Participate in a Survey on the Use of Pharmacotherapy for the Treatment of Alcohol Use Disorders

ASAM member Nassima Ait-Daoud Tiouririne is conducting a survey at the University of Virginia on the use of pharmacotherapy for the treatment of alcohol use disorders by both psychiatrists and family practitioners. The survey looks at barriers preventing physicians from using medications with strong evidence for efficacy and ways to improve knowledge about these drugs. Participants that complete the survey may be entered in a raffle to win an iPad or a one-year membership to the American Society of Addiction Medicine. The survey is open through May 31 and may be completed online.

ASAM Chapters Foster Open Dialogue on Addiction Treatment

ASAM Chapters Foster Open Dialogue on Addiction Treatment

by Kate Volpe | Mar 29, 2013

NYSAM hosts a meeting in New York to provide education on addiction medicine practices and research.

The New York Society of Addiction Medicine (NYSAM) is mid-way through planning a series of local meetings throughout New York state to engage all addiction treatment providers in the latest research and best practices in treating addictions. NYSAM President, Norman Wetterau, MD, said in a recent NYSAM newsletter that the “NYSAM Board has had a vision that includes statewide dialogue among addiction medicine professionals and breaking down the walls between non-medical and medical groups providing addiction care.”

To facilitate this dialogue, NYSAM is in the process of developing a series of regional summits through a partnership with the Alcoholism and Substance Abuse Providers of New York State (ASAP) and Friends of Recovery – New York (FoR-NY).  Two regional sessions have been held, and each had over 200 people in attendance.   Each session is targeted to the local area, with region specific themes and summit agendas.  Designed as one day events, the summits follow a standard format: plenary speakers in the morning and educational sessions in the afternoon. The planning teams identify local government officials and professionals in medical, legal and judicial fields to provide insight and advice on addiction treatment.

At the regional summit in Long Island, a town hall meeting and press conference allowed attendees to submit questions throughout the morning that were answered by leaders from each organization. New York Assemblyman Joseph S. Saladino was invited to participate in the town hall. He has been very active in promoting awareness and education about addiction and recently helped sponsor legislation in New York for an enhanced prescription monitoring program called theInternet System for Tracking Over-Prescribing, or I-STOP. The Town Hall meeting was an overwhelming success with twelve media outlets attending, including FOX News, WCBS and Associated Press Video.

NYSAM worked to have the sessions that they organized approved for CME credit, and the other organizations worked to obtain credit hours for other treatment professionals. Dr. Wetterau said, “This collaboration with ASAP compliments the administrative support they provide for NYSAM and sets the table for increased collaboration on conferences and other events.”

The events help foster networks to continue the conversation long after each session ends. As Dr. Wetterau commented, “Substance use disorders are medical problems but they have many community and social aspects. Our patients need our medical help but also need services and assistance outside of our offices. As a result of these events at least one member of the NYSAM board will be in contact with non-medical leadership of these events. We can let each other know what we are doing, problem solve together and hopefully have future events together.”

NYSAM also joined forces with the other organizations to secure corporate support of the meeting, with each organization sharing notes and contacts about what had worked well in the past. Local hotels were used for each day-long meeting, and ASAP negotiated the contracts with the hotels.

For other ASAM chapters looking to set up similar types of events – the good news is that you don’t have to do it alone! Chapters can connect with other state level organizations like Associations of Substance Abuse Programs and Recovery Alliance networks. And there are many companies that help negotiate contracts and meeting planning at hotels, many of which work off of commission from the hotel at no cost to the organization. For more information on the NYSAM program, you can contact Dr. Wetterau or contact Janet Braga, the Director of Development at ASAP, both of whom helped coordinate all of the logistics for the summits.

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United Nations Office on Drugs and Crime - International Standards on Drug Use Prevention

There was a time when drug prevention was limited to printing leaflets to warn young people about the danger of drugs, with little or no resulting behaviour change. Now, science allows us to tell a different story. Prevention strategies based on scientific evidence working with families, schools, and communities can ensure that children and youth, especially the most marginalized and poor, grow and stay healthy and safe into adulthood and old age. For every dollar spent on prevention, at least ten can be saved in future health, social and crime costs.

These global International Standards summarize the currently available scientific evidence, describing interventions and policies that have been found to result in positive prevention outcomes and their characteristics. Concurrently, the global International Standards identify the major components and features of an effective national drug prevention system. It is our hope that the International Standards will guide policy makers worldwide to develop programmes, policies and systems that are a truly effective investment in the future of children, youth, families and communities. This work builds on and recognizes the work of many other organizations (e.g. EMCDDA, CCSA, CICAD, Mentor, NIDA, WHO2) which have previously developed standards and guidelines on various aspects of drug prevention.

Click here to download the Publication.

