Act of 2009 into the U.S. House of Representatives on June 12.
Accidental drug overdose is the second leading cause of preventable death in the U.S., with more than 22,000 deaths in 2005. Deaths resulting from accidental drug overdoses increased more than 400 percent between 1980 and 1999, and more than doubled between 1999 and 2005.
The bill cites that between 2001 and January 2008, it is estimated that more than 2,600 overdoses have been reversed in 16 public health programs across the U.S. that use reversal agents, such as naloxone. The legislation also cites the need for overdose prevention programs in correctional facilities, addiction treatment programs, and other places where people are at higher risk of overdosing after a period of abstinence.
Key components of the Drug Overdose Reduction Act of 2009 include:
- Create a federal grant program to provide cities, states, tribal governments, and community-based groups with funding to reduce drug overdose deaths. $27 million per year would be available for both fiscal years 2010 and 2011.The grant money would used to:
- Purchase and distribute drug overdose reversal agents, such as naloxone.
- Train first responders and others in a position to respond, law enforcement, and correctional officials.
- Implement programs to provide overdose prevention, recognition, treatment, or response to those in need.
- Assign the Centers for Disease Control and Prevention with responsibility for reducing overdose deaths.
- Commission studies on causes of the recent rise in overdose deaths; local, state, and federal barriers to overdose reduction and effective overdose reduction programs.
- Create a nationwide surveillance system for monitoring overdose trends.
The proposed legislation can be accessed at: http://www.govtrack.us/congress/billtext.xpd?bill=h111-2855
Also see a related report from the Drug Policy Alliance issued in March 2009. Prevention Overdose, Saving Lives: Strategies in Combating a National Crisis available at: http://www.drugpolicy.org/docUploads/OverdoseReportMarch2009.pdf
< Back to top >
Drug Use Widespread Among Arrestees, ONDCP Says
An annual study of newly arrested offenders finds that 87 percent of men accused of crimes tested positive for the presence of illicit drugs, according to the White House Office of National Drug Control Policy (ONDCP).
The 2008 Arrestee Drug Abuse Monitoring Program (ADAM II), which includes data on male arrestees booked for offenses in 10 major metropolitan areas, found that positive drug test rates ranged from 49 percent in Washington, D.C., to 87 percent in Chicago. Marijuana, cocaine, opiates and methamphetamine were the most common illicit drugs detected, with polydrug-use rates ranging from 15 percent in Atlanta to 40 percent in Chicago.
Offenders were not tested for alcohol use, the drug most commonly associated with crime. Traces of alcohol remains in the system for a limited period of time, whereas drug testing can detect traces of drugs like marijuana weeks or even months after use.
The report found significant geographic differences in illicit-drug prevalence: for example, 41 percent of arrestees in Chicago tested positive for cocaine, compared to just 17 percent in Sacramento. And while less than one percent of arrestees in the eastern U.S. tested positive for methamphetamine, 35 percent of those booked on criminal charges in Sacramento had meth in their system, as did 15 percent of arrestees in Portland, Ore.
The ADAM II report also found that more than 80 percent of arrestees who reported illicit drug use within the past year had been arrested previously -- a finding that ONDCP said argued in favor of expanding programs that divert nonviolent offenders to addiction treatment rather than prison.
"Not only does this new report reaffirm the strong link between drug use and crime, but it also tells us that we must concentrate our resources on programs that have been proven to break the cycle of drugs and crime," said ONDCP Director Gil Kerlikowske.
The press release and the ADAM II report can be accessed at : http://www.whitehousedrugpolicy.gov/news/press09/052809.html
JoinTogether.org – June 2, 2009
< Back to top >
NIH Panel to Consider NIDA/NIAAA Merger
A special panel at the National Institutes of Health (NIH) has recommended a formal study on the possibility of merging the National Institute on Drug Abuse (NIDA) with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to form a National Institute on Addiction, but another putative merger -- between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) -- has been dismissed as nothing more than a "rumor" by a SAMHSA official.
At an April 28-29 meeting on the NIH campus, the research agency's Scientific Management Review Board (SMRB) -- formed in 2006 to examine how NIH should be optimally organized -- recommended that the merger of NIDA and NIAAA be formally considered, under the rubric of "whether organizational and/or management change within NIH could further optimize research into substance use, abuse, and addiction research."
