AT Forum NEWS NOTES & UPDATES #153
Compiled & Edited by Sue Emerson - Publisher
Prior Edition: May 2011
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ABUSE/ADDICTION
MEDICATION-ASSISTED TREATMENT (MAT) AND OPIOID ADDICTION
New Report Shows Significant Growth in Substance Abuse Treatment Admissions Related to Prescription Opiates from 1999 to 2009
This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2009 and trend data for 1999 to 2009. which provides information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems. For 2009, 1,963,089 substance abuse treatment admissions aged 12 and older were reported to TEDS by 49 States and Puerto Rico. (Georgia and the District of Columbia did not report admissions for 2009.)
Five substance groups accounted for 96 percent of the 1,963,089 TEDS admissions aged 12 and older in 2009: alcohol (42 percent), opiates (21 percent), marijuana (18 percent), cocaine (9 percent), and methamphetamine/amphetamines
The report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that one of the most notable shifts that has occurred in this period was in the rise of opiate admissions attributable mostly to prescription drugs — from 8 percent of all opiate admissions in 1999 to 33 percent in 2009. In 2009:
- Just over half (54 percent) of primary non-heroin opiate admissions were male
- For primary non-heroin opiate admissions, the average age at admission was 31 years
- Most primary non-heroin opiate admissions (88 percent) were non-Hispanic White
- Two-thirds (66 percent) of primary non-heroin opiate admissions reported oral as the route of administration, while 18 percent reported inhalation and 13 percent reported injection
- Medication-assisted opioid therapy was planned for 19 percent of admissions for primary opiates other than heroin
- Sixty-two percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana (25 percent), alcohol (22 percent), and tranquilizers (12 percent)
Heroin represented 92 percent of all opiate admissions in 1999 but declined steadily to 67 percent in 2009. In 2009:
- About two-thirds (67 percent) of primary heroin admissions were male
- For primary heroin admissions, the average age at admission was 35 years
- More than half (59 percent) of primary heroin admissions were non-Hispanic White, followed by 20 percent who were non-Hispanic Black and 19 percent who were of Hispanic origin
- Sixty-seven percent of primary heroin admissions reported injection as the route of administration, and 29 percent reported inhalation
- Medication-assisted opioid therapy was planned for 28 percent of heroin admissions
Treatment Episode Data Set 1999 — 2009 is based on data from the 1999 to 2009 Treatment Episode Data Set (TEDS).
The SAMHSA press release can be accessed at: http://www.samhsa.gov/newsroom/advisories/1106222941.aspx
The date PDF file can be accessed at: http://atforum.com/addiction-resources/documents/teds2k9nweb.pdf
Source: The Substance Abuse Mental Health Services Administration — June 23, 2011
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A new national study shows that from 1998 to 2008 (the most recent year with available figures) substance abuse treatment admissions among those 12 and older related to the abuse of benzodiazepine drugs rose from 22,400 in 1998 to approximately 60,200 in 2008. The report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that while benzodiazepine related admissions represented only 3.2 percent of all substance abuse admissions among this population in 2008, it had grown from the 1.3 percent it represented in 1998.
The study shows that the vast majority of benzodiazepine related admissions involved the abuse of another substance (95 percent) and in 82.1 percent of these cases, benzodiazepines were the secondary drug of abuse. Overall opiates were the primary substance in most of these cases (54.2 percent) — a pattern which roughly held true for nearly every age group except adolescents and those aged 45 and older (see Chart). Among adolescents, marijuana was by far the most frequently reported primary substance of abuse used with benzodiazepines, while among those age 45 and older alcohol as a primary substance of abuse rivaled opiates (42.1 percent for alcohol versus 47.1 percent for opiates).
The report is based on data from the 1998 to 2008 Treatment Episode Data Set (TEDS).
The report is available at: http://oas.samhsa.gov/2k11/028/TEDS028BenzoAdmissions.cfm
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (June 2, 2011). The TEDS Report: Substance Abuse Treatment Admissions for Abuse of Benzodiazepines. Rockville, MD.
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EUROPAD Journal - Heroin Addiction and Related Clinical Problems. 2011 (June), Vol. 13, No. 2 Now Available Online
Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. The June issue features the Basics on Addiction: A Training Package for Medical Practitioners or Psychiatrists Who Treat Opioid Dependence. Sections include:
- Neurobiology of opioid dependence
- Clinical assessment of opioid dependence
- Maintenance pharmacotherapies: treatment principles and clinical application
The PDF file can be downloaded at:
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Interim methadone (IM) was designed as an option to initiate methadone among opioid-dependent patients in the absence of scheduled psychosocial services rather than putting them on a waiting list for standard methadone (SM) treatment, which includes counseling. The aim of this randomized clinical trial was to determine if the absence of regular counseling had an adverse effect on methadone treatment outcomes at 4 months. Two hundred thirty participants were randomized to IM, SM, or restored methadone (RM*).
