The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients.
The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients.
Drug Alcohol Depend. 2014 Mar 15;
Authors: Edelman EJ, Chantarat T, Caffrey S, Chaudhry A, O'Connor PG, Weiss L, Fiellin DA, Fiellin LE
BACKGROUND: Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown.
METHODS: We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using generalized estimating equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing.
RESULTS: Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p<0.001), while non-condom use did not (23% vs. 21%, p=0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use.
CONCLUSIONS: While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
PMID: 24726429 [PubMed - as supplied by publisher]
Differential diagnosis for a stable patient maintained on buprenorphine who gives a urine toxicology screen negative for buprenorphine.
Differential diagnosis for a stable patient maintained on buprenorphine who gives a urine toxicology screen negative for buprenorphine.
Am J Addict. 2014 May;23(3):318-9
Authors: Sethi R, Petrakis I
PMID: 24724891 [PubMed - in process]
Suboxone versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness
Suboxone versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness
Book. 2013 11 14
Addiction to opioids causes major medical, social, and economic problems to both the individual and society. Opioid dependence is defined as a strong desire to use the substance, difficulty in controlling its use, the presence of a physiological withdrawal state, tolerance of the use of the drug, neglect of alternative pleasures and interests and persistent use of the drug, despite harm to oneself and others. It is a complex disease involving physiological, psychological, genetic, behavioral and environmental factors. In Canada, it is estimated that there were more than 80,000 regular illegal opioid users in 2003. The number of illegal drug-related overdose deaths in Canada was 958 in 2002. Opioid dependence is related to the abuse of not only illegal opioid drugs (e.g. heroin), but also some of the most commonly prescription drugs, such as codeine-containing Tylenol, hydromorphone, oxycodone, morphine and others. Treatment of opioid dependence includes three approaches: stabilization, detoxification and maintenance. Stabilization is usually achieved by opioid substitution treatments to ensure that the drug use becomes independent of mental state (such as craving and mood) and independent of circumstances (such as finance and physical location). The next stage is detoxification that is to withdraw from opioids. The final step is maintenance to prevent relapse. Detoxification refers to the process by which the effects of opioid drugs are eliminated in a safe and effective manner, such that withdrawal symptoms are minimized. Appropriate use of the detoxification agents plays a crucial role in increasing the successful detoxification rate, while minimizing the side effects and withdrawal symptoms. Methadone (μ-opioid receptor agonist) or buprenorphine (μ-opioid receptor agonist and κ-opioid receptor antagonist) are recommended first-line treatments in opioid detoxification. Naloxone is an opioid antagonist without agonist properties. In opioid-dependent patients, naloxone precipitates withdrawal. Suboxone (buprenorphine/naloxone) was approved by Health Canada in 2007 for substitution treatment in opioid drug dependence in adults. It is a fixed combination of buprenorphine (a partial μ-opioid receptor agonist) with naloxone (an opioid antagonist) in a 4:1 ratio. The addition of naloxone to buprenorphine is expected to decrease the intravenous abuse of buprenorphine, because when taken sublingually, absorption of naloxone is minimal, however it can rapidly precipitate opioid withdrawal when injected. Suboxone is recommended for the treatment of opioid dependence for patients in whom methadone is contraindicated (such as patients at high risk of, or with QT prolongation, or hypersensitivity to methadone). The purpose of this review is to provide evidence on the comparative clinical effectiveness and cost-effectiveness of use of Suboxone compared with methadone, for the treatment of patients with opioid dependence. Subgroups such as children and pregnant women may also have access to opioids thus, the clinical benefits and risks of Suboxone for these patients will be examined as well, when evidence is available.
Following the decision by Massachusetts Governor Deval Patrick to order a ban on prescribing and dispensing the pure hydrocodone painkiller Zohydro, Vermont’s governor announced an emergency order to make it more difficult for doctors to prescribe the drug.
Vermont Governor Peter Shumlin said he joins the many critics of the drug, who are wondering why the Food and Drug Administration (FDA) approved it, according to the Associated Press. “What puzzles all of us is the recent FDA action to approve a new opiate that’s stronger and likely to be even more addictive because of its strength,” he said.
