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Last week, ADAW featured a published paper recommending that higher doses of buprenorphine be used in the era of fentanyl (see "ASAM recommends higher doses if needed for treatment with buprenorphine," ADAW, Jan. 7, 2024, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.33984). The American Society of Addiction Medicine (ASAM) did not have time to get back to us by deadline but did respond to our questions for this week's issue. Below are our questions, in italics, followed by their responses. [ABSTRACT FROM AUTHOR]

A policy paper released this month by the American Association for the Treatment of Opioid Dependence (AATOD) focuses on some of the challenges facing opioid treatment programs (OTPs) today. For example, it cites an article published in the New England Journal of Medicine (July 5, 2018) by Michael Botticelli that promotes the idea of methadone being available in primary practice settings for the treatment of opioid use disorder (OUD) (see ADAW, July 16, 2018). "AATOD recommends that this proposal should only be considered after careful, conservative, and thoughtful evaluation," according to the policy paper. "As history and our policies have shown, we do not reject the public health model for increasing access to care for OUD, nor are we ignoring what has been learned about clinical standards of care to treat this illness. It is important to understand, however, the complexity of inducting a new patient into methadone maintenance treatment when developing policies for increasing access to medication assisted treatment." [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]

Last week's issue featured the announcement of a new payment model for addiction treatment, a combination of capitated and bundled reimbursement that places the treatment provider at risk in the event of repeat admissions. Greg Williams, executive vice president of Facing Addiction with NCADD, described the rationale for the system: Treatment providers should not be paid if patients don't get well. Anne Marie Polak, senior director at Leavitt Partners and in charge of the “Incentivizing Recovery” project the organization is convening, described the basics of how the project works. None of the treatment organizations participated in the project, which resulted in the white paper released Sept. 7 (see ADAW, Sept. 17). [ABSTRACT FROM AUTHOR]

The article discusses a white paper issued by Beacon Health Options "Confronting the Crisis of Opioid Addication" calling for a focus on outpatient medication-assisted treatment by primary care. Topics discussed include its focus on the need to treat opioid addiction as chronic condition, its criticism of providers of detox who did not participate in the continuum of care needed for chronic conditions and its support for 10 levels of care of the American Society of Addiction Medicine (ASAM).

The article presents the white paper from American Association for the Treatment of Opioid Dependence (AATOD) which focuses on how opioid treatment programs can coordinate with office-based buprenorphine prescribers.

A new research paper on the neurobiology of opioid addiction is replete with complex terms, such as the pivotal "hyperkatifeia" (coined about a decade ago to describe an increase in the intensity of the negative emotional signs of drug withdrawal). But the primary takeaway message from the report's author, National Institute on Alcohol Abuse and Alcoholism (NIAAA) Director George Koob, M.D., is much more accessible and direct. [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]

The article looks at a paper authored by the American Society of Addiction Medicine (ASAM) which calls for the banning of medical marijuana due to the oath of physicians to do no harm to patients. The U.S. Food and Drug Administration's policy on smoking marijuana as a means of drug delivery is reviewed. The ASAM's view on the addictive properties of marijuana are discussed.

The article focuses on a report in an issue of the "Palm Beach Post" on the downfall of the sale of a portfolio of addiction recovery treatment centers by real estate investor Frank Cid due to alleged kickbacks, patient brokering and fraud. It cites the alleged unethical practices in patient urine testing and billing, move by Cid to sue Florida Association for Recovery Residences (FARR) president John Lehman for defamation and the impression of Lehman over the revenue source of the centers.

The article explains that stainless steel paper clips help in the production of medications that treat addiction because the steel makes chemical reactions produce a higher opiate yield in drugs such as buprenorphine with naloxone.

