AT Forum NEWS NOTES & UPDATES #135
October 2009
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: September 2009
Contents
MEDICATION-ASSISTED TREATMENT
Clinical Guidelines and Liability Prevention Webinar is Now Available for Viewing on Demand
New Short Report - Heroin & Other Opiate Admissions to Substance Abuse Treatment
DEA Letter Sparks Fears About Intimidation of Buprenorphine Docs
IHRA Launches ‘Addicted to News’ Media Guidelines
GOVERNMENT NEWS & REPORTS
Pamela Hyde Nominated for SAMHSA Administrator Post
Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999-2006
MISCELLANEOUS
Little Progress in Cutting Drug Use as Treatment Resources Continue to Lag
Text Messages Could Prevent Fatal Overdose
MEDICATION-ASSISTED TREATMENT (MAT)
Clinical Guidelines and Liability Prevention Webinar for OTPs is Now Available for Viewing on Demand
If you missed the SAMHSA/CSAT Minimize Liability, Manage Risk, Ensure Patient Safety: Effective Strategies in Outpatient Methadone Treatment live webinar, it is now available for viewing on the web at no charge. The webinar was coordinated by IRETA/Northeast ATTC.
This program is designed for healthcare and mental health professionals who are involved in the direct care of patients seeking help for opioid dependence. Conducted by experts in insurance, law, policy, and daily clinical practices, the training will provide the framework for applying best practices and developing comprehensive risk management strategies that improve patient safety and enable OTPs to eliminate, transfer, reduce, and manage the risks associated with medication-assisted treatment for opioid dependence.
The webinar is approved for continuing education credits.
You can register and view the Clinical Guidelines and Liability Prevention Webinar at: http://ireta.org/webinarOnDemand.html
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New Short Report - Heroin & Other Opiate Admissions to Substance Abuse Treatment
This past August, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a short report on heroin and other opiate admissions to treatment. The report was based on data from the 2007 Treatment Episode Data Set (TEDS). Highlights include:
- As the primary substance of abuse, opiates accounted for almost one fifth (19 percent) of all substance abuse treatment admissions in 2007
- Heroin admissions were almost three times as likely as admissions for other opiates to report cocaine as a secondary substance of abuse (51 vs. 18 percent), but only half as likely to report marijuana as a secondary substance of abuse (11 vs. 22 percent)
- Heroin admissions were nearly three times as likely as other opiate admissions to report five or more prior treatment admissions (26 vs. 9 percent)
- Heroin admissions tend to be older, male, black, and Hispanic compared to admissions for other opiates
- Heroin admissions tend to be less educated and less likely to be employed than admissions for other opiates
It is widely accepted that the most effective substance abuse treatment programs provide services that meet the specific individual needs of the client. Recognizing and understanding the differences between primary heroin admissions and other primary opiate admissions may help treatment providers design more effective opiate abuse treatment protocols.
The 4-page PDF file can be accessed at : http://www.atforum.com/addiction-resources/documents/196HeroinVsNonHerWeb.pdf
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (August 27, 2009). The TEDS Report: Heroin and Other Opiate Admissions to Substance Abuse Treatment. Rockville, MD.
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DEA Letter Sparks Fears About Intimidation of Buprenorphine Docs
A recent letter from the Drug Enforcement Administration (DEA) to doctors certified to prescribe buprenorphine sparked concerns about intimidation and a perceived attempt to suppress the number of physicians prescribing the anti-opiate medication -- an impression that the Obama administration moved quickly to dispel.
The July 24 letter was addressed to individual healthcare providers who had received waivers from the Drug Addiction Treatment Act (DATA) in order to prescribe Subutex and Suboxone, both buprenorphine-based drugs that are used as an alternative to methadone maintenance.
DEA Miami Field Office diversion manager Barbara A. McGrath wrote that waiver recipients are "subject to inspection" by the DEA and that the agency was developing plans "to include inspections of DATA-waiver practitioners." About 18,000 physicians currently are authorized to prescribe buprenorphine.
"To accurately plan for and properly allocate resources effectively and efficiently, we are attempting to discern whether the DATA-waived portion of your medical practice will need to be inspected," according to McGrath, who advised recipients of the letter who don't want to prescribe the drug can exit the program by filling out an attached form. "Once DEA receives and processes your request, we can remove your name from the list of those medical practices scheduled for inspection," McGrath wrote.
