MASAM - Massachusetts Society of Addiction Medicine
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MASAM News
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 news
2018
November 13, 2018
Impact of Opioid Epidemic on Children Varies by State
While opioid use continues to plague certain states more than others, each state is unique in how it attempts to stem the crisis and its effect on families. A new study published in Child Abuse and Neglect finds that between 2010-2015 there was significant variation across the country in regards to opioid prescription rates as well as the number of children placed into foster care.
November 6, 2018
FDA Set to Approve Potent Opioid For Market Despite Adviser’s Objections
The head of the Food and Drug Administration’s (FDA) Anesthetic and Analgesic Drug Products Advisory Committee has made public his opposition to the FDA’s expected approval of a new opioid medication, Dsuvia. The company, AcelRx, believes the medication is important as it provides a pre-measured, short-acting analgesic that may also reduce the number of fatal dosing errors that occur in hospitals.
October 30, 2018
Illicit Fentanyl is Driving Overdose Deaths, But Expanded Access to Treatment Can Help
The president has signed the Support for Patients and Communities Act, a wide-ranging bill passed by Congress to target the opioid crisis. Some of the changes it will bring include better recording of international packages mail through the US Postal Service, expanding Medicare coverage for methadone, and loosening restrictions caused by the Institutes of Mental Disease (IMD) exclusion.
The Hill
October 23, 2018
Combustible and Electronic Tobacco and Marijuana Products in Hip-Hop Music Videos, 2013-2017
In this study, researchers reviewed available music videos for all hip-hop songs listed on Billboard magazine’s weekly Hot R&B/Hip Hop Songs list between 2013-2017 to understand the use marijuana and tobacco imagery. Findings indicate an increasing use of such imagery as well as popularity of music videos. Those videos containing electronic use, brand placement increased from 25 percent in 2013 to 88 percent in 2017.
October 16, 2018
Addiction is Hard to Talk About. That’s Why Steve Carell and Timothee Chalamet Wanted to Make Beautiful Boy
Beautiful Boy (out Oct. 12) is the movie adaptation of two memoirs written by a father and son that shows the 360-degree view of addiction as a family disease. Actors Steve Carell and Timothee Chalamet share why making this movie was so challenging and rewarding.
October 9, 2018
Who's Responsible For The Opioid Epidemic? Doctors or Pharmaceutical Companies?
Dr. Barry Schultz was sentenced to 157 years for what Florida prosecutors described as physician drug-dealing. Mallinckrodt, the pharmaceutical company that flooded Florida with hundreds of millions of oxycodone pills paid only a small penalty. The question many are asking is: who is responsible for the opioid epidemic?
October 2, 2018
Addiction Training for Doctors
As physicians, we implore policymakers to pass legislation that will help teach addiction medicine, grow the work force and save lives. We can do this by funding medical school and residency program training and curriculums, offering student loan repayment options for those treating addiction, and increasing the number of health care professionals who are equipped to provide medications for the treatment of opioid addiction.
New York Time Opinion Section (Read More) >>>
September 25, 2018
Senate Passes Sweeping Opioids Package
The Washington Post
The Senate has passed a bill costing $8.4 billion and is expected to create, expand and renew programs across multiple agencies aimed at addressing the nation’s deadly opioid epidemic. The House passed a similar measure in June but the two chambers will need to negotiate a few differences, including the “IMD Exclusion” (Institutions for Mental Disease exclusion), an obscure rule that prohibits Medicaid reimbursements for inpatient substance use treatments in facilities treating those with mental illness.
September 18, 2018
FDA Approves New Dosage Strength of Buprenorphine and Naloxone Sublingual Film as Maintenance Treatment for Opioid Dependence
Food & Drug Administration
The U.S. Food and Drug Administration approved Cassipa (buprenorphine and naloxone) sublingual film for the maintenance treatment of opioid dependence. This will provide a new single dosage strength (16 milligrams/4 milligrams) of buprenorphine and naloxone sublingual film.
