A Thought for Recovery Month Selected Papers of William L. White "There are whole professions whose members share an extremely pessimistic view of recovery because they repeatedly see only those who fail to recover. The success stories are not visible in their daily professional lives. We need to re-introduce ourselves to the police who arrested us, the attorneys who prosecuted and defended us, the judges who sentenced us, the probation officers who monitored us, the physicians and nurses who cared for us, the teachers and social workers who cared for the problems of our children, and the job supervisors who threatened to fire us. We need to find a way to express our gratitude at their efforts to help us, no matter how ill-timed, ill-informed, and inept such interventions may have been. We need to find a way to tell all of them that today, we are sane and sober and have
taken responsibility for our own lives. We need to tell them to be hopeful, that RECOVERY LIVES! Americans see the devastating consequences of addiction every day; it is time they witnessed close up the regenerative power of recovery."
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Methadone Safety: Clinical Practice Guidelines from the American Pain Society and College on Problems of Drug Dependence PCSS – O This presentation reviews evidence on methadone safety, properties of methadone, and recommendations for safer use, include careful patient assessment, use of alternative opioids and treatments, education and counseling, use of ECG screening and monitoring, careful dose initiation and titration, careful monitoring and follow-up, and use of risk mitigation strategies.
DEA Reschedules Hydrocodone Combination Products ASAM On August 22nd, the US Drug Enforcement Agency (DEA) formally rescheduled hydrocodone combination products (HCPs), moving them from Schedule III to Schedule II of the Controlled Substances Act. This move of HCPs to a more restrictive class was supported by a DEA evaluation of relevant data and recommended by the US Department of Health and Human Services’ (HHS) Assistant Secretary for Health. Starting on October 6th, HCP prescriptions must comply with Schedule II protocols, which mean prescription refills will be prohibited...
Law Limiting Physician Speech Upheld; Doctors Call for Rehearing AMA Wire The Florida state law bars physicians from freely discussing firearm safety with their patients, putting political agendas before public health and the patient-physician relationship. While one of the judges on the three-person panel sided strongly with physicians in opposing the law, the two other judges ruled in favor of the state...
Treating Prescription Opioid Dependence Journal of the American Medical Association This study represents a rigorous experimental evaluation of outpatient buprenorphine stabilization, brief taper, and naltrexone maintenance for treatment of prescription opioid dependence. Results suggest that a meaningful subset of prescription opioid-dependent outpatients may respond positively to a 4-week taper plus naltrexone maintenance intervention.
Gambling Addiction: An Introduction for Behavioral Health Services Providers SAMHSA This eight-page brief provides an introduction to pathological gambling, gambling disorder, and problem gambling, and their link with substance use disorders. It describes tools available for screening and diagnosis, as well as strategies for treating people with gambling problems.
The Efficacy-Effectiveness Distinction in Trials of Alcohol Brief Intervention Addiction Science and Clinical Practice This article aims to: (i) clarify the meaning of the terms “efficacy” and “effectiveness” and other related concepts; (ii) review the method and findings on efficacy-effectiveness measurement in the 2007 Cochrane Review by Kaner and colleagues; and (iii) make suggestions for further research in this area. Conclusions are: 1) to avoid further confusion, terms such as “efficacy trial”, “effectiveness trial”, “clinical representativeness”, etc. should be clearly defined and carefully used; 2) applications of BI to novel settings should begin with foundational research and developmental studies, followed by efficacy trials, and political pressures for quick results from premature effectiveness trials should be resisted...
Impulsivity as a Vulnerability Factor for Poor Addiction Treatment Outcomes Journal of Substance Abuse Treatment This review explores the hypothesis that individual differences in neurocognitive aspects of impulsivity (i.e., cognitive and motor disinhibition, delay discounting and impulsive decision-making) among individuals with a substance use disorder are linked to unfavorable addiction treatment outcomes, including high drop-out rates and difficulties in achieving and maintaining abstinence.
EU Agency Endorses Suspension of Oral Methadone Products European Medicines Agency The Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh), a regulatory body representing the European Union (EU), has added its endorsement to recommendations calling for suspension of marketing authorization of methadone oral solutions that contain high molecular weights of the additive povidone until the product can be reformulated.
Heavy Drinking May Attenuate Elevated Inflammatory Cytokine Levels of Major Depression in Alcohol Disorders Brain, Behavior, and Immunity Significantly elevated levels of all cytokines were observed among alcohol use disorder (AUD) patients with major depression (MD) with less frequent weekly alcohol use (less than 4 days) and lower typical quantity of drinks (less than 10 drinks), compared to AUD patients with MD with more alcohol use. Higher levels of circulating cytokines among AUD patients with MD compared to those without suggests MD contributes to changes in immune function in the context of AUD, and alcohol use severity may modulate this contribution.
Economist: Comprehensive Opioid Addiction Treatment “Pays for Itself” The New York Times The New York Times "Upshot" blog argues that although addressing the increasing rate of opioid abuse "would cost money...evidence suggests it would pay for itself." Austin Frakt writes that where people who are already addicted to opioids are concerned, long-term maintenance therapy, although costly, is the most cost-effective.
AHRQ: Little Evidence for Opioids in Managing Long-term Chronic Pain Journal of the American Medical Association Patients taking opioid medications for chronic pain over the long-term have an increased risk of serious dose-dependent harms, according to a review of the evidence on long-term opioid use by the Agency for Healthcare Research and Quality (AHRQ)...
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The views and positions of any content published in ASAM Weekly are not necessarily endorsed by ASAM nor a reflection of ASAM's beliefs and policies. The features are presented as a summary of the contemporary issues being represented and expressed in scientific, governmental, commercial, and media sources across the specialty field of addiction medicine. Contact ASAM Weekly with any comments or feedback.