Out-of-Hospital Mortality Among Patients Receiving Methadone for Noncancer Pain JAMA Internal Medicine The objective of this large-scale study was to compare the risk of out-of-hospital death in patients receiving methadone for noncancer pain with that in comparable patients receiving sustained-release (SR) morphine sulfate. This retrospective cohort analysis was conducted using Tennessee Medicaid records from 1997 through 2009. The cohort included patients receiving morphine SR or methadone who were aged 30 to 74 years, did not have cancer or another life-threatening illness, and were not in a hospital or nursing home. 90% were receiving the opioid for back or musculoskeletal pain...
Editor’s Remarks William Haning, MD, FASAM, DFAPA It is difficult to know which article to emphasize: this week's piece on methadone-associated mortality, or the policy statement of the American Academy of Pediatrics on cannabis. In the 50 years since Vincent Dole and Marie Nyswander collaborated in devising methadone maintenance, addiction medicine as a discipline has been validated...
Posttraumatic Stress Symptoms and Cognitive-Based Smoking Processes Among Trauma-Exposed, Treatment-Seeking Smokers: The Role of Dysphoria Journal of Addiction Medicine (free ASAM member resource) Despite the co-occurrence and clinically significant relationship between trauma exposure and smoking, there is little understanding of the mechanisms underlying the posttraumatic stress symptoms-smoking relationship. This study examined whether dysphoria (ie, a psychopathologic symptom dimension that reflects depression's core affective, cognitive, and psychomotor features) accounted for the covariance between posttraumatic stress symptom severity and an array of smoking processes among trauma-exposed daily smokers...
The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update - Policy Statement American Academy of Pediatrics This policy statement is an update of the American Academy of Pediatrics abstract policy statement “Legalization of Marijuana: Potential Impact on Youth,” published in 2004. It includes ten recommendations for states that are considering the legalization of marijuana. The recommendations are fertile ground for controversy, bearing as they do on legalization, decriminalization, and medical employment of cannabis.
Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions SAMHSA and CMS This Informational Bulletin is intended to assist states to design a benefit that will meet the needs of children, youth, and young adults with significant mental health conditions. Children with significant emotional, behavioral and mental health needs can successfully live in their own homes and community with the support of the mental health services described in this document. Projects addressed are Psychiatric Residential Treatment Facility (PRTF-CMS) and the Children’s Mental Health Initiative (CMHI-SAMHSA).
NAADAC Minority Fellowship Program for Addiction Counselors NAADAC The Association for Addiction Professionals has been awarded the Now is the Time: Minority Fellowship Program for Addiction Counselors Master’s Level Grant from SAMHSA designed to increase the number of culturally-competent Master’s level addiction counselors available to underserved and minority populations, and transition age youth (ages 16-25). The program will provide tuition stipends of up to $20,000 per student for at least 30 graduate students in their final year of an accredited master’s program along with education, training, and mentorship. Applications due February 28, 2015.
Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen Journal of Correctional Health Care The Rapid Opioid Dependence Screen (RODS) is an 8-item measure of opioid dependence designed for quick, targeted screening in clinical and research settings. It is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth edition, criteria, reported as requiring 2 minutes to administer. This reports the initial validation of the RODS among a sample of 97 newly incarcerated, HIV-positive individuals. Transition to the DSM 5th Edition (DSM5) will need to be considered in future employment of the RODS.
Long Working Hours Are Linked to Risky Alcohol Consumption British Medical Journal This editorial by Cassandra Okechukwu reviews a linked meta-analysis, examining the association between long working hours and higher odds of alcohol use in cross sectional studies. It provides a thoughtful account of the complexities of populational characterizations, as well a consideration of alcohol use as both a response to long working hours and an aggravator thereof.
Addiction Patients Overwhelm Vermont's Expanded Treatment Programs NPR “Vermont Gov. Peter Shumlin attracted national attention last January when he devoted his entire State of the State address to Vermont's opiate addiction problem...But just as building new roads can make traffic worse, the upward trajectory in the number of people seeking treatment got even steeper as more help became available.” This NPR news piece may equally demonstrate the premise of, “If you build it, they will come,” and the happy problem of having people who have long needed care surging to the opportunity to receive it.
Effectiveness of Psychological Treatments for Depressive Disorders in Primary Care: Systematic Review and Meta-Analysis Annals of Family Medicine An examination by Klaus Linde & colleagues of 30 studies centered on the utility of psychological, non-pharmacological approaches to depression in the primary care setting. Efficacy was demonstrated, including for CBT approaches, the latter commonly manualized and thus less resource-demanding.
How America Is Making Painkiller Addiction Even Worse Business Insider This lay literature item reviews the present state of physician mis-prescription of opioids in the U.S., and several states’ responses to the problem. Replete with interesting graphics, it provides a very readable if brief account of the epidemic and physicians’ role in it. The emphasis upon a disease model and treatment strategies will resonate well with the aims of organized addiction medicine.
Use of the Nicotine Metabolite Ratio as a Genetically Informed Biomarker of Response to Nicotine Patch or Varenicline for Smoking Cessation The Lancet: Respiratory Medicine Substantial variability exists in therapeutic response and adverse effects with pharmacotherapies for tobacco dependence. Biomarkers to optimise treatment choice for individual smokers might improve treatment outcomes. This study (n=1246) tested whether a genetically informed biomarker of nicotine clearance, the nicotine metabolite ratio (NMR; 3′-hydroxycotinine:cotinine), predicts response to nicotine patch or varenicline for smoking cessation. Its therapeutically-useful conclusion was that “...Treating normal metabolisers with varenicline and slow metabolisers with nicotine patch could optimise quit rates while minimising side-effects.”
National Practice Guideline for Medications for the Treatment of Opioid Use Disorder Public Comment Period ASAM The link below from the ASAM Magazine of 15 October, 2014, gives the background for the following: From February 10-17, a draft of the National Practice Guideline for Medications for the Treatment of Opioid Addiction will be available for public comment on the homepage of the ASAM Website. This is an opportunity for members and the public to participate in the external review and provide comments. The final guideline is expected to be sent to the board in April.
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