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ATOD & Advocacy Update - Week Ending October 25, 2013



Experts Urge New Jersey Legislators to Take Steps to Curb Opioid Abuse
Addiction treatment experts urged New Jersey legislators last week to take steps to curb opioid abuse, including expanding what doctors are required to learn about addiction, and making participation in the state’s prescription drug monitoring program mandatory. The Daily Journal reports the experts also recommended implementing video conference technology that would allow doctors to discuss patient cases with pain management specialists. According to Dr. Daren Anderson, the chief quality officer at Community Health Center in Connecticut, a similar initiative in his state that used secure email messages to consult with pain management specialists reduced specialty visits by 56 percent. Experts urged legislators to support a campaign to educate the public on opioid abuse, and to increase long-term treatment facilities for addiction. They spoke at a hearing of the New Jersey Senate Health, Human Services and Senior Citizens Committee. The committee’s work is likely to lead to new legislation, because both Republicans and Democrats, as well as Governor Chris Christie, have expressed concern about prescription painkiller and heroin abuse, according to NJ Spotlight. Earlier this year, Christie signed into law a measure that encourages people to report drug overdoses. The law allows people to call 911 to report a drug overdose, without the fear of getting arrested for drug possession themselves.


Drinking To 'Numb,' Women Gain On Men In Alcohol Abuse
Carrie Bradshaw and her rounds of cosmopolitans; Bridget Jones with her glasses of chardonnay; Chelsea Handler declaring her passion for vodka. In sitcoms, rom-coms and comedy shows, female boozers are the stuff of jokes. They suffer through hangovers, complain about their bar bills, promise to cut back and then cheerfully renege. But many women find that their drinking doesn't lead to laughter. In the U.S. and Western Europe, growing numbers of women struggle with alcoholism; in some places, women's rates of alcohol abuse have achieved parity with men's. Ann Dowsett Johnston, the author of the new book Drink, speaks with NPR's Rachel Martin about what's driving the increase in female binge drinking and alcoholism. She shares what she's learned, from research and from her own alcoholism, about advertising, addiction and the challenges facing women who seek treatment. Please click here to continue reading.

Baby Boomers Continue Substance Use as They Age
Baby boomers appear to be carrying their substance abuse habits with them as they age, according to a behavioral health expert at the University of Pennsylvania’s Perelman School of Medicine. David W. Oslin, MD, says binge drinking and prescription drug use are particular concerns in this population. The implications are important for the substance abuse field, since there are 50 million people over age 65 in the United States, and people over 70 are the fastest growing group in the nation, he says. Despite the relatively common occurrence of substance use issues in baby boomers, health care providers often overlook them, Dr. Oslin observes. He adds that doctors and other health care professionals should routinely screen for and consider substance use when caring for older adults. The 2012 National Survey on Drug Use and Health found the rate of binge drinking among people ages 65 and older was 8.2 percent, and the rate of heavy drinking was 2 percent. Among adults ages 50 to 64, the rate of current illicit drug use has increased during the past decade, the survey found. The survey authors estimate the number of adults age 50 and older who will need alcohol or drug treatment will increase from 2.8 million in 2002-2006, to 5.7 million by 2020. Currently, 4 million older adults need substance use treatment, including 0.4 million needing treatment for illicit drugs, 3.2 million needing treatment for alcohol, and 0.4 million needing treatment for both. The rate of illicit drug use among baby boomers has been higher than those of older generations, Dr. Oslin noted at the recent California Society of Addiction Medicine meeting. Baby boomers, particularly those born after 1950, had much higher rates of illicit drug use as teenagers and young adults than people born in earlier years. According to the survey, in 2012, only 19.3 percent of persons aged 65 or older had ever used illicit drugs in their lifetime, while the lifetime rates of use were 47.6 percent for those aged 60 to 64 and were above 50 percent for those ages 20 to 59. The survey found marijuana and prescription psychotherapeutic drugs used nonmedically were the most commonly used illicit drugs among adults ages 50 or older in the past year. Dr. Oslin says older adults have increased sensitivity to alcohol and over-the-counter and prescription medications, compared with younger adults. They also take more medications, and these drugs can interact with alcohol. “It’s quite common for older adults to drink and to suffer from depression at the same time,” he says. “Many of them are on antidepressants, but that won’t help them stop drinking. They need an abstinence-oriented approach to get better.” He is especially concerned about the increased use of benzodiazepines and opioids among the aging population. He co-authored a study that found despite continuing concerns about benzodiazepines in older adults, they continue to be commonly prescribed in this age group. Older adults often are successfully treated for substance use disorders, particularly if the treatment is geared toward their age group, according to Dr. Oslin. “Many older adults don’t want to go to group therapy with younger adults, but they will go to individualized therapy or to groups with peers,” he says. In a study he conducted, Dr. Oslin found treatment for alcohol dependence with the drug naltrexone and therapy sessions was effective for older adults, who were less likely to relapse than younger adults. While baby boomers with substance use disorders have some considerations that are specific to their age group, Dr. Oslin says he has found many strategies that work apply to all age groups. Addiction treatment is not one size fits all, he says. “There are many options—use them. Compliance with treatment is important. While abstinence is often the goal, it is not the only goal. And getting the right treatment from the beginning may not be as important as changing the treatment when it isn’t working.”