Two recent research papers highlight ongoing deficiencies in the provision of addiction and mental health treatment services to veterans, though the report focusing on depression treatment for patients with substance use disorders (SUDs) suggests that shortcomings in treatment for co‐occurring disorders affect all populations. [ABSTRACT FROM AUTHOR]

A deeply researched white paper shows how mutual support groups can assist — and have assisted — people trying to deal with their drug use. The paper summarizes research on the use of these support groups and details how Narcotics Anonymous (NA) helps drug users, in much the same way Alcoholics Anonymous helps alcohol users, but there are some important distinctions. [ABSTRACT FROM AUTHOR]

This article discusses findings of the study "A Systematic Review of the Relationship Between Staff Perceptions of Organizational Readiness to Change and the Process of Innovation Adoption in Substance Misuse Treatment Programs." Topics covered include the research papers on "organizational readiness to change" reviewed by researchers, a model for outlining the measures for organizational readiness for change, and how treatment programs can embrace innovations -- new evidence-based practices.

The article talks about the concept of civil commitment for substance use disorders (SUDs), discussing a research paper released by Hazelden Betty Ford Foundation. Topics discussed include the views of some people that addiction is a disease and its treatment should not be coerced; a paper by the U.S. National Institute on Drug Abuse (NIDA) on it; and the benefits of involuntary commitment laws for substance use disorders.

The article discusses Recovery Brands and Elements' white paper on Internet marketing which was presented during the annual meeting of the National Association of Addiction Treatment Providers (NAATP). Topic discussed include claims that Recovery Brands' website does not allow advertisers to promise cures, its promise to fully disclose site ownership and sponsorships and examples of unethical digital marketing practices such as the use of only one phone number by a low-quality directory site.

A new payment model for addiction and recovery services was released last week in the form of a white paper called “Incentivizing Recovery.” The model, which is based on bundling — multiple providers get paid from the same fee — and capitation — the fee is preset, as in managed care – was proposed by Leavitt Partners, Facing Addiction with NCADD and Remedy Partners. [ABSTRACT FROM AUTHOR]

In a far‐reaching clarion call for attention to addiction in the midst of the COVID‐19 pandemic, Pete Nielsen, CEO of the California Consortium of Addiction Professionals and Programs (CCAPP), urges policymakers to recognize that the isolation required in shelter‐in‐place will fuel even more deaths from alcohol, drugs and suicide. In The Disease of Addiction Thrives on Isolation, released this month, Nielsen warns that these deaths were already "on track to break records in the number of victims in our state this year," and goes on to say that those "who survive this year will face a second wave of death due to tobacco related diseases and or relapse to drug of choice unless tobacco is routinely treated in substance use disorder." [ABSTRACT FROM AUTHOR]

The article focuses on the growing involvement of peer-based services in the recovery process of individuals leaving treatment for addiction in the U.S. The author discusses the problem of distinction on the role of peer support workers in the addiction service continuum and its integration within the community treatment infrastructure. Moreover, the author cites the paper of William L. White, which gives emphasis on authority distinction among peer support workers, sponsors and counselor.

ADAW asked a number of national leaders to reflect on the coming months and assess what they foresee in the treatment of alcohol use disorder (AUD), and respondents took care to cast their responses in a positive light. But given the many challenges from a scientific and societal standpoint in achieving breakthroughs in AUD treatment, a comment from Rutgers Health Department of Emergency Medicine Chair Lewis S. Nelson, M.D., may have best summarized the complexity of the task ahead. [ABSTRACT FROM AUTHOR]

The article cites the release of a report, called the white paper, by the U.S. Treatment Research Institute (TRI) that offers guidance on what substance abuse treatment providers must do to integrate with primary health care. Topics include an overview of the movement of treatment services toward collaboration and co-location with health care, how to solve existing problems associated with integration, and barriers to integration. INSET: Workforce changes.

The article discusses the traditional six-month rule of demonstrated abstinence from alcohol use before liver transplant eligibility. Topics covered include the reference given to a paper which deals with inadequate referral to transplant for end-stage liver disease patients with an alcohol use history and the story related by surgeon Richard B. Freeman which sought to determine which patients with kidney disease should receive dialysis.

The article presents study conducted by researchers from Brandeis University's Heller Graduate School for Social Policy and Management, discussing short of patient limits suffered by buprenorphine prescribers. Topics include substantial gap between permitted capacity and actual prescribing practice; views of professor Cindy Parks Thomas, on same; and concerns over Drug Enforcement Administration scrutiny of medical records.