The letter then goes on to require that physicians who want to continue prescribing or dispensing buprenorphine for treatment of opioid addiction complete a questionnaire and prepare for an inspection visit by having a variety of documents on hand, including DEA forms, their state license, treatment documentation, and their CSAT certification and waiver letter.
Objectively, the letter could be read as a simple administrative missive aimed at determining which doctors are subject to inspection under the DATA law. But given DEA's reputation among some doctors for choosing heavy-handed enforcement over patient needs -- along with a perceived hostility toward buprenorphine and other opiate-replacement therapies -- the letter resulted in an immediate outcry from recipients.
"Clearly these letters suggest to physicians that if they don't want a DEA inspection they can just opt out of prescribing Suboxone," said Richard Saitz, M.D., a board-certified addiction medicine specialist and professor at the Boston University School of Medicine, who received one of the DEA letters at his home address. Saitz said that the letters may have led some doctors to conclude that "it is the last straw and not worth it to them to put up with all of the challenges one needs to surmount to prescribe buprenorphine."
Charles O'Keeffe, a professor at Virginia Commonwealth University School of Medicine and an epidemiology and community health expert at the school's Institute for Drug and Alcohol Studies, noted that the majority of letter recipients were family practitioners and internal-medicine specialists who "went to the trouble to take the courses and get certified to prescribe" -- in other words, just the kind of providers that buprenorphine backers are hoping will embrace the drug as a way to treat addiction in office-based practices rather than clinical settings.
"Overall, the feeling was that it was inappropriate to single out these physicians," who may be especially vulnerable to feeling pressured by the DEA, said O'Keeffe.
Tom McLellan, deputy director of the Office of National Drug Control Policy (ONDCP), said the field's reaction was understandable, and that the Obama administration is working on a followup letter that will explicitly encourage physicians to become certified to prescribe buprenorphine.
"If you didn't know where the (DEA) letters came from it could be interpreted as a purely administrative document," said McLellan. "The problem is if you get a letter from the IRS or the DEA, it evokes strong emotional reactions."
McLellan told Join Together that acting DEA administrator Michelle Leonhardt "understood immediately" how the letter could have been misinterpreted. "She repeatedly assured me that neither she nor the DEA are against buprenorphine or are trying to discourage the use of buprenorphine," said McLellan. "They are merely trying to carry out their regulatory responsibilities."
"Let's cut DEA some slack on this," McLellan continued. "The field has to understand that this is not your father's ONDCP or DEA -- we're trying to work together to increase the appropriate availability of buprenorphine."
Source: JoinTogether.org – News Feature by Bob Curley - October 1, 2009
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EUROPAD Journal – Heroin Addiction and Related Clinical Problems. 2009(Sept ), Vol. 11, No. 3 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 the new September 2009 issue include:
- Methadone Treatment in Italy in the Third Millennium: Continuing Fear of Treatment
- Pharmacology and Neurochemistry of Methadone
- Alcoholics With a History of Heroin Consumption: Clinical Features and Chronology of Substance Abuse
- Opioid Dependence and Quality of Life: Changes in the Heroin Epidemic
- Predictors for Non-Relapsing in Methadone- and Buprenorphine-maintained Heroin Addicts: A Comparative Study
The PDF file can be downloaded from ATForum.com at: <HeroinAdd11-3.pdf>
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GOVERNMENT NEWS & REPORTS
Pamela Hyde Nominated for SAMHSA Administrator Post
New Mexico health and human services secretary Pamela Hyde has been nominated by President Obama on Oct. 2 to become the next administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Hyde, who has 30 years of experience in healthcare management and consulting -- much in the mental-health arena, including serving as president and CEO of the managed behavioral healthcare firm Comcare -- has served in a variety of public posts, including as a state mental health director and state human services director.
She was appointed cabinet secretary of the New Mexico Human Services Department in 2003 by Gov. Bill Richardson after working in state government in Ohio and for the city of Seattle. Hyde also is an attorney and worked in a variety of legal-services positions early in her career.
"Hyde has been with my administration since day one and has been a tremendous asset for the people of New Mexico, providing greater access to quality resources they need to be successful in life," Richardson said. "She not only improved the services available through the Human Services Department but took on the task of improving and streamlining the way behavioral health services are administered in our state, something no other state has tried, much less accomplished."
"Ms. Hyde has worked tirelessly to improve access, quality, and accountability of health and human services programs for the residents of her state," added Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services.
Rear Admiral Eric Broderick has filled in as acting SAMHSA administrator since the departure of Terry Cline, Ph.D., last fall.
