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The most prominent issue at the large conference (attended by more than 1,700) of the American Association for the Treatment of Opioid Dependence (AATOD) was regulation, specifically, the new guidelines from the Substance Abuse and Mental Health Services Administration (SAMHSA) on how opioid treatment programs must operate. [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]

Not just another meeting, the conference of the American Association for the Treatment of Opioid Dependence (AATOD) held last week in Las Vegas was a coming together of the minds of the only providers in the country who have ever treated patients with opioid use disorder (OUD) with methadone. And it was clearly time for this meeting to be a positive one, focused on the importance of comprehensive care to patients. ADAW has written about the challenge to opioid treatment programs (OTPs) posed by the Modernizing Opioid Treatment Access Act (MOTAA) many times (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34028, https://onlinelibrary.wiley.com/doi/10.1002/adaw.34003, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33951), and one key advocacy session on May 21 presented the case very clearly. [ABSTRACT FROM AUTHOR]

Forget about the meaningless term "behavioral health" (even though you'll see it everywhere). It's not a standard of care for people with addiction. This is especially true for peers. Would you want someone with depression you in your recovery from addiction? Or, would you want someone with addiction helping you in your recovery from depression? [ABSTRACT FROM AUTHOR]

Called the 988 Suicide and Crisis Lifeline, this three‐digit number was launched more than a year ago by the Substance Abuse and Mental Health Services Administration (SAMHSA) to great fanfare. It appeared to everyone to be mainly for suicide prevention. But it is in fact for every crisis, and substance use is included. [ABSTRACT FROM AUTHOR]

The recent Federal Trade Commission (FTC) and Department of Justice (DOJ) action against Monument Inc. for selling patient data, is just the tip of the iceberg. Monument Inc. positions itself as a treatment provider (the website home page says it provides "therapy" for alcoholism) but in its extensive terms of use, it says it is not a treatment provider. And in fact, since the FTC/DOJ action last week, Monument radically changed its website, removing the offending promise of "confidentiality" which it breached, but still selling services (lowest price $15/month). [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]

Changes to the CFR 42 Part 8 regulations covering methadone treatment for opioid use disorder (OUD) have been welcomed by opioid treatment programs (OTPs) (see ADAWhttps://onlinelibrary.wiley.com/doi/10.1002/adaw.34023), which are the only providers with experience using methadone for this condition. However, the devils are, as always, in the details. It's not just a matter of the Substance Abuse and Mental Health Services Administration (SAMHSA) changing its rules. [ABSTRACT FROM AUTHOR]

There's no way that publicly funded treatment for substance use disorders (SUD) can survive on any one program. This includes the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant, which some people — and some states — think covers it all. Far from it, the block grant has remained at just about $2 billion for decades. So it's important from time to time to remind everyone — policymakers, treatment providers and patient advocates — that states and program managers can use braided funding, but often need more information on what sources are available and how they can be used. [ABSTRACT FROM AUTHOR]

The Legal Action Center has been a central resource for information on 42 CFR Part 2, the regulation protecting (ostensibly, now) confidentiality of substance use disorder (SUD) treatment records, for more than three decades. This article is our 350th one on Part 2 since 2010, when the move to weaken the consent part of the regulations began. So we talked to Legal Action Center attorneys Jacqueline Seitz and Deborah A. Reid last week about the Final Rule for Part 2, issued this month by the Department of Health and Human Services (HHS) (see Confidentiality for SUD records: Final rule issued, ADAW Feb. 19; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34035). [ABSTRACT FROM AUTHOR]

New York Governor Kathy Hochul has proposed cutting the budget of the state's Office of Addiction Services and Supports (OASAS) by more than 13% and supplanting the funding with money from the opioid settlement fund. This, according to treatment providers and other experts, is not good policy. [ABSTRACT FROM AUTHOR]

On Feb. 2 the Substance Abuse and Mental Health Services Administration (SAMHSA) released its final rule for opioid treatment programs and methadone, just as ADAW went to press (see SAMHSA issues final rule updating OTP methadone rules, ADAW Feb. 5; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023). The American Association for the Treatment of Opioid Dependence (AATOD), which represents more than 1,300 opioid treatment programs (OTPs) in the United States, last week commended SAMHSA for the guidance, which it called "enlightened and thoughtful." In a Feb. 5 press statement, AATOD president Mark Parrino noted that the regulations have been reviewed by the Drug Enforcement Administration (DEA). For the final rule, go to https://www.federalregister.gov/documents/2024/02/02/2024‐01693/medications‐for‐the‐treatment‐of‐opioid‐use‐disorder. [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]

This month, the Contingency Management Policy Group (CMPG) headed by H. Westley Clark, M.D., issued a statement calling on the federal government to rescind the $75 limit on what can be paid per year to patients being treated for substance use disorder. Contingency management is the only effective treatment for stimulant use disorders, involving payment for negative drug tests, but it doesn't work unless the dollar figure is much higher. [ABSTRACT FROM AUTHOR]

The oft‐cited statistic of 100,000 overdose deaths a year in the United States has an oft‐unspoken hidden additional tragedy: the children left behind when a parent dies. [ABSTRACT FROM AUTHOR]