September 11, 2018
Opioid Use Disorder: Treat The Family, Not Just The Patient
American Medical Association
Opioid use disorder affects us all. It is important to recognize the impact addiction has on the family and to provide them with tools for helping their loved ones.
Read More>>>
September 4, 2018
Fight Drug Abuse, Don’t Subsidize It
New York Times (Op-ed)
Safe injection Sites (SIS) have been in operation for years outside of the US and now several cities (San Francisco, New York, Seattle etc…) are legislating to allow for similar programs. Deputy Attorney General Rod Rosenstein strongly disagrees and emphasizes the illegalities and detriments awaiting communities. Although there are few studies demonstrating effectiveness compared with other treatment modalities, the Deputy Attorney General cites a city council member (1) and the estimations of a chief medical officer (2) as evidence that safe injection sites will fail.
Reference 1: http://www.redmond-reporter.com/opinion/safe-injection-sites-are-not-the-answer-to-our-heroin-problem-guest-editorial/
Reference 2: https://www.theatlantic.com/health/archive/2017/11/why-cant-addicts-just-quit/545552/
August 28, 2018
Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality
New England Journal of Medicine
In this study funded by the National Institute of Health (NIH), researchers sought to better understand whether weight gain after smoking cessation attenuates other health benefits. The results indicate there is a temporary elevation in risk of type 2 diabetes among quitters who gained weight but that overall and cardiovascular mortality decreased substantially in all weight-change groups.
August 21, 2018
Don’t Call People ‘Addicts,’ Penn Researchers Say
Whyy.org
A new study found that terms such as "alcoholic" and "addict" carry more stigma than more recent terms such as "person with a substance use disorder." Explicit bias is recognized as a contributor to the stigma of addiction but the authors also used a word-association task and found evidence for implicit bias.
August 14, 2018
Massachusetts Opioid Bill Includes Help For Pain Patients
The Boston Globe
A bill just passed by the Massachusetts Senate is being applauded for the broad approach it is using to address pain and addiction. The legislation will look at requirements for insurance companies to cover non-opioid pain therapies, establish a pilot program to provide medication-assisted treatments (MAT) in correctional facilities and even require emergency departments to initiate MAT after an overdose, among other things.
Drug Treatment In NJ's Jails Helps Break Cycle Of Crime and Addiction
NorthJersey.com
Several studies have shown that recently released inmates are over 100 times more likely to die from an opioid overdose than the general population. The Atlantic County Jail system is the nation's first correctional program to provide medication-assisted treatments (MAT), which has helped lower rates of recidivism and officials anticipate will reduce the overall overdose-death rate in the county.
Read More>>>
August 7, 2018
How Lessons From HIV/AIDS Crisis Can Apply to The Opioid Crisis
The Philadelphia Inquirer
Every public health crisis must be understood as both a medical issue and a social issue. As we grapple with the overdose crisis, communities and policymakers should heed three key lessons from the fight against AIDS: stigma is the enemy, activism is the accelerator, and medicines work only when people have access to them.
July 30, 2018
Mortality Due to Cirrhosis and Liver Cancer in The United States, 1999-2016: Observational Study
The British Medical Journal
By analyzing death certificate and population data (1999-2016) from the US Census Bureau and the Center for Disease Control (CDC), the authors present concerning trends in death rates attributable to cirrhosis. Annual deaths from cirrhosis increased by 65 percent over this time period while people ages 25-34 experienced the greatest relative increase in mortality (10.5 percent), mainly driven by deaths due to alcoholic cirrhosis.
July 24, 2018
Association of Chronic Opioid Use With Presidential Voting Patterns in US Counties in 2016
JAMA Network
In this study using a national sample of Medicare claims data, the authors found chronic use of prescription opioids was correlated with support for Donald Trump in the 2016 presidential election. This correlation is also related to underlying socioeconomic characteristics such as income, disability, insurance coverage, and unemployment which emphasizes the relationship between public policy and the burden of mental illness.
