A Collaborative Initiative for Patients and Clinical Professionals

AT Forum is made possible by an unrestricted educational grant from
Covidien Mallinckrodt, St. Louis, MO,
a manufacturer of methadone & naltrexone.

AT Forum Volume 19, #4 - Fall 2009Fall 2009 Newsletter

From The Publisher

Georgia Declares Methadone Treatment Awareness Day

governmentOne of the greatest challenges facing opioid treatment programs (OTPs) today is to continue to improve the public's perception of methadone maintenance as a successful treatment option for opioid-dependent patients, and to reduce the stigma often associated with it. This past March, the Opioid Treatment Providers of Georgia (OTPG) set an excellent example, with the help of perhaps the best advocates for methadone treatment: OTPs, patients, and patients' families. Other state provider associations and treatment programs should be encouraged to follow suit.

On March 4, Georgia held the first Methadone Treatment Awareness day in the state - and the first in the country.     "Our main goal was to educate the legislature," Stacey Pearce, owner and program director of GPA Treatment of Macon, Inc., told AT Forum. And for the 65 providers, patients, and family members who came to the state's capitol for the event, the experience was uplifting.

Rep. Stephanie Stuckey Benfield (D-Atlanta) requested time at the beginning of the day's legislative session to recognize Methadone Treatment Awareness Day, recalled Stacey Pearce, who was sitting in the House of Representatives' gallery with the other attendees. "She introduced us, we all stood up, and everybody applauded for us!"

During the day, the group set up in a room off the rotunda, so legislators could stop by and pick up literature and a 15-minute stigma-reduction DVD created by the OTPG. Representative Benfield, who has been very supportive of OTPs, and who sponsored the resolution declaring the awareness day, had a fact sheet about methadone placed on every representative's desk.

Acknowledging that sometimes patients are hesitant about participating in public events, Ms. Pearce was pleased about the good turnout of patients willing to tell their stories and discuss their treatment. With the help of OTPG president Joelyn T. Alfred, she called every OTP in the state - around 40 at the time (the number is growing) - and said "please send staff, please send patients." In addition, e-mails were sent to every contact, including program directors and counselors, reminding them of the date. "But it really helps to do personal calls."

Lessons Learned

Lack of Press Coverage - "We should have contacted the media," admitted Ms. Pearce. Like many programs, OTPs in Georgia don't have a good mechanism for press outreach. "It's one of the things we as a state organization need to work on."

Historically, many OTPs have not sought press coverage because they feel that the less known about them, the better. "We think they won't notice us if we're quiet." In fact, one unexpected benefit of the awareness day, Ms. Pearce said, was to reinforce positive feelings in staff and patients about medication-assisted treatment (MAT).

Better Organization - "We did things a little bit last minute," Ms. Pearce said. "It would have been better to have everything prepared ahead of time." There should be a deadline for tasks, and there should be a committee with specific tasks assigned to each person.

The Georgia providers will have a chance to learn from their mistakes: there will be another awareness day next year in the capitol building rotunda.

To order the stigma-reduction DVD, "Exploring the World of Opioid Dependency," go to http://www.otpgeorgia.org/. The cost is $40 for non-OTPG members.

Sue Emerson
Publisher
Feedback@ATForum.com


Risks of Methadone - Prescription Drug Interactions in MMT Patients

PillsMany opioid-dependent patients on methadone maintenance treatment (MMT) require prescription medications for co-occurring mental and physical conditions. The staff at opioid treatment programs (OTPs) need to know and record what these medications are, just as the patient's other health care providers need to document the patient's methadone treatment and opioid dependence. Otherwise, interactions between methadone and prescription drugs can cause a drug overdose, contribute to cardiac arrhythmias, reduce cognitive function, or have other serious or potentially fatal results.

