Addiction Treatment Forum reports on substance abuse news of interest to opioid treatment programs and patients in methadone maintenance treatment.

newsAT Forum NEWS NOTES & UPDATES #149

February 2011

Compiled & Edited by Sue Emerson - Publisher

Prior Edition: December 2010 / January 2011

List of all News/Updates

 

Contents

 

MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION

Patients with Chronic Pain and a Prescription Drug Use Disorder Have Easily Identifiable Risk Factors

Maine Tops Nation in Treatment Admissions for Prescription Painkillers

NFL Players: Injury, Pain, and Opioid Misuse

CDC: Prescription Drug Overdoses and Binge Drinking Vary by Race, Income


GOVERNMENT & FUNDING NEWS

House Republicans Propose Massive Cuts to HIV/AIDS Programs

Spending On Behavioral Health Is A Shrinking Portion Of Overall Health Expenditures

FDA Announces New Steps Aimed at Cutting Risks from Acetaminophen

NIDA Addiction Science & Clinical Practice December 2010 Now Available Online


MISCELLANEOUS

Physician Substance Abuse Training 'Inadequate,' Experts Say

Increased Mortality in HIV-Infected Patients with Untreated Psychiatric and Substance Use Disorders


NEW RESOURCES / EVENTS TO NOTE

New Website On Hepatitis Drug Interactions

Webinar on Parity


SUGGESTED READING

Prison Reform: A Smart Way for States to Save Money and Lives — 1/17/11

Leading The Way - General's Story of Drug Dependency Should Spur Army to Help the Injured — 1/29/11

Pharmacies Besieged by Addicted Thieves — 2/6/11

D.C.'S Leading Provider of Clean Needles to Drug Addicts to Close Feb. 25 — 2/9/11

For Some Troops, Powerful Drug Cocktails Have Deadly Results — 2/11/11

Bono Mack Seeks Closure Of National Drug Intelligence Center — 2/10/11

Report: Medicare's Lax Oversight Makes Its Prescription Drug Program Vulnerable to Fraud — 2/11/11

Wait for Liver Transplant Longer in Some States — 2/15/11





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

Medications

Patients with Chronic Pain and a Prescription Drug Use Disorder Have Easily Identifiable Risk Factors

A number of studies have identified risk factors for prescription drug use disorders (PDUDs) but were limited by pain-clinic settings and reliance on proxy measures such as aberrant medication-taking behaviors or urine testing. In this study, patients with chronic pain who were taking prescription or nonprescription analgesics were recruited from the waiting room of an urban primary-care clinic. Researchers used DSM-IV criteria to identify patients with lifetime drug abuse or dependence or current alcohol dependence.

Comments: This study shows patients at risk for PDUD can be identified using a few easy questions. The difficult question is what we should do to help these patients. At the very least, closer monitoring and judicious prescribing of opioids and sedatives is warranted.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2010. Access checked 2/16/11. Darius A. Rastegar, MD

Original Source: Liebschutz JM, Saitz R, Weiss RD, et al. Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. J Pain. 2010; 11(11):1047—1055.

< Back to top >


Maine

Maine Tops Nation in Treatment Admissions for Prescription Painkillers

New government data shows that Maine consistently outstripped other states over the past decade when measured by the number of residents seeking treatment for prescription painkillers, the Bangor Daily News reported Jan. 4.

The report, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), reviewed national trends in admissions to treatment for substance abuse between 1998 and 2008.

In 1998, only 28 per 100,000 Maine residents sought treatment for non-heroin opiate addiction. By 2008, that ratio had jumped to 386 per 100,000 residents -- well above the national average of 45 per 100,000.

"At this point," said Guy Cousins, who directs the Maine Office of Substance Abuse, "prescription drugs are nearly as readily available as alcohol in Maine homes."

Cousins' office has conducted a multi-pronged campaign to address the problem; it educates doctors and other prescribers of the drugs, monitors and tracks prescriptions to eliminate "doctor-shopping" and over-prescription, and promotes the adoption of alternative pain management approaches, including methadone and the opiate replacement drug Suboxone.