Read More>>>
July 17, 2018
The Emerging Role of Inhaled Heroin in The Opioid Epidemic
JAMA Neurology
Chasing the Dragon (CTD) is a form of inhalation that involves heating heroin to inhale the fumes which avoids first-pass metabolism and is less likely to cause infection compared intravenous routes. It is also becoming a more popular method with young adults. Although CTD is known to have distinct brain toxicity including toxic leukoencephalopathy, further understanding is needed to reduce potential morbidity and develop therapeutic options.
July 10, 2018
Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities
New England Journal of Medicine
Despite widespread awareness of the opioid-overdose crisis, the epidemic continues to worsen. In this perspective, the authors recommend increasing access to treatment through Primary Care Providers similar to prior public health crisis. They provide thoughtful recommendations about federal regulations on buprenorphine training, myths regarding evidence based treatments, and recommendations for medical school education.
July 3, 2018
House Passes Bipartisan Package to Fight Opioid Crisis
Washington Post
The House of Representatives passed a sweeping package to fight the opioid crisis. Comprising of nearly 60 bills, the legislation includes measures encouraging nonaddictive pain treatment, fighting the rise of synthetic drugs, and allowing physician assistants and nurse practitioners to prescribe medication for opioid use disorders.
ASAM Press Release: Addiction Medicine Community Applauds House of Representatives for its Action
June 19, 2018
Cars Into Walls, Breaking Hands With Hammers: How the White House Is Warning Against Opioids
STAT
The White House has unveiled several "hyper-realistic" ad campaigns to deter 18-24 year-olds from misusing opioids. Although reminiscent of the "This Is Your Brain On Drugs” campaigns, which studies have found ineffective, many supporters believe these emotionally driven ads are necessary to drive awareness to dangers of opioids
Read More>>>
June 12, 2018
Suicide Rates Crashing Rising Across the US
Centers for Disease Control and Prevention (CDC)
CDC researchers examined state-level trends in suicide rates from 1999-2016 and found that suicide rates increased by more than 30% in over half the United States. More than half (54%) of those who died by suicide did not have a known mental health disorder but many factors contribute to suicide risk, including problematic substance use (28%).
June 5, 2018
You’re Not a Drug Dealer? Here’s Why the Police Might Disagree
New York Times
When an overdose victim dies, state laws can find acquaintances culpable. The New York Times reviewed hundreds of cases throughout the country in which friends and family were charged with homicide for deaths due to overdose.
Read More>>>
May 29, 2018
Treat Addiction Like Cancer
New York Times
Addiction, like cancer, is a complex disease that requires a multipronged approach. However, the treatment pathway for cancer is comprehensive and evidence-based while for addiction it can often be exploitive and provided mostly outside the medical system.
Read More>>>
May 22, 2018
We really do have a solution to the opioid epidemic — and one state is showing it works
Vox
Virginia developed a public-health driven program that expands addiction services throughout the state's health care system while utilizing Medicaid funding. Early results indicate the Addiction and Recovery Treatment Services (ARTS) program has increased treatment for those with opioid use disorders by 29 percent and decreased opioid related emergency visits by 31 percent.
Read More>>>
May 15, 2018
The Pain Hustlers
The New York Times Magazine
In 2012, Insys Pharmaceuticals was a small company with only one branded product, a potent opioid called Subsys. By 2013, Subsys was the most widely-prescribed branded opioid in its class (transmucosal immediate-release fentanyl) and that same year Insys became the best-performing initial public offering. All the while, federal agencies were pursuing criminal investigations.
Read More>>>
May 8, 2018
Suicide: A silent contributor to opioid-overdose deaths
The New England Journal of Medicine
Two epidemics are contributing to decreased life expectancies in the US: opioid-related fatalities and suicide. Many experts believe the data for both are inaccurate yet the risks of co-occurrence are high. Drs. Oquendo and Volkow argue that accurate statistics, increased screening and improved treatment and prevention strategies are needed to address the crisis within a crisis.
Read More>>>
May 1, 2018
When raised among drug and alcohol “abuse”, what makes some teens ‘resilient’?