Boston Documentation Study

To assess risks associated with inadequate documentation, a recent study conducted by Alexander Y. Walley, MD and colleagues accessed the electronic medical records of the Boston Public Health Commission (BPHC) MMT program. The program is affiliated with, but separate from, the Boston Medical Center (BMC), where MMT patients obtain their primary medical care. The researchers' goal was to check BPHC patients' medical records for evidence-or lack of evidence-of MMT and opioid-dependence documentation.

Of the 350 patients enrolled in the MMT program in July 2007, only one-fourth (24 percent) met the study's criteria for entry. Almost half (47 percent) had not signed a release for the MMT to communicate with the primary care physician. Another one-fourth had signed a release form, but not specifically for BMC.

Findings

The primary care provider had no record of opioid dependence for 30 percent of the BPHC study participants, and no record of methadone medication for 11 percent.

Over two-thirds of participants (69 percent) were taking one medication that could interact with methadone; 19 percent were taking three or more.

Specific types of interaction ranged from "may decrease methadone effects" (11 percent) to "a potentially QT-interval prolonging effect" (39 percent).

Of the nine participants whose MMT documentation was missing, 78 percent were taking at least one drug that could interact with methadone.

The authors described the BPHC study as most likely a "best case" scenario for medical record documentation of opioid dependence and MMT. This was because of the affiliation between the MMT and the medical center. "The coordination problems identified in this study likely loom larger among patients receiving both MMT and primary medical care from unaffiliated providers," they noted.

The authors acknowledged that some primary care physicians knew that their patients were receiving MMT, or were opioid dependent, but did not document it.

Suggestions for OTPs and Patients

Federal confidentiality regulations (42 CFR Part 2) require that alcohol and drug abuse treatment records not be shared unless the patient specifically allows it. Patients are encouraged to sign a release for sharing information with their other physicians, but patients may be reluctant to let their primary care physicians know that they are on MMT, out of concern that their physicians will withhold pain relievers or anxiety medications.

OTPs sometimes need to educate patients about how important it is to let other physicians know about their methadone treatment. Often it's best if patients take information about their other prescriptions directly to the OTP, where staffers already have earned the patients' confidence and are knowledgeable about methadone.

Patients may feel more reassured about disclosing their methadone treatment if they can link with providers who are familiar with MMT. On-site primary care is ideal, but often impractical. Directing patients to local primary care providers who are sophisticated about MMT encourages communication and lowers the risk of medication interactions.

Patients who do not want to tell physicians outside the OTP about their methadone treatment need to be reassured that the OTP will back them up if they do. Laura F. McNicholas, MD, PhD, director of the Center of Excellence in Substance Abuse Treatment and Education at the Philadelphia Veterans Affairs Medical Center in Philadelphia, tells her patients that if they go to a doctor outside the VA system, they must tell the doctor that they are taking methadone. (All records within the VA system are shared electronically.) If patients are afraid that the other physician won't help them, because of stigma issues, the OTP should say, "Then come back here and we will try to help you."

Dr. McNicholas asks her patients to show her any prescription from an outside doctor before filling it. "I need to see who wrote it," she says, noting that some physicians write prescriptions too liberally.

It's the responsibility of clinical staff to let MMT patients know they must tell other physicians that they are on MMT and are being treated for addiction. This is likely to bring up valid concerns about stigma. Some physicians even refuse to treat patients who are on MMT, says Dr. McNicholas. confidential

The Walley study at BPHC focused on the need for documentation in the medical record, but it may be even more important that the documenting physicians be receptive toward MMT. OTPs can help by finding physicians who won't stigmatize patients, and who will treat patients' medical and psychiatric conditions properly. Some OTPs choose to educate physicians about MMT, especially when the physicians appear to be overprescribing-or, as is often the case, underprescribing-for methadone patients.

MMT patients, like anyone, can develop anxiety disorders that may require benzodiazepine treatment. Just because someone is in MMT doesn't necessarily mean that other psychiatric medications aren't needed, notes Ivan Montoya, MD, acting deputy director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at the National Institute on Drug Abuse. "If I have a patient with a panic disorder, and the patient is on methadone, I have to treat the patient with a benzodiazepine," says Dr. Montoya, a psychiatrist.