Source: JoinTogether.org - October 5, 2009
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Increase in Fatal Poisonings Involving Opioid Analgesics in the U.S, 1999-2006
Last month, the Centers for Disease Control and Prevention (CDC) issued a report detailing fatal poisonings involving opioid analgesics in the U.S. during the time period 1999-2006. Highlights include:
- From 1999 through 2006, the number of fatal poisonings involving opioid analgesics more than tripled from 4,000 to 13,800 deaths
- Opioid analgesics were involved in almost 40% of all poisoning deaths in 2006
- In about one-half of the deaths involving opioid analgesics, more than one type of drug was specified as contributing to the death, with benzodiazepines specified with opioid analgesics most frequently
- The number of poisoning deaths involving methadone increased nearly sevenfold from almost 790 in 1999 to almost 5,420 in 2006, which is the most rapid increase among opioid analgesics and other narcotics involved in poisoning deaths
The report can be accessed at: http://www.cdc.gov/nchs/data/databriefs/db22.htm
Source: Center for Disease Control and Prevention - September 2009
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MISCELLANEOUS
Little Progress in Cutting Drug Use as Treatment Resources Continue to Lag
The U.S. has made little progress in cutting the rate of illicit drug use since 2002 -- in part because addiction treatment remains difficult to access -- and a pair of prominent and closely watched national surveys offer mixed and sometimes divergent perspectives on adolescent drug-use trends.
The 2008 National Survey on Drug Use and Health (NSDUH), released last week by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that the overall rate of current use of illicit drugs remained level at about 8 percent, a figure that has barely budged since 2002, when 8.2 percent of those contacted for the survey acknowledged using illicit drugs.
Progress was reported in certain segments of substance misuse, however, notably those that have received significant public attention in recent years: Nonmedical use of prescription drugs declined from about 2.8 percent of U.S. residents over age 12 in 2007 to 2.5 percent in 2008, for example, and the number of individuals reporting use of methamphetamine fell by more than half between 2006 and 2008. Heavy alcohol use among full-time college students ages 18-22 also declined, from 19.5 percent in 2005 to 16.3 percent in 2008.
"Some of these trends are not huge, but we can't ignore them because they might be the start of a more consistent trend," said Joe Gfroerer, principal statistician for the NSDUH at SAMHSA.
The NSDUH includes data on drug use among adults as well as adolescents, but the Obama administration emphasized a handful of findings about youths, notably that past-month use of illicit drugs fell from 11.6 percent in 2004 to 9.3 percent in 2008, and that reported youth misuse of prescription drugs declined to its lowest level since 2002.
The annual 2009 Pride Survey -- released this week -- drew somewhat different conclusions, finding "small but significant" increases in past-month illicit-drug use among the more than 122,000 6th- to 9th-grade students surveyed between August 2008 and June 2009. "Most of the increases witnessed were small (less than 1 percent)," according to a summary of the Pride Survey findings. "However, they suggest that decreases in adolescent drug use over the last several years may have come to a halt."
(SAMHSA's Gfroerer said that while both surveys are large, the findings aren't comparable because the Pride Survey isn't nationally representative, with data drawn only from schools that choose to take part.)
The NSDUH findings on prescription drugs were seemingly contradictory, at times: while overall and youth misuse of prescription drugs fell, for instance, more Americans began nonmedical use of prescription drugs than initiated use of any illicit drug other than marijuana.
"It's a mixed report, frankly," said Tom McLellan, deputy director of the Office of National Drug Control Policy (ONDCP). . "Everyone who has been pushing back against the abuse of pharmaceuticals should be proud that their work is having a positive effect. But I worry about flatlining of declines in drug abuse and young people perceiving drug use as less risky than they used to; in the past, that softening in attitudes has been a sign of trouble on the horizon."
Gil Kerlikowske, director of ONDCP, said that, "Although we see some success in the reduction of overall illicit drug use, methamphetamine and prescription drug abuse among teens, there are indications that progress in other areas may be at a standstill, or even slipping back."
"As we develop the Obama administration's first drug-control strategy, we will emphasize a balanced approach that can respond to current and emerging drug-abuse trends. Improving substance-abuse prevention and treatment systems will be among our priorities," said Kerlikowske.
Of course, past administrations and drug czars have also promised a "balanced" approach to battling the nation's drug problem, but the rhetoric has rarely matched to reality, according to budget analyst and former ONDCP staffer John Carnevale, Ph.D. A new policy brief from Carnevale Associates, "The Continued Standstill in Reducing Illicit Drug Use: Is the Policy-Budget Mismatch to Blame?," cites "the eight-year failure of ONDCP to meaningfully match its federal drug-control budget to the demand reduction goals set forth by its own policy."