University of Michigan Health Lab
Researchers examined functional MRI and performance testing data in 57 participants of the Michigan Longitudinal Study to better understand why some young adults in families with addiction are less prone to subsequent substance misuse. The participants with more resilience showed heightened activation in the prefrontal cortex but no difference in the processing of rewards.
April 24, 2018
Risk thresholds for alcohol consumption: combined analysis of individual-participant data
The Lancet
This study indicates that most current guidelines on alcohol consumption are too high. The authors analyzed alcohol use data on almost 600,000 current drinkers without cardiovascular disease from 83 prospective studies across 19 countries. They found that all-cause mortality was lowest in people who drank 100 grams (7 US drinks) or less of alcohol per week but cardiovascular disease (excluding myocardial infarction) and alcohol consumption were associated at all levels.
April 17, 2018
Addiction experts have new tools, tough challenges
Pittsburgh Post-Gazette
After years of surging drug overdoses, some of the officials and medical clinicians most deeply involved in the fight against the opioid epidemic have hope that they finally have the tools, the funding and the public support needed to get the epidemic under control.
April 10, 2018
Is kratom a safe herbal remedy or a dangerous opioid?
The Philadelphia Inquirer
At a “smoke shop” in Philadelphia, employees and customers profess the benefits and safety of kratom while a nationally recognized forensic laboratory has found it present in about 1-3% of postmortem cases, along with other substances.
Read More>>>
April 3, 2018
Are There Risks From Secondhand Marijuana Smoke? Early Science Says Yes.
Kaiser Health News
Most of the public would not dispute the harms of second-hand smoke from tobacco, but what about marijuana? The research is still in its infancy but scientists are concerned that some of the risks could be worse.
March 27, 2018
ASAM’s Response to Trump Administration Initiative
ASAM.org
Corey Waller, MD, MS, FACEP, DFASAM, Chair of ASAM’s Legislative Advocacy Committee, had this to say about the President’s announcement, “President Trump’s plan rightly recognizes addiction as a chronic brain disease and includes many important initiatives to reduce the suffering and death caused by this terrible disease. However, as has been said before, we cannot arrest and prosecute our way out of this crisis, and an overemphasis on law enforcement approaches at the expense of prevention, treatment and recovery support services, will not serve our nation well. ASAM stands ready to be part of what should, and must be, a nationwide effort to prevent deaths and engage people in treatment, while we lay the groundwork for a more robust addiction treatment infrastructure and workforce that will lead us all to a stronger and healthier future.”
March 20, 2018
Shattering the Myth of the ‘Addicted Baby’
Above the Law
By definition newborns cannot be born with substance use disorders. This is a misunderstanding of the physiologic effects of withdrawal but the persistent belief of this phenomena in popular culture has a more sinister effect by stigmatizing those who need help.
March 13, 2018
Emergency Department Data Show Rapid Increases in Opioid Overdoses
Center for Disease Control and Prevention (CDC)
According to a new report from the Centers for Disease Control and Prevention (CDC), Emergency Department (ED) visits for opioid overdoses rose 30% in all parts of the US from July 2016 through September 2017. Large cities saw an increase of 54% while the Midwestern region was higher at 70%. These findings are troubling given the increasing efforts of many who work hard to increase awareness and funding, improve treatments and preventions, and ultimately, help save lives.
March 6, 2018
Americans are increasingly becoming more self-destructive in 'nightmarish' trend
USA Today
According to a new report from two non-profit organizations, there is a disproportionate increase in drug deaths among racial and ethnic minority groups in America- along with other alarming findings. The authors are advocating to create a National Resilience Strategy that focuses on prevention, awareness and treatment.
February 20, 2018
2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter
CMS
The Centers for Medicare & Medicaid Services (CMS) released Part II of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies (the Advance Notice), and Draft Call Letter. The proposed updates will continue to create more choices for Medicare beneficiaries selecting MA and Part D plans in 2019.