JSAS Healthcare, Inc. in Asbury Park, N.J. (formerly Jersey Shores Addiction Services, Inc.), has a policy for benzodiazepines, says Susan F. Neshin, MD, medical director. Patients are told that if a physician is going to prescribe a benzodiazepine, JSAS must first have a letter from that physician saying that he or she knows that the patient is taking methadone. Dr. Neshin gives patients a "Dear Doctor" letter to take to their physician, and offers to talk with the physician about addiction treatment.

Methadone Interactions With Other Drugs: Advice for Patients

  • loose pillsAvoid alcohol and illicit drugs.
  • When prescribed a medication, ask if it is safe to take with methadone.
  • Inform doctors and dentists about all drugs (prescription and nonprescription), herbal supplements, vitamins, and over-the-counter products you are taking.
  • Always take medications exactly as prescribed, such as with or without food, and at a specific time of day. If you miss a dose, call your doctor or pharmacist and ask what you should do.
  • Call your clinic immediately If you have any unpleasant symptoms after taking a medication or health product. Never treat symptoms, stop a medication, or change a dose on your own.

Source: AT Forum Patient Education Brochure - Methadone Drug Interactions available in English and Spanish online at: http://atforum.com/patient/education_brochures.php#intro

Sources

Velarde Mayol C, Peinó Andión J, Gómez de Caso Canto JA. [The Methadone Maintenance Program for intravenous heroin addicts. What information do primary care physicians have?] Aten Primaria. 1996;17(9):581-584. [Article in Spanish]

Walley AY, Farrar D, Cheng DM, Alford DP, Samet JH. Are opioid dependence and methadone maintenance treatment (MMT) documented in the medical record? A patient safety issue[published online ahead of printJuly 4, 2009].J Gen Intern Med. 2009;24(9):1007-1011.

http://atforum.com/documents/methadoneadvisory.pdf

 

Medication-Assisted Treatment (MAT) During Pregnancy - Part II

This is the second of two articles on treating pregnant patients in MAT, clinical considerations related to their care, and outcomes for their babies.

We thank Karol A. Kaltenbach, PhD, clinical associate professor, Department of Pediatrics, and clinical associate professor, Department of Psychiatry and Human Behavior, Thomas Jefferson Medical College, Thomas Jefferson University; and Hendree E. Jones, PhD, associate professor, Department of Psychiatry and Behavioral Sciences, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, for again sharing their knowledge and insight with our readers.

Opioid treatment programs (OTPs) are caring for increasing numbers of pregnant patients-some who become pregnant while in methadone treatment programs, others who decide to begin methadone treatment upon learning they are pregnant. Helping these mothers-to-be through their pregnancy and to a successful outcome can be a highly rewarding experience for OTP staff.

Methadone Dose Management

Induction and Stabilization

Initial methadone doses for pregnant women are generally based on the same criteria as those for women who are not pregnant. Pregnant patients already taking methadone usually continue their existing dosage. As with all patients starting methadone treatment, induction is based on individualized dosing. Induction should be done slowly, based on the individual response to treatment. Careful observation for signs and symptoms of withdrawal or sedation is essential. Patients are considered stabilized when they are without opioid craving, and are comfortable with their dose for the full 24 hours before their next daily dose. It is important that doses for pregnant women be individualized, as they are with nonpregnant patients.

Later Stages of Pregnancy

As pregnancy progresses, many women require dose increases, especially during the third trimester. Careful monitoring to achieve a comfortable dosage in the last trimester ensures the best outcome for mother and child. Drs. Kaltenbach and Jones stress how important it is to increase the methadone dosage gradually, based on the patient's clinical response. If single daily doses of methadone are not enough, Drs, Kaltenbach and Jones suggest dividing the daily dose into two doses, and giving them at least eight hours apart; for example, half in the morning and half in the evening. Many OTPs monitor changes in the mother's blood methadone levels to guide dose adjustments. A useful indication of underdosing is the mother's sense of how active her baby is within the uterus.

