AT Forum NEWS NOTES & UPDATES #142
June 2010
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: May 2010
Contents
OPIOID ADDICTION AND MEDICATION-ASSISTED TREATMENT (MAT)
Judge Rules Pa. Board Must Answer Nurse's Methadone Suit
For Prescription Opioid Dependence, Relapses Associated With Shorter Treatment Course
Afghan Opium Production Down, American Forces Hopeful
Heroin Maintenance Can Help Hardcore Addicts, Study Finds
Experts Struggle to Determine Overdose Deaths
California Medi-Cal Budget Cuts
GOVERNMENT
David K. Mineta Confirmed as ONDCP Deputy Director of Demand Reduction
Sen. Hatch Wants Welfare Recipients Drug Tested
NEW WEB RESOURCES TO NOTE
New Resource Guide for Recovery Groups
OPIOID ADDICTION AND MEDICATION-ASSISTED TREATMENT (MAT)
Judge Rules Pennsylvania Board Must Answer Nurse's Methadone Suit
In a groundbreaking case that could help to define the rights of recovering drug addicts, a federal judge in Scranton has ruled that the Pennsylvania Board of Nursing must answer a lawsuit that says the agency has a secret, unwritten policy that forbids any nurse from holding a license while receiving methadone treatment for a chronic opioid addiction.
Requiring nurses who are recovering from heroin addiction to prove that they are "weaned" from methadone may be found to violate the Americans with Disabilities Act, U.S. District Judge James M. Munley held in Reynolds v. Commonwealth of Pennsylvania.
The article can be viewed at:
http://www.law.com/jsp/article.jsp?id=1202462885638&Judge_Rules_Pa_Board_Must_Answer_Nurses_Methadone_Suit=#
Source: The Legal Intelligencer by Shannon P. Duffy — June 22, 2010
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For Prescription Opioid Dependence, Relapses Associated With Shorter Treatment Course
In persons dependent on prescription opioids, tapering with buprenorphine during a 9-month period, whether initially or after a period of substantial improvement, led to nearly universal relapse in the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study, presented at the American Psychiatric Association 2010 Annual Meeting in New Orleans.
The study results can be accessed at:
http://www.medscape.com/viewarticle/722342?sssdmh=dm1.618588&src=nlconfnews&spon=12&uac=84966BT
Source: Medscape Business of Medicine — May 24, 2010
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Afghan Opium Production Down, American Forces Hopeful
A combination of poor growing conditions and government and military interdiction contributed to decreased opium production in Afghanistan this year, the New York Times reported May 22.
American officials hope that a bad year, coupled with aid and incentives, could push Afghanistan's farmers to move off the poppy crop, which help fund the Taliban opposition.
"If the government of Afghanistan will help us next year," said one farmer, Obidullah, "we will not grow poppy."
Weather and willpower might not be enough to kill production, however. Poppy is still the most profitable crop in Afghanistan, and short supply has driven up prices, encouraging many farmers to stick with the risk. And while the opium trade is technically illegal in Afghanistan, the American military is not authorized to enforce local laws.
Moreover, as one officer noted, attacking farmers would do little to win over the hearts and minds of the populace necessary to rebuild the country.
Source: JoinTogether.org - May 27, 2010
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Heroin Maintenance Can Help Hardcore Addicts, Study Finds
Heroin addicts who can't quit using and don't respond to methadone treatment can be helped by maintenance doses of heroin, according to a study conducted by researchers at King's College London.
Reuters reported May 28 that heroin maintenance, while obviously not a cure for addiction, at least kept most of the hardcore addicts in the study away from street drugs, which in turn helped prevent use of dirty needles and other unhealthy behaviors. In fact, about two-thirds of the heroin-maintenance group tested clean for the presence of street drugs, a far better performance than among methadone patients, two-thirds of whom typically test positive for use of street drugs.
Some of the study participants stayed in the program for more than two years and were able to get jobs and reconnect with family members, researchers added. "People are not only physically getting better, but they're getting back into society," said study author John Strang.
The findings were published in the May 28, 2010 issue of The Lancet.
Source: JoinTogether.org - June 1, 2010
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Experts Struggle to Determine Overdose Deaths
Overdoses from prescription drugs have sometimes led to civil or criminal charges against prescribing physicians, but even toxicologists have problems distinguishing between overdose deaths and fatalities from other causes, Time reported June 16.
The result is that the courts, not heath officials, are often left to determine drug users' cause of death.
Complicating factors include use of alcohol or other drugs in combination of prescription medications and underlying health conditions. Even Steven Karch, a cardiac pathologist considered the leading expert on overdose deaths, says that current medical technology can't determine which drug actually caused a patient to die.
Drug tolerance among patients varies and grows over time, meaning that an effective painkilling dose for one patient could be deadly for another. Karch said it is therefore impossible to determine a standardized "lethal dose."
"Postmortem redistribution" — a shift in detectable drug levels that takes place after death — also can confound diagnosis of overdose deaths.
Juries, however, are often swayed by courtroom testimony that makes diagnosis of overdose deaths seem far more certain than it is. "It's a giant miscarriage of justice," said Karch.