February 13, 2018
Cheers? No thanks! Low- and no-alchohol lifestyle booms
The Guardian
Dry January is gaining in popularity but so is low or no alcohol lifestyles. In the UK sales of low alcohol beverages are up almost 30% and the industry is responding with a wider selection of high-quality low-alcohol beers, wines, and even spirits. Read More>
February 6, 2018
FDA panel gives qualified support to claims for 'safer' smoking device
KPCC
Phillip Morris has developed a product that heats but does not combust tobacco which the company claims is safer than cigarettes. An FDA advisory panel has voted against the companies claims that the product reduces the risk of tobacco-related disease but did vote in favor the statements that the product reduces the body's exposure to harmful chemicals. Read More >
January 23, 2018
Opioid Addiction Knows No Color, but Its Treatment Does
The New York Times
This is an updated report on the rates of drug overdose deaths from 1999-2016. Some key findings include that the rate in 2016 was more than 3x that in 1999 and those involving synthetic opioids other than methadone doubled in 2016 when compared to 2015. Read More >
January 16, 2018
Drug Overdose Deaths in the United States, 1999–2016
CDC
This is an updated report on the rates of drug overdose deaths from 1999-2016. Some key findings include that the rate in 2016 was more than 3x that in 1999 and those involving synthetic opioids other than methadone doubled in 2016 when compared to 2015. Read More >
January 9, 2018
Why some people swear by Alcoholics Anonymous — and others despise it
Vox
A journalist’s review of several cases and of the literature leads to his conclusion that 12-step facilitation and Alcoholics Anonymous (AA) work for many individuals but not for everyone. He concludes that the influence of a positive social network is fundamental and the availability of multiple treatment options (beyond 12-step and AA) is necessary to address the diversity of individuals seeking help. Read More >
ASAM Weekly News (2017)
December 26, 2017 The single biggest reason America is failing in its response to the opioid epidemic Vox After covering the opioid epidemic for more than a year, a journalist writes about the challenges America faces in combating this crisis and the continued role stigma plays in worsening the situation. Read More > December 19, 2017 The surgeon general and his brother: A family’s painful reckoning with addiction STAT The US Surgeon General Dr. Jerome Adams has a personal connection with addiction through his younger brother and understands the challenges faced by many families. Read More > December 12, 2017 Statement from FDA Commissioner Scott Gottlieb, MD, on the approval of a new formulation of buprenorphine and FDA’s efforts to promote more widespread innovation and access to opioid addiction treatments US FDA The US Food and Drug Administration (FDA) has approved a monthly formulation of buprenorphine. Given the severity of the opioid crisis, Dr. Gottlieb discusses the FDA’s new efforts of advocating for the use of medication assisted treatments (MAT). Read More >
December 5, 2017 Largest study of opioid deaths reveals who is at most risk Science News Researchers analyzed over 13,000 cases of opioid-related deaths in the Medicaid system and found an increased likelihood for those with a diagnosis of chronic non-cancer pain, recent opioid and benzodiazepine prescription as well as a diagnosis of a mental health or substance use disorder. Read More > See Abstract > November 27, 2017 Why women are at particular risk of developing an alcohol-use disorder? She Knows Recent data from National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) shows that alcohol use has been on the rise across the board but women in particular seem to be at additional risk of developing alcohol use disorders. Read More > November 21, 2017 Time to adopt view of opioid-use disorder as chronic disease AMA Wire In an article for the American Medical Association, Dr. Soper discusses some of the continued challenges of addiction treatment such as burdensome insurance and regulatory policies as well as the continued stigma coming from other physicians. Read More > November 14, 2017 Survey: nearly half of Americans have a family member or close friend who’s been addicted to drugs Vox A recent Pew survey of American adults found that almost half of those surveyed have either a close friend or family member with an addiction and the rates do not differ significantly by gender, race, education, or even political affiliation. Read More > November 7, 2017 ASU study: Communication is key for keeping your kids off drugs