DEA Should Establish Buy-Back Program for Unused Prescription Drugs: NY Senator
U.S. Senator Charles Schumer of New York is calling on the Drug Enforcement Administration (DEA) to establish a buy-back program for unused prescription drugs. A buy-back program would encourage people to return their unused prescriptions, he said. Schumer wrote a letter to DEA Administrator Michele Leonhart recommending ways the agency could work with pharmacies and law enforcement agencies to expand programs to collect unused drugs, The Post-Standard reports. Under current DEA regulations, pharmacies cannot hold take-back events. Schumer noted that take-back events are infrequent and can be inconvenient. Schumer is recommending the agency amend regulations under the Secure and Responsible Drug Disposal Act of 2010 so that pharmacies and community organizations can hold take-back programs. “The DEA needs to be working with local pharmacies, governments and law enforcement agencies to get prescription drugs off the street, and take-back and buyback programs are the way to do that.  The DEA must change the regulations so that certified pharmacies can hold take-back events and provide this vital service, and should put more funding behind buybacks to incentivize people to turn over their prescription drugs,” he said in a news release.

Heroin Use, Deaths on the Rise in Middle Class America
Colorado ranks second in the nation for prescription pill abuse. Experts say as prescription pills get harder to access, people turn to cheaper, more accessible heroin. According to the Substance Abuse and Mental Health Services Administration, heroin use in America is up 75 percent between 2007 and 2011. Deaths and overdoses are also on the rise. Many heroin addicts start on prescription pain killers prescribed for minor injuries. When they run out of their prescription, they often turn to heroin because it’s cheaper and easier to get. One Oxycontin pill can cost up to $80 and may only last a few hours whereas $100 worth of heroin can last several days. Click here to continue.


Is Suboxone a Wonder Drug that Helps Heroin Addicts Get Clean--Or Just Another Way to Stay High?
Five months ago, Chris resolved that it was finally time to get clean. Sort of.
The 34-year-old Brooklyn real estate broker (who declined to be identified by his real name; "Chris" is a pseudonym) had begun using heroin and quit once before, in his late teens. But family problems and a few tough months caused him to relapse, and soon he was snorting the drug two or three times a week. After nearly a year of using, the days between doses started to get dicey, and Chris got worried. On the off days, he says, "I was never myself. I was irritable, exhausted, had no motivation or desire to do things I once enjoyed doing. I wasn't happy." So, in between bags of heroin, Chris scored Suboxone, a prescription painkiller used to treat opiate addiction. He'd use it when he was making a halfhearted attempt to get sober, or when he just didn't want to feel bad between bags. Thanks to its main ingredient, buprenorphine hydrochloride, Suboxone eliminated the agonizing heroin withdrawal, the "three days of complete hell" he had to go through every time he tried not to use. Continue here.

Patients Taking Buprenorphine for Opioid Addiction May Benefit From Longer Detox
A new study suggests patients taking buprenorphine to treat their opioid addiction may benefit from tapering off the medication over four weeks instead of a shorter period. The longer detoxification is effective when it is followed by treatment with naltrexone, a drug that blocks opioid strength, the researchers found. Researchers at the University of Vermont followed 70 people undergoing outpatient treatment for opioid addiction. For the first two weeks of the 12-week study, patients took buprenorphine. They were randomly selected to reduce the dose of the drug over one, two or four weeks. All of them then received naltrexone treatment and behavior therapy, HealthDay reports. Patients who tapered off buprenorphine over four weeks were more likely to stop abusing opioids, compared with those who tapered off the drug over one or two weeks. The findings are published in JAMA Psychiatry.

