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Two categories of medications that have soared in popularity in addressing weight loss could eventually become impactful strategies in the treatment of opioid use disorder (OUD) and alcohol use disorder (AUD). But the findings that suggest this potential has been observational to this point, meaning more targeted trials will be necessary before these therapies can be seen as a breakthrough. [ABSTRACT FROM AUTHOR]

Despite policy guidance suggesting the critical importance of making medications for opioid use disorder (MOUD) widely available in correctional settings, newly published data suggest that uptake of these treatments in local jails continues to be slow. [ABSTRACT FROM AUTHOR]

With her compassion and knowledge, Linda Hurley, CEO of CODAC Behavioral Healthcare in Rhode Island, is able to convince corrections staff of the benefits of methadone and buprenorphine. But it isn't easy. [ABSTRACT FROM AUTHOR]

Community mental health facilities see a significant presence of patients with opioid use disorder (OUD), but the availability of evidence‐based medication treatment for individuals in these settings remains disappointingly low, newly published results of a RAND survey suggest. [ABSTRACT FROM AUTHOR]

The largest substance use prevention and treatment implementation study ever conducted is reporting highly disappointing results on its primary outcome: Local communities' implementation of evidence‐based strategies to combat opioid overdose had no significant impact on opioid overdose death rates. [ABSTRACT FROM AUTHOR]

Last month, both houses of Congress reintroduced the Comprehensive Addiction Resources Emergency (CARE) Act. Led by Senators Elizabeth Warren (D‐Mass.) and Tammy Baldwin (D‐Wisc.), and Representatives Jamie Raskin (D‐Md.), Ann Kuster (D‐N.H.), David Trone (D‐Md.), and Brittany Pettersen (D‐Colo.), 86 lawmakers signed on to reintroduce this legislation which has been rightly called the "most ambitious" ever introduced to confront the substance use disorder (SUD) epidemic. It would include almost $1 billion per year directly to tribal governments and organizations. [ABSTRACT FROM AUTHOR]

New regulations for opioid treatment programs (OTPs) create many new flexibilities for methadone practitioners and providers, and last month'h webinar for administrators focused on the key points. The Substance Abuse and Mental Health Services Administration (SAMHSA), which implements the 42 CFR Part 8 regulations, presented the information to about 800 attendees via a Zoom call on March 20 that was hosted by the American Association for the Treatment of Opioid Dependence (AATOD). Next week, ADAW will cover the March 27 webinar, which was for clinicians. For more on the new rule, see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023. [ABSTRACT FROM AUTHOR]

A pair of anti‐drug coalitions in Hunterdon County, New Jersey, took a step beyond their core work in primary prevention to advance the provision of medications for opioid use disorder (MOUD) in their community. Their efforts came about as part of a coalition training partnership jointly sponsored by Community Anti‐Drug Coalitions of America (CADCA) and pharmaceutical company Indivior, maker and distributor of brand‐name Suboxone products for OUD. [ABSTRACT FROM AUTHOR]

As always, ADAW's Preview issue includes this review of stories in 2023. We couldn't include everything but did focus on the areas that required in‐depth reporting, including methadone reform, which is a moving and controversial target. Click on the links for the abstracts. Subscribers can read full articles. [ABSTRACT FROM AUTHOR]

In a Morbidity and Mortality Weekly Report (MMWR) released last week, the federal Centers for Disease Control and Prevention (CDC) reported that overdose (OD) deaths from smoking illegally manufactured fentanyls and fentanyl analogs have increased dramatically, from 13.3% to 232.1% from 2020 to 2022. The study, "Routes of drug use among drug overdose deaths — United States, 2020‐2022" is by Lauren J. Tanz, ScD, and colleagues at the CDC and the Oak Ridge Institute for Science and Education. [ABSTRACT FROM AUTHOR]

Results of a new observational study suggest that urine drug screening in telehealth‐based treatment for opioid use disorder (OUD) is highly feasible and not inherently more prone to unexpected results or tampering than testing conducted in traditional in‐person care. The study's investigators said they think the results support the trend toward relaxing restrictions on the delivery of buprenorphine treatment for OUD. [ABSTRACT FROM AUTHOR]

As Scott E. Hadland, M.D., senior author of a dramatic paper published last week in the New England Journal of Medicine puts it, drug use among adolescents is not getting more common — it's at its lowest in almost 50 years. But it's getting more deadly, due to fentanyl. In "The Overdose Crisis among U.S. Adolescents," by Hadland and lead author Joseph Friedman, Ph.D., the problem is laid out clearly: After guns and car crashes, overdose (OD) deaths are now the third leading cause of death among adolescents. [ABSTRACT FROM AUTHOR]