Arizona State University Researchers surveyed over 3,000 seventh and eighth grade students about their use of alcohol, marijuana, and tobacco and found that those who did not talk with their parents about substance use were more likely to try illicit substances. Read More > October 24, 2017 Ex-DEA agent: Opioid crisis fueled by drug industry and Congress 60 Minutes | The Washington Post A joint investigation by 60 minutes and The Washington Post raised alarms about an industry-lobbied legislation which constrained the US Drug Enforcement Agency’s (DEA) enforcement powers and led to the recent withdrawal of drug czar nominee, Senator Tom Marino. Read More > October 17, 2017 Mandatory Guidelines for Urine Testing Updated to Include Four Semi-Synthetic Opioids SAMHSA Oxycodone, oxymorphone, hydrocodone, and hydromorphone are the most common opioids used without a prescription and will now be included on standard urine drug testing for federal employees in the US. Read More > October 10, 2017 Pharmacy Benefit Management of Opioid Prescribing: The Role Of Employers And Insurers Health Affairs Blog Pharmacy Benefit Managers can play a significant role in reducing opioid addictions through utilization review programs. Further steps should be carefully considered such as quantity limits, step therapy, and restricted formularies which could reduce health costs and negative outcomes. Read More > October 3, 2017 The Social Life of Opioids Scientific American Considering the importance of opioids in pain, addiction, and human bonding, recent studies in the social sciences are suggesting that social capital may be a protective factor in the opioid crisis. Read More >
September 26, 2017 FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks US FDA Given the risks of an untreated opioid use disorder, the U.S. Food and Drug Administration (FDA) is advising clinicians that patients taking benzodiazepines or other central nervous system (CNS) depressants should not be broadly excluded from treatment with buprenorphine or methadone. Read More > September 19, 2017 CDC awards $28.6 million to help states fight opioid overdose epidemic CDC Newsroom In addition to the $12 million awarded in June, the Centers for Disease Control and Prevention (CDC) is now awarding more than $28.6 million in additional funding to over 44 states as part of the Department of Health and Human Services’ five-point strategy to fight the opioid overdose epidemic. Read More > September 12, 2017 Hurricane Harvey: Addicted and Evacuated Can Be a Harsh Combination Texas Public Radio As people flee the flood waters of Hurricane Harvey, those on methadone maintenance may no longer have access to their treatment centers and are facing significant obstacles in receiving care. Read More > September 5, 2017 TRENDS IN THE USE OF METHADONE, BUPRENORPHINE, AND EXTENDED-RELEASE NALTREXONE AT SUBSTANCE ABUSE TREATMENT FACILITIES: 2003-2015 (UPDATE) SAMHSA Surveys of substance abuse treatment facilities from 2003-2015 show that 8-10% provide methadone through Opioid Treatment Programs (OTPs); however, there has been a larger increase in the total number providing treatment with buprenorphine (79%) and injectable naltrexone (39%). Read More > August 29, 2017 PCORI Board approves $10 million for new studies on reducing unsafe opioid prescribing Patient-Centered Outcomes Research Institute The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors recently approved $10 million to fund two studies focused on reducing opioid use for pain management. One study evaluates nonpharmaceutical strategies such as Cognitive Behavioral Therapy, acupuncture etc… while the other looks at different monitored interventions that may help practitioners prescribe fewer opioids. Read More > August 22, 2017 A government health agency is funding the first-ever study on medical marijuana’s impact on opioid abuse Market Watch The National Institutes of Health (NIH) has awarded a five-year $3.8 million grant for the first-ever long-term study testing whether medical marijuana reduces opioid use among HIV +/- adults with chronic pain. Read More > August 8, 2017 OPIOID MISUSE INCREASES AMONG OLDER ADULTS SAMHSA 9.5 million American adults misused opioids in 2014. While the misuse has decreased among young adults from 2002-2014, the rates among older adults (50+) have increased. Read More > August 1, 2017 Rising threat: Death by fentanyl Harvard Gazette The spread of illicit fentanyl expedites the dangers of the opioid epidemic. Dr. Wakeman of Massachusetts General Hospital provides insight into this worrisome trend. Read More > July 25, 2017 STATE AND SUBSTATE ESTIMATES OF NONMEDICAL