AT Forum NEWS NOTES & UPDATES #144
August 2010
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: July 2010
Contents
OPIOID ADDICTION AND MEDICATION-ASSISTED TREATMENT (MAT)
SAMHSA Issues 2009 N-SSATS Report on Substance Abuse Treatment Facilities
Drug Addicts Get Hooked via Prescriptions, Keep Using 'To Feel Like a Better Person,' Research Shows
PCSS-Methadone Updates Guidance on Methadone Interactions and Induction Dosing
Washington State Imposes New Rules on Prescribing Powerful Painkillers
Police Challenged by Crashes Involving Prescription Drugs
Maine Methadone Clinic Closes Over DEA Investigation
GOVERNMENT
SAMHSA Website Redesign Coming in September
FDA Planning Final Opioid Recommendations by 2011
July 2010 Issue of ONDCP Update is Now Available Online
New National HIV/AIDS Strategy For The United States Released
MISCELLANEOUS
EVENTS TO NOTE
American Association for the Treatment of Opioid Dependence, Inc. (AATOD) National Conference
OPIOID ADDICTION AND MEDICATION-ASSISTED TREATMENT (MAT)
SAMHSA Issues 2009 N-SSATS Report on Substance Abuse Treatment Facilities
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released findings from the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of substance abuse treatment facilities that provides data on the location and characteristics of alcohol and drug abuse treatment services throughout the U.S.
In 2009, the number of OTPs, and the number of OTP patients receiving methadone treatment increased by 9.5 percent and 5.6 percent respectively. While the number of patients receiving buprenorphine treatment in OTPs or through physician offices increased by almost one-third in 2009, methadone accounts for over 90 percent of total patients receiving medication-assisted treatment. (See chart below).
| Description | 2009 | 2008 | Percent Change 2009 vs. 2008 |
| # Facilities Operating SAMHSA Certified OTPs | 1,239 | 1,132 | 9.5% |
| # OTP Patients Receiving Methadone in OTPs | 283,177 | 268,071 | 5.6% |
| # OTP Patients Receiving Buprenorphine in OTPs | 5,647 | 4,280 | 31.9% |
| Sub-total of OTP Patients | 288,824 | 272,351 | 6.0% |
| # Patients Receiving Buprenorphine in Other Facilities | 14,876 | 11,452 | 29.9% |
Other highlights of the report include:
- Patients receiving methadone or buprenorphine in OTPs accounted for 24 percent of all patients in substance abuse treatment facilities.
- Private-for-profit organizations operated 50 percent of OTPs but only 29 percent of all substance abuse treatment facilities.
Note: 13,513 eligible substance abuse treatment facilities responded to the 2009 N-SSATS survey and reported a total of nearly 1.2 million clients in treatment in their facilities on March 31, 2009.
The 224 page report can be accessed at:
http://www.atforum.com/addiction-resources/documents/nssats2k9web.pdf
Source: The Substance Abuse and Mental Health Services Administration — Available online in August, 2010
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Drug Addicts Get Hooked via Prescriptions, Keep Using 'To Feel Like a Better Person,' Research Shows
If you want to know how people become addicted and why they keep using drugs, ask the people who are addicted.
Thirty-one of 75 patients hospitalized for opioid detoxification told University at Buffalo (UB) physicians they first got hooked on drugs legitimately prescribed for pain. Another 24 began with a friend's left-over prescription pills or pilfered from a parent's medicine cabinet. The remaining 20 patients said they got hooked on street drugs.
However, 92 percent of the patients in the study said they eventually bought drugs off the street, primarily heroin, because it is less expensive and more effective than prescriptions.
They continued using drugs because they "helped to take away my emotional pain and stress," "to feel normal," "to feel like a better person."
Results of the study appear in the current issue of Journal of Addiction Medicine.
The information will be used to train medical students and residents at the UB School of Medicine and Biomedical Sciences and practicing physicians to screen for potential addiction among their patients, and to perform an intervention or refer for treatment before an addiction becomes life-threatening.