- Patients in the IM condition received a mean of 0.7 counseling sessions over the study period, while patients in the SM and RM conditions received 8.4 sessions and 17.7 sessions, respectively.
- There was no difference in treatment retention between groups (IM=92%, SM=81%, and RM=89%).
- There was no difference in heroin use outcomes between groups. All 3 reported 29 days of use in the prior 30 days at baseline, which decreased to 3.3, 5.5, and 3.0 days in the IM, SM, and RM groups, respectively.
* RM=SM plus meetings with a counselor who had a reduced caseload.
Comments: Although the frequency of counseling in the SM group was low and all IM patients were eventually transitioned to SM, these findings suggest that, in resource-limited settings where methadone treatment wait lists are common, IM is a reasonable alternative.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue May/June 2011. Access checked 6/16/11. Jeanette M. Tetrault, MD
Original Source: Schwartz RP, Kelly SM, O'Grady KE, et al. Interim methadone treatment compared to standard methadone treatment: 4-Month findings. J Subst Abuse Treat. 2011;41(1):21-29
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Law enforcement and public health officials throughout the country are reporting that oxymorphone abuse is increasing. Oxymorphone is most commonly known by the brand name Opana. The deaths of at least nine Louisville area residents between January and April 2011 have been linked to polydrug abuse of oxymorphone in combination with alprazolam and/or alcohol; more oxymorphone-related deaths are expected to be confirmed as toxicology testing is completed on other decedents. Since January 2008, oxymorphone-related deaths also have been reported in California, Colorado, Connecticut, Florida, Michigan, New Mexico, North Carolina, Ohio, South Dakota, Tennessee, and Washington Additionally, in March 2009, Newport (TN) law enforcement authorities reported that oxymorphone resulted in five fatal overdoses within a 3-month period.
The 2-page report can be accessed at: http://www.justice.gov/ndic/pubs44/44817/sw0011p.pdf
Source: U.S. Department of Justice- National Drug Intelligence Center — May 19, 2011
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Prescription Drug Monitoring Programs Are Not Associated with Lower Rates of Overdose or Prescription Opioid Consumption
Electronic prescription drug monitoring programs (PDMPs) proliferated from 16 to 32 states in the 2000s in an effort to address overdose fatalities attributed to increased prescriptions for opioid analgesics. Researchers conducted time-series regression analyses of 1999—2005 PDMP data to determine state-level associations between PDMPs, overdose rates, and prescription opioid distribution rates. Results were adjusted for median age, race/ethnicity, education, and level of urbanization.
- Over the study period, mean drug overdose rates doubled, opioid-related overdose mortality rates tripled, and mean morphine milligram equivalent (MME) consumption rates tripled with no significant differences between states with or without PMDPs.
- States with PDMPs had rates of Schedule-III opioid consumption (mainly hydrocodone) that were 20-MME-per-person higher, and rates of Schedule-II opioid consumption that were 20-MME-per-person lower, than states without PDMPs.
- The 3 PDMP states with serialized tamper-resistant prescription forms and the largest populations (California, New York, and Texas) had lower drug overdose mortality, lower opioid-related overdose mortality, and lower rates of opioid prescribing than other PDMP and non-PDMP states.
- Presence of a PDMP was not a significant predictor of drug overdose mortality, opioid-related overdose mortality, or MME consumption.
Comments: According to these results, PDMPs are not associated with a reduction in overdose or opioid prescription rates. Their presence was associated with the prescription of opioids that are less regulated. The study did not account for the possibility that PDMPs were implemented in states with higher overdose rates or that implementation of PMDPs may increase overdose surveillance. The requirement of serialized tamper-resistant prescription forms may reduce overdose but should be balanced with the potential concomitant decrease in access to treatment. To be an effective tool for addressing the rise in prescription-drug-related overdose, PMDPs require further development.
Published In: Alcohol, Other Drugs, and Health: Current Evidence a project of the Boston Medical Center issue May/June 2011. Access checked 6/16/11. Alexander Y. Walley, MD, MSc
Original Source: Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring program and death rates from drug overdose. Pain Med. 2011;12(5):747-754.