USE OF PRESCRIPTION PAIN RELIEVERS SAMHSA: The CBHSQ Report More than 26 million Americans have misused prescription pain relievers since 2002. Recent estimates indicate a decrease in the national trend but that rates can vary across regions, states and even between census tracts. Read More > July 18, 2017 New Data on Opioid Use and Prescribing in the United States JAMA Although the number of opioids prescribed peaked in 2015, a recent report from the US Centers for Disease Control demonstrates a substantial variability at the county level and illustrates the need for more unified approaches to this epidemic. Read More > July 11, 2017 Prescription Opioid Use among Adults with Mental Health Disorders in the United States Journal of the American Board of Family Medicine Americans with a mood or anxiety disorder receive 51% all opioids prescribed in the United States. A recent study of nationally representative survey data raises concerns of the risks and frequency of prescription opioid use in this population. July 4, 2017 STAT forecast: Opioids could kill nearly 500,000 Americans in the next decade STAT Experts from across the country believe the death toll from the opioid epidemic will only get worse before it gets better and recent trends are producing alarming forecasts. June 26, 2017 America's new tobacco crisis: The rich stopped smoking, the poor didn’t The Washington Post Although the rate of Americans who smoke is declining, there is a socioeconomic gap which underlies many of these successes and creates ongoing challenges for certain populations. Read More > June 20, 2017 FDA requests removal of Opana ER for risks related to abuse US FDA The U.S. Food and Drug Administration has requested that Endo Pharmaceuticals remove reformulated Opana ER (oxymorphone hydrochloride) from the market. This decision was based upon postmarketing data demonstrating a shift in routes of abuse from nasal to injection, which has resulted in more serious harm and disease outbreaks. Read More > June 13, 2017 The Role of Science in Addressing the Opioid Crisis The New England Journal of Medicine The opioid epidemic is a rapidly evolving public health crisis. In response, NIH is partnering with private industry to launch an initiative in three scientific areas: developing better overdose and prevention interventions, researching new and innovative treatments, and finding non-addictive interventions to manage chronic pain. Read More > June 6, 2017 Quetiapine-XR Effective on Depressive Symptoms, Substance Use Disorder Psychiatry Advisor According to research presented at the American Psychiatric Association 2017 Annual Meeting, the atypical antipsychotic quetiapine-XR may be effective in reducing substance abuse (alcohol, marijuana, and tobacco) in patients with bipolar disorder. It also may be more effective in reducing depressive symptoms in bipolar patients with comorbid substance use disorder. Read More > May 30, 2017 Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis. Journal of Addiction Medicine The authors found sex-specific differences among young adults who use nonmedical prescription opioids; pain is an important risk factor in young men while non-medical use of benzodiazepines is a more important factor in women. Read More >
May 23, 2017 Hepatitis C Virus Infection Among Women Giving Birth — Tennessee and United States, 2009–2014 CDC: Morbidity and Mortality Weekly An analysis of US and Tennessee birth certificate data from 2009-2014 found that maternal HCV infections nearly doubled and in Tennessee mothers in rural areas had a nearly threefold increase of infection. Read More > May 16, 2017 THE PLIGHT OF OPIOID ADDICTION MAY GET A LOT WORSE WITH THE AMERICAN HEALTH CARE ACT Newsweek Healthcare advocates and physicians are concerned that the new healthcare plan will make treatment for substance abuse unaffordable. Read More > May 9, 2017 Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies BMJ The current review compared the risk for all cause and overdose mortality rates from 19 research studies with patients receiving opioid substitution treatment. Read More > May 2, 2017 ASAM Commends President Trump's Nomination for Assistant Secretary of Mental Health and Substance Use ASAM Advocacy President Donald Trump announced his nomination of Elinore McCance-Katz, MD, PhD to serve as the Assistant Secretary for Mental Health and Substance Use in the Department of Health and Human Services. ASAM sent a letter to Dr. Tom Price to express support for the nomination. Read More > April 25. 