May 17, 2018

MASAM has been active in supporting inclusion of language in various state bills that would mandate evidence-based treatment of OUD for adults incarcerated in the Commonwealth.  We include a letter from the Association for Behavioral Healthcare that nicely summarizes the issues.  In which bill we ultimately succeed in promoting humane and effective care is not predictable currently.

Letter to HCF Chairs re MAT in CARE Act 5.15.18 (click here) 

ASAM Weekly

Below you'll find the lead stories of ASAM Weekly. Click here If you want to subscribe,

2019

April 16, 2019

One of us was a pain patient saved by opioids, the other was addicted to them. We both deserve a solution.

Serious pain and addiction are public health conditions that are widespread, stigmatized and misunderstood. Comprehensive policy changes that address the dueling epidemics of serious pain and addiction in this country are sorely needed and the two sides should work together to effect cultural changes in how pain and addiction are treated.

Los Angeles Times >>>

 

April 9, 2019

The opioid epidemic is increasingly killing black Americans. Baltimore is ground zero.

For the past two decades, the news media has generally focused on white victims of the opioid epidemic in suburban and rural areas, such as in West Virginia and New Hampshire, but Baltimore has similar overdose death rates (49.1 per 100,000 in 2015). Historic disinvestment and segregation in the area has led to high poverty rates and racial disparities which are exacerbating the opioid crisis.

Vox >>>

April 2, 2019

Op-Ed: We must invest in addiction treatment providers

On March 25, members of ASAM’s Connecticut chapter (CT-SAM) penned an op-ed in the New Haven Register commending Congress for authorizing programs to strengthen the addiction workforce, and calling on Congress to fund them in FY2020’s federal budget. The SUPPORT for Patients and Communities Act authorized $25 million for a student loan repayment program for clinicians who work in substance use disorder treatment in high-need areas. The 21st Century Cures Act authorized $10 million to support training grants for medical professionals who provide treatment for addiction in community-based settings. While these authorizations are a step in the right direction, the op-ed notes that without full funding, medical professionals will continue fighting this epidemic without the resources they need.

New Haven Register >>>



March 26, 2019

Aspiring Doctors Seek Advanced Training in Addiction Medicine

The opioid epidemic has made the deficit of addiction-trained doctors painfully apparent which is spurring medical institutions throughout the United States to create fellowships in addiction medicine. Now medical students across the country are getting excited about the field and identifying addiction medicine as part of their future career paths.

National Public Radio (NPR) >>>

March 19, 2019

Outcome Differences in Neonates Exposed In-Utero to Opioids Managed in the NICU Versus Pediatric Floor

In this retrospective study, 235 infants with neonatal abstinence syndrome (NAS) were treated with a protocol using oral morphine in the neo-natal intensive care unit (NICU) or the pediatric unit, depending on physiologic stability at birth. Infants treated on the NICU had a longer length of stay in the hospital and increased number of days of medication treatment suggesting that care outside the NICU could improve short-term outcomes and reduce costs.

Journal of Addiction Medicine (JAM) >>>

March 12, 2019

United loses in court on behavioral health coverage rules

A federal judge has ruled that United Behavioral Health breached its fiduciary duty to patients by using unreasonable and overly restrictive guidelines to make coverage decisions for tens of thousands of mental health and substance use disorder patients. If upheld, the decision could have wide ramification on how insurers provide coverage under federal and state parity laws.

Modern Healthcare 



March 5, 2019

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

In this study, 886 cigarette smokers were randomized to receive behavioral support along with either nicotine replacement therapy (NRT) or electronic cigarettes (EC) and monitored for abstinence rates. At the end of one year, abstinence rates were 18.0% in the EC group and 9.9% in the NRT group; however, over 80% of abstinent individuals in the EC group were still using electronic cigarettes while only 9% of abstinent individuals in the NRT group were still using NRT.

New England Journal of Medicine

February 26, 2019

Cannabis use in teens linked to risk of depression in young

While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood. In this study, researchers conducted a systematic review and meta-analysis of over twenty-three thousand individuals and found that cannabis use during adolescence is associated with a significantly increased risk of depression and suicidality in adulthood.

JAMA Psychiatry  

February 19, 2019

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

Although most drug epidemics in the United States have disproportionately affected nonwhite communities, the current opioid epidemic is heavily concentrated among low-income white communities. In this population-based study the authors reviewed records from California’s prescription drug monitoring program and compared the rates of prescriptions (opioids, benzodiazepines, and stimulants) with zip code tabulation areas which include racial, ethnic, and income information. Implicit bias and access to care may underlie the racial/ethnic variance.

JAMA Internal Medicine >>>

February 12, 2019

Breaking the Silence

Physicians are people who appear to have it all together but are suffering in silence. Dr. Alisa Duran discusses her reasons for participating in a wellness program for physicians and opening up about addiction.

JAMA Network

February 5, 2019

Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome

Economic forces have shaped the course of the opioid epidemic across the United States. In this study, the authors examined 10-year, county-level data on long-term unemployment, clinician supply, rurality, and rates of neonatal abstinence syndrome (NAS) for 8 states which included 6.3 million births and 47,224 cases of NAS. There was a significant association among higher long-term unemployment, higher mental health clinician shortage areas, and higher county-level rates of NAS

JAMA Network

January 29, 2019

Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses

In this study across US counties, marketing of opioid products to physicians was associated with increased opioid prescribing and deaths from prescription opioid overdoses. The number of marketing interactions between physicians and pharmaceutical companies demonstrated a stronger association with mortality than the total dollar amount spent on each physician.

JAMA>>>

January 22, 2019

Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder

This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period. Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.

Journal of Addiction Medicine (JAM) >>>>

January 15, 2019

Is Marijuana as Safe as We Think?

Permitting pot is one thing; promoting its use is another. Malcolm Gladwell discusses cannabis legalization, a recent report from the National Academy of Medicine, and an alarming book by Alex Berenson.

The New Yorker >>>>

January 8, 2019

Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children

In this noninferiority randomized clinical trial of 90 children presenting to emergency departments with pain due to acute extremity injuries, intranasal ketamine (1.5 mg/kg) was noninferior to intranasal fentanyl (2 µg/kg) for pain relief. Although ketamine was associated with more adverse events, they were mild and transient.

JAMA Pediatrics >>>>

ASAM Weekly 2018 (archive)