DRUGS OF DEPENDENCE THE ROLE OF MEDICAL PROFESSIONALS BMA Board of Science January, 2013

In this report, the BMA, through its Board of Science, seeks to open and refocus the debate on drug treatment and drug policy through the eyes of the medical profession. The first step in such a debate is to ensure that the facts are presented, along with the evidence to support them. For this reason, we have set out to establish the evidence and seek to draw conclusions from it. We do not have a predetermined medical position on the ways in which policy might be changed, rather a desire to start from a secure baseline of knowledge. As with so many other medical conditions, we believe that there is no ‘one size fits all’ solution to the problem of drug misuse, and the medical profession’s familiarity with the need for advocacy for each individual patient should be at the forefront of this debate.

There will inevitably be differences of opinion and of interpretation. Individuals have experiences that affect their views. They have different ethical, moral and religious persuasions; identifying a common, agreed pathway may prove to be difficult. Taking into account the myriad differences in approach across the world, this is no doubt an understatement.

As a surgeon, I have had limited contact with the medical problems associated with drug use but it has become clear to me that the present approach is not satisfactory. My understanding has been greatly enhanced by the superb team of contributors to this report. Their contributions have been reviewed by all of the main committees of the BMA. We believe that this report is an up-to-date resource that will provide the factual foundation for informed debate.

The medical profession would never condone drug taking. Individuals, who press others into experimenting with the use of drugs, may deserve punishment. But those who fall into drug dependence become a medical problem from which we, as a society, cannot escape and they badly need our help.

In this country, we are beginning to see evidence of a reduction in the use of hard drugs but they remain a major hazard for those who try them and the dependence that may follow is a lifelong problem for many.

So we acknowledge that, while some progress has been made, this should not lull us into the false belief that we can put this problem out of our minds in the hope that it might go away.

The medical profession should look squarely at the issue and debate it as a medical problem. We have vast expertise to call upon and compassionate understanding to offer. Our involvement, indeed our leadership, in this debate will ensure that the medical issues become central to the national debate and the criminal justice aspects are put into a more accurate context.

We have the special opportunity to listen to patients’ views and concerns and to guide them, as individuals, through the various treatment options. We owe it to the patients, their families and those around them to get actively involved in the national debate and so to ensure that the medical aspects are at the heart of the discussions.

Professor Averil Mansfield
Chairman, BMA Board of Science

Click here to download the Publication.

Addiction Expert: Care Needed in Implementing New Buprenorphine Prescribing Rules

In January, new government regulations took effect that allow greater take-home privileges for buprenorphine patients who are treated in clinic-based Opioid Treatment Programs (OTPs). While this change will allow more patients to have increased flexibility as they progress in their recovery, providers must be careful in deciding who to give the medication to, in order to avoid diversion, says a New York addiction specialist.

“Prescribers and the rest of the health care team need to have a dual focus on both doing everything they can to help the patient, and also trying to keep buprenorphine prescribing safe by limiting misuse, abuse and diversion that may come about by their prescribing,” says Dr. Edwin A. Salsitz, MD, Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center.

The changes in regulations, made by the Substance Abuse and Mental Health Services Administration (SAMHSA), do not apply to methadone treatment. Previously, patients could not receive a one-week take-home supply of buprenorphine or methadone from an OTP until they were stable in treatment for nine months. Under the new rule, this time requirement for patients receiving buprenorphine products no longer applies. If an OTP physician program physician determines that a patient is suitable, the program can dispense a one-week supply of medication, or longer, to a newly admitted patient.

SAMHSA made the changes based on several factors, including differences between methadone and buprenorphine in abuse potential and actual abuse, death rates, and the fact that methadone is subject to tighter federal controls than buprenorphine. “Buprenorphine abuse has been increasing, but SAMHSA believes that the controls and oversight in place in the OTP, as well as enhanced monitoring will mitigate abuse concerns,” the agency stated in a letter to treatment providers.

Buprenorphine also can be prescribed by certified physicians in an office-based setting, known as office-based opioid treatment (OBOT). Office-based treatment is a popular choice among patients who wish to avoid daily visits to a treatment clinic, Dr. Salsitz notes. However, he adds, not all patients are initially suitable candidates for office-based treatment. “The main benefit of someone going to an opioid treatment program and being dispensed buprenorphine is the security and structure that OTP provides,” he says. “It is virtually impossible for an OBOT to provide the same oversight, structure and security for both the patient and the medication, as is provided by clinic-based treatment. One possible paradigm is to begin buprenorphine treatment in an OTP if enhanced oversight and structure are needed, and then when the patient has stabilized, the patient can be referred to an office-based treatment program.”

Choosing whether a patient addicted to opioids should be treated with buprenorphine or methadone, and whether they should be treated in a clinic or in a physician’s office, are complicated issues, Dr. Salsitz observes. “These issues currently have no clear answers, but they need to be researched and evaluated,” he says.

In stressing the need for strict oversight of buprenorphine prescribing, Dr. Salsitz pointed to a recent SAMHSA report that found hospital emergency department visits linked to buprenorphine increased substantially – from 3,161 visits in 2005 to 30,135 visits in 2010, with 52 percent involving non-medical use. He notes, “If a doctor gives a new patient 30 days of buprenorphine without any real followup, some of that medication may end up on the street.”

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