Just when the mother may need a higher dose of methadone, she may face increased pressure from well-meaning family or friends to take less methadone-or even to stop taking it-"for the sake of the baby." This advice is not based on evidence or knowledge, and only adds to feelings of guilt and uncertainty the mother may have as the birth draws near. OTP staff can be very helpful to the patient by providing information, advice, and reassurance in a sympathetic and understanding way.

Labor, Delivery, and Post-Delivery

Methadone treatment continues throughout labor and delivery, and into the post-delivery period. Once the mother has given birth, the dosage needs to be re-evaluated. For patients who were already on methadone maintenance, the TIP 43 Consensus Panel recommends post-delivery doses that are usually similar to those given before pregnancy. For those who initially were not in methadone maintenance treatment, post-delivery doses should be adjusted until the patient is on a comfortable dose and is stabilized. As during pregnancy, any decrease in dosage should be based on signs of overmedication, and any increase should be based on the patient's methadone blood levels and signs and symptoms of withdrawal.

Some patients express the desire to be medication-free after their baby is born. This is usually not an ideal time to discontinue methadone. OTP staff need to advise patients about the possibility of relapse during methadone tapering, and the increased likelihood of relapse associated with the stresses of early motherhood. The importance of continuing treatment during this time cannot be overemphasized.

Neonatal Abstinence Syndrome

Some babies born to methadone-maintained mothers develop a temporary and treatable condition called neonatal abstinence syndrome (NAS). Signs and symptoms include increased sucking on the thumb or fingers, uncoordinated feeding efforts, excessive high-pitched crying, sleeplessness, irritability, and tremors. Neonatologists use a scale such as the Neonatal Abstinence Score developed by Finnegan and colleagues to diagnose NAS, assess its severity, and determine how well the baby is responding to treatment. While not all babies born to MAT mothers need medication to treat NAS, all babies should be evaluated for NAS during the first few days after birth.

NAS may be mild or severe, and may begin just after birth or up to two weeks later. The likelihood and severity of NAS depend on many factors, but the mother's methadone dosage or blood level has not consistently been shown to be one of them. Other drugs that may contribute to NAS include heroin, morphine, and other opioids; alcohol; nicotine; and benzodiazepines.

Newborns with NAS are treated in the hospital for several days or up to several weeks. NAS can be treated without any long-term effects on the baby. Some babies with mild symptoms of withdrawal can be soothed during stressful periods by being wrapped tightly in a blanket and gently rocked. Although evidence is limited, the severity of NAS may be reduced by breastfeeding. NAS is considered controlled when babies have rhythmic feeding and sleep cycles and optimal weight gains, and a low average score on a scale such as the Neonatal Abstinence Score.

Breastfeeding

Breastfeeding should be encouraged in OTP patients unless the mother is HIV positive, is using illicit drugs or alcohol, or has another contraindicating condition. The well-known benefits of breastfeeding include transferring protective antibodies to the baby, providing optimal nutrition, promoting attachment between mother and child, and lessening the mother's stress. Methadone levels in breast milk are very low, and are unrelated to the mother's blood methadone concentrations. The American Academy of Pediatrics considers methadone compatible with breastfeeding at any maternal dose.

Unfortunately, some caregivers still discourage breastfeeding, due to prejudice or lack of knowledge. "You'd be surprised how many people still counsel women not to breastfeed" Dr. Kaltenbach said. "Or they put a limit on the mother's dose," Dr. Jones added.