In a clear but measured and scientific dispute against standard practice today, the American Society of Addiction Medicine (ASAM) has called for an end to the standardization of doses of buprenorphine for opioid use disorder (OUD). The recommendations, published in the Journal of Addiction Medicine, ASAM's flagship journal, note that doses should be optimal based on the individual needs of the patient. This was never in question within medical circles, including ASAM, but insurance policies and the tyranny of what is expected have led to suboptimal doses, both in the induction phase and the maintenance phase, of treatment. [ABSTRACT FROM AUTHOR]

Recovery housing, with guidelines issued recently by the Substance Abuse and Mental Health Services Administration (SAMHSA) (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32517 and https://onlinelibrary.wiley.com/doi/10.1002/adaw.33879), is not really open for people with opioid use disorder (OUD) who need to take medications for opioid use disorder (MOUD), namely methadone or buprenorphine, according to a report from Georgetown University's (GU) Addiction and Public Policy Initiative of the O'Neill Institute at Georgetown Law. And this policy of not allowing medications, which exists in many of the country's 18,000 recovery homes, is a violation of federal civil rights laws, noted the report, authored by Regina LaBelle, director of the Addiction and Public Policy Initiative at the O'Neill Institute of Georgetown Law. [ABSTRACT FROM AUTHOR]

Newly published research has uncovered a strong association between patients' out‐of‐pocket costs for buprenorphine and the likelihood that they will keep using the medication for opioid use disorder (OUD). The study, involving privately insured individuals who initiated buprenorphine treatment between 2013 and 2020, also showed a disappointingly low rate of one‐year continuation of the treatment overall. [ABSTRACT FROM AUTHOR]

The federal Department of Health and Human Services (HHS) has a policy, called the exclusion program, of banning health care providers from billing Medicare or Medicaid for five years, even if they are in recovery, cooperate with the courts, are abstinent, pass regular drug tests, have their medical licenses back, and have never harmed a patient. Last week, ADAW interviewed two such providers —a doctor and a nurse — who agreed to go public with their stories. [ABSTRACT FROM AUTHOR]

Results of a new study based on in‐depth interviews with 23 Narcotics Anonymous (NA) attendees in South Africa suggest that treatment and recovery programs should pay closer attention to potentially problematic substitute behaviors in recovery. Nineteen of the 23 participants reported engaging in a substitute behavior, with nicotine the most common replacement substance and binge eating/overeating the most common non‐substance behavior. [ABSTRACT FROM AUTHOR]

With fentanyl's influence accounting for most of the changes in local and national drug trends, it should come as no surprise that fentanyl appears to be responsible for a major shift in the profile of methamphetamine‐related deaths in Los Angeles County. A significant increase in deaths in which opioids were a contributing factor has been accompanied by a drop in deaths with associated cardiovascular factors, a primary danger of stimulant use. [ABSTRACT FROM AUTHOR]

Mark Parrino, founder and President of the American Association for the Treatment of Opioid Dependence (AATOD), highlighted some of the reasons for the current outlook on opioid treatment programs (OTPs) – which for a few months or years, depending on your perspective, has not been great. The main reason is the American Society of Addiction Medicine (ASAM), which used to be a solid partner of AATOD and OTPs (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.30330), but which in recent years has had a change in leadership and advocacy. What ASAM wants now is for MOTAA to pass – a bill which would allow ASAM‐certified physicians to prescribe methadone for opioid use disorder (OUD) to their patients. Under current federal law and regulation, only federally certified OTPs can provide (prescribe and dispense) methadone, and they do a lot more than just provide the medication. [ABSTRACT FROM AUTHOR]

Groups Recover Together (Groups), founded in 2014, is a quickly expanding enterprise. It is a bricks‐and‐mortar buprenorphine treatment program, funded mainly by venture capital and with a business model that can't fail: If patients don't recover, the payer gets their money back. Now relying on this "value‐based contracting" method, an easy sell to many Medicaid authorities, the organization has 12 facilities and treats 20,000 patients a week, according to Cooper Zelnick, chief revenue officer. [ABSTRACT FROM AUTHOR]