The agency also works with law enforcement and community partners to hold drug take-back programs to reduce the number of prescription drugs diverted from patients to the black market.

Source: JoinTogether.org - January 11, 2011

< Back to top >


NFL Players: Injury, Pain, and Opioid Misuse

Football

A new study performed by researchers at the Washington University in St. Louis has found that players retired from the National Football League (NFL) are far more likely than the general population to use and misuse opioid painkillers, the L.A. Times reported Jan. 28.

The research, commissioned by ESPN with funding from the National Institute on Drug Abuse (NIDA), is the first of its kind.

According to the study abstract, 644 players in the 2009 Retired Players Association Directory were surveyed by phone between March and August 2010, with a 53.4 percent completion rate. ESPN's Outside the Lines said the surveyed players had retired between 1979 and 2006, and on average were 48 years old and had played 7.6 seasons.

The study's chief findings were that 52 percent of the former players had used opioids while playing, of whom 71 percent reported misuse. Players who misused opioids while playing were three times as likely to have misused them in the past 30 days as those who used them as prescribed. The majority of players (63 percent) who used prescription painkillers during their careers obtained them from someone other than a doctor.

Half of the retired players in the survey said they had been seriously injured three times or more while playing, and half also said they had received concussions, though many kept playing because the concussions were undiagnosed.

"The rate of current, severe pain is staggering," said Linda B. Cottler, Ph.D., who led the research. She is a professor of epidemiology in psychiatry at Washington University in St. Louis.

Cottler and her team found that three factors correlated with current abuse of pain medications, according to ESPN: "significant pain, undiagnosed concussions and heavy drinking."

The study, "Injury, pain, and prescription opioid use among former National Football League (NFL) players," was published online on Jan. 28, 2011, in Drug and Alcohol Dependence.

Source: JoinTogether.org - February 4, 2011

< Back to top >


CDC: Prescription Drug Overdoses and Binge Drinking Vary by Race, Income

In a first-of-its-kind report, the Centers for Disease Control and Prevention (CDC) broke down data on health disparities by race, ethnicity, income, and education, The New York Times reported Jan. 13.

The report included data on the impact of alcohol and drug use on different segments of the United States population. For example, more Americans now die from prescription drug overdoses than from illicit drugs. In particular, White, non-Hispanic deaths from prescription drug overdoses outnumber those of African-Americans.

The Times said that the "trend switched in 2002, after doctors began prescribing more powerful painkillers, antidepressants and antipsychotics - more easily obtained by people with health insurance."

Many of the health disparities, like obesity or tobacco use, worsened for individuals with low incomes, or who lacked education or insurance.

One exception was binge drinking, which is on the rise. Unlike many other health disparities, the problem -- consuming four drinks at a sitting for women, and five for men -- is more common among those with higher incomes and better education.

Low-income individuals, however, consume more alcohol when they binge, Native Americans especially.

The full report, CDC Health Disparities and Inequalities Report - United States, 2011 (PDF), was published Jan. 14, 2011 in the Morbidity and Mortality Weekly Report, Supplement / Volume 60

Source: JoinTogether.org - January 20, 2011

< Back to top >


GOVERNMENT & FUNDING NEWS

House Republicans Propose Massive Cuts to HIV/AIDS Programs

AIDS Ribbon

"Republicans in the House of Representatives have proposed massive cuts to both domestic and global HIV/AIDS programs that will have severe ramifications to millions of people's lives both here in the United States and around the world," commented Carl Schmid, Deputy Executive Director of The AIDS Institute. "While it may help achieve short-term goals to reduce federal government spending, this reckless action will have long-term impacts on the health and wellbeing of people living with HIV/AIDS and on efforts to prevent HIV infections in the future. In the long run, the costs to society and individual's lives will be far greater than any short term savings."