In January, Shumlin spoke about Vermont’s “full-blown heroin crisis” during his State of the State address. He focused his entire speech on drug addiction and its consequences.
When Governor Patrick announced the Zohydro ban, he cited a public health emergency stemming from opioid abuse. Zohydro is designed to be released over time, and can be crushed and snorted by people seeking a strong, quick high. It was approved for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Other hydrocodone drugs on the market, such as Vicodin, also contain acetaminophen.
In December 2012, a panel of experts assembled by the FDA voted against recommending approval of Zohydro. The panel cited concerns over the potential for addiction. In the 11-2 vote against approval, the panel said that while the company’s manufacturer, Zogenix, had met narrow targets for safety and efficacy, the painkiller could be used by people addicted to other opioids, including oxycodone.
Zogenix announced it will assemble an oversight board designed to spot misuse of the drug.
The FDA’s decision to approve Zohydro has been criticized by some legislators and public health groups. FDA Commissioner Margaret Hamburg has received letters protesting the decision from 28 state attorneys general and four senators, among others.
A new government report finds twice as many adult men as women entered substance abuse treatment facilities in 2011. The report found 1.2 million men, and 609,000 females, entered such facilities that year.
Among teens 12 to 17, the rate of substance dependence for both males and females was about 7 percent, UPI reports. The findings come from the Substance Abuse and Mental Health Services Administration (SAMHSA). Teenage boys were more likely to abuse marijuana, while teenage girls were more likely to abuse alcohol.
Twenty-two percent of women ages 18 to 24 said marijuana was their primary substance of abuse, compared with 3 percent of men the same age. Women 65 and older were almost three times as likely to abuse prescription painkillers such as oxycodone, compared with men of the same age.
“This report provides insight into how age and gender relate to substance abuse, SAMHSA Chief Medical Officer Elinore McCance-Katz said in a news release. “SAMHSA believes that health care professionals can use this information in designing programs that are better tailored to effectively meet the treatment needs of both genders.”
No other major retailers have joined CVS in pledging to pull tobacco from store shelves, the Associated Press reports. CVS, the nation’s second largest drugstore chain, announced earlier this year it will stop selling tobacco products by October 1.
Major retailers want to see what happens after CVS stops selling tobacco, before deciding how to proceed, the article notes. The company has more than 7,600 retail stores. Public health advocates have pressured retailers for years to stop selling cigarettes and other tobacco products. CVS says its annual sales of tobacco products total about $2 billion, or about 1.6 percent of the company’s revenues in 2012.
The company’s announcement caught many people in the retail industry by surprise, the article notes. CVS stock has risen about 11 percent since it made the announcement. Many analysts predict it is unlikely other drugstore chains will make a similar decision to pull tobacco products. Walgreens CEO Greg Wasson last month said that instead of stopping sales of tobacco products, his company would focus on helping people quit.
Some discount chains, such as Family Dollar, have added tobacco to their stores in recent years.
There are several reasons retail chains may want to consider dropping tobacco sales, according to the AP. The cigarette business faces tax increases, smoking bans, health concerns and social stigma. The number of Americans who smoke continues to drop. In addition, selling tobacco products runs counter to the healthy image drug chains want to project.
In March, the attorneys general of 28 states and territories urged major retailers to follow the lead of CVS and stop selling tobacco products. They sent letters to Rite Aid, Walgreens, Kroger, Safeway and Walmart, which are among the nation’s biggest pharmacy retailers.
Advocates of medical marijuana came to Capitol Hill this week to urge legislators to pass a measure that would ban the federal government from restricting state medical marijuana laws.
Currently, 20 states have legalized medical marijuana, but the drug remains illegal under federal law. New York may become the next state to legalize medical marijuana, Time reports. The bill is unlikely to pass in the Republican-controlled House, the article notes. Democrats in the Senate do not want to champion the issue in a midterm election year. The Obama Administration seems willing to consider taking marijuana off the federal government’s list of the most dangerous drugs, according to the magazine.
“Once you use this medication and it works for you, or you see it work for a loved one, it really is crazy that we can’t even get a hearing at this point,” said Steph Sherer, Executive Director of Americans for Safe Access, a medical marijuana advocacy group. “We’re actually regulating this product from seed to consumption.” Her group brought 152 people to Washington to lobby Congress.