Last week's annual meeting of the American Psychiatric Association (APA) featured much more than the usual addiction‐focused programming, which has been growing year by year. It was, under the direction of outgoing president Petros Levounis, M.D., himself an addiction psychiatrist, based on addiction. So is the current issue of the APA's flagship journal, the American Journal of Psychiatry, which featured three major articles on addiction. Two were presented last week; one, a commentary by Keith Humphreys, Ph.D., and colleagues, focused on the barriers to Medicaid reimbursement for treatment, mainly erected by a few states (ADAW will cover that in depth next week). [ABSTRACT FROM AUTHOR]

Allegra Schorr and Linda Hurley will each receive the Nyswander/Dole "Marie" Award during the conference of the American Association for the Treatment of Opioid Dependence (AATOD) next month. Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates of New York State (COMPA), and Hurley, president and CEO of CODAC Behavioral Healthcare in Rhode Island, will accept the awards from AATOD. The award, the highest accolade AATOD can bestow upon someone in recognition for having made significant contributions in the field of opioid use disorder treatment, is named after Vincent Dole, M.D., and Marie Nyswander, M.D., two pioneers in the research of medication‐assisted treatment for addiction. Dole and Nyswander were the first recipients of this award in 1983. [ABSTRACT FROM AUTHOR]

The Substance Abuse and Mental Health Services Administration (SAMHSA), which regulates opioid treatment programs (OTPs), buprenorphine prescribing, and funds the block grant for publicly funded treatment for substance use disorders (SUDs) has called on providers to make treatment easier to access. In SAMHSA's "Advisory: Low Barrier Models of Care for Substance Use Disorders," released quietly on Dec. 8, the federal agency said research proves that "low barrier" care — a phrase from advocates who wanted fewer restrictions to buprenorphine (most of which have now been removed) — is effective. The document calls patients "clients" (most of the time), and cites research supporting bridge clinics, syringe services programs, and "culturally responsive and trauma‐informed care." Although the advisory is not limited to opioids, much of the content, and references, are, with a special focus on buprenorphine. Mutual support organizations like Alcoholics Anonymous, which is free, are not mentioned. [ABSTRACT FROM AUTHOR]

Overdose deaths tripled among 35 to 44‐year‐old pregnant and postpartum women (PPW) from 2018–2021 and rose markedly in all pregnant and postpartum girls and women ages 10 to 44, a new study by the National Institute on Drug Abuse (NIDA) has found. The study, "Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID‐19 Pandemic," was published Nov. 22 in JAMA Psychiatry by Beth Han, M.D., Ph.D., and colleagues from NIDA. [ABSTRACT FROM AUTHOR]

When we weren't looking, the annual "Innovations" issue crept up on us. And coincidentally, so did advances in the use of psychedelics to treat substance use disorders (SUDs). ADAW reviewed its own archives, as well as the medical literature, attended a conference and found that indeed, psychedelics can be used not only to treat post‐traumatic stress disorder (PTSD), but to treat SUDS, in particular, alcohol use disorder (AUD). [ABSTRACT FROM AUTHOR]

Last week the Drug Enforcement Administration (DEA) announced that it would extend exceptions that went into effect at the start of the COVID‐19 pandemic for telemedicine prescribing of buprenorphine. The exceptions, started in March 2020 (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664), allow for prescribing buprenorphine even in cases where there is no in‐person medical evaluation and were initially meant to limit the spread of the virus. Now, however, they are discussed as ways to limit the overdose crisis. The proposal applies, moreover, to all controlled substances, not just to buprenorphine. [ABSTRACT FROM AUTHOR]

The "central registry" is a state‐run system in every state with opioid treatment programs (OTPs) and is designed with one purpose: to keep patients from enrolling in more than one program. The model central registry is New York's, set up decades ago by John Phillips, long retired from the state but an active member and co‐president of Stop Stigma Now. Legally, a central registry preserves the confidentiality of patient information, and collects no information other than what is needed to prevent multiple enrollments. It collects nothing about dose, pregnancy status, and so on. [ABSTRACT FROM AUTHOR]

In the first head‐to‐head study of nalmefene nasal spray (OPVEE is the trade name) vs. naloxone to reverse opioid overdose conducted in volunteers, researchers found that nalmefene worked faster than a 4 milligram (mg) dose of naloxone. It worked much faster, in fact, 2.7 mgs of OPVEE reversed respiratory depression within five minutes, compared to 20 minutes for 4 mgs of naloxone. The study, "Reversal of Opioid‐Induced Respiratory Depression in Healthy Volunteers: Comparison of Intranasal Nalmefene and Intranasal Naloxone," was published March 11 in the Journal of Clinical Pharmacology. The opioid that was given to the volunteers was remifentanil, a synthetic opioid. [ABSTRACT FROM AUTHOR]

Recent news from Oregon and California indicate that decriminalization has failed and encouraging public drug use isn't actually a success either. Measure 110, passed in Oregon three years ago, decriminalized possession of small amounts of all illegal drugs. Overdose rates went up, as more drug users were attracted to the state. The streets of San Francisco and Oakland, California, just for example, have been populated by out‐of‐state drug users looking for cheap fentanyl, government hand‐outs, and most recently, free housing. [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]

Women who use prescription opioids for pain during pregnancy are more likely to deliver their babies prematurely, a study by Sarah S. Osmundson, M.D., and colleagues at Vanderbilt University has found. The study, "Prescription Opioid Exposure During Pregnancy and Risk of Spontaneous Preterm Delivery," was published Feb. 5 in JAMA Network Open. [ABSTRACT FROM AUTHOR]