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 #147

November 2010

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: October 2010

List of all News/Updates

METHADONE AND MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION

Characteristics of Substance Abuse Treatment Admissions Reporting Primary Abuse of Prescription Pain Relievers: 1998 and 2008

This report from the Treatment Episode Data Set (TEDS) compares the characteristics of admissions reporting primary abuse of pain relievers in 1998 with corresponding admissions in 2008. Highlights include:

Substance abuse treatment admissions reporting primary pain reliever abuse increased from 18,300 in 1998 (1.1 percent of all admissions) to approximately 105,680 (5.6 percent) in 2008
Admissions for primary abuse of prescription pain relievers in 2008 were more than 3 times as likely as those in 1998 to be aged 18 to 24 (26.5 vs. 7.5 percent)
Admissions for primary pain reliever abuse in 2008 were more likely than those in 1998 to be unemployed (41.1 vs. 28.6 percent)
The percentage of primary pain reliever admissions with a co-occurring psychiatric disorder increased from 19.4 percent in 1998 to 38.6 percent in 2008
Admissions for pain reliever abuse continue to be concentrated in the Northeast and Southern regions of the U.S. (65.3 percent in 2008 vs. 58.8 percent in 1998)

The 6-page PDF report can be accessed at: http://oas.samhsa.gov/2k10/230b/230bPainRelvr2k10Web.pdf

Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies — September 23, 2010

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AATOD 2010 National Conference Audio Tapes Available for Ordering

If you were unable to attend the AATOD National Conference in Chicago this past October, audio CDs are available through JOB Conference Recording Service. The cost is $15 for individual sessions and $145 each for the pre- conference and conference CDs. There is an additional charge for shipping. Contact information is 202-269-2000 and job_crs@att.net.

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Patients with HIV infection and Opioid Use Who Receive Methadone Maintenance Are More Likely to Initiate and Adhere to Antiretroviral Therapy

People with HIV-infection and injection drug use (IDU) are less likely to initiate and adhere to antiretroviral therapy (ART) than those with no IDU. Methadone maintenance treatment (MMT) reduces IDU and may improve adherence to ART. To determine whether MMT is positively associated with ART initiation and adherence, researchers studied a cohort of 231 ART-naïve opioid users with HIV infection and IDU in Vancouver between 1996 and 2008, comparing the 24% of subjects receiving MMT at baseline with those who were not. Follow-up was at 24 months.

The cumulative incidence rate of ART initiation was 64% for patients who were receiving MMT at baseline and 45% for those who were not.
After accounting for viral load and CD4+ cell count, subjects receiving MMT were more likely to initiate ART than those who were not (relative hazard ratio, 1.62).
Among the 152 subjects who initiated ART during the study period, subjects on MMT were more likely to achieve 95% or greater adherence to ART than those who were not (adjusted odds ratio, 1.49).

Comments: Although this study does not provide biologic adherence outcomes, such as change in CD4+ cell count or viral load, it does demonstrate a positive association between MMT and ART initiation and adherence. These findings support the World Health Organization's recommendation that opioid agonist treatment be accessible to opioid-dependent HIV-infected individuals.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue July/August 2010. Access checked 11/20/10. Alexander Y. Walley, MD, MSc

Original Source: Uhlmann S, Milloy MJ, Kerr T, et al. Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users. Addiction. 2010;105(5):907-913.

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Promoting Access to Hepatitis C Treatment via Integration with Methadone Maintenance Programs

Opioid-dependent patients who are infected with hepatitis C virus (HCV) should, but seldom do, receive HCV treatment. This retrospective observational study examined the feasibility and effectiveness of integrating HCV evaluation and treatment into a methadone maintenance treatment (MMT) program. Medical records of all patients who enrolled in MMT during the first 2 years of integrated HCV evaluation and treatment were reviewed (N=291). Of the 188 MMT patients (65%) who screened positive for HCV-antibody, 159 were eligible to receive further HCV evaluation and treatment based on insurance status,* and 125 accepted.

Eighty-three (66%) patients were found to have chronic HCV infection, and 21 of 83 (25%) initiated treatment.
Sustained virologic response (i.e., undetectable viral load 6 months following treatment) was achieved in 8 of 21 patients (38%) who initiated treatment.
Seventeen patients had contraindications to HCV treatment, and 45 patients opted to forego or delay treatment, most commonly due to personal choice (29 of 45 patients).

*Medicaid-insured patients were offered treatment, and uninsured patients or patients with insurance not accepted by the methadone program were offered off-site care.