Source: The AIDS Institute — February 14, 2011

< Back to top >


Spending On Behavioral Health Is A Shrinking Portion Of Overall Health Expenditures

A recent study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed healthcare costs from 1986 to 2005 to determine patterns in expenditures for behavioral health services.

In 2005, the latest year comparable data is available, behavioral health spending accounted for 7.3 percent ($135 billion) of the $1.85 trillion spent on all health care services in the U.S. During the 20-year study period, both mental health and substance abuse spending grew more slowly than all other health spending: 4.8 percent annually for substance abuse, 6.9 percent annually for mental health, and 7.9 percent annually for all health care services. The same pattern held in the most recent 2002-2005 period, in which spending for substance abuse grew slowest (5.0 percent), followed by mental health (6.4 percent), and all health (7.3 percent).

SAMHSA Administrator Pamela S. Hyde, J.D., commented, "Behavioral health services are critical to health systems and community strategies that improve health status and they lower costs for individuals, families, businesses, and governments. The value of behavioral health services is well documented. Studies have shown that every dollar invested in evidence-based treatments yields $2.00 to $10.00 in savings in health costs, criminal & juvenile justice costs, educational costs, and lost productivity. Yet, too many people don't get needed help for substance abuse or mental health problems and health care costs continue to skyrocket."

The study's key findings included: spending on addiction medications is increasing but still remains relatively small. As a result of the introduction of new medications to treat substance dependence, spending on addiction medications has grown rapidly -- from $10 million in 1992 to $141 million in 2005. More recent data from IMS Health shows continued rapid increases up to $780 million in 2009. However, it remains only a small fraction of the entire amount spent on substance abuse treatment (0.6 percent of $22 billion in 2005).

The full news release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1102024442.aspx

Source: The Substance Abuse and Mental Health Services Administration — February 3, 2011

< Back to top >


FDA Announces New Steps Aimed at Cutting Risks from Acetaminophen

On Jan. 13th the FDA announced it is asking all makers of prescription products that contain acetaminophen to limit the amount of the drug to 325 milligrams per tablet or capsule. They are also requiring a Boxed Warning on all prescription acetaminophen products that highlights the potential risk for severe liver injury. In addition, the FDA is requiring a Warning on labels of all prescription products that contain acetaminophen that highlights the potential for allergic reactions.

Used effectively in both prescription and over-the-counter (OTC) products, acetaminophen is among the most commonly used drugs in the United States.

The FDA continues to receive reports of severe liver injury associated with the use of products that contain acetaminophen. Sandra Kweder, M.D., deputy director of FDA's Office of New Drugs, says the agency's most recent action is aimed at making pain medications containing acetaminophen safer for patients to use.

"Overdoses from prescription products containing acetaminophen account for nearly half of all cases of acetaminophen-related liver failure in the U.S., many of which result in liver transplant or death," says Kweder.

Most of the cases of severe liver injury occurred in patients who

The new dosage limit will not affect other aspects of prescribing acetaminophen combination products. The number of tablets, capsules, or other dosage units that may be prescribed and the time intervals at which they may be prescribed will not change.

The change will be phased in over three years.

The consumer update can be accessed at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm239747.htm

Source: U.S .Federal and Drug Administration — January 13, 2011

< Back to top >


NIDA Addiction Science & Clinical Practice December 2010 Issue Now Available Online

The December issue of the National Institute of Drug Abuse journal includes the following articles:

The December issue can be accessed at: http://www.nida.nih.gov/ascp/vol5no2.html

< Back to top >



MISCELLANEOUS

Physician Substance Abuse Training 'Inadequate,' Experts Say

According to educators at Yale School of Medicine and other U.S. medical schools, doctors-to-be require a lot more training to address substance abuse than they currently receive, HealthCanal.com reported Jan. 6.

Substance use disorders are at the root of a staggering array of medical, behavioral, and social problems, said the authors. In the U.S. alone, drug and alcohol abuse caused more than 100,000 deaths and cost the country more than $300 billion annually.