Observation of improved adherence with frequent urine drug testing in patients with pain.
J Opioid Manag. 2014 Mar-Apr;10(2):111-8
Authors: Yee DA, Hughes MM, Guo AY, Barakat NH, Tse SA, Ma JD, Best BM, Atayee RS
OBJECTIVE: To determine the relationship between urine drug testing (UDT) frequency and patient adherence for prescribed buprenorphine, carisoprodol, fentanyl, hydrocodone, methadone, morphine, and oxycodone.
SETTING: Patients with pain routinely seen by private practitioners.
DESIGN: A retrospective analysis was conducted on urinary excretion data analyzed by Millennium Laboratories between March 2008 and May 2011.
PATIENT PARTICIPANTS: Patients in the United States with chronic pain who underwent routine UDT to confirm adherence for prescribed medications.
INTERVENTIONS: Adherence for the urine drug test was defined as the presence of parent drug and/or metabolite(s) greater than or equal to the lower limit of quantitation. The percent of adherence for prescribed medications was compared to the average percent of the same in subjects with five or more visits.
MAIN OUTCOMES: Correlation analyses were used to determine the relationship between adherence for prescribed medications and number of visits.
RESULTS: There were 255,168 specimens submitted for testing from 166,755 individuals. When monitoring with more frequent visits (≥5 visits) adherence was higher by 1 percent for buprenorphine (89 percent vs 88 percent); 8 percent for carisoprodol (77 percent vs 69 percent); 5 percent for fentanyl (95 percent vs 90 percent); 7 percent for hydrocodone (83 percent vs 76 percent); 3 percent for methadone (96 percent vs 93 percent); 5 percent for morphine (92 percent vs 87 percent); and 8 percent for oxycodone (90 percent vs 82 percent).
CONCLUSIONS: Adherence for prescribed medications is higher with frequent urine monitoring. UDT can be used as tool that may help improve this in patients with chronic pain.
PMID: 24715666 [PubMed - in process]
Transdermal opioids for cancer pain control in patients with renal impairment.
J Opioid Manag. 2014 Mar-Apr;10(2):85-93
Authors: Melilli G, Samolsky Dekel BG, Frenquelli C, Mellone R, Pannuti F
OBJECTIVES: As guidelines for opioid use in renal-impaired patients with cancer are limited, the authors sought to assess the efficacy, safety, and tolerability, of transdermal buprenorphine for moderate/severe cancer pain in renal-impaired outpatients.
METHODS: In a prospective parallel-group active-controlled study, n = 42 consecutively recruited outpatients with or without renal impairment (serum creatinine ≥1.3 or ≤1.2 mg/dL, respectively) were treated with transdermal buprenorphine (group BUP) or fentanyl (group FEN), respectively. Patients were followed up, at home, by the nonprofit ANT-Italia-foundation physicians in Bologna, Italy. Measurements at 10 (T1), 30 (T2), and 90 (T3) days after enrollment (T0) were pain intensity (Numerical Rating Scale [NRS]), Karnofski score, opioid dose (μg/h), rescue-dose consumption, and occurrence of adverse effects. Patients recorded subjective measurements in a personal diary. Upon data analysis, investigators were blinded to the patient group.
RESULTS: At T0, in groups BUP and FEN, median NRS score was 8.0 (CI, 7.4-8.4); its reduction over time (T3; NRS = 3.0; CI, 2.1-3.8 and 2.0-4.0, respectively) was significant and constant in both groups (t-test; T0-T1, T1-T2, and T2-T3; p < 0.0001, p < 0.001, and p < 0.05, respectively). At all times, there were no significant differences in pain scores between the groups. In all evaluations, adverse effects were reported n = 73/126 times (60.8 percent) and showed no significant association (X(2), p > 0.05) with the study groups.
CONCLUSIONS: Transdermal buprenorphine, in outpatients with cancer and renal impairment, is as effective, safe, and tolerable as fentanyl in patients without such impairment. These results add further evidence to the notion that buprenorphine, with its peculiar pharmacokinetics, may be an appropriate choice for opioid treatment in patients with renal impairment.