Source: JoinTogether.org — June 23, 2010
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California Medi-Cal Budget Cuts
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."
Visit the ATForum.com homepage for ongoing developments.
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GOVERNMENT
David K. Mineta Confirmed as ONDCP Deputy Director of Demand Reduction
David K. Mineta was confirmed unanimously by the United States Senate on June 22, as Deputy Director of Demand Reduction for the Office of National Drug Control Policy (ONDCP).
Mr. Mineta will oversee ONDCP's Office of Demand Reduction, which focuses on promoting drug prevention and drug treatment programs, as well as the agency's newly created focus on programs for individuals in recovery from addiction. With the forthcoming departure of ONDCP deputy director Tom McLellan, Mineta will become the point person for addiction treatment and prevention within the White House agency.
"I welcome with great pleasure David Mineta as Deputy Director," said ONDCP Director Gil Kerlikowske. "His appointment underscores this Administration's and this Agency's recognition of the essential role local communities have to play in preventing and treating drug use, as well as in promoting recovery."
The ONDCP press release can be accessed at:
http://www.whitehousedrugpolicy.gov/news/press10/062210mineta.html
Source: Office of National Drug Control Policy — June 22, 2010
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New Study Shows a Dramatic Rise in the Proportion of Older Americans Admitted for Substance Abuse Treatment from 1992 to 2008
A new study reveals that between 1992 and 2008 the proportion of substance abuse treatment admissions involving older Americans (aged 50 and older) nearly doubled -- from 6.6 percent of all admissions in 1992 to 12.2 percent in 2008. The study, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also shows a sharp rise during this period in the proportion of older Americans admissions related to illicit drug abuse -- even though alcohol abuse is still the leading cause for admissions involving this age group.
The SAMHSA study reveals that from 1992 to 2008 the proportion of admissions among this age group due primarily to:
- Heroin abuse more than doubled -- from 7.2 percent to 16.0 percent
- Cocaine abuse quadrupled -- from 2.9 percent to 11.4 percent
- Prescription drug abuse rose from 0.7 percent to 3.5 percent
- Marijuana abuse increased from 0.6 percent to 2.9 percent.
At the same time admissions primarily related to alcohol abuse decreased from 84.6 percent in 1992 to 59.9 percent in 2008.
The proportion of older American treatment admissions involving multiple substance disorders has nearly tripled from 13.7 percent in 1992 to 39.7 percent in 2008.
"These findings show the changing scope of substance abuse problems in America." said SAMHSA Administrator Pamela S. Hyde, J.D. "The graying of drug users in America is an issue for any programs and communities providing health or social services for seniors."
Changing Substance Abuse Patterns among Older Admissions: 1992 and 2008 is based on data from SAMHSA's Treatment Episode Data Set (TEDS). The 4 page report is available on line at: http://oas.samhsa.gov/2k10/229/229OlderAdms2k10Web.pdf.
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) — June 16, 2010
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Study Shows 111 Percent Increase in Emergency Department Visits Involving Nonmedical Use of Narcotic Pain Relievers in Five-Year Period
From 2004 to 2008 the estimated number of emergency department visits linked to the nonmedical use of narcotic prescription pain relievers rose from 144,644 visits to 305,885 visits a year.
Visits to hospital emergency departments involving nonmedical use of prescription narcotic pain relievers more than doubled, rising 111 percent, between 2004 and 2008, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention. The study used data from SAMHSA's Drug Abuse Warning Network (DAWN) emergency department system. It examined emergency department visits for nonmedical use of legal drugs, such as using them without a prescription.
"The abuse of prescription drugs is our nation's fastest-growing drug problem. And this new study shows it is a problem that affects men and women, people under 21, and those over 21,"said Office of National Drug Control Policy Director Gil Kerlikowske. ``The newly released National Drug Control Strategy contains specific steps that all of us can take to address this issue."
The three prescription opioid pain relievers most frequently involved in hospital emergency department visits from 2004 to 2008 were:
- Oxycodone products — ED visits involving nonmedical use rose 152 percent, to 105,214
- Hydrocodone products — emergency department visits involving nonmedical use rose 123 percent, to 89,051
- Methadone products — emergency department visits involving nonmedical use rose 73 percent, to 63,629
The numbers of emergency department visits involving nonmedical use of other types of prescription pain relievers such as morphine, fentanyl and hydromorphone were lower, but they also showed sharp rises during this period — for example, hydromorphone-related nonmedical use visits rose 259 percent from 2004, to 12,142 in 2008. These upward trends reflect in part dramatic increases in the rate at which these drugs are prescribed in the United States.
"We urgently need to take action," said CDC director Dr. Thomas Frieden. "Emergency department visits involving non-medical use of these prescription drugs are now as common as emergency department visits for use of illicit drugs. These prescriptions medicines help many people, but we need to be sure they are used properly and safely."
