Somewhat Better Outcomes With Longer-Term Treatment For Opioid-Addicted Youth

New research published in the November 5 issue of JAMA reveals that long-term therapy rather than short-term therapy for opioid-addicted adolescents yields better results. Those who received continuing treatment with the combination medication buprenorphine-naloxone were less likely to test positive for opioids and reported lower rates of opioid use compared to adolescents who participated in a short-term detoxification program with the same medication.

Adolescents tend to abuse opioids in the form of heroin or prescription pain-relief medications. Recent research suggests that more and more young people are abusing these types of drugs, and therefore treatment needs are rising as well. "The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months. Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist medication [drugs that mimic the effect of opioids by altering the receptor]," write George Woody, M.D. (University of Pennsylvania, Philadelphia) and colleagues.

To compare outcomes of opioid-addicted adolescents who receive either short-term detoxification or long-term treatment using buprenorphine-naloxone, Dr. Woody and colleagues conducted a study with 152 patients, 15 to 21 years of age. The long-term treatment medication consists of an oral medication that relieves symptoms of opiate withdrawal (buprenorphine) and a drug that prevents or reverses the effects of injected opioids (naloxone). Patients who were randomized to receive the 12-week buprenorphine-naloxone treatment received up to 24 mg. per day for 9 weeks and smaller amounts through the twelfth week. The remaining participants (the detox group) received up to 14 mg. per day, with doses tapering off through day 14. Individual and group counseling was offered to all participants.

Wood and colleagues found that at weeks 4 and 8, the detox group had a higher percentage of opioid-positive urine test results. Specifically, after 4 weeks, 61% of participants in the detox group had opioid-positive urine test results compared to 26% of participants in the 12-week buprenorphine-naloxone group. The figures after 8 weeks were 54% positive in the detox group and 23% positive in the 12-week buprenorphine-naloxone group. By the twelfth week, the buprenorphine-naloxone group had been tapered off of their treatment and 43% tested positive for opioids compared to 51% of detox group patients.

About 21% of detox group patients and 70% of buprenorphine-naloxone patients remained in treatment by week 12. Patients in the 12-week buprenorphine-naloxone group reported, during weeks 1 through 12, less use of opioids, cocaine and marijuana, as well as less injecting and less need for additional addiction treatment. Both groups measured high levels of opioid use at follow-up.

The authors clarify that, "Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group."

"Because much opioid addiction treatment has shifted from inpatient to outpatient where buprenorphine-naloxone can be administered, having it available in primary care, family practice, and adolescent programs has the potential to expand the treatment options currently available to opioid-addicted youth and significantly improve outcomes," conclude Woody and colleagues." Other effective medications, or longer and more intensive psychosocial treatments, may have similarly positive results. Studies are needed to explore these possibilities and to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence."

David A. Fiellin, M.D. (Yale University School of Medicine, New Haven, Conn.) writes in an accompanying editorial that more evidence is necessary in order to claim any treatment is effective for opioid-addicted individuals.

He concludes that: "The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling; close monitoring for relapse; and, in some cases, naltrexone should be offered following buprenorphine tapers. From a research perspective, additional efforts are needed to provide a stronger evidence base from which to make recommendations for adolescents who use opioids. There is limited research on prevention of opioid experimentation and effective strategies to identify experimentation and intercede to disrupt the transition from opioid use to abuse and dependence."
___________
source: MediLexicon News

Titan Pharmaceuticals Announces Positive Results from Phase III Clinical Trial of Probuphine for the Treatment of Opioid Addiction

Titan Pharmaceuticals, Inc. (AMEX:TTP) today announced positive, statistically significant results from its randomized, double-blind, placebo controlled, multi-center Phase III clinical trial of Probuphine®. Probuphine is Titan’s novel, subcutaneous implant formulation designed using its ProNeura technology to deliver six months of buprenorphine. Buprenorphine is currently marketed as a sublingual formulation for the treatment of opioid addiction.

