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In Medications for Opioid Use Disorder in Jails and Prisons: Moving Toward Universal Access, a report summarizing a meeting April 20 led by the Johns Hopkins Bloomberg School of Public Health and updated last week, medical and public health experts from across the country call for making methadone and buprenorphine universally available in jails and prisons. [ABSTRACT FROM AUTHOR]

A sign‐on letter spearheaded by the National Alliance for Medication Assisted Recovery (NAMA), and harm reduction groups, including the Urban Survivors Union (USU) and the Drug Policy Alliance (DPA) is calling for reducing restrictions on methadone and opioid treatment programs (OTPs), so that patients don't have to go to the clinics so often. Included in the over 100 signatories are Patty McCarthy Metcalf of Faces & Voices of Recovery, Ben Levenson of the Levenson Foundation (and former founder of Origins) and many addiction physicians, as well as drug user organizations. Many of the signers have said for months that OTPs should be eliminated entirely. [ABSTRACT FROM AUTHOR]

It is constantly heard that medication‐assisted treatment (MAT) for opioid use disorder (OUD) works most effectively in conjunction with behavioral therapy. New research suggests that MAT programs could enhance their patients' ability to combat cravings by tapping into the power of mindfulness‐based therapeutic strategies. [ABSTRACT FROM AUTHOR]

A recent literature review from Taiwan, "Risk of motor vehicle collisions after methadone use: A systematic review and meta‐analysis" by T.Y. Tsai and colleagues, found that methadone use is associated with an almost doubled risk of motor vehicle collisions, and concluded that "clinicians should exercise caution in implementing methadone maintenance therapy for drivers." The study, published in the current issue of Drug and Alcohol Dependence, flies in the face of what is known in this country about methadone maintenance: That it is safe for driving when taken in therapeutic doses. ADAW asked the National Institute on Drug Abuse (NIDA) to comment on the study. Here is what they said. [ABSTRACT FROM AUTHOR]

When patients seek treatment, they are supposed to receive "informed consent," but the actual rules are governed by state law, according to the Legal Action Center. We wondered about this when a recent unscientific survey of residential treatment programs showed that many do not provide buprenorphine for patients with opioid use disorder (OUD). Buprenorphine, methadone and naltrexone are the only three medications approved by the Food and Drug Administration (FDA) for the treatment of OUD, and methadone can only be provided in a federally licensed opioid treatment program (OTP). Methadone and buprenorphine are both opioids themselves, which seems to be the main objection to use of these medications. [ABSTRACT FROM AUTHOR]

Results of a study published this month in Psychiatric Services suggest that if states want to ensure greater provision of evidence‐based care for opioid use disorder (OUD), expanding Medicaid offers an effective strategy for doing so. At the same time, the study data indicate that Medicaid expansion alone is not sufficient for making agonist therapies accessible in dramatic numbers. [ABSTRACT FROM AUTHOR]

A significant proportion of methadone patients still are not receiving daily dosing levels that conform to evidence‐based standards of practice, according to data in a new study published in the Journal of Substance Abuse Treatment. The study's lead researcher, who has looked at this topic over a span of nearly 30 years, believes that even within the nation's opioid treatment programs (OTPs), stigma among some professionals toward use of medication‐assisted treatment (MAT) contributes to dosing that may prove too low to encourage treatment retention and reduce illicit drug use. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration (FDA) has awarded eight companies "Innovation Challenge" grants to spur the development of medical devices, including diagnostic tests and mobile medical applications, to prevent and treat opioid use disorder (OUD). The FDA launched the challenge last spring, and there were more than 250 applications. "The FDA remains committed to addressing this national crisis on all fronts, with a focus on encouraging medical product innovation to prevent new cases of opioid abuse and addiction and to treat those addicted," the agency stated in announcing the grants last month. [ABSTRACT FROM AUTHOR]

Section 2005. Medicare coverage of certain services furnished by opioid treatment programs. This provision expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering Medication‐Assisted Treatment (MAT) to expand access to treatment options for Medicare beneficiaries. Currently, OTPs are not recognized as Medicare providers, meaning that beneficiaries receiving MAT at OTPs for their opioid use disorders must pay out‐of‐pocket. In 13 states, the highest rate of opioid‐related inpatient stays is among the over 65 population. Under the provision Medicare will pay the outpatient OTPs through bundled payments made for wholistic services, including necessary medications, counseling, and testing. [ABSTRACT FROM AUTHOR]

