AT Forum NEWS NOTES & UPDATES #141

May 2010

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: April 2010

List of all News/Updates

 

Contents

MEDICATION-ASSISTED TREATMENT (MAT) & METHADONE

Governor's Budget Cuts Call for Near-Elimination of California's Drug Medi-CalProgram

New SAMHSA National Study — Treatment Admissions for Prescription Pain Killers on the Rise

Men and Women Cite Different Reasons for Misusing Prescription Painkillers

Travel To Methadone Clinics Costly To Pennsylvania Taxpayers — New Legislation Proposed

Journal of Addictive Diseases — Special Issue on Women, Children, and Addiction

Army Opiate Treatment Utilization Up 500 Percent

Study Finds Low Hepatitis C Rates in Methadone Maintenance Participants

GPS for the Recovering? Researchers Studying Behavior Through Mapping

GOVERNMENT NEWS & REPORTS

ONDCP Releases 2010 National Drug Control Strategy

Insurers Seek to Limit Scope of Federal Parity Regulations

NIDA News Scan May 2010 Issue Now Available Online

DRUG COURTS AND PRISON

Drug Courts Cut Crime, Recidivism, Prison Costs, International Study Finds

Sentencing Commission Releases Guidelines on Alternative Penalties

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METHADONE & MEDICATION-ASSISTED TREATMENT (MAT)

Governor's Budget Cuts Call for Near-Elimination of California's Drug Medi-Cal Program

The Governor's revised budget for May proposes to eliminate virtually all of the California Drug Medi-Cal (DMC) program, excluding perinatal services. Approximately 55% of patients enrolled in medication-assisted (methadone) treatment use DMC to pay for their addiction treatment services. According to the California Opioid Maintenance Providers "with these cuts, it is reasonable to anticipate a complete dismantling of the network of 142 statewide clinics that provide methadone treatment to approximately 35,500 individuals."

Note: Visit the http://www.atforum.com/ home page for ongoing news and developments on this story.

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New SAMHSA National Study - Treatment Admissions for Prescription Pain Killers on the Rise

On May 13, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a new study that included new 2008 substance abuse treatment admissions. The survey report, National Admissions to Substance Abuse Treatment, also included limited data on admission trends from SAMHSA's Treatment Episode Data Sets (TEDS) for 1998 to 2008.

Trends in Opioid Treatment Admission

Admissions for opioid treatment increased 42 percent during the decade, with the majority of the increase attributed to abuse of prescription opioids such as hydrocodone, hydromorphone, oxycodone, and morphine (see chart below).

Admissions for Opioid Treatment	1998	2008	% Increase
Heroin	246,788	267,335	8
Other Opioids	19,870	111,251	460
Total	266,658	378,586	42

Opioids Admissions Other Than Heroin (2008)

• Non-Hispanic Whites made up 89 percent of admissions for primary opioids other than heroin (48 percent males and 41 percent females)
• Primary opioids other than heroin were most frequently used orally (69 percent), followed by inhalation (17 percent) and injection (11 percent)
• Medication-assisted opioid therapy was planned for 19 percent of prescription opioid admissions
• Sixty-two percent of admissions for prescription opioids reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana (23 percent), alcohol (22 percent), and tranquilizers (11 percent)

Heroin Admissions (2008)

• Heroin accounted for 14 percent of TEDS admissions aged 12 and older in 2008 compared to 8.6 percent in 1998.
• Injection was reported as the usual route of administration by 65 percent of primary heroin admissions; inhalation was reported by 31 percent. Daily heroin use was reported by 71 percent of primary heroin admissions
• Most primary heroin admissions (78 percent) had been in treatment prior to the current episode, and 27 percent had been in treatment five or more times
• The majority of heroin admissions (52 percent) were 35 years of age or older
• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by the criminal justice system (15 percent vs. 38 percent) and more likely to be self-referred (56 percent vs. 32 percent)
• Medication-assisted opioid therapy was planned for 30 percent of heroin admissions

Heroin Admission Trends 1998 — 2008

General measures of heroin abuse including percent of admissions and injection as the preferred route of administration among treatment admissions were relatively consistent from 1998 through 2008. The study noted however, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of heroin-using sub-populations. Highlights include:

• TEDS data indicate that heroin abuse has been increasing among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions
• Route of administration of heroin was closely linked to age and race/ethnicity. Injection increased among young adults; inhalation increased among the those 45 and older
• Medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 1998 and 2008.In 1998, about 40 percent of all heroin admissions received medication-assisted opioid therapy.