Probuphine showed a clinically and statistically significant difference over placebo in illicit opioid use over 16 weeks as measured by urine testing performed three times per week (p=0.0361) – this was the primary endpoint acceptable to the U.S. Food and Drug Administration (FDA). Additionally, Probuphine achieved statistical significance in the Phase III trial’s key secondary endpoint, the difference in illicit opioid use from weeks 17-24 (p=0.0004). Moreover, Probuphine treatment showed a statistically significant difference in illicit opioid use versus placebo over the full six-month (weeks 1-24) period (p=0.0117).

“We are extremely pleased by these positive results and the potential of Probuphine to be an important advance in the treatment of opioid addiction,” said Marc Rubin, M.D., President and CEO of Titan. “Even as buprenorphine, with estimated sales of half a billion dollars in worldwide sales, is fast becoming the gold standard for opioid addiction treatment, there are growing concerns about compliance with and abuse of the currently available treatment options and a critical need for safe, effective treatment options. These data show that our proprietary subcutaneous implant can safely deliver Probuphine over six months. We look forward to completing this development program and forging strategic alliances to commercialize Probuphine worldwide.”

Additional secondary efficacy analyses, including the mean percentage of urines negative for illicit opioids over treatment weeks 1-16, 17-24, and the complete six-month period also statistically favored Probuphine over placebo. Another important indicator of treatment effectiveness, patient retention, was approximately 66 percent for Probuphine compared to 31 percent for placebo. Probuphine was also well tolerated throughout the six-month trial.

“These data are very promising and I believe that the success of Probuphine should have a very significant impact on our ability to effectively treat opioid addiction,” said Walter Ling, M.D., Professor of Psychiatry and Director of the Integrated Substance Abuse Programs at the David Geffen School of Medicine at UCLA, and a principal investigator in this trial. “As a clinician, I am concerned by the growing problem of opioid addiction, especially prescription opioid abuse, and the challenge of effectively treating our patients with a safe, abuse-resistant and diversion-resistant treatment. These data could translate into a dramatic change in our treatment possibilities.”

Worldwide, it is estimated that there are 6 million opioid addicts. Approximately one-half of this potential patient population is addicted to illicit opioids, such as heroin, and the other half to prescription drugs, such as oxycontin, methadone, and codeine. Until recently, the only approved medication assisted therapies for opioid addiction had been available at only a limited number of authorized facilities in the U.S. As of 2000, U.S. physicians can be certified to prescribe less restricted opioid addiction medications in an office setting, which has greatly expanded patient access to opioid addiction pharmaceutical therapies. Despite these advances, this remains a highly underserved market with only about 750,000 people globally receiving medicinal treatment for opioid addiction.
More details here...
___________
source: Business Wire

Illegal Painkiller Overdoses Kill More Than 1,000 Americans

More than 1,000 Americans died in 6 cities between 2005 and 2007 from overdosing on nonpharmaceutical fentanyl (NPF), in the biggest ever epidemic of overdoses involving illegally produced versions of the painkiller. Health officials predict there will be further outbreaks of NPF overdose because the illegal narcotic is easier and cheaper to produce than heroin.

The figures are being reported today by the US Centers for Disease Control and Prevention (CDC), in the 25th July issue of the Morbidity and Mortality Weekly Report (MMWR).

Illicitly manufactured nonpharmaceutical fentanyl (NPF) is 30 to 50 times more potent than heroin. It is a synthetic opioid and classed by the US authorities as a narcotic.

The findings of a CDC and Drug Enforcement Agency (DEA) investigation showed that between 4th April 2005 and 28th March 2007, a total of 1,013 deaths occurred in six US jurisdictions; the largest NPF epidemic to date. This is nearly 10 times higher than an epidemic in the 1980s when 110 people died of fatal overdoses of different fentanyl analogs, said the report.

The largest number of deaths were in metropolitan Chicago (349), Philadelphia (269), and Detroit (230). The other areas were St. Louis, Missouri, and the states of Delaware and New Jersey.

Emergency medical staff said some of the victims were found with the needle still stuck in their arms. The drug was so powerful that they died before completing the injection, said Dr Stephen Jones, a co- author of the report who is now retired from the CDC, reported Reuters.

