Mental Health Parity Proposed Rule for Medicaid and CHIP Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposal applies certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid and Children's Health Insurance Program (CHIP). The Act ensures that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.
Editor’s Comments William Haning, MD, FASAM, DFAPA Comments relating to health care financing and policy rightly do not achieve the same level of excitement in the reading audience as hearing about a new procedural or therapeutic development. Few of us, if any, got into our field because of the attractive quality of the bookkeeping associated with it. Yet of those leaving the field, many will do so for exactly that reason of bookkeeping, and not because of the difficulty of patient care. A 2010 report by Eby & colleagues in the Journal of Substance Abuse Treatment noted an annual employment turnover for counselors of 33.2%; less easily tracked is the attrition of physicians who treat those with addictions.
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FROM JOURNAL OF ADDICTION MEDICINE
Abuse and Intentional Misuse of Promethazine Reported to US Poison Centers: 2002 to 2012 Journal of Addiction Medicine (free ASAM member resource) Promethazine-alone abuse/misuse most frequently resulted in minor outcomes, and less than 20% required medical admission. Abuse/misuse of PC resulted in a higher frequency of health care facility treatment and a trend toward more moderate outcomes. These differences are most likely attributed to the co-formulate...
A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care National Alliance on Mental Illness Achieving true equity in accessing mental health and substance use disorder care requires vigilant attention by advocates and public agencies responsible for enforcement. This 24-page report describes a survey conducted by NAMI to assess the experiences of people living with mental illness and their families with private health insurance. The findings of the survey are supplemented with an analysis of 84 health plans in the top 15 states by projected 2014 exchange enrollment.
Stakeholders’ Challenges and Red Flag Warning Signs Related to Prescribing and Dispensing Controlled Substances National Association of Boards of Pharmacy The goal of this stakeholder consensus document is to provide health care practitioners with an understanding of their shared responsibility to ensure that all controlled substances are prescribed and dispensed for a legitimate medical purpose as well as providing guidance on which red flag warning signs warrant further scrutiny...
FDA Issues Final Guidance on the Evaluation and Labeling of Abuse-Deterrent Opioids US Food and Drug Administration The US Food and Drug Administration issued a final guidance to assist industry in developing opioid drug products with potentially abuse-deterrent properties. Opioid drugs provide significant benefit for patients when used properly; however opioids also carry a risk of misuse, abuse and death. To combat opioid misuse and abuse, the FDA is encouraging manufacturers to develop abuse-deterrent drugs that work correctly when taken as prescribed, but, for example, may be formulated in such a way that deters misuse and abuse, including making it difficult to snort or inject the drug for a more intense high.
Buprenorphine Maintenance Program with Contracted Work/Education and Low Tolerance for Non-Prescribed Drug Use BMC Psychiatry This is a seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analyzed. A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. While the outcome of the study provides additional endorsement of pharmacological management of heroin dependence using buprenorphine, the
treatment arm did include modalities other than simply medication (employment, education). This is not described in detail but cannot be discounted as a positive cofactor in achieving the outcome.
Belief about Nicotine Selectively Modulates Value and Reward Prediction Error Signals in Smokers Proceedings of the National Academy of Sciences Little is known about how prior beliefs impact biophysically described processes in the presence of neuroactive drugs, which presents a profound challenge to the understanding of the mechanisms and treatments of addiction. The authors engineered smokers’ prior beliefs about the presence of nicotine in a cigarette smoked before a functional magnetic resonance imaging session where subjects carried out a sequential choice task. Using a model-based approach, they show that smokers’ beliefs about nicotine could override the effects of nicotine and the absence of effects of nicotine. While any enduring effect of this mind-over-matter demonstration was not shown, there could be clinical significance to these findings in the induction phase of nicotine cessation.
New Global Fund to Help Countries Defend Tobacco Control BBC News The $4m fund is a joint effort by Bloomberg Philanthropies and the Bill and Melinda Gates Foundation, who say that tobacco control gains are being put at risk by the industry's use of trade agreements and litigation. Demonstrating that there is a risk to complacency despite gains made in reducing tobacco use, particularly with respect to poorer populations, tobacco companies argue they are protecting investments, including intellectual property rights. The fund has been launched in Abu Dhabi at an international conference on tobacco control. The former New York City mayor, Michael Bloomberg, said: “The significant gains we have seen in efforts to reduce tobacco use are at risk of being undermined by the tobacco industry's use of trade agreements and litigation.”
Child/Adolescent Anxiety Multimodal Study: Evaluating Safety Child and Adolescent Psychiatry Participants ages 7 to 17 years (mean = 10.7 years) meeting the DSM-IV criteria for 1 or more of the following disorders: separation anxiety disorder, generalized anxiety disorder, or social phobia were randomized (2:2:2:1) to cognitive-behavioral therapy (CBT, n = 139), sertraline (SRT, n = 133), a combination of both (COMB, n = 140), or pill placebo (PBO, n = 76). Data on AEs were collected via a standardized inquiry method plus a self-report Physical Symptom Checklist (PSC). This purports to demonstrate safety of SSRI treatment for children; however, the duration of the study is not noted in the abstract.
A Critical Time to Donate ASAM 2015 marks the Ruth Fox Memorial Endowment’s 25th Anniversary, and now more than ever it is important to ensure the longevity of the fund. The endowment was first established with a goal to raise $10 million dollars. Twenty five years later, the endowment is just at $3.6 million. It is vital that our membership help grow the endowment as it serves as the foundation for ASAM to expand its voice as the expert resource for addiction medicine. Donate today!
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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.