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Deaths related to prescription opioid therapy are under intense scrutiny, prompting those in pain medicine — clinicians, patient advocates, and regulators — to understand the causes behind avoidable mortality in legitimately treated patients. Studies reporting on statistics, causes, and adverse events involving opioid treatment are now available in a special supplement of Pain Medicine, a journal published by Wiley-Blackwell on behalf of the American Academy of Pain Medicine (AAPM).
"Preventing unnecessary deaths from opioid therapy should be a central focus for everyone working in the field of pain medicine," said Lynn R. Webster, MD, FACPM, FASAM, Medical Director and Founder of Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah, and officer for the AAPM. "Our primary objective is to increase understanding of the major risk factors associated with opioid-related deaths and exploring methods that mitigate the adverse effects involved in treating patients with analgesics that are potentially lethal."
In a study, a panel of pain medicine experts led by Dr. Webster, reviewed the medical literature and state and federal government sources to assess frequency, demographics and risk factors associated with overdose deaths caused by opioids. Analysis revealed a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. While methadone represented less than 5% of opioid prescriptions dispensed, one third of opioid-related deaths in the U.S. were attributed to this drug.
Researchers determined that root causes of deaths from methadone included physician error due to knowledge deficits, patient non-adherence to prescribed medication regimen, and unanticipated medical or mental health comorbidities. Furthermore, some insurance companies require that methadone be used as first-line therapy to control pain over other opioid therapy. Forcing the use of methadone by health care providers who may not be aware of how to safely prescribe this drug may lead to greater mortality risk.
Additional contributors to overall opioid-related deaths included the presence of sleep-disordered breathing and use of other drugs that depress the central nervous system such as alcohol, benzodiazepines, and antidepressants. Approximately two thirds of opioid-related deaths are caused by opioids other than methadone. "Patients with depression, anxiety, or other mental illness who also have chronic pain need structured care that minimizes risks associated with opioid therapy," concluded Dr. Webster. "It is very difficult to safely treat chronic pain in patients who have serious mental health issues. We must strike a balance between treating pain and preventing harm."
As of June 23, articles in the special issue were available for free download at:
Source: Wiley-Blackwell — June 13, 2011
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A Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject Drugs — Research Abstract
Introduction - High rates of hepatitis C virus (HCV) transmission are found in samples of people who inject drugs (PWID) throughout the world. The objective of this paper was to meta-analyze the effects of risk-reduction interventions on HCV seroconversion and identify the most effective intervention types.
Methods - We performed a systematic review and meta-analysis of published and unpublished studies. Eligiblestudies reported on the association between participation in interventions intended to reduce unsafe drug injectionand HCV seroconversion in samples of PWID.
Results - The meta-analysis included 26 eligible studies of behavioral interventions, substance-use treatment, syringe access, syringe disinfection, and multicomponent interventions. Interventions using multiple combined strategies reduced risk of seroconversion by 75% (pooled relative risk, .25; 95% confidence interval, .07—.83). Effects of single-method interventions ranged from .6 to 1.6.
Conclusions - Interventions using strategies that combined substance-use treatment and support for safeinjection were most effective at reducing HCV seroconversion. Determining the effective dose and combination ofinterventions for specific subgroups of PWID is a research priority. However, our meta-analysis shows that HCVinfection can be prevented in PWID.
The article is available online at: http://jid.oxfordjournals.org/content/204/1/74.full.pdf#page=1&view=FitH
Source: Journal of Infectious Diseases — July 1, 2011 issue
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About 20 physicians will begin training this summer in the first 10 residency programs to be accredited by the American Board of Addiction Medicine (ABAM).The programs are designed to provide doctors from a variety of specialty backgrounds with comprehensive training in the identification and treatment of patients with substance abuse issues.
For now, the focus is getting the training programs under way, said Kevin Kunz, MD, MPH, president of the ABAM and the ABAM Foundation."Addiction medicine is a specialized field of practice open to all physicians from all medical specialties," he said.It is related to, but distinct from, the addiction psychiatry subspecialty, which is limited to psychiatrists and falls under the American Board of Psychiatry and Neurology, an ABMS member.
The field has developed in response to unmet needs of people struggling with substance abuse, said Daniel Alford, MD, MPH, associate professor and director of the new addiction medicine residency program at Boston University School of Medicine.Most people with addiction issues enter the health care system through primary care, but many fall through the cracks because their physicians don't have the expertise to treat them, he said. "Most often these patients don't want a referral," he said.
The ABAM wants to increase the number of physicians able to diagnose and treat addiction, so patients can access care from a variety of avenues, Dr. Kunz said.