"We are seeing an increase in the number of patients addicted to prescription drugs," says Richard Blondell, MD, professor of family medicine and senior author on the study, "so we wanted to better understand how they first got hooked.
"This information suggests that there is a progressive nature to opioid use, and that prescription opioids can be the gateway to illicit drug addiction. It also tells us that people who use prescriptions illegally may be at greater risk for subsequent heroin use than those who use prescriptions legally."
The study group was recruited from patients admitted to the detoxification unit in Erie County Medical Center in Buffalo who were addicted to opioids. Researchers collected demographic and socioeconomic information from participants, plus the types of drugs they used, age of first use, preferred opioids and how they administered the drugs. They also asked participants how they got started and how their drug use progressed.
Replies showed that the average age of users was 32; that 65 percent were men, 77 percent considered themselves white, and 74 percent had a high school diploma or equivalent.
Why did they begin using? Slightly more than half -- 51 percent -- said they first used the drugs for pain -- after surgery, for back pain or after an injury, and 49 percent said because they were curious and/or someone they were with had the drugs. Those who became addicted from using drugs legally prescribed for pain were more likely to be older, female, have a college degree and more likely to take their drugs orally, rather than nasally or via injection.
Users' comments on how they got started using drugs other than for pain, and why they continued, were revealing. "Pill parties" were a common starting point. One person said the drug "was handed to me by my friend, this guy I know, someone who was at the party." Another patient said kids are using it "like Viagra."
Prescription drugs are available in high schools, "at the prom" and used by athletes "to make it through the game," and later to get high on weekends and during the off-season, according to the users.
When asked if any doctor had ever asked about a substance use problem before writing a prescription, of the 53 participants who answered the question, 74 percent said no.
The press release can be accessed at: http://www.buffalo.edu/news/11652
Source: University at Buffalo — August 20, 2010
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PCSS-Methadone Updates Guidance on Methadone Interactions and Induction Dosing
In July, the Physicians Clinical Support System for methadone (PCSS-M) updated their guidelines on methadone interactions with other drugs and OTP methadone induction dosing. PCSS-M is a support system to connect prescribers of methadone with experienced clinicians for one-to-one mentoring regarding the use of this medication. PCSS-M is coordinated by the American Society of Addiction Medicine (ASAM) in conjunction with other leading medical societies, and is made possible by support from the Center for Substance Abuse Treatment (CSAT), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
The updated guidelines can be accessed at: http://www.pcssmethadone.org/pcss/documents2/PCSS-M_OTP_induction_dosing_update_07.2010.pdf
http://www.pcssmethadone.org/pcss/documents2/PCSS-M_Methadone_drug_interactions_updated_07.2010.pdf
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Washington State Imposes New Rules on Prescribing Powerful Painkillers
The state of Washington plans to impose tough new rules on doctors who want to prescribe opiate painkillers to patients, including mandatory third-party evaluation of patients who request higher doses of the drug but don't show signs of improvement, the New York Times reported July 28.
Other states are closely watching the regulatory efforts in Washington, designed to crack down on prescription-drug abuse and overdose deaths that some attribute to physician ignorance or laxness in prescribing such powerful medications.
"This is not just about addicts but little old ladies with arthritis starting to die because of this kind of medical practice," said pain specialist Alex Cahana, who is helping to draft the Washington regulations.
Advocates for pain sufferers say the new rules will result in legitimate patients being denied needed medication.
Source: JoinTogether.org - July 29, 2010
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Police Challenged by Crashes Involving Prescription Drugs
Car crashes involving prescription drugs are often harder to detect and prosecute than those involving alcohol or illicit drugs, the New York Times reported July 25.