The article discusses concerns by the National Association of Drug Court Professionals (NADCP) over the medication-assisted treatment (MAT) for people with addiction in trouble with the criminal justice system. Topics discussed include the opposition of the criminal justice system to methadone and buprenorphine as little is known about what medications work for what patients and how long the treatment should last and the refusal of courts to allow clients to remain on MAT.

The article discusses a study that determined the inadequacies of screening, brief intervention and referral treatment (SBIRT) as addiction treatment route. It references a study published in "Addiction" that evaluated alcohol interventions in randomized controlled trials (RCTs) in general healthcare. Findings indicated lack of evidence on viability of SBIRT for illegal drug use treatment and recommends buprenorphine treatment right away for disorders due to use of opioid use or misuse.

The article discusses the features of the Substance Abuse and Mental Health Services Administration's (SAMHSA) geographic U.S. map. Topics covered include the shortcomings of the map such as the non inclusion of buprenorphine providers and poverty factor not reflecting income status of opioid users as well as the non-inclusion of naltrexone and concerns about the second round of funding of the SAMHSA.

The article reports on a survey of the American Association for the Treatment of Opioid Dependence (AATOD) related to limitation in access to opioid treatment programs (OTPs) in the U.S. states. Topics discussed include absence of Medicaid coverage being the major cause of limitation; exclusion of buprenorphine drug treatment for opioid abuse in Medicaid reimbursement; and views of Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) President Allegra Schorr on the same.

The latest comprehensive analysis of brief substance use interventions in general medical settings suggests that while brief interventions targeting alcohol may lead to small decreases in alcohol use, the evidence base for brief interventions targeting other drugs remains very limited. [ABSTRACT FROM AUTHOR]

The research conducted to date on using methadone in office‐based settings to treat opioid use disorder (OUD) suggests that patients generally report greater satisfaction with their care and see no sacrifice in treatment outcomes, according to a newly published review. A somewhat surprising aspect of the findings, however, indicates that the pace of research on this subject has slowed to a crawl at a time of significant urgency in improving access to high‐quality OUD treatment. [ABSTRACT FROM AUTHOR]

Operating with less national fanfare than the prominent public debate over reforming police practices, a nonprofit initiative that began in Massachusetts in 2015 continues to build toward its mission to make nonarrest diversion a standard law enforcement practice nationally. [ABSTRACT FROM AUTHOR]

The article reports that public comments are seeked by the U.S. Agency for Healthcare Research and Quality (AHRQ) on a draft that will establish protocols for the treatment of opioid use disorder with medications in primary care settings, and mentions deadline for sending comments.

Carl Varney and Shannon Hall — two men from eastern Kentucky with severe opioid use disorder (OUD) in the past — praised their recovery at Teen Challenge, a Christian faith‐based, abstinence‐based treatment program. We don't hear enough about this aspect of treatment, which, although controversial because it is faith‐based and abstinence‐based and not welcome in many states, works for some people. Here is Varney's story, which he told to ADAW at the Rx and Illicit Drug Summit last month. [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]

The article looks at strategic initiatives of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), focusing on the need for substance abuse recovery support. Additional topics discussed include the promotion of social inclusion for recovering drug addicts and efforts to reduce underage drinking and prescription drug abuse.

The article discusses how U.S. economic conditions have shifted the fund raising strategies of alcohol and drug abuse treatment centers. Topics include an overview of the fund raising strategies being used by leaders at various treatment centers, such as a celebrity luncheon, featuring U.S. radio and television celebrity Dr. Drew Pinsky, by Arapahoe House in Colorado.