Comments: This small retrospective study demonstrates the feasibility of integrating HCV care with MMT programs. Treatment outcomes among HCV patients in this sample were comparable to those of other published studies. Although the results are encouraging, further evaluation using an off-site comparator group would lend further support to this model of care.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue July/August 2010. Access checked 11/20/10. Jeanette M. Tetrault, MD

Original Source: Harris KA, Arnsten JH, Litwin AH. Successful integration of hepatitis C evaluation and treatment services with methadone maintenance. J Addict Med. 2010;4(1):20-26.

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GOVERNMENT

Leading Change: A Plan for SAMHSA's Roles and Actions 2011 — 2014

In October, the Substance Abuse Mental Health Services Administration (SAMHSA) issued a draft document outlining eight Strategic Initiatives through at least 2012. The paper outlines the goals, priorities and action steps for forming the basis of SAMHSA's Strategic Plan. It was developed based on discussions with Federal, state and local leaders, constituency groups, advisory council members, members of congress, people in recovery and family members.

The eight strategic initiatives are:

Prevention of Substance Abuse and Mental Illness - Create prevention prepared communities where individuals, families, schools, workplaces, and communities take action to promote emotional health and prevent and reduce mental illness, substance abuse including tobacco, and suicide across the life span.
Trauma and Justice - Reduce the pervasive, harmful, and costly impact of violence and trauma by implementing trauma-informed approaches in health systems and by diverting people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery.
Military families - Support our service men and women, veterans, their families and communities by leading efforts to ensure that needed behavioral health services are accessible and effective.
Health Reform - Broaden health coverage and the use of evidence based practices to increase access to appropriate and high quality care, and to reduce disparities that currently exist between the availability of services for substance use and mental disorders and other medical conditions.
Housing and Homelessness - Provide housing and reduce barriers to accessing effective programs that sustain recovery for individuals with mental and substance use disorders who are homeless.
Health Information Technology for Behavioral Health Providers - Ensure the behavioral health provider network, including prevention specialists and consumer providers, fully participates with the general health care delivery system in the adoption of health information technology.
Data, Outcomes, and Quality-Demonstrating Results - Realize an integrated data strategy that informs policy, measures program impact, and results in improved quality of services and outcomes for individuals, families, and communities.
Public Awareness and Support - Increase understanding of mental and substance use disorders to achieve the full potential of prevention, help people recognize these conditions and seek assistance with the same urgency as any health condition, and make recovery the expectation.

Leading Change: A Plan for SAMHSA's Roles and Actions 2011 - 2014 can be accessed at: http://www.samhsa.gov/about/sidocs/SAMHSA_SI_paper.pdf

Source: Substance Abuse and Mental Health Services Administration — October 2010

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U.S. Departments of Health and Human Services and Justice Award Almost $76 Million to Enhance Adult and Juvenile Drug Treatment Courts

The U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), and the U.S. Department of Justice's Bureau of Justice Assistance (BJA) and Office of Juvenile Justice and Delinquency Prevention (OJJDP) are awarding up to almost $76 million in Fiscal Year 2010 grants to enhance the court services, coordination, and substance abuse treatment capacity of adult and juvenile drug treatment courts.

"SAMHSA and BJA are committed to building on the success of treatment drug courts by bolstering their ability to provide essential alcohol and drug treatment, recovery support, screening, assessment, case management, and program coordination services to thousands of people working to free themselves from lives of substance abuse and crime," said SAMHSA Administrator Pamela S. Hyde, J.D. "These efforts are critically important since more than 60 percent of all people in state and federal prisons and local jails have substance abuse problems. By effectively addressing these substance abuse problems our nation can significantly reduce crime, lessen the burden on the criminal justice system and restore countless lives."

"We know that drug courts are central to reducing drug abuse and to keeping communities safe. These grants will help communities launch new drug courts and enhance courts where they already exist," said Laurie O. Robinson, OJP's Assistant Attorney General. "Our National Institute of Justice recently released preliminary findings from its five-year, multi-site evaluation of adult drug courts. The early analysis shows that after 6 months, and again after 18 months, drug court participants reported less drug-related and criminal activity."

The press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1010251731.aspx

Source: Substance Abuse and Mental Health Services Administration — October 25, 2010

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September/October Issue of SAMHSA News Now Available Online

The new issue of SAMHSA News focuses on Health Reform: What You Need To Know. Articles related to the Affordable Care Act include:

At the 6-Month Mark - September 23 marked the 6-month point for the Affordable Care Act. Some important changes took effect on that day.
What Are Health Homes? - For individuals with chronic conditions, a "health home" provides a central point for various physicians involved in care, including behavioral health.
Timeline for the Affordable Care Act - What takes effect when? Check this timeline for details of what's happening from 2010 to 2014.
New at HealthCare.gov - The Affordable Care Act's website offers updated info every day.