For further information go to: http://www.ama-assn.org/amednews/2011/06/06/prsa0606.htm
Source: American Board of Addiction Medicine — June 6, 2011
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The first public account identifying AIDS was published in the Morbidity and Mortality Weekly Report (MMWR) by the U.S. Centers for Disease Control and Prevention (CDC) on June 5, 1981. That date is now regarded as the beginning of the pandemic. The POZ looks back at the milestones of the past 30 years in the lives of people with and affected by HIV/AIDS.
The timeline is available at: http://www.poz.com/30/timeline.shtml
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"Even though Afghanistan has a near monopoly on global opium and heroin production, the economics of the trade conspire such that the country makes far from the lion's share of revenues. At retail prices the total world opiate value is approximately $65 billion — $55 billion for heroin and $10 billion for opium."http://www.executive-magazine.com/getarticle.php?article=14339
As Dr. Volkow said to a group of drug experts convened by the surgeon general last month to discuss the problem, "In the past, when we have addressed the issue of controlled substances, illicit or licit, we have been addressing drugs that we could remove from the earth and no one would suffer." But prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. "The challenges we face are much more complex," Dr. Volkow said, "because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders."http://www.nytimes.com/2011/06/14/science/14volkow.html?_r=1
"In drug courts, America has found not only a solution to an important public policy problem, it has hit yet again upon an essential truth — the power of personal responsibility and accountability."http://thehill.com/blogs/congress-blog/campaign/166311-drug-courts-save-lives-tax-dollars
A Real Debate About Drug Policy - George P. Shultz and Paul A. Volcker on why the 'War on Drugs' has Failed � and what to do Next — 6/11/11
"The question is: What is the best way to go about it? For 40 years now, our nation's approach has been to criminalize the entire process of producing, transporting, selling and using drugs, with the exception of tobacco and alcohol. Our judgment, shared by other members of the commission, is that this approach has not worked, just as our national experiment with the prohibition of alcohol failed. Drugs are still readily available, and crime rates remain high. But drug use in the U.S. is no lower than, and sometimes surpasses, drug use in countries with very different approaches to the problem."http://online.wsj.com/article/SB10001424052702304392704576377514098776094.html
At least 30% of employers are likely to stop offering health insurance once provisions of the U.S. health care reform law kick in in 2014, according to a study by consultant McKinsey.http://www.medscape.com/viewarticle/744145?src=mp&spon=21
In 2009, there were seven million Americans abusing prescription pain and anxiety drugs, up 13% from the prior year, according to the most recent data from DEA. The agency expects 2010 numbers to show another double-digit increase.And there's big money in it for criminals. The trafficking in prescription drugs is close to becoming a billion-dollar industry, industry experts say.http://money.cnn.com/2011/06/01/news/economy/prescription_drug_abuse/?section=money_latest
Not everyone is convinced that the days of abusing OxyContin are over. The F.D.A. is requiring Purdue Pharma to conduct clinical trials before it can claim that the new version is less abuse-prone. Though many addicts appear frustrated by the reformulation, Dr. Mark Publicker, an addiction medicine specialist at Mercy Recovery Center in Westbrook, Me., said he was "absolutely certain" that people would figure out how to abuse the new OxyContin.http://www.nytimes.com/2011/06/16/health/16oxy.html?_r=2&emc=eta1
The committee said it will put funding for the drug testing program on hold until Defense develops a training program for commanders that will make sure they "properly utilize the information derived from prescription drug testing, including awareness of treatment alternatives, the circumstances under which disciplinary action is appropriate, and necessary measures to safeguard medical privacy."http://www.nextgov.com/nextgov/ng_20110617_1667.php?oref=topnews
Writing for a unanimous court, Justice Elena Kagan held that "a court may not impose or lengthen a prison sentence to enable an offender to complete a treatment program or otherwise to promote rehabilitation." The reason was simple: Federal law says that "imprisonment is not an appropriate means of promoting correction and rehabilitation."http://www.latimes.com/news/opinion/opinionla/la-ed-rehab-20110620,0,2729593.story
Officials at the National Institute on Drug Abuse said that the opening of a new agency that will take the place of both the NIDA and the National Institute on Alcohol Abuse and Alcoholism, will likely occur in October 2013 instead of 2012.http://www.latimes.com/health/boostershots/la-heb-agency-merger-06192011,0,4571535.story
Men and women in the U.S. military are more medicated than ever — and their doctors don't even know who takes what. The Department of Defense doesn't keep track of medical prescriptions doled out to service members in combat, despite ongoing pleas from federal officials to do just that.http://www.thedaily.com/page/2011/06/22/062211-news-military-drugs-1-2/
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