The 4-page DAWN report can be accessed at:
http://oas.samhsa.gov/2k10/DAWN016/OpioidEdHTML.pdf
CDC recently released an issue brief, "Unintentional Drug Poisoning in the United States," showing more than 26,000 deaths from unintentional drug poisoning in the United States in 2006 — more than 70 each day. The issue brief provides recommendations on how health care providers, private insurance providers, and state and federal agencies can work to prevent unintentional drug overdoses.
The issue brief can be accessed at:
http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/brief.htm
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention — June 17, 2010
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SAMHSA Releases FAQ's for Applying Substance Abuse Confidentiality Regulations to Health Information Exchange
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator (ONC) for Health Information Technology announced today the release of the Frequently Asked Questions (FAQs) for applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE).
The Substance Abuse Confidentiality Regulations, 42 CFR Part 2, govern the use and disclosure of alcohol and drug abuse patient records that are maintained at federally funded substance abuse programs. Both SAMHSA and ONC want to assure that our constituents receive every tool and resource possible to enable a more complete understanding of these federal regulations which were enacted in 1972 and in 1975. The FAQs set forth the general provisions of Part 2, provide guidance on the application of 42 CFR Part 2 ("Part 2") to electronic health records (EHRs), and identify methods for including substance abuse patient record information into health information exchanges that are consistent with the Federal statute.
The FAQs will serve as a valuable resource to a variety of individuals, including specialty and medical providers as well as HIE technical developers and policy makers. The FAQs are not meant to provide legal advice.
A meeting is being planned for August 4th from 8:30 a.m.-12:30 p.m. to provide those interested an opportunity to provide input on the utility of the FAQs.
The 17-page PDF document of the FAQs can be accessed at:
http://www.samhsa.gov/HealthPrivacy/docs/EHR-FAQs.pdf
For more information health privacy, see http://www.samhsa.gov/HealthPrivacy/
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) — June 16, 2010
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New Report Provides Startling Look at Substance Abuse On An Average Day In The Life Of American Adolescents
On an average day, 508,000 adolescents aged 12-17 in the United States drink alcohol; 641,000 use illicit drugs; and more than 1 million smoke cigarettes, according to a national survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).
The study, A Day in the Life of American Adolescents: Substance Use Facts Update, presents a stark picture of the daily toll substance abuse takes on America's youth.
Among the report's major findings is that on any given day during 2008, 563,000 adolescents used marijuana, nearly 37,000 used inhalants, 24,000 used hallucinogens, 16,000 used cocaine and 2,800 used heroin.
The report also sheds light on how many adolescents used illegal substances for the first time. On an average day in 2008:
- Approximately 4,360 adolescents used an illicit drug for the first time
- Approximately 2,500 adolescents abused pain relievers for the first time
The full report is available at:
http://www.oas.samhsa.gov/2k10/185/185TypicalDay.htm
Source: The Substance Abuse and Mental Health Services Administration (SAMHSA) — June 3, 2010
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Sen. Hatch Wants Welfare Recipients Drug Tested
Jobless people seeking unemployment benefits or welfare should be required to undergo mandatory drug testing, according to a new proposal by Sen. Orrin Hatch (R-Utah), CBS News reported June 16.
Hatch is seeking to amend a tax-breaks and social-programs bill to allow the government to withhold aid to persons who fail drug tests, though he suggested that states could enroll offenders in drug-treatment programs.
Exempting drug users from government assistance would cut the federal budget and reduce the deficit, said Hatch.
"[The amendment is] a way to help people get off of drugs to become productive and healthy members of society, while ensuring that valuable taxpayer dollars aren't wasted," he said.
Reason magazine's Matt Welsh, meanwhile characterized, the proposal as the "flippant tramplings of our privacy rights."
Source: JoinTogether.org — June 23, 2010
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NEW WEB RESOURCES TO NOTE
WilliamWhitePapers.com
William "Bill" White has made available free-of-charge (via the link below) a vast amount of his work in addiction & recovery writing, interviews, & PowerPoint presentations.
This site contains the full text of more than 200 articles, 5 monographs, 30+ recovery tools, 9 book chapters, 3 books, and links to an additional 12 books written by William White and co-authors over the past four decades. Those papers selected for inclusion contain all of the articles and monographs authored by William White on the new recovery advocacy movement, recovery management and recovery-oriented systems of care.
The website can be accessed at: www.williamwhitepapers.com.
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New Resource Guide for Recovery Groups
Faces and Voices of Recovery has published a new guide to "mutual-aid" groups that can help support addiction-recovery organizations.
"This one-stop resource is for people in or seeking recovery from addiction, their families and friends and for addiction treatment service providers and other allied service professionals," according to the group. "Numerous research studies have shown that mutual aid groups play a significant role in the process of recovery. Here you can learn about the many varieties of online and in-person mutual aid groups that are helping people find and sustain their recovery from addiction to alcohol and other drugs."
The free online guide organizes more than 50 mutual-aid organizations into a dozen categories including medication-assisted treatment, co-occurring health conditions, family- and friend-focused, gender-specific, and faith-based.
The online guide can be accessed at:
http://www.facesandvoicesofrecovery.org/resources/support/
Source: JoinTogether.org - June 24, 2010
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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.