"Despite the fact that the substance use is responsible for an enormous burden of disease in their patients, and evidence-based screening approaches have been developed, physicians often fail to identify and treat substance abuse routinely," said Patrick O'Connor, M.D., chief of the Section of General Internal Medicine at Yale and lead author of the paper.

"This may result not only in ongoing substance use and its complications, but also in inadequate treatment of the medical conditions for which their patients are being seen."

O'Connor and his colleagues made the following recommendations to address the training deficit:

"Creating an educational environment that fully integrates and adequately prioritizes substance abuse competencies into residency education, as well as in medical school itself, is critical to assuring that physicians are armed with the tools to provide adequate evidence-based care to their patients," he said.

"Programs ... must take responsibility for assuring that trainees have adequate curricular time and resources along with suitably trained core faculty to support this critical educational effort."

The article was published in the Jan. 4 issue of Annals of Internal Medicine.

Source: JoinTogether.org - January 18, 2011

< Back to top >


Increased Mortality in HIV-Infected Patients with Untreated Psychiatric and Substance Use Disorders

Many HIV-infected patients suffer from co-occurring psychiatric and substance use disorders. Researchers studied health records of 9751 HIV-infected patients in the Kaiser Permanente Northern California health plan from 1996 to 2007 to determine the presence of psychiatric or substance use disorders from ICD-9 codes and to look for records of treatment for these disorders. Relative hazards (RHs) for mortality were calculated and adjusted for a number of factors including CD4 count, HIV viral load, hepatitis C co-infection, and receipt of antiretroviral medications.

Comments: In addition to supporting prior observations that HIV-infected patients with co-occurring psychiatric and/or substance use disorders have a higher mortality risk, this study found lack of treatment for these disorders is associated with even higher risk. Lack of adherence to antiretroviral medications did not appear to account for this discrepancy. These findings reinforce the importance of psychiatric and substance abuse treatment for this vulnerable population.

Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue November/December 2010. Access checked 2/16/11. Darius A. Rastegar, MD

Original Source: DeLorenze GN, Satre DD, Quesenberry CP, et al. Mortality after diagnosis of psychiatric disorders and cooccurring substance use disorders among HIV-infected patients. AIDS Patient Care STDs. 2010;24(11):705—712.

< Back to top >



NEW RESOURCES / EVENTS TO NOTE

New Website On Hepatitis Drug Interactions Now Available

December saw the launch of a new website for interactions with hepatitis drugs. The site has many of the features of the HIV site, http://www.hiv-druginteractions.org/, though currently fewer interactions are listed.

The website can be accessed at: http://www.hep-druginteractions.org/

Source: University of Liverpool — December 16, 2010

< Back to top >


Webinar on Parity

The Substance Abuse and Mental Health Services Administration (SAMHSA), Partners for Recovery InitiBalanceative will be conducting a free one hour webinar on the new Federal parity law on March10th at 1:00 EST. The Parity 201 webinar is designed for States and providers, and includes a detailed discussion about implementation of the new parity law. This discussion will include details on State-level implementation efforts, interplay between the Federal parity law and State parity laws, and anticipated additional pieces of regulatory guidance.

 

< Back to top >



SUGGESTED READING

Prison reform: A smart way for states to save money and lives — 1/17/11

With nearly all 50 states facing budget deficits, it's time to end business as usual in state capitols and for legislators to think and act with courage and creativity.

We urge conservative legislators to lead the way in addressing an issue often considered off-limits to reform: prisons. Several states have recently shown that they can save on costs without compromising public safety by intelligently reducing their prison populations.

http://www.washingtonpost.com/wp-dyn/content/article/2011/01/06/AR2011010604386.html

Leading the way - General's story of drug dependency should spur Army to help the injured — 1/29/11

Army Lt. Gen. David Fridovich has had a sterling career and is the deputy commander of the nation's special operations forces, overseeing about 60,000 highly trained troops. But he was on the front page of Thursday's USA Today for a different reason — his dependency on prescription painkillers.