It may be more difficult to engage individuals with illicit drug use disorders into 12‐Step participation compared with those with alcohol use disorders, but newly published data suggests that the effort carries a significant payoff. [ABSTRACT FROM AUTHOR]

A much‐studied South Dakota initiative addressing repeat offenders for driving under the influence (DUI) now has the most compelling research evidence of support to date, with publication of individual‐level data showing program participants less likely to face rearrest or revocation of probation. The 24/7 Sobriety Program neither requires nor forbids offender participation in substance use treatment, relying instead on the deterrent effect of frequent alcohol testing combined with modest sanctions for noncompliance. [ABSTRACT FROM AUTHOR]

Opioids are still the dominant news story in the substance use disorder (SUD) field. Last year saw continued funding from the Substance Abuse and Mental Health Services Administration — and, of course, Congress — for the treatment field. Formulations of buprenorphine, the looming loss of confidentiality protections, the growing acceptance of cannabis, and a focus on quality and ethics were among the important stories for ADAW readers. [ABSTRACT FROM AUTHOR]

Zachary Talbott, who founded Counseling Solutions Treatment Centers in 2015 and operated opioid treatment programs (OTPs) in Chatsworth, Georgia, and Murphy, North Carolina (see ADAW, August 17, 2015), which were then acquired by BayMark Health Services in August 2018 (see ADAW, Sept. 10, 2018), and who ultimately set his sights on returning home to Maryville, Tennessee, had a plan. Anyone who knows him knew he would. He recently joined ReVIDA Recovery Centers as their director of clinical services to develop, implement and oversee a comprehensive behavioral health program within the company's continuum of care. [ABSTRACT FROM AUTHOR]

The article reports that the director of the U.S. Office of National Drug Control Policy, Gil Kerlikowske, gave a speech emphasizing the necessity of including substance abuse treatment with services offered alongside primary care.

An excerpt from a 2010 position paper on patient privacy protection and electronic health records from the U.S. advocacy group for substance abuse treatment advocacy, Faces and Voices of Recovery, is presented.

The article announces the features of the celebrity treatment program called, "Promises Malibu and Passages," in the U.S. The article reveals that the celebrity program requires the patient to pay a monthly fee of up to $40,000 regardless of the treatment period. In addition, Chris Prentiss, Passages cofounder, ensured the quality of its service.

The article announces the availability of the updated version of treatment programs guide from the Substance Abuse and Mental Health Services Administration. The 2006 "National Directory of Drug and Alcohol Abuse Treatment Programs" is a paper-based complement to the directory on the Internet. The updated directory provides information on treatment programs and facilities in the U.S., the District of Columbia, Puerto Rico and four U.S. territories.

Proposed legislation in New Jersey that would bar prior authorization requirements for medication‐assisted treatment (MAT) under Medicaid has sailed through several legislative committees, as medical specialists lament insurance wait times that can place patients with opioid use disorders at serious risk. [ABSTRACT FROM AUTHOR]

Addiction medicine consulting teams in acute‐care hospitals are beginning to show promise as an effective referral source to specialty treatment for opioid use disorders (OUDs). But inconsistencies in how these consult services are structured suggests much room for refinement, according to a newly published study. [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 kind of collaboration between generalist physicians and specialty treatment that has become second nature in addressing chronic conditions such as diabetes remains largely absent in the health care community's response to opioid use disorders. The result, say behavioral health experts interviewed by ADAW, often can be incomplete or inappropriate care in the office‐based practices that national leaders increasingly see as the focus of the treatment response to the opioid crisis. [ABSTRACT FROM AUTHOR]

The article reports on the phased-in program for heroin addiction in the state of Virginia to reduce waiting lists for treatment opportunities. It mentions the proposed state funding that will be matched by the federal government to expand treatment to all Medicaid members and increase reimbursement rates. Incoming chief medical officer Katherine Neuhausen discloses that starting January 1, 2017 any Medicaid member can walk into any facility and get treatment.

Announces that the Hazelden treatment program's Butler Center for Research and Learning is seeking nominations for the third annual Dan Anderson Research Award, which recognizes the work of a researcher who has advanced the scientific knowledge of addiction recovery. Requirements for nominees; Deadline for nominations; Contact information.

Reports that the Hazelden Foundation's Butler Center for Research and Learning is soliciting nominations for the Dan Anderson Research Award, recognizing the contribution of a researcher who has advanced the scientific knowledge of addiction recovery. Requirements; Nomination deadline; Contact information.