Outcomes for Infants

familyShort-term. Birthweight is a major factor in infant health. Studies have consistently found that infants born to methadone-maintained mothers have higher birthweights than infants born to heroin-dependent women. Dr. Kaltenbach noted, "Pregnant women who enter methadone maintenance treatment late in their pregnancy have increased obstetrical risk, because they have not had the longer-term benefit of preventative health care. They have a higher risk of having a premature baby, and once you have a premature baby, you have all the problems associated with prematurity that are not necessarily a direct result of drug exposure."

Long-term. Few recent studies have focused on the long-term outlook for babies born to methadone-maintained mothers, but available data have not indicated any severe developmental delay during the early years of life. Dr. Kaltenbach pointed out that babies exposed to methadone before birth develop well within the normal range through age two. No significant developmental differences have been found between children of mothers maintained on methadone and a comparison group of non-drug-exposed children, when various social, biological, and health factors were considered. "Drug exposure was one risk factor," she said, "but the environment the child was raised in was the most important, in terms of developmental outcome."

Suggestions for Managing Pregnant Patients in OTPs

Drs. Kaltenbach and Jones offer the following suggestions for managing the complex needs of pregnant patients on methadone maintenance:

Continued Opioid and Poly-Substance Abuse. Pregnant women who relapse to opioid use, or abuse alcohol, nicotine, benzodiazepines, or other drugs, increase their risk of medical complications. They need to be educated about how these drugs can increase the severity of NAS, or can cause fetal alcohol spectrum disorder, premature labor, or other complications. Weekly drug testing and more intensive counseling is recommended.

Co-Occurring Disorders. Mood disorders during pregnancy have been associated with adverse maternal health behaviors, a high risk of postpartum depression, and undesirable behavior of the offspring. According to Dr. Jones, "Opioid-dependent pregnant patients should be screened for disorders and given appropriate medication and behavioral treatments."

Methadone-Drug Interactions. OTP staff need to pay special attention to the potential for drug interactions in pregnant patients. Factors such as the physiological changes that accompany pregnancy can change the way drugs interact and are metabolized in the body.

OTP staff need to check all medications the patient is taking, including over-the-counter drugs, dietary supplements, and medications prescribed by other health care providers. It may be necessary to adjust either the methadone dose or the dose of other medications being given.

Patients' Questions. Pregnant patients will have many questions that OTP staff will be called upon to answer, especially about what to expect at the hospital.

Patients find it very helpful to visit the hospital before their delivery date so they can meet the hospital staff, visit the nursery, and have a chance to ask questions.

Dedicated Staff Can Make a Difference

A woman who elects to combine pregnancy and methadone maintenance will face challenges in the months ahead. She will most likely have special concerns about balancing her own physical and emotional needs with the welfare of the baby she is carrying. With the help of dedicated medical, nursing, and counseling staff throughout her pregnancy, this can be a happy and rewarding time for her. The chances of a positive outcome for her and her baby can be excellent.

 

Lack of Opioid Addiction Treatment in Prisons: Misperceptions and Missed Opportunities

jailbarsIt's an old, oft-repeated story. An intravenous heroin user— we'll call him Vern— shoplifts, sells drugs, gets caught, and goes to prison, where he's forced to quit heroin. Months later he's released— and he's back on heroin the same day.

But Vern's story has a new twist. The next time he's in prison, he's offered methadone maintenance treatment. He's released months later, enters an opioid treatment program, stays on methadone, gets a job, and returns to his family.

Vern was lucky. Most U.S. prisons don't offer treatment for opioid addiction, according to a recent survey published in the journal Drug and Alcohol Dependence. All but one of the 52 U.S. prison systems responded to the survey.

The survey found:

The survey found that only about 1,600 to 1,800 heroin-dependent inmates in U.S. state and federal correction systems receive methadone. This is less than one percent of the more than 200,000 heroin-dependent individuals who pass through U.S. correctional facilities each year. The proportion of surveyed facilities offering methadone was similar across the Western, Midwestern, and Northeastern regions of the U.S. (about 65 percent) but much lower in the South (only 35 percent).