State Substance Use Disorder Parity Laws Can Increase Treatment Rate: Study
State laws that require private health plans to provide coverage for substance use disorders (SUD) that is equal to benefits for general medical coverage can increase access to SUD treatment, a new study suggests. More than half of states have enacted these laws, known as parity laws. The Emory University researchers analyzed state-level SUD parity laws in the private insurance market that were implemented between 2000 and 2008. They found parity laws increased state-level treatment by 9 percent in all specialty SUD treatment facilities, and 15 percent in facilities that accept private insurance. The study appears in JAMA Psychiatry. The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated SUD parity into federal legislation, HealthCanal reports. “This research suggests that the recent federal parity legislation holds promise for improving access to SUD treatment in this country,” said lead researcher Hefei Wen.

Poll of Teens Finds 77 Percent Say They Don’t Drink Alcohol
A poll of high school teens finds 77 percent say they don’t drink alcohol. According to Mothers Against Drunk Driving (MADD), which released the poll, 69 percent of teens say they don’t drink, and an additional 8 percent say they used to drink, but don’t anymore. When asked why they don’t drink, teens said their top five reasons were because it’s illegal, it can be harmful to their health, it can affect their grades, their parents disapprove, and they don’t want to be like their peers who drink, according to HealthDay. According to the poll of 695 students, more than half said they would be less likely to be friends with or date someone who is an underage drinker, the article notes. The results were released during Red Ribbon Week, a national campaign to raise awareness about the dangers of drug and alcohol use among young people. “As adults, we know how dangerous underage drinking is for our kids, but these new survey results show that teens are getting the message, too,” MADD National President Jan Withers said in a news release.

Longer Detox Might Work Better for Prescription Pain Med Addiction
A longer period of detoxification may be more effective for people being treated for addiction to prescription painkillers called opioids, according to a small new study. Abuse of prescription opioids such as oxycodone, hydrocodone and hydromorphone is a major public health problem in the United States. The new 12-week study, which included 70 people undergoing outpatient treatment for opioid addiction, was published online Oct. 23 in the journal JAMA Psychiatry. Please click here to continue reading.

'Just flooding us': Tenn. spike in drug-dependent newborns is warning to nation
On an average day, neonatal nurse practitioner Carla Saunders faces two dozen babies born hooked on drugs, infants so sick with the pain of withdrawal that they cry nonstop, claw their faces and writhe in agony at the sound of a voice or the touch of hand. But that’s just the average. “Today, it may be even higher,” says Saunders, who staffs the 60-bed intensive care unit at East Tennessee Children’s Hospital in Knoxville, Tenn. “It’s been as high as 37.” The babies are part of a grim trend in Tennessee, where a new report shows that the number of newborns dependent on drugs their mothers took during pregnancy is higher than ever — and experts say it should be a warning to the rest of the nation.Rest of this story is here.

Experts Call for Better Addiction Medicine Education for Physicians
Many doctors fail to diagnose and treat substance use disorders, in part because they have not been educated about addiction medicine, according to three experts. They call for better training in this week’s Journal of the American Medical Association. A number of diseases are caused by substance use disorders, and hospitals are “clogged” with patients suffering from these illnesses, write Dr. Evan Wood of the University of British Columbia, Dr. Jeffrey H. Samet, President of the American Board of Addiction Medicine (ABAM), and Dr. Nora D. Volkow, Director of the National Institute on Drug Abuse. The experts write that new therapies and behavioral interventions have been developed for a number of addictions, Newswise reports. “Despite the availability of these evidence-based prevention and treatment strategies, only a small fraction of individuals receive prevention or treatment consistent with scientific knowledge about what works,” Dr. Samet said. “There is a remarkable gap between the science of addiction medicine and the care that patients actually receive,” Dr. Wood said. “Ultimately, this stems from the fact that investments in research have not been coupled with strategies to adequately train physicians to deliver evidence-based care.” He noted that only about 10 percent of people with an alcohol addiction receive recommended care. Most treatment for addiction in the United States and Canada is provided by layperons, the article notes. ABAM has accredited 18 addiction medicine fellowship programs across the country. Doctors who complete one of these fellowships are eligible to sit for the ABAM exam to become certified in addiction medicine.

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