A highly unusual meeting took place in 2014—a group of experts, including federal officials, and top legislators – namely, former senators Carl Levin (D‐Michigan) and Orrin Hatch (R‐Utah) met in June of that year to discuss changing the Drug Addiction Treatment Act of 2000 (DATA 2000), which regulated buprenorphine prescribing up until it was eviscerated in the spending bill last month (see https://onlinelibrary.wiley.com/doi/epdf/10.1002/adaw.20431). The lawmakers wanted to raise the maximum number of patients one physician could have (at the time, it was 30 under DATA 2000, and 100 under the 2006 amendment; since then it has been raised further). [ABSTRACT FROM AUTHOR]

A digital opioid addiction treatment program that as of late 2021 had raised around $68 million in capital financing has made it clear that it sees buprenorphine treatment delivered virtually as a permanent solution to the opioid crisis, rather than a pandemic‐era stopgap. [ABSTRACT FROM AUTHOR]

When the federal Centers for Disease Control and Prevention (CDC) first issued its opioid prescribing guideline for pain in 2016, many in the addiction treatment field didn't think physicians would do what the agency — which has no enforcement authority and doesn't govern physician practice — was recommending: a limit for the amount and duration of opioids to be prescribed for pain (see CDC issues draft opioid prescribing guidelines for chronic pain, ADAW Dec. 21, 2015; https://onlinelibrary.wiley.com/doi/10.1002/adaw.30424). What happened was a broadscale reduction in access to opioids for pain, causing significant suffering (see Chronic pain patient stories: Withdrawal, pain and fear, ADAW Jan. 15, 2018; https://onlinelibrary.wiley.com/doi/10.1002/adaw.31822). Physicians, it turned out, were afraid of what the Drug Enforcement Administration (DEA) — which certainly does have enforcement authority — and state medical boards — which could take away medical licenses — would do. So many physicians tapered, and even abandoned patients who not only needed opioids for pain, but had become dependent on them, subjecting their patients to both massive increases in pain and withdrawal at the same time. Some committed suicide. At the same time, opioid overdose deaths — which the CDC had mistakenly thought would decrease as a result of reducing access to opioids for pain — continued to increase. [ABSTRACT FROM AUTHOR]

The Substance Abuse and Mental Health Services Administration (SAMHSA) has said that patient safety comes first, which means that Opioid Treatment Program (OTP) patients may get increased methadone take‐homes even without permission. Preemptive guidance to obtain approval from the OTP's State Opioid Treatment Authority (SOTA) — an office within the state alcohol and drug agency — already has been issued by SAMHSA's Center for Substance Abuse Treatment (CSAT), which regulates OTPs. The SOTA approval to close the OTP can come either via the OTP extranet (an internet that can only be accessed by authorized users), or verbally to the OTP sponsor (owner), said Christopher Garrett, SAMHSA spokesperson. In addition, requests to close may be submitted to SAMHSA retroactively, he told ADAW last week, as Hurricane Ian was bearing down on Florida. [ABSTRACT FROM AUTHOR]

Prescribers can spend hours trying to find a pharmacy that has buprenorphine — especially in rural areas. This is not a new problem, and in fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a meeting about it last August. A report was supposed to have been issued by now, but so far, according to the press office, there is nothing. [ABSTRACT FROM AUTHOR]

Representative Donald Norcross (D‐N.J.), normally a champion of addiction treatment, caused outrage in methadone treatment field last month when he referred to the opioid treatment program (OTP) model as a "cartel" in his official press statement supporting the Modernizing Opioid Treatment Access Act, which would allow office‐based addiction physicians to prescribe methadone for opioid use disorder (OUD). The proposed legislation would, like the OTAA (Opioid Treatment Access Act) proposed last year (see "Mammoth bipartisan bill would revamp SAMHSA programs," ADAW, May 16, 2022; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33428) threaten the "turf" of OTPs. ADAW wrote about the introduction of the bill last month (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33428). [ABSTRACT FROM AUTHOR]

The American Academy of Addiction Psychiatry (AAAP), in commenting on methadone reforms proposed by the federal government, has warned against unintended consequences of making it too easy to access methadone, and wants more studies done on liberalized take‐home doses, but the main opposition to the proposal was opening up prescribing to nonphysicians. [ABSTRACT FROM AUTHOR]

Recently Pennsylvania's governor Josh Shapiro approved the first state‐licensed mobile unit to treat substance use disorder (SUD). Gaudenzia is the treatment provider. [ABSTRACT FROM AUTHOR]