The general told a frank story of how he got hooked and recovered. It's a gutsy thing to do given the military's culture, which doesn't provide room for displays of weakness. But Fridovich's journey is an example of the prevalence of the problem.

http://www.lasvegassun.com/news/2011/jan/29/leading-way/

Pharmacies Besieged by Addicted Thieves — 2/6/11

The orange signs posted throughout Chet Hibbard's pharmacy here relay a blunt warning: We Do Not Stock OxyContin.

"Outside hiring an armed guard to be in here 24/7, I don't know what else to do." CHET HIBBARD, a Maine pharmacist who has stopped selling OxyContin.

Mr. Hibbard stopped dispensing the highly addictive painkiller last July, after two robbers in ski goggles demanded it at knifepoint one afternoon as shocked customers looked on. It was one in a rash of armed robberies at Maine drugstores last year, a sharp increase that has rattled pharmacists and put the police on high alert.

http://www.nytimes.com/2011/02/07/us/07pharmacies.html?_r=1

D.C.'s leading provider of clean needles to drug addicts to close Feb. 25 — 2/9/11

The leading provider of clean needles to drug addicts in the District to help stem the spread of AIDS plans to shut its doors by the end of the month, officials said Wednesday, in the city that has the highest HIV/AIDS prevalence rate in the country.

Michael Rhein, president of the board of PreventionWorks, said dwindling private donations, delays in city funds and high turnover of top managers at the nonprofit agency in recent years were among the factors that led to the decision to close Feb. 25.

http://www.washingtonpost.com/wp-dyn/content/article/2011/02/09/AR2011020906233.html

For Some Troops, Powerful Drug Cocktails Have Deadly Results — 2/11/11

In his last months alive, Senior Airman Anthony Mena rarely left home without a backpack filled with medications.

He returned from his second deployment to Iraq complaining of back pain, insomnia, anxiety and nightmares. Doctors diagnosed post-traumatic stress disorder and prescribed powerful cocktails of psychiatric drugs and narcotics.

http://www.nytimes.com/2011/02/13/us/13drugs.html?_r=2

Bono Mack seeks closure of National Drug Intelligence Center — 2/10/11

Rep. Mary Bono Mack on Wednesday introduced legislation calling for closure of the National Drug Intelligence Center.

Bono Mack, R-Palm Springs, has made tackling the nation's drug problems one of her top stated priorities in recent years, but called the Pennsylvania-based Intelligence Center a waste of taxpayer money.

"It's time to shutter the place for good and transfer its responsibilities to other federal facilities," Bono Mack said in a written statement.

http://www.pe.com/localnews/politics/stories/PE_News_Local_D_drug10.298abbf.html

Report: Medicare's lax oversight makes its prescription drug program vulnerable to fraud — 2/11/11

Crooks are taking advantage of lax oversight in Medicare's Part D prescription drug program to obtain highly addictive drugs including oxycodone, Ritalin, and methadone, according to results of a federal probe.

The report by an independent inspector says Medicare can't verify all the prescriptions it pays for, leaving the system open to exploitation by criminals using fake medical ID numbers and the identities of dead doctors.

http://abcnews.go.com/Business/wireStory?id=12894855

Wait for Liver Transplant Longer in Some States — 2/15/11

Where you live plays a big role in how sick you are, and how long you wait, before getting a scarce liver transplant - if you survive long enough. Now the network that runs the U.S. organ transplant system is exploring steps to ease some of the disparities. Critics who want more nationwide sharing of donated livers fear any changes won't help enough.

http://www.aolhealth.com/2011/02/15/some-states-offer-shorter-waits-for-liver-transplants/?icid=main%7Chtmlws-main-w%7Cdl7%7Csec3_lnk3%7C201554




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 unrestricted educational grant from Mallinckrodt Inc., a Covidien company, St. Louis, MO, a manufacturer of opiate and alcohol addiction products

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.