The authorities decided to carry out the investigation after receiving a number of reports of overdoses linked to NPF. For instance in April 2006 increases in overdoses among illegal drug users were reported in Camden, New Jersey, which triggered similar reports in other jurisdictions, including Chicago and Detroit, which had been discovered earlier but falsely attributed to heroin overdose until urine samples of some of the dead showed traces of fentanyl.

Thus in May 2006 the CDC started ad-hoc case-finding surveillance in six state and local jurisdictions. This was later taken over by the DEA. This is how the 1,013 NPF related deaths were identified. After this the DEA started regulating access to N-phenethyl-4-piperidone, which is used to make illegal analogs of fentanyl.

The CDC report said the pattern of NPF overdoses points to illegal distribution networks, citing as an example that the NPF found in Chicago and Detroit most likely came from a clandestine production site in Mexico. However, they can't explain why they did not find any NPF-related deaths in other areas of high heroin use, such as in New York City.

As well as the deaths discovered through the CDC/DEA surveillance system, over the same period there were reports of other NPF-related deaths from suburban and rural areas of Illinois, Michigan, and Pennsylvania and in Kentucky, Maine, Maryland, Massachusetts, New Hampshire, Ohio, and Virginia.

The CDC suggested that although the number of NPF-related deaths spotted by the CDC/DEA surveillance system fell substantially in 2007, they predict further epidemics of NPF overdoses are likely because the drug is easier and cheaper to produce than heroin.

Deaths related to heroin and other illicit drugs are well documented in the US. From 1999 to 2005, the figure went up by 87.5 per cent, from 4.0 to 7.5 per 100,000 of the population (age-adjustied deaths from unintentional drug poisoning, mostly linked to pharmaceutical and/or nonpharmaceutical drugs).

The CDC said their report had four limitations: first the figures could be under-reported because for example only participating centers in six jurisdictions were included in the surveillance; second, there is no standard toxicology definition of cause of death for fatal drug overdoses; third, some of the deaths could be misclassified as NPF when they were really pharmaceutical fentanyl-related deaths (ie legal use); and finally, in addition to fentanyl, other substances may have contributed to the overdoses, including alcohol.

Nevertheless, the CDC said the figures are sufficient to warrant improvements in a number of areas relating to drug overdoses. These include improvements in identifying and reporting drug overdose, so law enforcers and public health officials can act more quickly (eg to seize drugs and provide outreach support).

The agency also said there was a need to develop or expand:

* National standards for toxicologic testing and classifying cause of death in drug overdose and poisoning.

* Professional standards for referring overdose surivivors for addiction treatment and education, such as those that exist for suicide survivors.

* Public health programs to help drug users get treatment, be educated about risks of overdose, and learn ways to avoid and deal with overdose.

Jones said in a telephone interview reported by Reuters that the report highlights "an extraordinary episode of fatal drug overdoses".

"But it's got to be recognized as part of the bigger problem of the increasing numbers of drug overdose deaths in the United States," he added.
_______
source: MediLexicon

Rehabbing: Abstinence vs. methadone

It’s not a news flash that Pike County has an above average percentage of drug abusers, nor is it a revelation that opiates are the drug of choice for most of the area’s addicts.

And, with the recent trial of Billy Reed, who was convicted of manslaughter for killing a motorcyclist while driving under the influence of methadone and other drugs, some in the county have questioned methadone’s use in the treatment of opiate addiction.

One of methadone’s opponents is the state’s largest anti-drug coalition, Operation UNITE, which favors abstinence-based treatment.

“In general, UNITE is greatly concerned about any method that would treat addiction without counseling. Methadone just exchanges one drug for another. We don’t see it as an effective way of treating a person with substance abuse issues,” said UNITE Communications Director Dale Morton.

Joe Chapman, the director of the methadone-prescribing Williamson Treatment Center, disagrees.

“I’m a firm believer in abstinence (treatment), and it works for a lot of people. We’re here for those it doesn’t work for,” he said, adding that those being treated with methadone, as a requirement to receive the drug, must attend counseling treatment.