Construction, mining and health care practitioner occupations are among those with the highest proportion of drug‐related overdose deaths among 26 studied occupation groups, newly published research from the Centers for Disease Control and Prevention (CDC) suggests. With the identification of the causes for the disproportionate overdose death rates by profession being beyond the scope of this study, researchers hope the data will spur additional studies in this generally under‐researched area, to inform workplace strategies to help mitigate the threat of overdose. [ABSTRACT FROM AUTHOR]

Through the NIH HEAL Initiative, NIH awarded 15 grants to form JCOIN. The awards, which total approximately $105.4 million, will support the innovation network over multiple years. JCOIN consists of research institutions and two centers that will provide supportive infrastructure — the Coordination and Translation Center and the Methodology and Advanced Analytic Resource Center. [ABSTRACT FROM AUTHOR]

During the COVID‐19 pandemic, New York state made a deal with Indivior, maker of Suboxone, to save money, at the risk of harming more people in the state living with opioid use disorder (OUD). This decision presents a major challenge for people with OUD, especially in the midst of a worsening opioid epidemic that is compounded by the COVID‐19 pandemic. Buprenorphine, a critical component of the drug Suboxone, is a life‐saving medication for people with OUD. It works by having a high affinity for the receptor that binds opiates — thereby kicking other opiates (fentanyl, heroin) off, and reducing the likelihood of overdose. Once on the receptor, the patient does not feel cravings or withdrawal. Unlike a regular opiate, buprenorphine has a ceiling effect that means it is very unlikely to cause an overdose. [ABSTRACT FROM AUTHOR]

The National Institute on Drug Abuse (NIDA), part of the federal National Institutes of Health, has advice for parents in the midst of the opioid epidemic: "[T]alk openly about the effects of opioids and other drugs with your children and stay actively engaged in their lives." [ABSTRACT FROM AUTHOR]

Louis Trevisan, M.D., came to the Substance Abuse and Mental Health Services Administration (SAMHSA) only a few months ago as its new director of the Center for Substance Abuse Treatment (CSAT). An addiction psychiatrist, he was at the American Association for the Treatment of Opioid Dependence (AATOD) conference in Orlando last month for most of the meeting, focusing on the opioid crisis. [ABSTRACT FROM AUTHOR]

Topiramate's use as a treatment for alcohol use disorder (AUD) is not a new idea, Bankole Johnson, M.D. (now of ondansetron fame; see ADAW, March 25, April 1), reviewed it many times (see ADAW, Oct. 15, 2007; Feb. 11, 2008; June 16, 2008; Nov. 3, 2008; June 7, 2010; Jan. 31, 2011; Feb. 24, 2014). But a comprehensive review published recently in the Journal of Addiction Medicine is concise. While not approved by the Food and Drug Administration for AUD, topiramate can be prescribed off‐label, and should be considered as a treatment for the condition, according to Ajay Manhapra, M.D., and colleagues in the article, "Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review." Like ondansetron and other possible AUD medications, including those that are approved (like acamprosate and naltrexone), topiramate doesn't work for everyone. But pharmacogenetic testing may help identify those who are likely to respond, according to the review. In addition, there are early studies indicating it could be used to treat cocaine and nicotine use disorder, as well as behavioral addictions. [ABSTRACT FROM AUTHOR]

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced the availability of more than $10 million in grant funding to expand treatment capacity for substance use disorders in family treatment drug courts. The Funding Opportunity Announcement, posted Nov. 5, states that the application due date is Jan. 4, 2019. "The purpose of this program is to expand substance use disorder (SUD) treatment services in existing family treatment drug courts, which use the family treatment drug court model in order to provide alcohol and drug treatment (including recovery support services, screening, assessment, case management, and program coordination) to parents with a SUD and/or co‐occurring SUD and mental disorders who have had a dependency petition filed against them or are at risk of such filing," according to the announcement. "Services must address the needs of the family as a whole and include direct service provision to children (18 and under) of individuals served by this project." Grant recipients must provide an approach that combines the "sanctioning power" of treatment drug courts with treatment services that promote successful family preservation and reunification. "Priority funding should address gaps in the treatment continuum for court involved individuals who need treatment for a SUD and/or co‐occurring SUD and mental disorders while simultaneously addressing the needs of their children," according to the announcement. The funding is to help participants reduce substance misuse, reduce SUD and co‐occurring disorder severity and decrease out‐of‐home placements for children, according to the announcement, which goes on to say that this "should also decrease the number of parents or guardians whose parental rights have been or will be terminated." Eligible applicants include state governments and territories, counties, cities or towns, as well as federally recognized tribal organizations and consortia. Family treatment drug courts that received an award for FY 2017 or FY 2018 under this program are not eligible to apply. An anticipated 25 awards will be given, with award amounts of up to $425,000 a year for up to five years. No cost sharing is required. For more information, contact Jon.Berg@samhsa.hhs.gov [ABSTRACT FROM AUTHOR]