At last week's meeting of the College on Problems of Drug Dependence, the primary gathering of researchers funded by the National Institute on Drug Abuse (NIDA), there were many sessions on buprenorphine but none devoted to methadone, and when methadone was mentioned, it was about the need to expand it beyond opioid treatment programs (OTPs). In one session we attended, even MOTAA, the bill which would allow physicians to prescribe methadone for opioid use disorder, was lambasted as being restricted to addiction medicine physicians. Methadone in primary care was the main ideology propounded. Interesting, as there is no research on how effective or safe this would be. As one expert asked us later, "If they had cancer, wouldn't they want to go to an oncologist?" There is also the fact that only OTPs have used methadone; no one else in the United States has any experience treating opioid use disorder with the medication. We are reminded of the words of Sigmund Freud to his audience at Clark University in 1909: "We have heard a large number of judgements on psycho‐analysis from people who know nothing of this technique and do not employ it." [ABSTRACT FROM AUTHOR]

Corrections are made to the articles "Delegate to the AATOD board from New York reported highlights from key initiatives for her state," published on May 27, and "Looking Ahead to No Stigma: Better Access, Better Integration of Methadone," featured in the May 21, 2024 issue.

Buffalo‐area emergency physicians' effort more than five years ago to brace for the effects of a sudden shuttering of pain clinics has evolved into an initiative across New York to connect patients with opioid use disorder (OUD) to timely medication treatment. New York MATTERS (Medication Assisted Treatment and Emergency Referrals), which features an electronic referral platform overseen by the state Department of Health, is expected to expand its reach into New York City this year and is seeking a first‐time allocation of line‐item funding in the state budget. [ABSTRACT FROM AUTHOR]

From making methadone available from drugstores to eliminating regulations requiring the involvement of opioid treatment programs (OTPs), a two‐day workshop sponsored by the National Academies of Sciences, Engineering and Medicine (NASEM) had as its premise the need to expand methadone treatment at a time when opioid overdoses continue to increase. [ABSTRACT FROM AUTHOR]

Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its 2021 National Survey on Drug Use and Health (NSDUH) data. [ABSTRACT FROM AUTHOR]

As drug overdose deaths continue to skyrocket, another report in what seems like an endless parade of them calls for an expansion of treatment. [ABSTRACT FROM AUTHOR]

A newly released study suggests that economic impact payments to individuals during the pandemic might have contributed to a surge in opioid overdose deaths, but the results are being portrayed to the public as having a much more dramatic impact. While the study paper from researchers at Bowling Green State University clearly states that the results don't indicate that the payments caused the rise in deaths, language in a news release from the Ohio Attorney General's Office implies a cause‐and‐effect relationship. [ABSTRACT FROM AUTHOR]

A week after the federal Department of Health and Human Services (HHS) issued a final rule liberalizing treatment for opioid use disorder (OUD) in opioid treatment programs, it issued a less patient‐friendly rule. ADAW has written about 400 articles on confidentiality and substance use disorder treatment, an area that has seen continued erosion since 2010 when the government started acceding to claims that requiring a patient to consent to the release of his or her substance use disorder (SUD) treatment information in a digital age (think "Electronic Health Record") would be just too inconvenient. The most recent step came in the Federal Register issued Feb. 8, which changes the confidentiality rules to align with those of HIPAA. The rule, through the HHS Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), finalized modifications to the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR part 2 ("Part 2"), which protect the privacy of patients' SUD treatment records. In a press release about the rule, HHS said this: "Specifically, today's final rule increases coordination among providers treating patients for SUDs, strengthens confidentiality protections through civil enforcement, and enhances integration of behavioral health information with other medical records to improve patient health outcomes." [ABSTRACT FROM AUTHOR]

More than a year ago the X‐waiver for buprenorphine prescribing was eliminated, but that did not increase prescribing (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33832). States where the preauthorization requirement was eliminated did not see increases in buprenorphine prescribing (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33956). So what is the problem? A study published last month, "Prescriptions for Buprenorphine in Michigan Following an Education Intervention," compared counties that had education about buprenorphine for prescribers with those that didn't and found that educating general (not addiction) clinicians might be one solution. (Addiction medicine specialists already know how to prescribe buprenorphine.) [ABSTRACT FROM AUTHOR]

A small coastal town with one road in and one road out, Winthrop, Massachusetts, is a place one might expect to be able to keep out methadone, said Winthrop Police Chief Terence Delehanty, speaking at the PAARI Summit (Police Assisted Addiction & Recovery Initiative) in Boston last week. Not so, he said. [ABSTRACT FROM AUTHOR]

Stigmatizing comments from a loved one about methadone or buprenorphine treatment, based on prevalent misinformation, can deeply sting for a person with opioid use disorder (OUD) who is relying on one of the medications as a component of recovery. As a new study featuring data from interviews with 52 treatment patients suggests, these comments often have harmful consequences for treatment, derailing disclosers' progress and placing them at serious risk. [ABSTRACT FROM AUTHOR]