And, while abstinence-based treatment is the more noble of the two, methadone treatment is arguably the more successful one. According to UNITE’s Web site, of the 1,591 adults and juveniles who have entered its drug court program, only 594, or 37 percent, have graduated.

“Most that go through treatment end up relapsing,” admitted Morton, who added it takes several rehabilitation attempts, in many cases, to achieve success with abstinence-based treatment.

Conversely, of the 200 people currently under treatment at the Pikeville Treatment Center, 85 percent of those, “maybe more,” are being treated successfully, according to Dr. Steven Lamb, who prescribes methadone at the clinic.


Strengths

Chapman said 86 percent of the 700 patients treated at his center are performing successfully.

Success, however, in terms of methadone, does not equal rehabilitation as it does with abstinence treatments. Addicts do not stop being addicts because they switch from heroine, Oxycontin, Lortab, or another opiate, to methadone, which is also an opiate, said Lamb. They are merely addicted to a less-destructive drug.

Success with methadone, said Lamb, is defined when a person stops committing anti-social acts and begins committing pro-social acts. In other words, “they stop robbing drug stores and selling their babies’ diaper money,” and, instead, they become better parents, get jobs, or, in some way, they become more beneficial to society.

Part of methadone’s success — and in UNITE’s shortcomings — can be attributed to the nature of opiate addiction, which, according to Chapman, is “the most difficult addiction to overcome.”

Lamb said the reason it is so hard for opiate addicts to stop using is that after a person has been on narcotics for a long time, something happens to his brain. He said even people who have been using for a short time have trouble, because once they stop taking the drugs, they get sick and suffer withdrawal symptoms.

For these reasons, addicts “can’t go 24 hours without thinking where the next pill is going to come from,” he said, and obtaining more drugs become the addict’s constant thought.

Lamb said methadone is successful because it allows people to stop craving street drugs. Under medical supervision, a “therapeutic dose” can be obtained, which is strong enough to block the thought of drugs from a person’s mind, but not so strong as to make the person drowsy.

Because patients are less plagued by the thought of drugs, they can focus on improving their lives and are able to search for friends who aren’t drug users. Finding friends who do not use, said Lamb, greatly reduces chances of relapse.

Unfortunately, what makes methadone is so successful at treating opiate addiction is also liable for the negative aspects of the treatment.

Drawbacks

While it is a safer opiate alternative than street drugs, it is not a less addictive one, and people usually stay in methadone treatment for years or longer.

“Once you start (methadone), it’s terribly hard to stop,” said Lamb.

Chapman said the average treatment time for patients in the Williamson clinic is three years.

Lamb said the treatment at the Pikeville clinic takes no less than six months, but, for some, it takes years, and others may never stop treatment.

Lamb said the more slowly one comes off the drug, the better chances he has of staying off. But, staying off, said Lamb, is even harder than getting off.

He said many times people who successfully stop taking methadone or other opiates go about six or 12 months and then “the get in a rut. They start to feel awful and give up.” When they feel bad, he said, they often go back to using street drugs.

Methadone itself is a street drug, and can be harmful when used in that scenario.

The Kentucky Office of Drug Control Policy said methadone was the leading cause of overdose deaths in the state during 2006, and was detected in 41 percent of the 484 overdose death cases throughout the state. May times other drugs were also detected along with methadone.

But Chapman said clinics are not to blame. Though they do get blamed for the drug’s diversion onto the street, in reality, he said, clinics are only responsible for a small fraction of the methadone on the street.

Lisa Walls, assistant director for the Kentucky Division of Mental Health and Substance Abuse, agrees. She said most of the methadone obtainable on the streets was prescribed by private doctors, some of whom can prescribe the drug for pain, but not addiction.

Walls said the majority of street methadone is in the form of tablets, but methadone clinics only dispense liquid methadone, because it has less abuse potential.

While a physician may write a monthly prescription for pain, the most that can ever be taken out by a patient at a methadone clinic is a week’s dosage, and only a handful of patients are even allowed that much.

For a patient to be able to take out one day’s dose of liquid methadone, he has to have been a patient at the clinic, passing every drug test, and participating in counseling, for at least 90 days in Kentucky, or at least 30 days in West Virginia. For a patient to be able to take out a week’s worth of methadone, he has to have been a well-behaved patient for over a year, in Kentucky, or nine months in West Virginia.