"Anecdotes do not equal evidence." This sentence from the op‐ed "Cannabis Will Not Solve the Opioid Problem," by Kenneth Finn, M.D., in the Oct. 13 issue of MedPage Today, " sums up his view on the evidence for marijuana for pain. Focusing on "dispensary cannabis," he says there is no proof that it works. There may be "legitimate uses for cannabis‐based medications in specific disease states," he writes. But not for pain. Yes, the opioid epidemic originated in the pill mills and pain clinics and excess marketing by "Big Pharma," he writes. But that doesn't mean marijuana is a substitute for opioids as an analgesic. "There is sufficient data that cannabinoids and opioids share pharmacologic profiles, and some cannabinoids may modulate pain through several understood, and not so well‐understood, mechanisms," he writes. "They both modulate similar neurotransmitters along the pain pathways and may modulate inflammation, so there is evidence marijuana may be a possible pain reliever. That's good news, right?" Not so fast. Dispensary cannabis, which is where most patients would get the medication, wouldn't work, especially for the cancer patient population. Meanwhile, there has been a steady increase in opioid overdose deaths, even as more and more states approve medical marijuana, he noted. "Anecdotes do not equal evidence," he said. "I have had a few patients wean off opioids and use their marijuana of choice, not aware of the lack of regulation and a certain level of corruption at local and state levels. Our opioid crisis is worsening despite the expansion and commercialization of marijuana, heavily touted as a pain reliever. Currently, there is zero evidence in the medical literature for the use of marijuana as a medication or as an opioid substitute, particularly with poorly regulated and potentially harmful products. Even in this day of COVID‐19, you hear the outcry for 'evidence,' yet in the age of marijuana expansion, the appetite for 'evidence' has been completely aborted." Finn practices pain medicine in Colorado Springs. [ABSTRACT FROM AUTHOR]

The article profiles the Chronic Pain and Addiction Center at Silver Hill Hospital in New Canaan, Connecticut. A discussion of the approach that the center uses to treat patients with substance abuse and/or chronic pain is presented. The services and staff members that are available to patients at the center are discussed.

The article reports on research which the U.S. National Institute on Drug Abuse is conducting in 2012 in an effort to develop pain relieving opioids that are effective in treating pain but can't be abused. A discussion of five different types of abuse-deterrent formulations which have been developed by pharmaceutical companies is presented.

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. "Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities," the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, "All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors," also found that benzodiazepine use was associated with overdose. [ABSTRACT FROM AUTHOR]

Among the many breathtaking changes the federal government is making because of COVID‐19 (more methadone take‐homes, video‐only buprenorphine induction) is the recent announcement by the Office of Inspector General (OIG) of the Department of Health and Human Services that Medicare beneficiaries be provided more information about methadone, buprenorphine and naloxone, in a harm‐reduction‐style approach to reducing overdoses among the older population. In a data brief released last month, the OIG notes that people with opioid use disorder (OUD) could be particularly hard hit by COVID‐19, because of increased risk of respiratory disease, and that most Medicare beneficiaries at serious risk of opioid misuse or overdose in 2017 received high amounts of opioids the following year. However, only a quarter received a prescription for naloxone, which reverses opioid overdoses. In addition, only 7% of beneficiaries who were at serious risk in 2017 who were diagnosed with an OUD received a medication‐assisted treatment drug, "possibly because of challenges that beneficiaries have in accessing prescribers." For the policy brief, go to https://oig.hhs.gov/oei/reports/oei‐02‐19‐00130.asp. [ABSTRACT FROM AUTHOR]

