Follow us:

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

AT Forum NEWS NOTES & UPDATES #134

September 2009

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: August 2009

List of all News/Updates

MEDICATION-ASSISTED TREATMENT (MAT)

ASAM Introduces New “Mentoring” Service for Physicians Who Prescribe Methadone

physicians The American Society of Addiction Medicine (ASAM) announced a new service for health care providers prescribing methadone to treat opioid addiction or chronic pain - the Physician Clinical Support System for Methadone (PCCS-M). It is a support system to connect prescribers of methadone with experienced clinicians for one-to-one mentoring regarding the use of this medication.

Prescribers can contact a mentor, a knowledgeable colleague, by phone or e-mail with specific questions about the use of methadone. On-site support is also available.

There is also a PCCS-M website, http://www.pcssmentor.org/, where clinical information and materials such as patient information sheets and screening instruments, and evidence-based reviews on commonly encountered clinical questions can be downloaded.

The PCSS-M is coordinated by ASAM in conjunction with other leading medical societies, and is make possible by support from the Center for Substance Abuse Treatment (CSAT), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Interested physicians can call PCSS-M at 877-630-8812, or register online at www.PCSSmentor.org

Source: American Society of Addiction Medicine - August 17, 2009

< Back to top >

New Resource: Interpreting the Annals Methadone QTc Guidelines Article

heart A new 35-minute audiovisual lecture by Gavin Bart, MD, Director, Division of Addiction Medicine at the Hennepin County Medical Center, interprets the Annals of Internal Medicine Methadone QTc Guidelines article.

Topics covered include:

Methadone and QTc screening
Elements of clinical guidelines
QTc interval and risk stratification

The lecture is no longer available to view online.

< Back to top >

Study Finds U.S. Prison System Falls Short in Treating Drug Addiction

Almost a quarter of a million individuals addicted to heroin are incarcerated in the U.S. each year. However, many prison systems across the country still do not offer medical treatment for heroin and opiate addiction, despite the demonstrated social, medical and economic benefits of opiate replacement therapy (ORT).

According to new research from The Miriam Hospital, Brown University and their affiliated Center for Prisoner Health and Human Rights, just half of all federal and state prison systems offer ORT with the medications methadone and buprenorphine, and only in very limited circumstances. Similarly, only twenty-three states provide referrals for some inmates to treatment upon release from prison. These policies are counter to guidelines issued by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention, which say prisoners should be offered ORT for treatment of opiate dependence.

The study's findings are published online by Drug and Alcohol Dependence.

"Pharmacological treatment of opiate dependence is a proven intervention, is cost-effective and reduces drug-related disease and reincarceration rates, yet it remains underutilized in U.S. prison systems," said Amy Nunn, ScD, the study's lead author and an assistant professor of medicine (research) at The Warren Alpert Medical School of Brown University. "Improving correctional policies for addiction treatment could dramatically improve prisoner and community health as well as reduce both taxpayer burden and reincarceration rates."

The Miriam/Brown research team surveyed the medical directors at the 50 state departments of corrections, along with the Federal Bureau of Prisons and the District of Columbia prison, about their facilities' ORT prescribing policies and referral programs for inmates leaving prison. They received a total of 51 of 52 responses.

Although it appears methadone is offered more frequently than buprenorphine, the study highlights that:

Only 28 facilities (55 percent) offer methadone under any circumstances, although more than half of these provide it only to pregnant women or for chronic pain management.
Approximately 45 percent of facilities provided some community linkage to methadone treatment post-release.
Only seven prison systems (14 percent) offer buprenorphine in some circumstances, while 15 facilities (29 percent) offer referrals for some inmates to community buprenorphine providers upon release.

When asked why these treatments are not available in their prison system, the majority of facilities indicated they prefer drug-free detoxification over ORT. A number of prison systems also cited security concerns about providing methadone and buprenorphine to inmates. Interestingly, 27 percent of medical directors said they did not know how beneficial methadone is for treating inmates with opiate addiction, while half were unaware of the benefits of buprenorphine.
A major barrier to providing ORT after incarceration appears to be the lack of partnerships with community ORT providers. Many providers also cited their focus on inmate health during incarceration, rather than upon release, as another reason for not linking inmates to ORT after they've been released.