Relapses

Another problem with methadone treatment arises, as with the case of Billy Reed, when a patient on methadone relapses back to taking street drugs. Though mandatory drug testing is performed at clinics in both states to detect this scenario, even if a patient is found to be taking other drugs along with his methadone, he has to be weaned off the drug. Prescribers cannot just stop giving the drug to non-complying patients right away.

Testimony and evidence showed that Reed had methadone, Xanax, Valium and alcohol in his system in a blood test taken two hours after the wreck on Jan. 7 that killed Ronnie Church.

According to Lamb, it is very dangerous for a patient taking methadone to also take street drugs, especially if those drugs are Xanax and alcohol. He said the combination of Xanax, methadone and alcohol is deadly, and is the cause of most methadone-related overdose deaths.

Another dangerous consequence of a patient on methadone taking street drugs is that it impairs their driving ability, which methadone, when taken properly and by itself, does not do, said Lamb.

And, as the area has recently witnessed, when patients decide to use their methadone as an ingredient in their drug “cocktail,” and then decide to get behind the wheel, deadly consequences can arise as well, though not always for the drug abuser.
________
source: Appalachian News Express

New Medication Shows Promise In Addiction Treatment

Prescription drug addiction continues to rage nationwide and across the region, despite state and federal intervention.

In 2006, nonmedical use of prescription painkillers drew the highest number of new users, or "initiates," than any other illicit drug, with 2.2 million users, according to the 2006 National Survey on Drug Use and Health.

And according to the U.S. Drug Enforcement Administration, there are nearly 7 million Americans abusing such drugs today – more than the number of those using cocaine, heroin, hallucinogens, ecstasy and inhalants combined.

Despite the alarming statistics, many insurance companies don’t cover substance-abuse treatment. In fact, Medicaid in Virginia didn’t cover the cost for anyone but pregnant women until last July.

Lisa Williams, director of the suboxone treatment program at Highlands Community Services in Abingdon, said one of the most difficult obstacles in combating prescription drug abuse is the availability of the drugs and the lack of viable treatment options.

Until 2005, methadone was the only treatment for opiate addicts, but it has a number of drawbacks. First, it can only be distributed at clinics, which in rural areas such as Southwest Virginia can be far away. Second, methadone gives its user a feeling of euphoria that mirrors the effect of an opiate, and the more methadone you take, the greater the high.

And perhaps the most telling drawback is the spike in methadone overdose deaths in the western district of Virginia. According to the state medical examiner’s office, there were 264 fatalities in 2006 from drug overdoses, 70 because of methadone. It’s the leading cause of fatal overdoses in the state.

Suboxone was introduced in the U.S. in 2005 as an alternative to methadone. Like methadone, the drug works to placate withdrawal symptoms and cravings in opiate addicts.

But, Williams said, the drug is superior in several ways. Because it does not give its user a feeling of euphoria, it has little potential for abuse. It simply satiates the cravings. It also has a "ceiling effect," which means exceeding the prescribed dose does not increase the patient’s relief.

Suboxone also can be prescribed by certified physicians across the country, which makes the treatment more convenient in rural communities.

But there are drawbacks. Strict criteria govern the treatment. In order to start on the drug, a patient must be in a specific phase of withdrawal and cannot be taking certain other drugs that interact poorly with suboxone. Also, only certified physicians can administer the drug, and they are limited in the number of patients they can treat.

Williams said those enrolled in her program have an astonishing 87 percent success rate at beating their addiction.

But some say the drug may not be all it’s cracked up to be. Suboxone is the most expensive drug per milligram on the black market today, said Richard Stallard, head of the Southwest Virginia Drug Task Force. An 8-milligram pill sells for $25 to $30 on the street, which means 80 milligrams – the average dosage of OxyContin – would cost more than $400, he said.

"There have been several suboxone arrests. I am not saying that it doesn’t work when used properly," he said. " ... But to say it has no potential for abuse is totally wrong. No one is going to spend $30 on a pill that don’t make you feel good when you use it."