The 20-page issue can be accessed at: http://www.samhsa.gov/samhsanewsletter/Volume_18_Number_5/SeptemberOctober2010.pdf

Source: Substance Abuse and Mental Health Services Administration — November 17, 2010

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NIH Director Outlines Reorganization Plan for 'Substance Use, Abuse, and Addiction' Research

The director of the National Institutes of Health (NIH) says that a proposal to reorganize the federal government's major research agencies on substance abuse and addictions into a single entity "makes scientific sense," and has outlined a planning process to create a new Institute for "substance use, abuse, and addiction research and related public health initiatives."

In a November 18 message sent to NIH employees and in a press release issued the same day, Francis S. Collins, M.D., Ph.D., said a new single Institute would "enhance NIH's efforts to address the substance abuse and addiction problems that take such a terrible toll on our society."

This September, an NIH expert panel recommended the reorganization to Dr. Collins. The proposal has engendered significant discussion and debate in the addictions research community. Some opponents have expressed concern that the reorganization would diminish focus on alcohol problems such as drunk driving or teenage drinking that don't necessarily involve addiction. Collins' statement last week perhaps notably uses "substance use, abuse, and addiction" phrasing throughout.

Collins said a new task force will spend several months in a top-to-bottom assessment of all 27 NIH Institutes and Centers — including the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) — to identify and recommend research programs to be moved into the proposed new Institute. The task force is expected to submit a detailed restructuring plan for the Director's consideration in the summer of 2011.

If the NIH Director accepts the plan next summer, it moves to the desk of Health and Human Services Secretary Kathleen Sebelius, who — if she approves the plan — will notify Congress. Congress would then have six months during which it could block the restructuring by passing legislation; if it doesn't, NIH could then finalize the changes.

In his message to NIH employees, Dr. Collins announced a Dec. 1 "town hall" meeting of the NIAAA and NIDA staffs to provide more information and answer questions. Promising a "thoughtful, systematic" planning process that consults the stakeholders affected by the proposal, Collins also said that in the meantime, addictions research across NIH will continue "with all due speed" under the existing structure.

Source: JoinTogether.org — November 22, 1010

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Unprecedented Effort to Seek, Test, and Treat Inmates With HIV

Twelve scientific teams in more than a dozen states will receive National Institutes of Health (NIH) grants to study effective ways to prevent and treat HIV/AIDS among people in the criminal justice system. The grants will be awarded primarily by the National Institute on Drug Abuse (NIDA), with additional support from the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), all components of NIH. The research will take place over a five-year period.

"These important and wide reaching research grants will focus on identifying individuals with HIV within the criminal justice system and linking them to highly active antiretroviral therapy (HAART) during periods of incarceration and after community re-entry," said NIDA Director Dr. Nora D. Volkow. "We hope this effort will lead to decreased HIV/AIDS-related illness and death among those in the criminal justice system, as well as decrease HIV transmission in the community at-large, making an important impact on public health."

The seek, test and treat funding opportunity follows NIH-sponsored research conducted over the last few years which has indicated that identifying and offering treatment to all medically eligible HIV-positive individuals cannot only stop progression to AIDS and AIDS-related death, but can also help to prevent HIV transmission. These new grants will apply this strategy to the criminal justice system, where there is a high prevalence of HIV/AIDS and often poor access to treatment.

The newly funded research will compare different modalities of the seek, test, and treat strategy to identify, test, engage and retain HIV-positive offenders in treatment. Some of the projects will create and compare systems to better integrate and coordinate HIV management efforts within jails, prisons, health departments, universities, and community organizations. The grants will also support randomized controlled trials among large groups of HIV-positive parolees and probationers comparing varied approaches for linking them to screening, treatment and social services in their communities.

The NIDA press release can be accessed at: http://www.nida.nih.gov/newsroom/10/NR9-23.html

Source: National Institute on Drug Abuse — September 23, 2010

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November ONDCP News Update Now Available Online

The November issue of the Office of National Drug Control Policy newsletter is now available online. Articles in the issue include:

The Hazards of Drugged, Drunk, and Distracted Driving
Drug Recognition Experts: Making Our Highways Safer
Recovery Summit Held In Washington, DC
Around the Nation, ONDCP Supports Recovery Efforts

The 4-page newsletter can be accessed at: http://www.whitehousedrugpolicy.gov/update/update-nov2010.pdf

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NEW RESOURCES

New Parity Toolkit Available

The Parity Implementation Coalition, which is made up of Mental Health America and other organizations that worked to win passage of the federal Mental Health Parity and Addiction Equity Act, has created a toolkit to aid individuals seeking recovery, their families, providers and advocates understand their new rights and benefits under the law. The toolkit is designed to be a resource on how to better communicate with plans, how to prepare and document information should disputes arise with a health plan over coverage or reimbursement, and how to better understand basic appeals rights and procedures.

