Opinion: Mandatory Use of Prescription Drug Monitoring Programs Journal of the American Medical Association This editorial addresses a provocative topic, the mandatory prescription drug monitoring program (PDMP). Readers will find it useful to review the Supplemental Content (table of outcomes for 4 states mandating PDMP) when reading this full-text free article, whose authors attempt to reconcile widely divergent views in the concluding paragraphs. The PDMP registration rate among licensed prescribers who issue at least one controlled substance prescription is 35%, and not all enrolled prescribers regularly use PDMPs. Consequently, 22 of the 49 states with PDMPs now legally mandate prescribers to query the system before writing for controlled substances with recognized potential for abuse or dependence. These requirements face pushback from prescribers, many of whom consider them to be burdensome incursions into clinical
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Editor’s Remarks William Haning, MD, FASAM, DFAPA In the first citation this week, a JAMA editorial regarding the mandatory Prescription Drug Monitoring Program (PDMP) initiative, authors Haffajee, Jena, and Weiner provide an examination of the arguments for and against mandatory PDMPs. They note that there appears to be a positive epidemiologic impact of such programs, conceding that significant but small effect sizes are accompanied by risks to both physician and patient. While ideally reducing both the availability of drugs of abuse and the mortality associated with diverted narcotics, these initiatives unfortunately also create legal hazard to the prescriber and the potential for diminished access to the needful patient...
The Effect of Methadone Dose Regimen on Neonatal Abstinence Syndrome Journal of Addiction Medicine (free ASAM member resource) Although methadone maintenance has been the standard for the treatment of opioid dependence in pregnancy, there is no consensus on proper dosing. Single daily dosing is the most common strategy. Because of accelerated metabolism of methadone in pregnancy, this regimen may expose mother and fetus to daily episodes of withdrawal and possibly contribute to more severe Neonatal Abstinence Syndrome (NAS). This study reports on a protocol that increased both methadone dose and dose frequency in response to maternal reports of withdrawal...
Twitter Chatter about Marijuana Journal of Adolescent Health This article reflects an increasing trend in data-mining, employment of social media to ascertain drug user attitudes and trends; readers may weigh the conclusions against the relative novelty of the data extraction methodology. Findings included that most marijuana-related tweets reflected a positive sentiment toward marijuana use, with pro-marijuana tweets outnumbering anti-marijuana tweets by a factor of greater than 15. The most common theme of pro-marijuana tweets included the Tweeter stating that he/she wants/plans to use marijuana, followed by tweeting about frequent/heavy/or regular marijuana use, and that marijuana has health benefits and/or should be legalized. Tweeters of marijuana-related content were younger and a greater proportion was African-American compared with the Twitter average.
Senate Confirms Michael P. Botticelli as Director of the Office of National Drug Control Policy Office of National Drug Control Policy On Monday, February 9th, the Senate voted 92-0 to confirm the nomination of Michael P. Botticelli as Director of the Office of National Drug Control Policy (ONDCP). Mr. Botticelli will be the first ONDCP Director who is openly in long term recovery from a substance use disorder, recently celebrating 26 years in recovery.
National Practice Guideline for Medications for the Treatment of Opioid Use Disorder Public Comment Period Closes February 19 ASAM On February 19th, the public comment period for the draft National Practice Guideline will close. This is the last day members and the public can participate in the external review process and provide comments.
Funding Opportunity: DoD Alcohol and Substance Abuse Research Program Department of Defense The goal of the Alcohol and Substance Abuse Research Program (ASARP) is to identify and develop new medications to improve treatment outcomes for alcohol and substance use disorders, especially as related to traumatic brain injury and post-traumatic stress disorder. The program encourages the use of collaborative, multidisciplinary approaches to accelerate the translation of basic research into clinical trial studies. The first step in the application process, a Letter of Intent, is due February 26.
Impaired Neural Response to Negative Prediction Errors in Cocaine Addiction The Journal of Neuroscience Learning can be guided by unexpected success or failure, signaled via dopaminergic positive reward prediction error (+RPE) and negative reward-prediction error (−RPE) signals, respectively. Despite conflicting empirical evidence, RPE signaling is thought to be impaired in drug addiction. To resolve this outstanding question, the authors studied as a measure of RPE the feedback negativity (FN) that is sensitive to both reward and the violation of expectation, in a population of 50 cocaine users, both UDS negative and UDS positive; and 25 matched controls. The hypothesis appears supported.
Pharmacogenetic Approaches in the Treatment of Alcohol Use Disorders: Addressing Clinical Utility and Implementation Thresholds Addiction Science & Clinical Practice This piece by Christian Hendershot extensively and fluently reviews the current science in pharmacogenetic approaches to alcohol use disorders. It will particularly appeal to those addiction medicine physicians who employ pharmacologic approaches dominantly. It concludes, “The likelihood that pharmacogenetic protocols will see common use in alcohol treatment scenarios remains unknown. However, there is optimism about the potential for personalized approaches and consensus on the importance of predicting treatment response, giving reason to support near-term clinical translation research. Ultimately, the potential public health benefits of pharmacogenetics research are contingent on efficient translation—in turn requiring greater commitment to clinical utility and implementation research.”
Major Massachusetts Health Plans OK Methadone Treatment Boston Globe Multiple major Massachusetts health plans covering 2.6 million residents announced Thursday they will begin to cover treatment with the medication methadone by July 1, in an effort to address the epidemic of addiction to opiate drugs. Some plans such as Blue Cross/Blue Shield and the state’s public clinics already cover the long-validated treatment. The health plans said they decided to offer coverage independently after conversations with state officials on how they could help.
Treatment-Resistant Depression: Definitions, Review of the Evidence, and Algorithmic Approach Journal of Affective Disorders Most adults with major depressive disorder fail to achieve remission with index pharmacological treatment. Herein, the authors review treatment modalities proven effective in treatment-resistant depression.
Federal Government Set To Crack Down On Drug Courts That Fail Patients Huffington Post Politics The federal government is cracking down on drug courts that refuse to let opioid addicts access medical treatments such as Suboxone, said Michael Botticelli, acting director of the White House’s Office of National Drug Control Policy. Drug courts that receive federal dollars will no longer be allowed to ban the kinds of medication-assisted treatments that doctors and scientists view as the most effective care for a majority of patients with opioid addiction.
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