The information in TEDS was reported by State-licensed substance abuse treatment facilities (primarily those that received public funding) from across the U.S.

Note: TEDS is an admission-based system, and TEDS admissions do not represent individuals. Thus, for example, an individual admitted to treatment twice within a calendar year would be counted as two admissions.

The full report is available at: http://wwwdasis.samhsa.gov/teds08/teds2k8natweb.pdf

Source: Substance Abuse and Mental Health Services Administration - May 13, 2010

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Men and Women Cite Different Reasons for Misusing Prescription Painkillers

Emotional issues and psychological stress often spark misuse of prescription painkillers among women, whereas men are more likely to cite social and behavioral problems, according to researchers who investigated the underlying causes of opioid painkiller addictions.

Women who misused the drugs also were more likely to tell investigators that they had been abused sexually or physically, and that they had a past history of psychiatric or psychological problems.

HealthDay News reported April 30 that researcher Robert N. Jamison of Harvard's Brigham and Women's Hospital and colleagues studied 662 chronic-pain patients who took opioid painkillers. They found that misuse of the drugs occurred at about the same rate among men and women, but that gender differences showed up when patients were asked about what led them to misuse the painkillers.

The findings appear in the April 27, 2010 issue of the Journal of Pain.

Source: JoinTogether.org - May 5, 2010

 

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Travel To Methadone Clinics Costly To Pennsylvania Taxpayers — New Legislation Proposed

According to KDKA television investigators in Pittsburgh, Pennsylvania, millions of tax dollars are being spent on taxi fares for patients to travel to far away methadone clinics. The investigation found that more than 10,000 patients on methadone treatment in Pennsylvania get free transportation to the methadone clinic of their choice.

In Westmoreland County, it is estimated they spend $1.5 million a year transporting methadone patients. Allegheny County spends $1.3 million, Fayette County spends $509,000 and in Indiana County, $480,000 is spent.

The investigators interviewed one patient who takes a taxi 50 miles roundtrip each day at an estimated cost of more than $43,000 per year. The patient has been using taxi transportation to the clinic for more than seven years.

KDKA interviewed Pennsylvania State Senator Kim Ward (R-39), who said she "is obsessed" with cutting the methadone transportation program. "Our goal should be recovery and we should be responsible with taxpayer dollars when talking about transportation," she said. "We're not out to hurt people - I'm not out to hurt people. We need to be responsible and right now Pennsylvania is not being responsible."

A group of lawmakers including Sen. Kim Ward. Sen. John Eichelberger (R-30), Sen. Mike Stack (D-5), and Sen. Don White (R-41) unveiled a bipartisan package of legislation on May 26, overhauling Pennsylvania's methadone treatment laws to increase fiscal accountability and safety, and reduce the unlawful use of methadone and methadone poisoning deaths.

The measures making up the "Methadone Accountability" Package address the illegal diversion of methadone from treatment uses; methadone use and highway safety; and accountability in government-sponsored treatment, including cost to taxpayers, open-ended treatment, overdoses and deaths.

More details on the proposed individual Senate bills can be found at:
http://senatorward.com/press/2010/0510/052610.htm

Sources:

KDKA television in Pittsburgh, Pennsylvania — May 24, 2010
http://kdka.com/kdkainvestigators/methadone.clinic.travel.2.1712889.html

State Senator Kim Ward Media Advisory — May 24, 2010
http://senatorward.com/press/2010/0510/052410.htm

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Journal of Addictive Diseases — Special Issue on Women, Children and Addiction

The Journal of Addictive Diseases, the official Journal of the American Osteopathic Academy of Addiction Medicine, has devoted their current issue to articles related to women, children, and addiction. Articles of interest include:

• Women and Addiction: The Importance of Gender Issues in Substance Abuse Research
• Substance Use and Women's Health
• Addiction in Pregnancy
• Human Immunodeficiency Virus Risk Behavior Among Female Substance Abusers
• Pharmacotherapy in the Treatment of Addiction: Methadone
• Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense
• Prenatal Drug Exposure: Infant and Toddler Outcomes
• Children of Addicted Women

Free abstracts and individual articles are available for purchase at:
http://www.informaworld.com/smpp/title~db=all~content=g921472153

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Army Opiate Treatment Utilization Up 500 Percent

The number of U.S. Army soldiers enrolling in treatment for opiate addiction rose 500 percent between 2004 and 2009, Fox News reported May 6.

A total of 529 soldiers sought opiate-addiction treatment through the military last year, up from 89 in 2004. Enrollment jumped 50 percent in 2009 as the Obama administration began sending more troops to Afghanistan, one of the world's leading opium producers.