Incarceration provides a unique opportunity for treatment. It offers opioid-dependent inmates a chance for recovery, which will contribute a host of social, economic, and medical benefits to society. Treatment and counseling decrease the likelihood of post-release relapse. The World Health Organization says that pharmacologic treatment of opioid dependence should be available to prisoners at all times.

So—why do so few facilities offer treatment for opioid addiction?

The reasons correction officials cite show a surprising lack of basic understanding about opioid addiction.

According to the survey, facilities favor drug-free detoxification over providing patients with methadone or buprenorphine. Yet studies show that drug-free detoxification in prisons—in effect, forced detoxification—simply doesn't work. Kinlock and colleagues found a rapid return to opioid (principally heroin) addiction among most inmates within three months—often as early as one month-after release.

Corrections officials also commented:

Some prison officials did favor treatment, but cited administrative, political, or policy barriers, or lack of knowledge among personnel about how to implement treatment programs. Until prison staff and policy makers realize the urgent need for change, become knowledgeable about addiction, and introduce programs in their facilities, the treatment of opioid-dependent prisoners will remain a story of misperceptions and missed opportunities.

Sources:

Chandler RK, Fletcher BW, Volkow ND. Treating drug abuse and addiction in the criminal justice system: improving public health and safety. JAMA. 2009;301(2):183-190. PMID: 19141766. PMCID: PMC2681083 [available 2010/01/14].

Kinlock TW, Gordon MS, Schwartz RP, O'Grady KE. A study of methadone maintenance for male prisoners: 3-month postrelease outcomes. Crim Justice Behav. 2008;35(1):34-47. doi:10.1177/0093854807309111.

Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and buprenorphine prescribing and referral practices in U.S. prison systems: Results from a Nationwide Survey. Drug Alcohol Depend. 2009;doi:10.1016/j.drugalcdep.2009.06.015.

McCollister KE. Cost effectiveness of substance abuse treatment in criminal justice settings knowledge asset, Web site created by the Robert Wood Johnson Foundation's Substance Abuse Policy Research program. August 2009.

 

Q & A: Moving? How to Transfer Take-Home Privileges

arrowQuestion: I live in Nevada, and I've earned methadone take-home privileges at my opioid treatment program. I'm thinking about moving to another state. Will I be able to keep my take-home privileges when I transfer to another clinic? Also, I'd like to consider office-based methadone medical maintenance as a treatment option. Where is it available? - Lisa, Las Vegas, NV.

Answer: Current federal regulations on methadone take-home doses allow a one-month supply for patients who meet the eight criteria for eligibility (see AT Forum, Spring 2008). States and individual clinics can choose to implement policies that are stricter than the federal regulations.

What really matters is the individual program's policy on take-homes, because any program can be stricter about eligibility and take-homes than the state requires. "When patients are moving, they usually call programs and discuss financing, policy, procedures, and philosophy," Nicholas Reuter, MPH, senior public health advisor with the Division of Pharmacologic Therapies at the Center for Substance Abuse Treatment (CSAT), told AT Forum. "Then they make the decision of which program to go to."

To transfer your take-home privileges, your current program needs to contact the opioid treatment program (OTP) you want to transfer to. Your current program should ask about any state or program policies on transferring take-home privileges. You will need to sign a confidentiality waiver allowing both programs to discuss your treatment history.

CSAT recommends sending one years' worth of treatment records to the new program. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD) agreed, suggesting that the current program prepare a one-page overview documenting the patient's stability, such as negative toxicology results, lack of arrests, and employment information.

It's important to minimize the burden on the patient, but at the same time the new OTP is responsible for the patient, Mark Parrino said. It's unlikely that you will get your full take-home privileges right away, but also unlikely that you will be denied them. You may be asked to visit twice a week during the first month, for example.