PMID: 24715663 [PubMed - in process]
Hair analysis for long-term monitoring of buprenorphine intake in opiates withdrawal.
Ther Drug Monit. 2014 Apr 7;
Authors: Pirro V, Fusari I, Di Corcia D, Gerace E, De Vivo E, Salomone A, Vincenti M
BACKGROUND:: Buprenorphine is a psychoactive pharmaceutical drug largely used to treat opiate addiction. Short-term therapeutic monitoring is supported by toxicological analysis of blood and urine samples, whereas long-term monitoring by means of hair analysis is rarely used. Aim of this work was to develop and validate a highly sensitive UHPLC-MS/MS method to detect buprenorphine and norbuprenorphine in head hair.
METHODS:: Inter-individual correlation between oral dosage of buprenorphine and head hair concentration was investigated. Furthermore, an intra-individual study by means of segmental analysis was performed on subjects with variable maintenance dosage. Hair samples from a population of 79 patients in treatment for opiate addiction were analyzed.
RESULTS:: The validated UHPLC-MS/MS protocol allowed to obtain limits of detection and quantification at 0.6 and 2.2 pg/mg for buprenorphine, and 5.0 and 17 pg/mg for norbuprenorphine, respectively. Validation criteria were satisfied, assuring selective analyte identification, high detection capability, precise and accurate quantification. Significant positive correlation was found between constant oral buprenorphine dosage (1-32 mg/day) and the summed up head hair concentrations of buprenorphine and norbuprenorphine. Nevertheless, substantial inter-individual variability limits the chance to predict the oral dosage taken by each subject from the measured concentrations in head hair. In contrast, strong correlation is observed in the results of intra-individual segmental analysis, which proved reliable to detect oral dosage variations during therapy.
CONCLUSIONS:: Remarkably, all hair samples yielded buprenorphine concentrations higher than 10 pg/mg, even when the lowest dosage was administered. Thus, these results support the selection of 10 pg/mg as a cut-off value.
PMID: 24713865 [PubMed - as supplied by publisher]
Every few years the media report an epidemic of heroin overdose deaths; often after a celebrity like Phillip Seymour Hoffman dies to set off the spark. This time the spike in deaths—which is real– is being attributed to heroin mixed with fentanyl. Attention will fade but the deaths will continue. We wring our hands about overdoses, but do little to make effective treatment widely available. Our continuing refusal to prevent and treat addiction is a medical and social scandal.
Here are the policy changes I believe we must make to end this scandal:
1) Complete the transition to individual health insurance with complete coverage for addiction treatment. The bulk of addiction treatment today is provided by small free standing programs that depend on contracts with public entities for treatment “slots” or individual out of pocket payment. The programs with contracts are responsive to their funders, not to the patients who may be filling a slot at the moment. The organization and funding of our treatment system works against developing a long term relationship between patient and provider that is key to successful long-term recovery. When a patient leaves, the treatment entity has no continuing contact with that person. Obamacare can cover almost all the people with addiction in the country if states, employers and insurers implement it properly. Sadly, some existing treatment programs are dragging their heels or opposed to getting their patients covered because they find it easier to bill the state or because they cannot meet the administrative and clinical requirements for accepting insurance payments.
2) Integrate addiction, mental illness and medical treatment around individuals with severe addiction. Telling a patient who is unemployed, homeless, addicted and mentally ill to go someplace different for each service or to wait weeks for an appointment is malpractice because the providers know it will not happen. We should force consolidation of addiction treatment, mental illness and medical care providers to coordinate and take care of the most severely ill patients in one place. The few places where this kind of care is provided now get much better results for their patients.
3) Increase insurance payment rates for addiction treatment to a level that meets providers’ costs, draws in new responsible providers, and pays for the required coordination. Very low Medicaid and private insurance payment rates create and perpetuate the shortage of quality treatment. Appropriate payment rates will attract higher quality providers.
4) Reward longer stays in treatment and stop using providers that are unable to successfully retain patients in treatment long enough for it to be effective. Longer time in treatment, inpatient or outpatient, improves outcomes. Research shows that drug treatment for less than 90 days is generally not effective, but very few public or private insurance programs authorize that much treatment now. It is shocking that some treatment programs still throw a patient out if he relapses during treatment. Relapse is part of the disease and a signal for more treatment, not a reason to end it.
