Dr. Ryan, Immediate Past President of OHSAM to be on Panel in Washington D.C. – Live Webcast Thursday

Despite rising rates of Americans suffering from opioid addiction, millions of Americans still lack access to quality, evidence-based treatment for opioid use disorder (OUD).  Although there is no “one size fits all” approach to treatment, there is strong evidence demonstrating the effectiveness of FDA-approved medications, including buprenorphine, methadone, and naltrexone, for OUD treatment. Supporting development, access, and adoption of medication-assisted treatment for OUD is a key priority of the U.S. Food and Drug Administration (FDA) as part of its response to the opioid crisis. However, substantial challenges remain in patient access and provider utilization of medications for OUD treatment.

The objective for this public workshop is to generate an active discussion with providers and health system stakeholders on the armamentarium of therapies to treat opioid use disorder, current barriers to appropriate use of these medications, and opportunities to further reduce stigma and expand access to effective pharmacotherapies as part of an evidence-based approach to OUD treatment.

While this project is supported through a cooperative agreement with FDA, the views expressed in the accompanying documents are those of the participants in attendance, and do not necessarily reflect the official positions and policies of the Department of Health and Human Services, or imply endorsements by the U.S. Government or other organizations.

To view the live webcast and participate in event discussion click the picture below:

Capitol Building

Event date/time:

September 20, 2018 –

9:00 am to 4:15 pm

 

Location:

529 14th Street NW, Floor 13 Washington, DC 20045

Contact Info

518-796-8992
sarah.supsiri@duke.edu

Schedule of events can be found here.

Click the Register button below to register for this event.

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It’s Time to Measure Addiction Recovery Rates, Not Just Addiction Rates

Lost among the headlines of opioid addiction and overdose deaths are the many quiet stories of recovery. An estimated 22 million Americans— that includes the three of us — are in recovery from opioid and other addictions. We say “estimated” because states and the federal government don’t track recovery like they track addiction rates or overdoses.

Oregon, recently ranked last in providing mental health and addiction treatment services by Mental Health America, and almost last in terms of adults needing but not receiving treatment for substance use disorders, is about to change that. We urge other states to follow.

In the midst of a serious addiction crisis, in which 72,000 people died from overdoses in 2017, it can be easy to forget that recovery is not only possible but is the reality for nearly 10 percent of U.S. adults. Losing sight of that can skew public policy and funding priorities to narrowly focus on preventing deaths instead of aiming more broadly to both reduce unnecessary deaths and promote long-term wellness among the 20 million Americans who have a substance use disorder — barely 4 million of whom receive treatment.

City Buildings with Sunlight

Since 1971, the Substance Abuse and Mental Health Services Administration (SAMHSA) has tracked the rates of substance use disorder in all 50 states and the District of Columbia. The tool it uses, the National Survey on Drug Use and Health, is invaluable for measuring tobacco, alcohol, and drug use, as well as mental health and other health-related issues. But it has never included questions related to the most positive outcome of having a substance use disorder — recovery from it.

Filling this gap has been left to researchers like Harvard University’s John F. Kelly, who directs the Recovery Research Institute, with work like the National Recovery Study. Kelly’s study has one critical limitation though: It provides recovery rates only at the national level and leaves out regional and local estimates.

That’s what makes state reporting so important. More accurate numbers about recovery could provide information on the success of expanding treatment for opioid use disorder and help state policymakers decide where to direct increasing federal aid for addressing the opioid epidemic. These state-specific rates could also be used to help monitor the success of new policies like Good Samaritan and naloxone access laws. Regularly collecting statistics on recovery could also give us a sense of accomplishment compared to the ever-increasing overdose rates since 2000.

Thanks to advocacy by Oregon Recovers and an executive order recently signed by Kate Brown, Oregon’s governor, that declared addiction to be a public health crisis in Oregon, a new effort aims to lower the state’s addiction rate and increase its recovery rate. The first goal of this strategic initiative is easily measurable, since the annual National Survey on Drug Use and Health provides state-by-state data on addiction rates. But measuring progress on improving recovery wasn’t possible — until now.

The state’s Public Health Division, in partnership with Oregon Recovers, plans to pilot a biannual measurement of recovery rates through the Adult Behavioral Risk Survey, to be done in collaboration with the Centers for Disease Control and Prevention.

The pilot will add three questions to the digital version of the survey, which is performed once in the fall and once in the spring. It will ask a sample of Oregonians 1) if they once had a drug or alcohol problem but no longer do; 2) if they identify as a person in recovery; and 3) what supports or resources they use to assist their recovery.

This kind of information will help state authorities, policymakers, treatment providers, and recovery community organizations better understand what is working (including large-scale investments in statewide addiction treatment systems via funds from the Comprehensive Addiction and Recovery Act and 21st Century Cures Act), what is not working, and how individuals with addictions and those in recovery can better be served.