The Carnevale report noted that while total federal funding for drug-control activities grew by 39 percent between 2002 and 2009, 90 percent of the increase went to supply-reduction programs, and funding for drug prevention actually declined by 10 percent during the same time period. "Simply put, the only way to reduce the demand for drugs is to pay for programs that do just that," according to the Carnevale policy report.
As Kerlikowske works on his first National Drug Control Strategy -- typically released in January -- Carnevale said that a straightforward reallocation of resources might be necessary in the current budget environment. "A first step in fixing the drug-control budget will mean cutting all wasteful spending, especially for the expansion of supply-reduction programs during this decade, and using those resources instead to offset the cost of expanding long underfunded, critical demand-reduction programs."
The need for increased investment in addiction-treatment services was highlighted in the NSDUH data, which "continues to show a vast disparity between the number of people needing specialized treatment for a substance-abuse problem and the number who actually receive it," according to SAMHSA. The survey found that only 10 percent of Americans who need addiction treatment get help, a figure that has remained basically unchanged since 2002.
"The national data released today confirms that untreated alcohol and drug addiction remains at pandemic levels, with 23 million Americans suffering from the disease, approximately the same number that suffers from type 2 diabetes," said Victor Capoccia, director of the Closing the Addiction Treatment Gap initiative. "But you wouldn't know it from the way our country responds to the problem. Only one in ten Americans affected by addiction is treated, as opposed to four out of five people with diabetes."
Capoccia said that inability to pay for treatment was the biggest barrier cited by those who wanted help but didn't get care, and called for addiction services to be fully covered in national healthcare reform proposals
The 306-page 2008 NSDUH report can be accessed at: http://www.atforum.com/addiction-resources/documents/2k8Results.pdf
Source: Join-Together.org – News Feature by Bob Curley - September 18, 2009
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New Poll Shows Broad Bi-Partisan Support for Improving Access to Alcohol and Drug Addiction Treatment
A new survey, sponsored by the Open Society Institute, shows that in a time of partisan debate over health reform, Americans across party lines agree on improving access to addiction treatment. Despite difficult economic times, most are willing to pay out of their own pocket to make alcohol and drug addiction treatment more accessible and affordable for those who need services.
Large majorities see treatment as an effective, ongoing process. Yet many Americans who have personal experience with addiction report that finding affordable treatment is difficult.
Key findings include:
- More than three-quarters of Americans (77%) support including addiction treatment in health reform, including majorities of Democrats (88%), independents (72%), and Republicans (72%)
- Nearly seven in ten (69%) support paying two dollars more per month in health insurance premiums to make addiction treatment more accessible and affordable, including majorities of support across political parties
- Only one in four Americans (26%) say there are enough affordable, accessible, quality treatment centers and services in their community; nearly half (47%) reports an inadequate number of treatment centers
- Of those who know someone who has looked for addiction treatment, 46% say it was difficult finding affordable, quality treatment services. Additionally, a poll conducted in June 2009 found that half (49%) of Americans say they feel they could not afford the costs of treatment if they or someone in their family needed it
Results of the survey can be accessed at: http://www.soros.org/initiatives/treatmentgap/research/poll_20090923/poll_20090923.pdf
Source: Open Society Institute – September 23, 2009
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Text Messages Could Prevent Fatal Overdoses
A drug-treatment program in the U.K. has set up a text-messaging system for drug users, who can receive texts on what to do in case of an overdose as well as tips on harm reduction, the BBC reported Sept. 15.
The Swansea (Wales) Drugs Project is encouraging its patients and others to sign up for the Swansea Drugs Project Free Advice Support Texts. Message topics include overdose interventions -- "Don't panic. Put them in the recovery position, dial 999" (the U.K. equivalent of 911) -- and warnings against sharing needles and other drug paraphernalia. The messages also include admonishments against careless disposal of needles in public places.
"As an agency we are always seeking new and innovative ways of getting our message across to drug and alcohol users about how to reduce risks and live safer lives," said project director Ifor Glyn "The service will see the project use a texting service to send out regular messages warning people about the risks and dangers of drug taking, and suggesting ways in which they can protect themselves and responsibilities to the wider community."
The campaign was based on a similar texting service in Dublin, Ireland.
Source: JoinTogether.org - September 22, 2009
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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.