5) Require hospitals, health centers, HMO’s and other primary providers, as a condition of their participation in Medicaid, Medicare, and public employee health programs, to demonstrate that they diagnose all patients with alcohol and drug disease and that they have a clinically sound program that gets individuals the care they need. Today, most hospitals refuse to provide addiction treatment at any appropriate scale even though many of their patients would have better clinical outcomes if they got brief interventions or treatment.
6) Stop the revolving door at detoxification programs. Current policy and reimbursement get the patient out the door as soon as he or she is “medically stable,” whether or not the person is connected or ready to enter real addiction treatment. The vast majority of people who leave detox without directly entering and staying in treatment quickly relapse. Many think they “failed” treatment but the truth is they never had any treatment, just detoxification.
7) Stop arresting people for non-violent drug offenses. And stop putting people back in jail or prison for non-violent addiction related probation violations. Our current policies ruin thousands of young lives. Addiction is a disease, not a crime. Drug court programs are fine, but they touch only a tiny proportion of the people in the criminal justice system who need treatment.
David L. Rosenbloom, PhD, is Professor, Boston University School of Public Health and former Director of Join Together.
This feature was originally published on the BU Today website.
Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, announced it has reduced prescriptions of narcotic painkillers by about 6.6 million pills in the past 18 months. The insurer limited the amount of opioids that members could obtain without prior approval of the company, WBUR reports.
Since the changes were implemented in July 2012, prescriptions for opioids including Percocet have declined by 20 percent, and those for long-lasting drugs such as OxyContin have declined by 50 percent, Blue Cross Blue Shield of Massachusetts President Andrew Dreyfus told The Boston Globe.
An initial review of prescription information, launched in 2011, revealed more than 30,000 of the company’s members received opioid prescriptions that lasted for more than 30 days. “What we found out is in looking at patients who deserved to get pain medications or needed pain medications, many of them were getting significantly more than they would need,” Dr. John Fallon, Senior Vice President and Chief Physician Executive, told WBUR.
Under the program, patients are initially given shorter-term prescriptions for opioids. Patients seeking long-term prescriptions must go through a review process. Before patients are given more medication beyond the new limits, they must be assessed for the risk of addiction, and must agree on a treatment plan with their doctor.
Patients with cancer or other terminal illnesses are exempt from the rules.
“In the past, physicians said that no one should be in pain, and people gave more prescription medication than they probably needed, and that led to supply sitting around, which was then used for inappropriate reasons,” Fallon said. “Now I think there’s an awareness in the physician community how hazardous these medications are.”
People seeking treatment for heroin addiction face a number of obstacles, including a lack of treatment beds, expensive care, and insurance companies that refuse to pay for inpatient rehab, according to ABC News.
Most insurance companies will not pay for inpatient heroin detoxification or rehab because withdrawal from the drug is generally not deadly, according to Anthony Rizzuto, a provider relations representative at Seafield Center, a rehabilitation clinic on Long Island, N.Y. He says insurance companies either claim the patient does not meet the “criteria for medical necessity” for inpatient care, or they require the patient to first try outpatient rehab and “fail” before being considered for inpatient treatment.
Most experts say inpatient care is often needed for a person addicted to heroin. Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps, kicking movements and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose, and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health can be fatal.
The symptoms of withdrawal are so bad that many people go back to using heroin, often with deadly consequences. Even people who are able to stop using heroin without treatment often relapse. They may overdose because they use as much heroin as they did before, but their system can’t handle the same level of drug as before they went through withdrawal.
Even patients who do get some insurance coverage for heroin treatment generally don’t get 30 days in a residential center. The average duration is 11 to 14 days, according to Tom McLellan, CEO of the nonprofit Treatment Research Institute in Philadelphia. After insurance companies stop paying, facilities discharge patients, even if they are not done with treatment.
The average cost of a 30-day inpatient stay is about $30,000.
About 3.7 million Americans, who live in states that have not expanded their Medicaid programs under the Affordable Care Act, suffer from mental illness, psychological distress or a substance use disorder and don’t have health insurance, according to a recent report.