Drunk-driving crashes are declining, but law-enforcement officials say that more people are being charged with driving under the influence of prescription drugs. However, unlike with alcohol, there's no standard for intoxication for prescription painkillers, anti-anxiety medications, and other legal drugs. Also, taking such drugs (alone or in combination with other substances or alcohol) has widely different effects on different people -- all of which makes prosecuting such offenses harder.
"How do we balance between people who legitimately need their prescriptions and protecting the public?" said Mark Neil of the National Traffic Law Center. "It becomes a very delicate balance."
Blood-alcohol content is the standard to measure drunk driving, and some states have made any detectable level of illicit drugs the presumption for intoxication. But that won't work for prescription drugs, which are legal.
Police departments are training officers to detect impairment by prescription drugs, and experts said that prevention and education also must play a role. "We have a pretty clear message in this country that you don't drink and drive," said U.S. drug czar Gil Kerlikowske. "We need very much to have a similar message when it comes to drugs."
In court, people accused of driving under the influence of prescription drugs often claim they didn't realize they were impaired. Prosecutors counter that such drugs have warning labels that should be heeded, but juries often sympathize with the drivers.
"Because most people on the jury will also likely be taking prescription drugs for some ailment, whether it's Lipitor or allergy pills or whatever it might be, they might think, 'I don't want that to become criminal,'" said Maryland attorney general Douglas Gansler.
Source: JoinTogether.org - July 29, 2010
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Methadone Maintenance Therapy Promotes Use of Antiretroviral Therapy Among HIV-Infected Injection Drug Users
Despite proven benefits of antiretroviral therapy (ART) in reducing HIV-related morbidity and mortality, many injection drug users (IDU) with HIV do not access treatment, even in settings with free health care.
Methadone maintenance therapy (MMT) has been shown to improve adherence to ART but to date there have been no prospective studies examining the role of methadone in improving initiation of ART. Investigators, partially funded by NIDA, recently conducted the first-ever study using a cohort of antiretroviral-naïve HIV-infected IDUs with access to health care to examine whether exposure to MMT would increase ART initiation and adherence.
Researchers collected data from 231 participants over the course of 12 years (May 1996-April 2008). At baseline and every 6 months during the study, participants completed questionnaires that asked for participant demographics as well as sexual, drug use and drug treatment histories since the last visit. By the end of the study, more than 65.8 percent of participants had initiated ART, with a higher incidence rate among those on MMT at baseline (64.2 percent) compared to those not on MMT (44.8 percent). Researchers also found that participants on MMT initiated ART at a faster rate and demonstrated increased adherence.
Since there are many barriers that HIV-infected IDU face in accessing appropriate treatment, MMT appears to be an effective and underutilized strategy for increasing access to care. "These results underscore the importance of providing MMT to opioid-dependent, HIV-infected IDU as a strategy to address the ongoing HIV epidemic among this population," note the authors.
Source: NIDA Addiction Research News — July 2010 available at: http://drugabuse.gov/newsroom/10/NS-07.html
Original Source: Uhlmann S, Milloy M-J, Kerr T, Zhang R, Guillemi S, Marsh D, Hogg RS, Montaner JSG, Wood E. Methadone Maintenance Therapy Promotes Initiation of Antiretroviral Therapy Among Injection Drug Users. Addiction. 2010; 105(5):907-13.
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Maine Methadone Clinic Closes Over DEA Investigation
On August 19, the Turning Tide methadone clinic in Rockport closed because of an ongoing U.S. Drug Enforcement Agency (DEA) investigation that deemed the clinic a "danger to public health and safety." The clinic's owner and one of the clinic counselors were recently charged with federal drug offenses. Maine has permanently revoked the clinic's license and the DEA seized all methadone stored at the clinic. The Maine Office of Substance Abuse (OSA) is sending Turning Tides' 280 patients to clinics in Bangor, Calais, Portland, South Portland, Waterville, and Westbrook for treatment.