It wasn't a live debate as had been planned, with most presenters, including Sarah Wakeman, M.D., and Andrew Kolodny, M.D., presenting remotely like almost all of the speakers, with their slides and microphones, at the American College of Medical Toxicology (ACMT) opioids symposium March 12 in New York City. [ABSTRACT FROM AUTHOR]

Last week, a NY coalition of harm‐reduction organizations, drug policy reformers and treatment providers joined state lawmakers in calling for medication‐assisted treatment (MAT) in all New York jails and prisons. We spoke to Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates of New York State (COMPA), on the need for all three medications — methadone, buprenorphine and naltrexone — to be available in all state and county facilities. [ABSTRACT FROM AUTHOR]

The article reports on the American Association for the Treatment of Opioid Dependence's criticisms against and recommendations for the plan of the U.S. government to increase the number of patients a physician can treat with opioid buprenorphine.

The article reports on decision of the U.S. agency Food and Drug Administration (FDA) to reassess the way it gives approvals for opioid medications for pain. Topics include comments of critics regarding the liberal approach adopted by FDA, measures by FDA to impact the criticism faced regarding its approach, and plans of FDA to convene a meeting of its Pediatric Advisory Committee.

The article offers information on the U.S. federal Centers for Disease Control and Prevention (CDC) and its draft guidelines for opioid prescription for pain issued on December 14, 2015, with a 30 day comment period and comments due January 13, 2016. Topics include the issue of overprescribing opioids for chronic pain, the guidelines' inapplicability to methadone or buprenorphine prescription for opioid use disorders, and guidelines for starting and continuation of opioid therapy.

The article offers news briefs on alcoholism and drug abuse in the U.S. as of December 18, 2017. Study findings show that abuse-deterrent opioids cause abuse reduction but may not money or protect lives due to their high prices and people's possible switching to other types of opioids like fentanyl-laced heroin. President Donald Trump plans to donate his next quarter salary of 100,000 dollars to an opioid prevention campaign.

The article presents a study comparing Zubsolv and Suboxone with regard to retention. Topics include the absence of withdrawal symptom increase and opioid cravings in Zubsolv, the psychological reliance and popularity of Suboxone, and the use of physicians with the DATA 2000 waiver. It also discusses the Induction, Stabilization, Adherence, and Retention Trial (ISTART) study on the feasibility of switching from Suboxone to Zubsolv.

The article reports on a 2013 decision which the U.S. National Association of Attorneys General (NAAG) made to send a sign-on letter to the U.S. Food and Drug Administration (FDA) calling for a black box warning label on prescription opioid analgesics. In the letter the association cited the risk of neonatal abstinence syndrome which is associated with opioid analgesics.

The article discusses an article on the use of opioids which was published in a 2013 issue of the "Insurance Journal". The article discussed concerns which have been voiced by U.S. insurance companies that cover workers' compensation about the overuse and overprescribing of opioids for workers' compensation recipients.The views that physician Leonard J. Paulozzi of the U.S. Centers for Disease Control and Prevention, has about long-term use of opioids, are discussed.

Reports on a legislative modification of the United States Controlled Substances Act that would give physicians greater freedom to use opiates to treat addiction. Proposed limited prescriptions for bubprenorphine which has been successfully used in Asia and Europe; Debates on the use of drug to treat addiction in Congress.

The article reports on a 2011 announcement from the medical products manufacturer Johnson & Johnson, in which the firm stated that it had submitted a supplemental New Drug Application to the U.S. Food and Drug Administration for the drug Nucynta, which is used to treat diabetic neuropathy.

The article discusses the approval of a tracking system to help physicians in Massachusetts determine whether patients seeking narcotics are doctor shopping or whether they are truly in need of pain medication.

The article offers news briefs related to drug and alcohol addiction in the U.S. According to the Drug and Alcohol Dependence, half of the federal and state prison systems offer opiate replacement therapy (ORT), despite its demonstrated efficacy and economic benefits. Meanwhile, a resident in Arkansas died after he and another man extracted and consumed a gel from a fentanyl patch.

Reports on the Arizona state Senate's approval of Proposition 200 to prohibit the medical use of marijuana and other federally controlled substances until such drugs receive US Food and Drug Administration approval. Governor Fife Symington's pledge to sign the bill into law; Voters approval of a comprehensive ballot measure which includes a provision allowing physicians to prescribe drugs as medical treatment.