Army officials said the uptick likely represents misuse of both illicit drugs like heroin and opiate-based prescription drugs. Heroin is easily available in Afghanistan, even on U.S. military bases. Use of the drug is widespread among Afghan forces, according to former U.S. soldiers who served in Afghanistan.

Few U.S. soldiers serving in Afghanistan have tested positive for opiates during random drug testing, however.

Source: JoinTogether.org - May 10, 2010

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Study Finds Low Hepatitis C Rates in Methadone Maintenance Participants

Researchers at an Israeli clinic offering methadone maintenance treatment have found that the treatment for opiate addiction appears to protect individuals against subsequent hepatitis C infection, Medscape Psychiatry reported April 19.

Presenting their findings at this month's American Society of Addiction Medicine (ASAM) Medical-Scientific Conference, Einat Peles, Ph.D., and colleagues reported that in a group of 207 hepatitis C-negative patients treated at their Tel Aviv clinic between 1993 and 2008, only 25 became hepatitis C-positive. This is seen as a critical finding in that hepatitis C rates among injection drug users have been estimated at 60 to 90 percent.

"This is a very important study because it shows that not only does treatment work for the addiction itself but is a preventive measure for hepatitis C," commented Gavin Bart, M.D., chair of this year's ASAM meeting and director of the Division of Addiction Medicine at Hennepin County Medical Center in Minnesota. The researchers identified the strongest factors predicting hepatitis C seroconversion in the methadone maintenance population as injection drug use history, benzodiazepine use at admission to treatment, and re-admission to the methadone maintenance program.

The study also found greater hepatitis C risk among women and among individuals under 30, though the researchers added that having children appeared to protect against seroconversion. The dose of methadone received did not constitute a risk factor for the illness, according to the research.

Source: JoinTogether.org - April 23, 2010

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GPS for the Recovering? Researchers Studying Behavior Through Mapping

National Institute on Drug Abuse (NIDA) researchers are studying whether additional clues to the environmental factors associated with addiction can be uncovered by tracking addicts' whereabouts through GPS technology, CNET News reported April 21.

Researcher David Epstein and colleagues are studying Baltimore heroin addicts in methadone maintenance treatment, and so far have tracked the daily activities of two of the subjects. Using a GPS provided to the addict to track motion and then a PDA on which the individual can periodically record feelings, stressors and drug use behaviors, the team found that one addict used drugs mostly on the relatively rare occasions when he was in impoverished areas of the city.

Looking ahead to the potential implications of this research, Epstein said, "You can have an intervention that on-the-spot warns people about where they are going based on data about neighborhoods in general and their behavior specifically."

Epstein believes that another advantage of the technology lies in the ability to obtain more accurate details of real-time behavior by addicts -- data that become skewed when they are collected many days after the fact through addicts' self-reporting.

Epstein presented details of the research at the annual meeting of the Association of American Geographers.

Source: JoinTogether.org - April 26, 2010

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GOVERNMENT NEWS & REPORTS

ONDCP Releases 2010 National Drug Control Strategy

On May 11, the Office of National Drug Control Policy (ONDCP) released its Drug Control Strategy for 2010. The 2010 Strategy establishes five-year goals to reduce drug use and its consequences, including:

• Reduce the rate of youth drug use by 15 percent;
• Decrease drug use among young adults by 10 percent;
• Reduce the number of chronic drug users by 15 percent;
• Reduce the incidence of drug-induced deaths by 15 percent; and
• Reduce the prevalence of drugged driving by 10 percent.

In addition, the Strategy outlines three significant drug challenges on which the Obama Administration will specifically focus this year: prescription drug abuse, drugged driving, and preventing drug use. Prescription drug abuse is the Nation's fastest growing drug problem, driving significant increases of drug overdoses in recent years. Drugged driving poses threats to public safety, as evidenced by a recent roadside survey which found that one in six drivers on weekend nights tested positive for the presence of drugs. Preventing drug use before it starts is the best way to keep America's youth drug-free.

ONDCP's budget request includes a 3.7 percent increase in treatment funding and a 13 percent increase in prevention funding to $3.9 billion and $1.7 billion, respectively.

The PDF file of the 2010 Strategy can be accessed at:
http://www.whitehousedrugpolicy.gov/publications/policy/ndcs10/ndcs2010.pdf

Source: The Office of National Drug Control Policy — May 11, 2010

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Insurers Seek to Limit Scope of Federal Parity Regulations

The 2008 federal addiction and mental-health parity law is under attack by insurance companies that want the Obama administration to delay implementation of the regulations and change some of the rules designed to ensure that behavioral-health problems are treated on par with other diseases, the New York Times reported May 9.