For additional information go to:
http://www.bangordailynews.com/story/Midcoast/State-seeking-methadone-for-280-patients,151893
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GOVERNMENT
SAMHSA Website Redesign Coming in September
The Substance Abuse Mental Health Services Administration (SAMHSA) Web site — SAMHSA.gov — is being redesigned to offer an easy-to-use online store for information and resources on substance abuse and mental health. This new information resource will replace the National Mental Health Information Center (NMHIC), the National Clearinghouse for Alcohol and Drug Information (NCADI), and SAMHSA's Health Information Network (SHIN). This new resource is expected to be available in September.
For additional information go to: http://store.samhsa.gov/
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FDA Planning Final Opioid Recommendations by 2011
As reported by Medscape Medical News, The US Food and Drug Administration (FDA) reports that new opioid recommendations will be unveiled early next year. The agency told Medscape Medical News the risk evaluation and mitigation strategies, known as REMS, are scheduled to be approved in 2011, with roll out and implementation to follow.
Regulators had been projecting a summer release, but a recent advisory committee vote against the agency's proposal was a blow to the plan. Most committee members agreed that safety measures for opioids are urgently needed but voiced concern that the current approach does not go far enough to protect the public.
The full article can be accessed at:
http://www.medscape.com/viewarticle/726875
Source: Medscape Medical News — August 13, 2010
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July 2010 Issue of ONDCP Update is Now Available Online
The July issue of the Office of National Drug Control Policy (ONDCP) newsletter is now available online. Articles in this issue include:
- Senate Confirms New ONDCP Deputy Directors
- Report Shows Dramatic Rise in Prescription Drug Abuse
- Release of TEDS Study on Prescription Drug Abuse
- Prescription Drug Take-Back Programs
- Delaware's New Prescription Drug Law
- 2010 World Drug Report Released
- ONDCP Urges Deeper U.S.-Russia Cooperation on Drugs
The newsletter can be accessed at:
http://www.ondcp.gov/update/update-jul2010.pdf
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New National HIV/AIDS Strategy For The United States Released
In July, President Obama committed to developing a National HIV/AIDS Strategy with three primary goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities.
The strategy and implementation plan can be accessed at:
http://www.whitehouse.gov/administration/eop/onap/nhas
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MISCELLANEOUS
New York Governor Paterson Signs Bills to Promote HIV Testing and Remove Barriers to Needle Exchange and Syringe Access
On July 30, Governor David A. Paterson announced the enactment of two bills to reduce the spread of HIV/AIDS by updating New York's HIV testing law to encourage increased testing rates and remove disincentives to participation in needle exchange and syringe access programs.
The Governor signed into law S.8227/A.11487, which will allow patients to agree to HIV testing as part of a general signed consent to medical care that remains in effect until it is revoked or expires. The bill will also require health care providers to offer testing to their patients between 13 and 64 years of age, as recommended by the federal Centers for Disease and Control (CDC), and will facilitate authorization for testing in the case of certain occupational exposures to HIV infection.
"The enactment of this bill represents a significant step forward in combating the HIV/AIDS epidemic," Governor Paterson said. "By making HIV testing a routine part of health care, this legislation will increase HIV testing rates, letting people learn their status and begin treatment at an earlier stage, which can significantly improve the length and quality of life and help reduce transmission of the disease."
Additional information on the signed bills can be accessed at:
http://www.ny.gov/governor/press/073010HivBill.htm
Source: New York State Governor David A. Patterson — July 30, 2010
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EVENTS TO NOTE
Minimize Liability, Manager Risk, and Ensure Patient Safety: Effective Strategies in Opioid Prescribing
Sponsored by the Substance Abuse and Mental Health Services Administration and the
Institute for Research, Education and Training in Addictions
September 21, 2010
Albuquerque, New Mexico
Contact: tinyurl.com/2b3kcuc
American Association for the Treatment of Opioid Dependence, Inc. (AATOD) National Conference
October 23-27, 2010
Chicago, Illinois
Contact: www.AATOD.org
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.