City View From Building

States such as Pennsylvania, South Carolina, Florida, Nevada, and Wisconsin are beginning to explore similar initiatives, but many more states need to follow Oregon’s lead.

Given the logistics of trying to develop state-by-state initiatives to measure recovery rates, a more efficient approach would be for SAMHSA to modify the National Survey on Drug Use and Health so it can measure recovery nationally and deliver this information to states. That means the same things would be measured in the same ways in all states, ensuring that results about addiction and recovery are comparable across states.

As individuals in long-term recovery, we believe it is essential that federal, state, and local authorities begin shifting their focus from the problem of addiction to the solution of recovery by tracking recovery rates among individuals with substance use disorders. By following Oregon’s example and collecting this valuable information, communities hit hard by this crisis will have a more complete and nuanced picture of the effects local programs are having. That will help them achieve higher rates of success in treating substance use disorders and promoting long-term recovery — which should be held up as the norm and expected outcome for the millions of Americans living with active addictions.

Robert D. Ashford is a recovery researcher pursuing a Ph.D. in health policy at the University of the Sciences in Philadelphia. Olivia Pennelle is a recovery journalist and owner of Liv’s Recovery Kitchen. Brent Canode is co-founder and chair of Oregon Recovers, a statewide recovery advocacy organization serving all Oregonians.

By ROBERT D. ASHFORDOLIVIA PENNELLEand BRENT CANODE

AUGUST 30, 2018

Original article here on statnews.com.

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What is Opioid Use Disorder in the New DSM-5?

Opioid Use Disorder is a diagnosis introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. It combines two disorders from the previous edition of the Diagnostic and Statistical Manual, the DSM-IV-TR, known as Opioid Dependence and Opioid Abuse, and incorporates a wide range of illicit and prescribed drugs of the opioid class.

Probably the most well-known and notorious type of Opioid Use Disorder is Heroin Use Disorder, yet less than 10% of people aged 12-17 years old in the United States with Opioid Use Disorder take heroin.

 Most people with Opioid Use Disorder use analgesic opioids, or painkillers whether they are prescribed for themselves of for someone else, or obtained some other way.

Symptoms of Opioid Use Disorder

The diagnosis of Opioid Use Disorder can be applied to someone who uses opioid drugs and has at least two of the following symptoms within a 12 month period:

  • Taking more opioid drugs than intended.
  • Wanting or trying to control opioid drug use without success.
  • Spending a lot of time obtaining, taking, or recovering from the effects of opioid drugs.
  • Cravings opioids.
  • Failing to carry out important roles at home, work or school because of opioid use.
  • Continuing to use opioids, despite use of the drug causing relationship or social problems.
  • Giving up or reducing other activities because of opioid use.
  • Using opioids even when it is physically unsafe.
  • Knowing that opioid use is causing a physical or psychological problem, but continuing to take the drug anyway
  • Tolerance for opioids.
  • Withdrawal symptoms when opioids are not taken.

Does Anyone on Opioids Have Opioid Use Disorder?

No. Many people are prescribed opioids for pain, for long and short periods, and do not develop an opioid use disorder. And while it is often the case that people will develop physical tolerance to prescribed opioids, and experience physical withdrawal symptoms if they do not take the drug, DSM-5 explicitly states that these are not applicable if the individual is experiencing these symptoms under appropriate medical supervision. Why? Because addictive disorders are primarily psychological in nature, and although someone can develop normal physical responses to prolonged drug exposure, that in itself does not constitute a disorder, if they have no cravings for the drug, no difficulty using appropriate dosages, and no lifestyle problems as a result of taking the drug (although someone in pain may have reduced activity as a result of their pain, that is not the same as reduced activity because they are seeking out opioid drugs.) This is a major step forward in the understanding of substance use disorders.

While many problematic heroin users claim their use is non-problematic, typically heroin use causes more significant and long lasting problems for users than use of other drugs. The exact numbers of problematic and non-problematic heroin users is unknown, and because of the secrecy surrounding heroin use, so it is difficult to compare problematic and non-problematic users. It does appear that those who develop Heroin Use Disorder have very significant psychological problems even before they start using the drug. In contrast, those who are able to control and manage their use tend to be more psychologically healthy and socially advantaged prior to use. The same may be true of those who do or do not become addicted to pain medication, but much more research is needed to understand exactly why some people become addicted when they take opioids, while others do not.

Screening

There are several screening tools available that have been developed by experts in addiction, and published so that others can use them. These screening tools can be used to determine whether someone is may need to be assessed for opioid use disorder. One very commonly use, simple tool that is used to screen for substance use disorders is the CAGE questionnaire, which is easy to remember using the acronym CAGE as key letters in four revealing questions. If someone answers yes to any of these questions, they would benefit from a more complete assessment.

C – stands for “cut down” – “Have you tried to cut down on your drinking or drug use, but couldn’t?”