Stallard said he started seeing the drug on the street about two years ago.

"Not many weeks go by in this area that there is not a suboxone purchased by undercovers [police]," he said. "I was here when oxy came in the mid-’90s. It started slow and then got big. Suboxone has some similarities."
_____
source: tricities.com

Promising Treatment Turns Into A Street Drug

He's a 35-year-old husband and father who grew up in a small suburb of Worcester. Prescription drugs led to heroin.

"I was doing dope every day."

She is a wife and mother, who got hooked on vicodin after surgery.

"I was just sick and tired of spending my money on drugs. I wanted to be clean," he told Team 5 Investigates.

But that changed when their doctors prescribed buprenorphine, also known as suboxone. "It got me clean for the first time in 10 years so they work, if you take them the correct way," he said.

"I was getting my life back," the mother said.

The little orange pill has been called a miracle drug by many medical experts. Suboxone is a safer way than methadone to treat heroin and painkiller addicts. Unlike methadone, a doctor prescribes suboxone.

"It prevents people from feeling withdrawal and it also gets rid of the craving," said Dr. Dan Alford, an opioid specialist with the Boston University Medical Center.

Suboxone is the only opioid for which doctors need special training and certification before they can prescribe it. Alford estimates that only 2 percent of physicians in the country, and in Massachusetts who are eligible to get the certification, actually do.

"Physicians aren't motivated to take this on, to embrace this," Alford said.

Patients prescribed suboxone sometimes get multiple refills, and often get little medical supervision. Only a small dose is needed, so some recovering addicts trade pills for heroin or OxyContin, or sell suboxone for between $5 and $15 per pill.

A recovering addict who declined to let Team 5 Investigates use his name said, "If you are getting a prescription of 120 and selling 90 of them, that's $900."

Team 5 investigates spent a day riding along with Tim O'Connor of the Worcester Police Vice Squad, and saw the problem firsthand.

"Those are his pills, he's just selling them," said O'Connor. He added that suboxone is starting to surface in nearly every drug bust.

A man who worked with police during a recent sting told Team 5 Investigates, "I walked to the first corner, looked around and asked for 'boxone. One guy had crack, one had dope, the other had suboxone."

Suboxone was never meant to be a street drug. In fact, it's the centerpiece of a multimillion-dollar government effort to shift the treatment of opiate addiction away from methadone clinics to private doctors' offices.

Even suboxone's manufacturer, Reckitt Benckiser Pharmaceuticals, uncovered disturbing trends in a report sent to the FDA earlier this year, including evidence of lax or inappropriate prescription by doctors. At a drug treatment center in Lynn, Mass., the report noted that a third of drug abusers said they used "bupe" to get high. More than a quarter of suboxone exposures involved children younger than 6 who found and ingested the drug in their homes. And, when mixed with other drugs, suboxone can be fatal. There have been 15 reported deaths since 2005.

Experts say the promise of suboxone treatment is tremendous when it's dispensed and supervised properly. But the great concern is, like the widely abused painkiller OxyContin, it is too often ending up in the wrong hands.

"I think similar to what happened with OxyContin, where there was a perception among the youth that it was safe, that it is a prescription medication, it's safe, so that is a concern," said Alford. "The solution is not clear to me."
____
source: TheBostonChannel.com

Methadone clinic fits well in health network

CITY OF NEWBURGH — Once set to close, a Newburgh methadone clinic has become the type of place the state wants to see across New York's health-care system.

What makes it interesting isn't so much the clinic itself but its place in a larger network of doctors, dentists, mental health workers and therapists.

The Greater Hudson Valley Family Health Center took over the clinic in January after St. Luke's Cornwall Hospital announced plans to shut it down. The nonprofit also had run the Center for Recovery since 2006. Adding the methadone clinic meant it could fill a piece missing in its plan to treat people through their entire range of health needs.

It's a concept of treating the whole person that Karen Carpenter-Palumbo said has become a priority in New York. Carpenter-Palumbo is the commissioner of the state Office of Alcoholism and Substance Abuse Services.