"In spite of overwhelming scientific evidence demonstrating that pharmacological treatment for addiction has greater health and social benefits than abstinence-only policies, many prison directors are philosophically opposed to treating substance use. Most prisons also do not provide referrals for substance use treatment for prisoners upon release," said Nunn. "These trends contribute to high reincarceration rates and have detrimental impacts on community health. Our interviews with prison medical directors suggest that changing these policies may require an enormous cultural shift within correctional systems."

Source: Jessica Collins Grimes - Lifespan – September 8, 20009

< Back to top >

GOVERNMENT

McLellan Confirmed for White House Demand-Reduction Post

Acclaimed addiction researcher A. Thomas McLellan has been confirmed by the U.S. Senate to serve as the deputy director of the White House Office of National Drug Control Policy (ONDCP).

The Philadelphia Inquirer reported Aug. 8 that McLellan's appointment was approved by unanimous consent.

McLellan, formerly the executive director of the Treatment Research Institute (TRI) at the University of Pennsylvania, will be in charge of demand-reduction policy at ONDCP. "The nation has gained a leader who has been at the forefront of science-based efforts to improve treatment systems for people suffering from drug addictions. We know Tom McLellan will bring this expertise to the country’s efforts to reduce demand for illegal substances of abuse," said TRI Board Chair Carolyn Asbury, Ph.D.

Source: JoinTogether.org – August 10, 2009

< Back to top >

RESEARCH & REPORTS

Heroin Maintenance Can Control Addiction, Study Concludes

Heroin addicts who are given maintenance doses of the drug were more likely to remain in treatment and less likely to use street drugs or engage in other criminal activity than those receiving methadone, according to a study of a heroin-maintenance program in Canada.

The New York Times reported Aug. 20 that researcher Martin T. Schechter of the School of Population and Public Health at the University of British Columbia said, "The main finding is that, for this group that is generally written off, both methadone and prescription heroin can provide real benefits."

After one year, 88 percent of the heroin-maintenance patients, who received doses of 450 milligrams of the drug, remained in the program and about two-thirds had greatly reduced their illicit activities, compared to 54 percent and 48 percent, respectively, among the methadone group. However, the heroin group experienced more side-effects, including 10 overdoses. A total of 226 addicts took part in the study.

"Heroin works better than methadone in this population of users, and patients will be more willing to take it," said Joshua

Boverman of the Oregon Health and Science University, a study co-author.

The study was published in the Aug. 20, 2009 edition of the New England Journal of Medicine.

Source: JoinTogether.org – August 24, 2009

< Back to top >

Many Baby Boomers Continue Illicit Drug Use into Their 50s

Many baby boomers (Americans born between 1946 and 1964) are continuing to use illicit drugs as they grow older, causing the rate of illicit drug use to go up within the 50 to 59 year old age segment of the population. According to a new publication, An Examination of Trends in Illicit Drug Use among Adults Aged 50 to 59 in the United States, produced by the Substance Abuse and Mental Health Services Administration (SAMHSA), those aged 50 to 59 reporting use of illicit drugs within the past year has nearly doubled from 5.1 percent in 2002 to 9.4 percent in 2007 while rates among all other age groups are statistically staying the same or decreasing.

“These findings show that many in the Woodstock generation continue to use illicit drugs as they age,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “This continued use poses medical risks to these individuals and is likely to put further strains on the nation’s health care system -- highlighting the value of preventing drug use from ever starting.

The report analyzes many aspects of this phenomenon including the types of illicit substances involved, different demographic and behavioral factors associated with higher rates of use, and other issues.

The full report is available on the web at: http://oas.samhsa.gov/2k9/OlderAdults/OAS_data_review_OlderAdults.pdf

Source: SAMHSA – August 19, 2009

< Back to top >

One in Five Teens Share Their Prescription Drugs with Friends

A survey of 12- to 17-year-olds in the U.S. has found that about 20 percent said they have given their prescription drugs like Oxycontin and Darvocet to friends or obtained drugs the same way, Reuters reported Aug. 18.