A – stands for “annoyed” – “Are family and friends annoyed about your drinking or drug use?”

G – stands for “guilty” –  “Do you ever feel guilty about your drinking or drug use?”

E – stands for “eye opener” – “Do you have a drink or use drugs as an ‘eye-opener” in the morning?

A more complex screening tool is the Opioid Risk Tool, which calculates the factors that place individuals at greater risk of having a substance use disorder. These factors include past family and personal history of substance use, a history of childhood sexual abuse, age, and history of past or present psychological disorders, including depression and schizophrenia.

Sources

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5TM. American Psychiatric Association. 2013.
  • Hser, Y., Evans, E., Huang, D., Brecht, M. and Li, L. “Comparing the dynamic course of heroin, cocaine, and methamphetamine use over 10 years.” Addict Behav 33:1581-1598. 2008.
  • Powell, D. “A pilot study of occasional heroin users.” Arch Gen Psychiatry 28 (4), pp. 586-94. 1973.
  • Sanchez, J., Chitwood, D. and Koo, D. “Risk Factors Associated with the Transition from Heroin Sniffing to Heroin Injection: A Street Addict Role Perspective.” Journal of Urban Health 83:896-910. 2006.

Original article here on verywellmind.com

For opiate addiction, study finds drug-assisted treatment is more effective than detox

Say you’re a publicly-insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

New research suggests you can do it the way most treatment-seeking addicts in the state do — by undergoing a medically-supervised “detoxification” that’s difficult, expensive and highly prone to failure.

Or you can try to quit the way that addiction researchers now widely agree it should be done (but rarely is): by combining abstinence programs with long-acting opioid medications such as methadone and buprenorphine, which allow patients to slowly wean themselves off their dangerous habit.

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Using drugs to treat opiate addiction is more effective and cheaper than detox programs, a new study says.

Neither method is easy, nor by any means failure-proof. But for each patient funneled into the second form of treatment, known as opioid agonist treatment, instead of the first, a study published Monday shows that taxpayers could reap substantial savings — $78,257 a person. And the patients themselves stand to gain longer and better lives.

Deep into a crisis of opioid addiction that claims 91 lives a day and holds close to 2.6 million Americans in its grip, the United States continues to suffer a yawning gap between what it knows about treatment and how the opiate-addicted are actually treated.

Close to 80% of those with an opioid-use disorder weren’t getting any treatment at all in 2015. Of the small sliver of those who did get some treatment, fewer than half in California got the kind of open-ended opioid agonist treatment that addiction researchers widely agree is most likely to lead to abstinence.

In fact, California, the state with the nation’s largest population of people with opiate addiction, still has regulations on the books that favor detox over opioid agonist treatment. For patients who are publicly insured, the state requires proof that a patient has tried detoxing two times or more and subsequently relapsed before it will pay for treatment with methadone or buprenorphine.

California’s Society of Addiction Medicine has said that medically managed withdrawal by itself should not be considered treatment of opioid use disorder. And exemptions to the state’s requirement are thought to be widely granted. Still, the language remains.

Published Monday in the Annals of Internal Medicine, the new study underscores that public policies that limit access to treatments such as methadone or buprenorphine don’t just shortchange patients who need help quitting; they’re costly to taxpayers footing the bill for their treatment as well.

If just one year’s worth of treatment-seeking opiate addicts were to get opioid agonist therapy instead of detox, the societal savings over the patients’ lifetimes would amount to $3.869 billion, the new study estimates.

Those patients would be in treatment longer, and the immediate cost of their treatment would increase, the new research finds. But over time, their increased likelihood of getting and staying clean would translate into lower downstream healthcare costs, a decreased likelihood of HIV infection (along with the costs of treating it), and less costly involvement with the criminal justice system.

“We believe our findings really do represent the reality in California,” said the study’s senior author, Bohdan Nosyk, a health economist with British Columbia’s Center of Excellence in HIV/AIDs. “The findings were really robust and, as new people come in, the savings will accumulate. So the numbers are conservative.”

Nosyk’s co-authors included addiction and epidemiological experts from UCLA’s Integrated Substance Abuse Programs and the Veterans Affairs Greater Los Angeles Healthcare System of Los Angeles.

In an editorial published alongside the study Monday, Drs. Jeanette M. Tetrault and David A. Fiellin said the new research strongly suggests that lawmakers should be using their policy clout to promote outpatient clinics that treat opiate addicts in their communities rather than costly inpatient units where patients go to detox.

“Threats to healthcare funding may have lasting consequences, especially if lawmakers do not heed the most science-based and policy-applicable data as decisions are being made,” wrote Tetrault and Fiellin, both Yale University internists with interests in addiction medicine.

Written by: Melissa Healy

Link to original article here: For opiate addiction, study finds drug-assisted treatment is more effective than detox