The 60-page PDF document can be accessed at: http://www.mentalhealthamerica.net/files/Parity_Toolkit_Final.pdf

Source: Parity Implementation Coalition — September 2010

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New 'Roadmap' for Integrating Substance Abuse Treatment into Primary Care

The Treatment Research Institute (TRI) released a much-needed 'roadmap' for new integration projects across the country: a white paper outlining the successes and challenges faced by model programs aimed at integrating substance abuse services into primary care.

The 43-page PDF document can be accessed at: http://www.tresearch.org/centers/LessonsLearned.pdf

Source: JoinTogether.org - October 20, 1010

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ATTC iTraining Series

The third Thursday of each month the Addiction Technology Transfer Center (ATTC) will provide free webinars to learn about various topics effecting the field of addictions treatment and recovery services. Each month, a different Regional Center will present information and resources on topics ranging from healthcare reform to implementing specific evidence-based practices. Upcoming webinars include:

The Role of ROSC in Healthcare Reform — December 16, 2010
Healthcare Reform: An Overview — January 20, 2011
Medicated-Assisted Treatment (MAT) — February 17, 2011

To sign up for the webinars go to: http://www.attcnetwork.org/learn/education/webinarseries.asp

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MISCELLANEOUS RESEARCH

Alcohol Ranked Most Harmful Drug

A group of British scientific experts has concluded that when combining its effects on the individual and on society, alcohol far outpaces other substances as the most harmful drug, the Associated Press reported Nov. 1.

The Independent Scientific Committee on Drugs, meeting via an interactive workshop, used multicriteria decision analysis to evaluate drugs' effects on the body and their impacts on society, including effects on families and on costs in areas such as health care and corrections. Heroin, crack cocaine and methamphetamine were ranked in the analysis as the most lethal drugs to the individual, but alcohol, heroin and crack were judged most harmful to others.

The combined harm score for alcohol was the highest, at 72 out of a possible 100, followed by heroin (55) and crack (54).

The authors explained that the rankings, based on 16 criteria, do not correspond to how drugs are currently classified in the United Kingdom. For example, last year the British government increased penalties for possession of marijuana, a drug that ranked far below alcohol and other illegal drugs in the experts' assessment of overall harm.

"What governments decide is illegal is not always based on science," said Wim van den Brink, professor of psychiatry and addiction at the University of Amsterdam. Yet study co-author Leslie King, an adviser to the European Monitoring Centre for Drugs, urged against interpreting the results as a call for alcohol prohibition. "Alcohol is too embedded in our culture and it won't go away," King said.

The findings were published online Nov. 1 in The Lancet.

Source: JoinTogether.org — November 2, 2010

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Teens and Parents Underreport Illicit Drug Use, Study

A new study indicates that teens and their parents don't tell the truth when asked about their use of cocaine and opiates, even if they are told they will be drug-tested and their responses kept confidential, HealthDay reported Oct. 25.

The study, led by Virginia Delaney-Black, M.D., a pediatrics professor at Children's Hospital of Michigan, compared survey responses collected from over 200 teens and over 200 adult caregivers (mostly mothers) with the results of hair tests for drug use. Participation in the study was limited to African-American families who had received care at one urban antenatal clinic.

Hair tests on the teens showed that 30 percent had used cocaine, whereas only one percent reported it. Hair tests from parents showed that 28 percent had used cocaine, but only about six percent said they had. Results for opiates were similar.

Other studies have shown that adults underreport their own substance use, but very few comparable studies have been done on teens who are not in the court system or in treatment. Estimates of national prevalence rates of teen use outside of the court system or clinical settings are based on data collected anonymously and on what teens report about their use; the new study suggests that the estimates may be too low.

The research "generally reinforces what we know from work in adults, which is that people are usually less honest about substance use than we hope," said Ty S. Schepis, a psychology professor at Texas State University at San Marcos.

The study, "Just Say 'I Don't': Lack of Concordance Between Teen Report and Biological Measures of Drug Use," appeared online Oct. 25 in Pediatrics and will appear in the November 2010 print issue.

Source: JoinTogether.org — October 28, 2010

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SUGGESTED VIEWING/READING

Good Morning America — Why so many Americans deal with pain by abusing prescription drugs. — 10/20/2010 Addiction

http://abcnews.go.com/Health/video/pain-drug-addiction-prescription-drug-medication-addict-11928689

A Flood of Opioids, a Rising Tide of Deaths — New England Journal of Medicine 11/17/2010

http://healthpolicyandreform.nejm.org/?p=13085

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 #147

November 2010

Contents