"There seemed to be a reasonable case for putting this on the table for discussion," said Lawrence A. Tabak, D.D.S., Ph.D., acting deputy director of NIH.
The SMRB members voted unanimously in favor of studying the merger despite the fact that every outside group and individual testifying live at the hearing opposed combining the two agencies. The topic is "not going away and the uncertainty is worse, I'm sure, than some definitive recommendation that we can make to who ever implements it," reasoned SMRB member Arthur Rubenstein, M.D., dean of the University of Pennsylvania School of Medicine.
Tabak said that a study committee would be formed to consider the merger, with results expected back by the next full meeting of the SMRB, likely in October or November.
This news feature can be accessed at : http://www.jointogether.org/news/features/2009/nih-panel-to-consider.html
Source: JoinTogether.org – Bob Curley - June 6, 2009
< Back to top >
New National Report Shows Substantial Disparities in the Levels of Substance Abuse Experienced Among States
A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) released in May 2009, providing state-by-state analyses of substance abuse and mental illness patterns reveals that there are wide variations in the levels of problems like illicit drug use found among the states, but that every state suffers from these problems. Findings include:
- Among those aged 12 and older, Iowa had less than half the current illicit drug use rate of Rhode Island (5.2 percent vs. 12.5 percent) – yet Iowa’s population aged 12 and older also had one of the nation’s highest levels of people experiencing alcohol dependence or abuse in the past year (9.2 percent).
- Vermont had the nation’s highest incidence rate of marijuana use among people aged 12 and older (2.5 percent) while Utah had the lowest (1.6) percent.
- The District of Columbia had the nation’s highest rate of past year cocaine use among those aged 12 and older (5.1 percent) while Mississippi had the lowest (1.6 percent).
- Utah had the nation’s lowest rate of current underage drinking (17.3 percent) while North Dakota had the highest (40 percent).
Findings on Nonmedical Use of Pain Relievers
In 2006-2007, 5.1 percent of all persons aged 12 or older reported having used pain relievers nonmedically in the past year, a percentage that remained relatively unchanged from 2005-2006 (5.0 percent).
- Arkansas had the highest percentage (7.3 percent) of persons aged 12 or older using pain relievers for nonmedical purposes in the past year, and South Dakota had the lowest rate in the Nation—3.4 percent.
- Arkansas, Kentucky, Oklahoma, and Tennessee ranked in the top fifth of states for this measure in each of the three age groups (12 to 17, 18 to 25, and 26 or older) and for the total population aged 12 or older.
- Nine states showed significant changes in the nonmedical use of pain relievers in the past year between 2005-2006 and 2006-2007: Connecticut, Florida, Iowa, Nebraska, and Utah had declines, and Arizona, Arkansas, Ohio, and Wisconsin showed increases.
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.
The full report is available online at http://oas.samhsa.gov/2k7state/TOC.cfm. Copies may also be obtained free of charge by calling SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) or http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=18128
Source: SAMHSA – June 4, 2009
< Back to top >
NEWS FEATURES
Wounds of War: Drug Problems Among Iraq, Afghan Vets Could Dwarf Vietnam
The U.S. could face a wave of addiction and mental-health problems among returning veterans of the Iraq and Afghan wars greater than that resulting from the Vietnam War, according to experts at the recent Wounds of War conference sponsored by the National Center for Addiction and Substance Abuse (CASA) at Columbia University.
Rather than the heroin addictions many Vietnam veterans brought back with them from Southeast Asia, today's returning soldiers are more likely to be addicted to prescription medications -- the very opiates prescribed to them by the military to ease stress or pain -- or stimulants used by soldiers to remain alert in combat situations.
"I think there's a lot more [soldiers addicted to] pharmacological opiates than the data show," said John A. Renner Jr., M.D., associate professor of psychiatry at the Boston University School of Medicine and associate chief of psychiatry at the U.S. Department of Veterans Affairs (VA) Boston Healthcare System. "A lot of them were using opiates before they went, and a lot are reporting that opiates are freely available in combat areas."