Former Gov. Eliot Spitzer and Gov. David Paterson mandated that state departments such as Carpenter-Palumbo's begin integrating services into a cohesive system.

That means more networks like the one Greater Hudson Valley now operates at 83 Commercial Place. About 70 service providers, government employees and politicians gathered there yesterday to celebrate its opening.

Chris Loscher, director of the Center of Recovery, said the methadone clinic opened in January with 204 patients and now has about 240. It's licensed for 300. Statewide, about 1 in 7 New Yorkers deals with some sort of addiction.

Methadone is used to help break a dependency on opiates. That used to be almost exclusively heroin addiction, Loscher said, but increasingly includes the patient who gets hooked on prescription pain killers after surgery.

Patients bring with them a variety of medical concerns along with the addiction, Loscher said. A person in the middle of a daily heroin habit might not care about regular dental visits but, as they begin to recover, things like healthy teeth and jobs start to seem more important, Loscher said.

Greater Hudson Valley tries to provide all those services within its network.

That's important, Carpenter-Palumbo said, because too many patients are asked to bounce from one service to another in a disjointed system.

"What happens then is, we lose the person," she said.

source: http://www.recordonline.com

Review Of Naltrexone Implants Needed, Australian Medical Association

An urgent review of the use of naltrexone (including implants) for opioid dependence is needed following reports of severe adverse reactions, according to two articles in the latest Medical Journal of Australia.

In its editorial, Associate Professor Robert Ali, Director of the Drug Alcohol Services Council in Adelaide, and his co-authors said that naltrexone is theoretically an attractive treatment for opioid dependence because it is inexpensive, long-acting, and generally well tolerated.

Oral naltrexone is used as a treatment for heroin and alcohol dependence.

However, the effectiveness and safety of oral treatments is compromised by poor patient adherence to taking regular doses. This has led to the development of long-acting naltrexone implants and depot injections.

Naltrexone implants have not been approved for human use in Australia, but these implants are being supplied through some private clinics.

Assoc. Prof. Ali says that naltrexone implants are currently obtained through the TGA Special Access Scheme but without the product being subjected to the usual rigorous scrutiny required for new devices in Australia.

"It is concerning that the recent research on naltrexone implants in Australia has not followed usual scientific processes," he said.

In a related study published in the journal, Dr Paul Haber, Head of Drug Health Services at Royal Prince Alfred Hospital, and his co-authors studied 12 patients who were admitted to hospital soon after receiving naltrexone in oral or implant form.

Eight of the cases were definitely or probably related to the naltrexone implant, including cases of severe opiate withdrawal and dehydration, infection at the implant site requiring surgery, and a psychiatric disorder.

The authors said these severe adverse events challenge the notion that naltrexone implants are a safe procedure.

"These events suggest a need for careful case selection, careful clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population," Dr Haber said.

"Patients should be warned of the associated risks, and appropriate procedures planned to respond to any complications."

Dr Haber also emphasises the importance of screening patients for underlying medical or psychiatric conditions and, importantly, coordinating with relevant service providers.

"Similarly, a close relationship between naltrexone implant providers and local emergency departments is important."

"The widespread and unregulated use of naltrexone implants without appropriate safeguards for patients, their families and service providers should be restricted until this therapeutic product has been assessed for safety and effectiveness," he said.

source: The Medical Journal of Australia

Opiate And Nicotine Addiction Shown To Have Additional Similarities

"That was good!" "Do it again."

This is what the brain says when people use tobacco, as well as 'hard drugs' such as heroin. New research published in the February 13 issue of The Journal of Neuroscience indicates that the effects of nicotine and opiates on the brain's reward system are equally strong in a key pleasure-sensing areas of the brain - the nucleus accumbens.

"Testing rat brain tissue, we found remarkable overlap between the effects of nicotine and opiates on dopamine signaling within the brain's reward centers," says Daniel McGehee, Associate Professor in Anesthesia & Critical Care at the University of Chicago Medical Center.

McGehee and colleagues are exploring the control of dopamine, a key neurotransmitter in reward and addiction. Dopamine is released in areas such as the nucleus accumbens by naturally rewarding experiences such as food, sex, some drugs, and the neutral stimuli or 'cues' that become associated with them.