CSAT would be concerned if stable patients were unfairly being denied take-home privileges. "I'm pro-patient," CSAT director H. Westley Clark, MD told AT Forum. "I want to know if there are any complaints about people being kept from having take-homes, not because of state law, but because of draconian rigidity in the receiving programs."

CSAT's Reuter noted that office-based methadone medical maintenance (MMM) exists in only a handful of programs in New York and Baltimore, and one in Seattle. "We changed our rules in 2001 to permit patients who are stable in treatment to receive a one-month supply of methadone," he said. "That pretty much meets their needs. That is what has come to be known as medical maintenance, in our view."

Resource:

The information source for each state's take-home regulations in the State Opioid Treatment Authority. A direct link (listed under the previous name, State Methadone Authority) is available at: http://dpt2.samhsa.gov/regulations/smalist.aspx.

 

New Mentoring Resource Now Available for OTP Physicians

HiresThere's a valuable new free resource available for opioid treatment programs (OTPs) from the American Society of Addiction Medicine (ASAM). The Physician Clinical Support System for Methadone (PCCS-M), allows methadone prescribers to obtain one-on-one mentoring about using this medication. Physicians can obtain advice and answers to specific clinical questions from the physician-mentors by phone or e-mail, or onsite.

ASAM announced the launch of PCCS-M August 17. With funding from the Center for Substance Abuse Treatment (CSAT), PCCS-M will provide support for three categories of providers who prescribe methadone: OTPs (10 physician-mentors), pain physicians (six mentors), and primary care physicians (nine mentors).

More than 50 physicians applied to be mentors, Andrew J. Saxon, MD, medical director for PCCS-M, told AT Forum. "We had to narrow it down to about half that number." Mentors will be paid out of CSAT funds. "As requests increase, we will expand the number of mentors, if necessary, to meet our participants' needs," said Saxon, who is professor of Psychiatry and Behavioral Sciences at the University of Washington, and director of the addiction patient care line at the VA Puget Sound Health Care System.

The PCCS-M website offers helpful clinical tools and resources, including federal regulations, practice guidelines, slide sets, and patient education materials.

Clinicians treating patients with methadone can get information from PCSS-M on a number of topics, including:

PCCS-M is an expansion of PCCS-B, a similar service ASAM started in 2003 for physicians who prescribe buprenorphine for treating opioid addiction. PCCS-M is coordinated by ASAM, in conjunction with other leading medical organizations.

For a list of the mentors, as well as other valuable clinical information go to the PCCS-M website at: http://www.PCSSmentor.org.

 

NEW RESOURCE: Guidelines on the QT: Methadone and the QT Interval

A new 35-minute audiovisual lecture by Gavin Bart, MD, Director, Division of Addiction Medicine at the Hennepin County Medical Center, interprets the Annals of Internal Medicine Methadone QTc Guidelines article (see AT Forum - spring & summer 2009 issues).

Topics covered include:

The lecture can be viewed at: https://umconnect.umn.edu/methadoneqtcscreening/

 

FAQs Updated at ATForum.com

Have you visited the Frequently Asked Questions section of ATForum.com lately?

The FAQs were reviewed and updated this summer. There are over 35 FAQs available on the following topics:

 

Events

events

American Academy of Addiction Psychiatry (AAAP) 20th Annual Meeting & Symposium
December 3-6, 2009
Los Angeles, California
Contact: http://www.aaap.org/

The American Academy of Pain Medicine Annual Meeting
February 3-6, 2010
San Antonio, New Mexico
Contact:http://www.painmed.org/

34th Southeast Conference on Addictive Disorders (SECAD) 2010
February 21-24, 2010
Nashville, Tennessee
Contact:http://209.196.57.200/ME2/Sites/Default.asp?SiteID=121FA692C6524EA6A7D1BB32DEE1BEFA

The American College of Psychiatrists Annual Meeting
February 23-28, 2010
Fort Lauderdale, Florida
Contact: www.acpsych.org