The settlement money coming from the Purdue bankruptcy is touted by many as going to the catchall category of "treatment," as in "treatment, prevention, recovery and harm reduction." But in fact, there is no guarantee it is going to any of those things, ADAW has learned. It's up to each state. [ABSTRACT FROM AUTHOR]

An Aug. 11 webinar hosted by the American Association for the Treatment of Opioid Dependence (AATOD) featured speakers from the opioid treatment program (OTP) community who have been operating methadone vans for years, as well as the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Both agencies just announced the approval of methadone vans, providing such vans are part of brick‐and‐mortar OTPs (see 'Mobile methadone now approved for licensed OTPs,' ADAW July 4; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33120). [ABSTRACT FROM AUTHOR]

The primary manner by which states have been using Medicaid to expand access to substance use disorder (SUD) treatment may actually be making it more difficult for individuals to receive the services most appropriate to their needs, a newly released paper suggests. Moreover, this preferred strategy in many cases violates the law, authors with the National Health Law Program contend. [ABSTRACT FROM AUTHOR]

At the American Association for the Treatment of Opioid Dependence (AATOD) meeting in Las Vegas last week, Allegra Schorr, M.S., delegate to the AATOD borad from New York, presented highlights from key initiatives for her state. Schorr is President of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA) and owner and vice president of West Midtown Medical Group, and opioid treatment program (OTP), outpatient substance use disorder treatment program, and primary care provider. [ABSTRACT FROM AUTHOR]

The AATOD conference was a great success, noted Allegra Schorr, B.S., who is President of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA) and owner and vice president of West Midtown Medical Group, an opioid treatment program (OTP), outpatient substance use disorder treatment program, and primary care program in New York City. The board meeting centered on changes to the guidelines (42 CFR Part 8) for OTPs, with widespeard agreement that the federal changes are "extremely positive," Schorr told ADAW. "There was some discussion regarding interpretation of the change to the counseling requirement," she said, adding that there is a need for greater clarification. [ABSTRACT FROM AUTHOR]

Medicaid expansion is improving access to evidence‐based medication treatment for opioid use disorder (OUD) among individuals referred by the criminal justice system, suggests a new study based on national treatment admissions data. However, medication treatment for the justice‐involved population still lags substantially behind medication treatment for those referred by other sources, suggesting that other barriers to effective care for justice‐involved individuals persist. [ABSTRACT FROM AUTHOR]

Attendees of the American Association of the Treatment with Opioid Dependence (AATOD) virtual conference last week learned from Elizabeth Gondles, Ph.D., with the American Correctional Association (ACA), of the strides made in outreach as justice‐involved individuals with opioid use disorder (OUD) can now get access, increasingly, to the medications methadone, buprenorphine or naltrexone. [ABSTRACT FROM AUTHOR]

Newly published research has shed further light on the factors that influence retention in medication treatment for opioid use disorder (OUD), confirming that variables such as young age and referral from the justice system increase the likelihood of treatment discontinuation before six months. Results of the study also suggest that many outpatient treatment programs are ignoring the evidence base for extended treatment and are using medications such as buprenorphine as a short‐term taper strategy only. [ABSTRACT FROM AUTHOR]

Last week Gov. Kathy Hochul of New York announced that the state has made all of the funding provided in the first year of the opioid settlement agreement available — a total of about $192.8 million. [ABSTRACT FROM AUTHOR]

An over‐reliance on federal block grants and "one‐off" funding initiatives has left the addiction treatment system under‐resourced to respond to an addiction crisis that stands to be at least as deadly as COVID‐19 during the span of the Biden administration, a trio of prominent researchers argue in a newly released policy paper. The authors suggest that the new administration and Congress should prioritize efforts to build on what they consider the most impactful developments in improving access and quality in addiction treatment, such as Medicaid expansion and parity mandates. [ABSTRACT FROM AUTHOR]

Just before Christmas, Congress passed a $2.3 trillion spending package that included $1.4 trillion in appropriations for fiscal year 2021 and $900 billion for COVID‐19 relief (another "stimulus" bill). The appropriations bill level‐funded the Substance Abuse Prevention and Treatment block grant (SAPT BG) at $1.858 billion, and level‐funded the State Opioid Response (SOR) grant at $1.5 billion (this grant program includes stimulants as of last year). However, the COVID‐19 relief part of the law gave the SAPT BG an extra $1.65 billion for FY 2021. [ABSTRACT FROM AUTHOR]