Nicotine and opiates are very different drugs, but the endpoint, with respect to the control of dopamine signaling, is almost identical. "There is a specific part of the nucleus accumbens where opiates have been shown to affect behavior, and when we tested nicotine in that area, the effects on dopamine are almost identical," says McGehee.

This research is important to scientists because it demonstrates overlap in the way the two drugs work, complementing previous studies that showed overlapping effects on physiology of the ventral tegmenal area, another key part of the brain's reward circuitry. The hope is that this study will help identify new methods for treating addiction - and not just for one drug type.

"It also demonstrates the seriousness of tobacco addiction, equating its grip on the individual to that of heroin. It reinforces the fact that these addictions are very physiological in nature and that breaking away from the habit is certainly more than just mind over matter," says McGehee.

This work is supported by grants from the National Institutes of Health, T32GM07839 and F31DA023340 to JPB, DA015918 and DA019695 to DSM.

Source: Scot Roskelley
University of Chicago Medical Center

Methadone Deaths Gain Attention Of Medical Examiners

Formerly a drug used only to treat heroin addiction, methadone is becoming more popular in recent years to treat pain.

As the use of the drug increases, so too do the deaths at an "alarming rate," according the National Drug Intelligence Center. Florida has become one of the leading states for methadone overdose deaths, according to the Center for Disease Control.

Now, authorities are wondering if methadone may be fatal even in therapeutic doses.
"I would never let anybody in my family take methadone unless they were a heroin addict to begin with," said Hillsborough County Medical Examiner Vernard Adams.

The chairman of the Florida Medical Examiners Commission on Friday distributed a study to other commissioners citing increased instances of sudden deaths among methadone users.

Researchers in Oregon reported in the study published last month that methadone has been implicated as a likely cause of sudden death at therapeutic doses. In the study published in the American Journal of Medicine, the researchers recommended clinical safeguards and further studies designed to enhance the safety of the drug.

Adams said he's also noticed some methadone-associated deaths that are different from other deaths attributed to drug overdoses.

In addition to the fact that deaths are occurring at therapeutic doses, Adams said some methadone deaths involve heart issues. Most drug overdoses involve respiratory failure, Adams said.

But Adams said he has no statistics and cannot cite specific cases related to this possible phenomenon. He said he just has a general sense that this is something that should be examined.

"The fact that these people are dying from methadone at therapeutic concentrations, this is anecdotal," Adams said. "We haven't studied it the way these people in Oregon have."

In Hillsborough County, methadone was listed as a contributing cause in 37 deaths in the first six months of last year. Methadone was listed as the only cause in five deaths. In 2006, methadone was listed as a cause in 49 deaths, according to medical examiner data. In ten deaths, methadone was listed as the sole cause. In 2005, methadone was listed as a cause in 30 deaths in the county and as the sole cause in 10 more.

The numbers reflect a trend in Florida, where methadone was listed as a cause in 392 deaths in the first six months of 2007 and in 716 cases in all of 2006, compared with 2005 when the drug was a cause in 620 deaths.

Stephen J. Nelson, the chairman of the state Medical Examiners Commission, distributed the Oregon study at the commission's regular meeting. Nelson said he wanted medical examiners to be aware of the potential problem and to be on the lookout. It's possible, he said, that the commission may attempt to track methadone levels in the deceased.

In November, the National Drug Intelligence Center published a study titled, "Methadone Diversion, Abuse and Misuse: Deaths increasing at Alarming Rate." According to the report, the quantity of methadone dispensed nationwide more than tripled between 2001 and 2006.

The report described methadone as "safe and effective when used as prescribed," but said the drug has increasingly been misused and abused.

Methadone has been used in addiction treatment for the past 50 years, according to the report, which noted that the drug's use in pain management has increased steadily since the late 1990s. Physicians turned to methadone as an alternative to oxycodone and hydrocodone, which were being increasingly abused. It also can be used less frequently and is less expensive than other drugs, the report states.

source: msnbc.com