Insurers contend that the rules issued by the administration go beyond the intent of Congress in passing the parity law, would inhibit their ability to control costs, and could raise patients' out-of-pocket expenses.

The law bans caps on the number of days spent in treatment if such limits don't apply to other forms of healthcare services, but insurers are objecting to the administration's efforts to control such "nonquantitative treatment limits" as managed-care guidelines, selection of providers, and reimbursement rates. Another bone of contention is a call for insurers to set a single deductible for all health services rendered, not separate deductibles for behavioral-health and general-health services.

Insurers like Aetna and the Blue Cross and Blue Shield Association said the law was not intended to ensure parity in reimbursement, but advocates for addiction and mental-health services said that access to treatment has been limited by insurers low payment rates for providers. American Psychiatric Association CEO James H. Scully Jr. said that some insurers have tried to skirt the law by "imposing new requirements for prior authorization and the submission of treatment plans for mental health services where there were no comparable requirements on the medical-surgical side."

Source: JoinTogether.org - May 13, 2010

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NIDA News Scan May 2010 Issue Now Available Online

The May 2010 issue of the National Institute of Drug Abuse (NIDA) Addiction Research News is now available online. Articles include:

• Predicting risk and resilience in children of opiate-dependent parents
• Low dose naltrexone + methadone during detox eases withdrawal symptoms, reduces cravings
• Potential viability of HIV medications for HIV prevention in high-risk populations, but not for standard use
• Understanding more about the needs and expectations of patients seeking outpatient substance abuse treatment

The May issue can be accessed at: http://drugabuse.gov/newsroom/10/NS-05.html

Source: The National Institute of Drug Abuse — May 2010

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DRUG COURTS AND PRISON

Drug Courts Cut Crime, Recidivism, Prison Costs, International Study Finds

Researchers who looked at drug courts in 12 countries issued a ringing endorsement of their effects on crime and costs to society, saying the concept of offering addiction treatment to drug offenders rather than prison has succeeded in countries from Belgium to Suriname.

The report, "Establishing Drug Treatment Courts: Strategies, Experiences, and Preliminary Outcomes," was prepared by researchers at American University and released by the Organization of American States' Inter-American Drug Abuse Control Commission. Researchers studied drug courts in Belgium, Bermuda, Brazil, Canada, Chile, United Kingdom, Ireland, Jamaica, Mexico, Norway, Suriname and the United States.

The study (PDF) concluded that drug courts reduce local crime and recidivism; lower incarceration costs; and provide addiction and related services to offenders, including healthcare, housing, and family support.

Maintaining adequate resources for operations was the biggest challenge facing drug courts internationally, researchers found.

"This study is important because until now we had no real idea of what was going on, no way for countries to network with each other or see what common issues they had in their courts and how to address them," said Caroline S. Cooper of the Justice Programs Office at the School of Public Affairs at American University.

Source: JoinTogether.org - May 3, 2010

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Sentencing Commission Releases Guidelines on Alternative Penalties

Judges may depart from federal sentencing guidelines in order to refer offenders with alcohol and other drug problems to addiction treatment or other alternatives to incarceration, according to new guidelines issued by the U.S. Sentencing Commission.

"The commission has heard from virtually every sector of the criminal-justice community that there is a great need for alternatives to incarceration," said commission chairman William K. Sessions III. "Expanding the availability of alternatives to straight incarceration is a public-safety issue. Providing flexibility in sentencing for certain low-level, non-violent offenders helps lower recidivism, is cost effective, and protects the public. The commission's action in this area amounts to a very modest but important step in the right direction."

The amendment to federal sentencing policy (PDF) "informs courts that departures from the guidelines may be warranted in situations where an offender's criminal activity is related to a treatment issue such as drug or alcohol abuse or significant mental illness and sentencing options such as home or community confinement or intermittent confinement would serve a specific treatment purpose."

The commission also recommended that courts "take into consideration the effectiveness of residential treatment programs as part of their decision to impose community confinement."

Separately, the commission also gave courts more discretion to consider age, mental and emotional conditions, physical condition, and military service, when relevant, in determining sentences.

The amendments issued by the commission were due to Congress by May 1. They will automatically go into effect on Nov. 1 unless blocked legislatively by Congress.

Source: JoinTogether.org - May 4, 2010

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