Twenty-four states have not expanded their Medicaid programs, according to USA Today. In the states that did expand Medicaid, about 3 million people with a mental health or substance use disorder, who were formerly uninsured, now are eligible for coverage. The findings come from the American Mental Health Counselors Association (AMHCA).
The Affordable Care Act originally required states to expand Medicaid benefits, but in 2012, the U.S. Supreme Court allowed states to opt out of participating in the expansion.
“It is really a tragedy,” said Joel Miller, Executive Director of AMHCA. “When uninsured people with mental health conditions, such as depression, gain Medicaid coverage, they become healthier and life expectancy increases, but in states that refuse to expand Medicaid, citizens will see their hopes dashed for a better life and better health.”
The report findings come from the National Survey on Drug Use and Health, which counted people with serious mental illness, serious psychological distress, and substance use disorders. The group found almost 75 percent (2.7 million adults) of all uninsured persons with a mental health condition or substance use disorder who are eligible for coverage in the non-expansion states live in 11 southern states that have rejected the Medicaid expansion: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.
More than 1.1 million uninsured people who have serious mental health and substance abuse conditions live in just two states — Texas (625,000) and Florida (535,000). These more than 1.1 million people are eligible for coverage under the new Medicaid expansion program, but won’t receive it, the report noted.
Employers in states where marijuana is legal for medicinal or recreational use must decide how to handle employees who use the drug when they are not on duty, USA Today reports.
Some workers in Colorado and Washington state, where recreational marijuana use is legal, say they are being punished for using the drug when they aren’t on the job. Employers say they are trying to maintain drug-free workplaces, the article notes.
“I imagine there will be a great deal of upheaval in the future. The law is going to be in flux for another 10 years,” said Curtis Graves, a staff attorney with the Mountain States Employers Council, which advises companies on workplace issues.
In the 20 states that allow medical marijuana, employers do not have to allow any kid of marijuana use in the workplace. In Colorado, workers cannot be fired for legal activities while they are off duty. However, the state’s courts have also ruled marijuana is not lawful, because the federal government still considers it illegal.
A growing number of employers in Colorado are testing prospective employees before hiring, and are continuing to perform random drug testing, according to Tiffany Baker, co-owner of the Denver DNA and Drug Center, which provides drug-testing services to employers. “I think big companies were already testing anyway,” she said. “I think small companies are … now more likely to send their workers over.”
In Washington state, manufacturers and companies working in federally regulated areas, such as the aerospace industry, have long tested job applicants for drug use. Jennifer Lambert, a vice president of the employment agency Terra Staffing Group, says these employers are continuing to test job applicants for drugs. “It’s sort of a Wild West scenario. It’s very, very tricky,” she said. “I feel badly when someone comes to us and doesn’t understand the implication of their pot smoking.”
The Food and Drug Administration (FDA) has approved a handheld device that delivers a single dose of the opioid overdose antidote naloxone, The New York Times reports.
The device, called Evzio, is similar to an EpiPen used to stop allergic reactions to bee stings, the article notes. It can be used by friends or relatives of a person who has overdosed. When the device is turned on, it will give verbal instructions about how to use it. The medication blocks the ability of heroin or opioid painkillers to attach to brain cells. Evzio is expected to be available this summer.
“This is a big deal, and I hope gets wide attention,” said Dr. Carl R. Sullivan III, Director of the Addictions Program at West Virginia University. “It’s pretty simple: Having these things in the hands of people around drug addicts just makes sense because you’re going to prevent unnecessary mortality.”
According to a news release from the FDA, family members or caregivers should become familiar with the instructions for use before administering Evzio. “Family members or caregivers should also become familiar with the steps for using Evzio and practice with the trainer device, which is included along with the delivery device, before it is needed,” the FDA advises. The agency notes that because naloxone may not work as long as opioids, repeat doses may be needed. A person utilizing the device should seek immediate medical care for the patient.
Many states have begun to make naloxone more widely available. The FDA notes existing naloxone drugs require administration via syringe, and are most commonly used by trained medical personnel in emergency departments and ambulances.