Allergy drugs, narcotic pain relievers, antibiotics, acne medications, antidepressants, and anti-anxiety medications were the most commonly shared. Three-quarters of those who borrowed drugs from friends said they did so in lieu of visiting a doctor.

About one-third of those who borrowed medications said they had experienced an allergic reaction or other negative side-effects as a result.

Past research has shown that 40 percent of adults also share their medications. "However, prior to our study, no one had asked adolescents how often they shared prescription medications, which meds they shared and what some of the outcomes were," said lead researcher Richard Goldsworthy of Academic Edge, Inc.

The study was published online in the Journal of Adolescent Health.

Source: JoinTogether.org – August 24, 2009

< Back to top >

Pain Relief Only One Motive For Opioid Use Among High School Seniors

Taking opioid drugs without a prescription appears relatively common among high school seniors, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine. The most common reasons survey respondents gave for taking the medications included relaxation, feeling good or getting high, experimentation and pain relief.

A total of 12.3 percent—reported using prescription opioids for non-medical reasons in their lifetimes, including 8 percent who reported having done so in the past year. The leading motives were to relax or relieve tension (56.4 percent), to feel good or get high (53.5 percent), to experiment (52.4 percent), to relieve physical pain (44.8 percent) or to have a good time with friends (29.5 percent).

"Notably, we found that more than seven in every 10 non-medical users of prescription opioids motivated by pain relief reported a lifetime history of medical use of prescription opioids," they continue. Other studies indicate that many adolescents obtain opioids from their own previous prescriptions. "These results suggest that appropriate pain management and careful therapeutic monitoring could contribute to reductions in the non-medical use of prescription opioids among adolescents."

Screening efforts should be used to differentiate between adolescents who need help with pain management and those who need a more comprehensive assessment for substance use disorders, they conclude.

Source: Jamamedia.org – August 3, 2009

< Back to top >

MISCELLANEOUS

West Virginia Leads Nation in Prescribing Drugs

Doctors in West Virginia write an average of 17.7 prescriptions for every resident of the state, far above the national per-capita rate of 11.5, Forbes reported Aug. 18.

Healthcare information firm Verispan said in a new report that Southern states tended to have the highest rate of prescription-drug use -- doctors in Alabama, South Carolina, Tennessee, Arkansas, Louisiana, Kentucky and Missouri all wrote prescriptions at a higher-than-average rate.

Experts said that the explanation lies in the fact that these states have higher rates of heart disease, obesity, and diabetes -- "chronic diseases that are largely preventable and are linked to lifestyle and physical activity," according to Jane Barlow of pharmacy-benefits management firm Medco Health Solutions.

West Virginia, for example, exceeds the national average for smoking, heart-disease deaths, diabetes, obesity, and mental-health problems (antidepressants were the third most prescribed drugs in the state, the report said).

Source: JoinTogether.org – August 25, 2009

< Back to top >

Returning Home: Access to Health Care After Prison

Incarcerated people experience increased rates of mental illness, substance abuse, and chronic and infectious disease. These populations also frequently are adversely affected by socioeconomic risk factors for poor health, including lower educational attainment and higher rates of poverty. Given this risk, such populations are in clear need of significant health services. Particularly upon release from an institution or correctional facility, former inmates may require substantial assistance in securing health care benefits and access. Without Medicaid or other programs, however, many individuals do not have access to appropriate care.

Some states have developed strategies and programs to improve access to health care and social services for prisoners released from institutions. These include reentry planning, pre-release screening and assistance with Medicaid applications. In a few states, “suspension,” rather than termination, of Medicaid benefits has been used to ensure access to health care and other needed support.

This brief provides background on the unique health care concerns at community reentry, policy experiences of states in reentry planning, integration of services and Medicaid suspension.

A PDF of the 8-page document can be downloaded at: http://www.ncsl.org/default.aspx?tabid=18020

Source: National Conference of State Legislators – July 2009

< Back to top>

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 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.

AT Forum NEWS NOTES & UPDATES #134

September 2009