This news feature can be accessed at: http://www.jointogether.org/news/features/2009/wounds-of-war-drug-problems.html
Source: JoinTogether.org – Bob Curley - June 15, 2009
< Back to top >
States Waste Billions Dealing with Consequences of Addiction, CASA Study Says
The vast majority of the estimated $467.7 billion in substance-abuse related spending by governments on substance-abuse problems went to deal with the consequences of alcohol, tobacco and other drug use, not treatment and prevention, according to a new report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University.
The report, titled, "Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets," found that 95 percent of the $373.9 billion spent by the federal government and states went to paying for the societal and personal damage caused by alcohol and other drug use; the calculation included crime, health care costs, child abuse, domestic violence, homelessness and other consequences of tobacco, alcohol and illegal and prescription drug abuse and addiction.
Just 1.9 percent went to treatment and prevention, while 0.4 percent was spent on research, 1.4 percent went towards taxation and regulation, and 0.7 percent went to interdiction.
"Such upside-down-cake public policy is unconscionable," said Joseph A. Califano, Jr., CASA's founder and chairman. "It's past time for this fiscal and human waste to end."
CASA estimated that the federal government spent $238.2 billion on substance-abuse related issues in 2005, while states spent $135.8 billion and local governments spent $93.8 billion. The report said that 58 percent of spending was for health care and 13.1 percent on justice systems.
Researchers estimated that 11.2 percent of all federal and state government spending went towards alcohol, tobacco and other drug abuse and addictions and its consequences. The report said that Connecticut spent the most proportionately on prevention, treatment and research -- $10.39 of every $100 spent on addiction issues -- while New Hampshire spent the least -- 22 cents.
State-by-state spending can be accessed at: http://www.jointogether.org/resources/shovelingup/shoveling-up-ii.html
The full report can be accessed at: http://www.jointogether.org/jump.jsp?path=/resources/shovelingup/shoveling-up-ii-final.pdf
Source: JoinTogether.org – May 28, 2009
< Back to top >
RESEARCH
Untreated Hepatitis C Infection is Associated with Decreased Health-Related Quality of Life in Patients Receiving Methadone
The vast majority of patients entering methadone treatment for opioid dependence have hepatitis C virus (HCV) infection. Despite the effectiveness of HCV treatment with pegylated interferon and ribavirin, a minority of patients undergo this treatment. In addition to adverse health consequences (e.g., cirrhosis and hepatocellular cancer), HCV infection is associated with somatic complaints and decreased quality of life (QOL). Investigators sought to determine the impact of untreated HCV infection on health-related QOL among 100 patients receiving methadone maintenance. Primary findings were as follows:
- Health-related QOL scores among patients with untreated HCV infection receiving methadone were significantly lower than scores for the general population and were also lower than scores among patients with untreated HCV who were not receiving methadone.
- The severity of depression among patients was associated with health-related QOL.
Comments:
There are a number of benefits of HCV treatment, including decreased risk for cirrhosis and hepatocellular carcinoma. The current study adds poor health-related QOL to the potential adverse impact of HCV infection on patients with opioid dependence receiving methadone. Studies that conduct serial assessments of health-related QOL in patients receiving methadone and HCV treatment are needed. In the meantime, physicians caring for patients receiving methadone should stress the potential improvements to health-related QOL and hepatic outcomes when discussing HCV treatment.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue May/June 2009. Access checked 6/14/09.
David A. Fiellin, MD
Original Source: Batki SL, Canfield KM, Smyth E, et al. Health-related quality of life in methadone maintenance patients with untreated hepatitis C virus infection. Drug Alcohol Depend. 2009;101(3):176–182.
< Back to top >
WEBINARS OF INTEREST
Legal Action Center Schedules Webinars on Addiction Treatment Issues
The Legal Action Center will be conducting three free 60-minute webinars on addiction treatment issues during July and August.
| Housing, Health Care, and Other Forms of Discrimination Against People with Alcohol/Drug Histories | July 29, 2009 | 3:00 pm (ET) |
| Medication-Assisted Treatment: Special Anti-Discrimination Issues | August 11, 2009 | 3:00 pm (ET) |
| New Federal Parity Legislation for Insurance Coverage of Addiction Treatment | August 26, 2009 | 3:00 pm (ET) |
You can register for these free webinars at: http://www.regonline.com/builder/site/Default.aspx?eventid=724860
< Back to top >
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 Covidien Mallinckrodt, St. Louis, MO, 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.