Photo source: Medgadget.com
Major obstacles remain to expanded treatment for addiction through the Medicaid program, according to USA Today. Although the Affordable Care Act (ACA) requires treatment be offered to people who are newly insured through insurance exchanges or Medicaid, experts say a federal law is limiting available beds nationwide.
A federal restriction does not allow drug treatment centers with more than 16 beds to bill Medicaid for residential services provided to low-income adults. The law was meant to prevent Medicaid dollars from funding private mental institutions that warehoused patients, according to the article. The result is that addiction treatment centers are turning away new Medicaid patients who are entitled to treatment under the ACA.
“We don’t have enough capacity right now,” Becky Vaughn, Executive Director of State Associations of Addiction Services in Washington, told the newspaper. “The unintended consequence is that you are discriminating against an adult who needs help,” said Elizabeth Stanley-Salazar, a Vice President at the Phoenix House. “We don’t do that for any other illness or disease.”
Toby Douglas, Director of California’s Health Care Services Department, said only 10 percent of the available inpatient beds in the state are in facilities that meet the federal government’s restrictions. Most treatment for substance abuse in Colorado is provided in centers with more than 16 beds, according to Arthur Schut, Chief Executive Officer of Arapahoe House. “Everyone is in agreement about how dumb this is,” he said. “It doesn’t work economically, and it doesn’t work for the people seeking treatment.”
The federal government does not plan to change the law, according to Suzanne Fields, a senior adviser on health care financing for the Substance Abuse and Mental Health Services Administration. She said the federal government is looking at alternatives, such as treating patients under programs already paid for with other federal funds.
Democratic governors around the country are reluctant to support the legalization of marijuana, despite enthusiasm for the idea among voters in their party. The New York Times reports the governors are concerned about managing legalization, as well as being perceived as being soft on crime by Republicans.
In California, where voters strongly favor legalization and its Democratic Party adopted a platform urging the state to follow Colorado and Washington state in legalizing recreational marijuana, Governor Jerry Brown has said he wants to see what happens in those areas.
Some Democratic governors are supporting medical marijuana measures. This year, bills have been introduced in 17 states to legalize recreational marijuana. No sitting governor or member of the Senate has offered a full endorsement of those measures. Governor Peter Shumlin of Vermont, a Democrat, has said he is open to the idea.
“Quite frankly, I don’t think we are ready, or want to go down that road,” said Connecticut Governor Dannel P. Malloy, a Democrat. His state has legalized medical marijuana and decriminalized possession of small amounts of marijuana. “Perhaps the best way to handle this is to watch those experiments that are underway. I don’t think it’s necessary, and I don’t think it’s appropriate,” he told the newspaper.
The Democratic governors of Colorado and Washington opposed legalization, but said they would follow through on voters’ wishes to set up recreational marijuana marketplaces. Washington Governor Jay Inslee said, “As a grandfather, I have the same concerns every grandfather has about misuse of any drug, including alcohol and marijuana. All of us want to see our kids make smart decisions and not allow any drug to become injurious in our life. I recognized the really rational decision that people made that criminalization efforts were not a successful public policy. But frankly, I really don’t want to send a message to our kids that this is a route that is without risk.”
Poison control centers are reporting an increase in the number of calls they are receiving for nicotine poisoning from e-cigarettes. This February, centers received 215 calls, compared with about one per month in 2010.
About half of calls related to nicotine poisoning from e-cigarettes involved children age 5 or younger, HealthDay reports. Dr. Tim McAfee, Director of the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health, which published the findings, said many people don’t know liquid nicotine is toxic. “The time has come to start thinking about what we can do to keep this from turning into an even worse public health problem,” he said.
McAfee said the Food and Drug Administration is expected to propose regulations for e-cigarettes, and he hopes they include childproof caps and warning labels. “These things can be hardwired into these products, rather than being left to the whim of the manufacturer,” he said. McAfee urged e-cigarette users to keep the devices and their refills out of the reach of children. “These should be treated with the same caution one would use for bleach. In some ways, this is more toxic than bleach,” he said.
He explained liquid nicotine can be poisonous if it is swallowed, inhaled, or absorbed through the skin or membranes in the mouth, lips or eyes. It can cause nausea, vomiting or seizures.
In a CDC news release, Director Dr. Tom Frieden said, “E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”