2017 ASAM Announces First-Ever Addiction TreatmentGap Awareness Week ASAM ASAM will be hosting the first ever Addiction Treatment Gap Awareness Week April 24th to 30th, 2017. This national awareness week will be dedicated to recognizing the significant gap in treatment for those with the disease of addiction. Read More > April 18, 2017 'Every life matters': Surgeon general addresses New Orleans doctors on stigma of addiction The New Orleans Advocate Speaking Friday to more than 2,000 doctors at the annual conference of the American Society of Addiction Medicine in New Orleans, U.S. Surgeon General Vivek Murthy told the story of a relative who had lost a son to an opioid addiction. Murthy’s opening address comes at a time when addiction specialists have been thrust into the limelight as never before. Read More > April 11, 2017 Effect of Maryland’s 2011 Alcohol Sales Tax Increase on Alcohol-Positive Driving American Journal of Preventive Medicine In 2011, Maryland increased the alcohol sales tax from 6% to 9%. The authors of this study found it resulted in a significant reduction in fatal or nonfatal motor vehicle injuries across different age groups but the most significant reduction was found in drivers aged 15-34 years. This study supports the idea that increasing alcohol taxes in combination with other alcohol-control policies could be an effective means of reducing drunk driving as well as improving other public health concerns. Read More > April 4, 2017 A Substance Use Cost Calculator for Employers National Safety Council "The Real Cost of Substance Use to Employers" tool is an easy-to-use tool that provides business leaders with specific information about the cost of substance use in their workplace based on size of employee base, industry, and state. March 28, 2017 THE FLAVOR TRAP: How Tobacco Companies Are Luring Kids with Candy-Flavored E-Cigarettes and Cigars Tobacco Free Kids: Report In recent years, there has been an explosion of sweet-flavored tobacco products, especially e-cigarettes and cigars. This widespread availability of flavored products is undermining the nation’s overall efforts to reduce youth tobacco use and putting a new generation of kids at risk of nicotine addiction and the serious health harms that result from tobacco use. Read More > March 21, 2017 Beyond Cigarettes: The Risks of Non-Cigarette Nicotine Products and Implications for Tobacco Contro The National Center on Addiction and Substance Use Using national data on nicotine use, the current report found that approximately 16% of adults and 15% of middle and high school students reported using at least one non-cigarette nicotine product and more than half of all users reported symptoms of nicotine addiction. A science-based approach to the regulation of all nicotine-containing products as well as prevention initiatives are needed. Read More > March 14, 2017 Are women increasingly at risk of addiction? The Washington Post There is an increasing cohort of women who are drinking (or abusing) alcohol more than women did only a few decades ago. Read More > March 6, 2017 Online Museum of African American Addictions, Treatment and Recovery: Hall of Fame Museum of African American Addiction Recovery Each year the Museum of African American Addictions, Treatment and Recovery nominates individuals who have made outstanding contributions to the treatment and recovery among African Americans. The 2017 recipients are Ijeoma Achara-Abraham, PsyD, Brother Earl Cannamore, and Dr. Carl C. Bell, M.D. whose contributions have made significant impacts in the field of addiction. Read More > February 28, 2017 Trends in Central Nervous System–Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States JAMA The number of Americans aged 65 and older taking at least three psychotropics or opioids more than doubled between 2004 and 2013. Analysis of the National Ambulatory Medical Care Survey raises concerns about prescribing practices that are showing increased opioid prescribing and inappropriate use of CNS depressants in this population. Read More > February 21, 2017 Brain Imaging Helps Predict Start of Heavy Alcohol Use Among Adolescents Brain & Behavior Research Foundation (eNews) Neuroimaging data can help improve the accuracy of predicting future alcohol use disorders. This model could provide a new strategy for identifying at-risk youth before initiation of alcohol use and possibly guide future studies in determining the neural mechanisms involved in adolescent alcohol use. Read More > February 14, 2017 Report: A quarter of teenagers who use e-cigarettes have tried ‘dripping’ The Washington Post Not surprisingly, e-cigarette users are tinkering with the technology. Dripping is a technique in which the e-cigarette juice is manually dropped directly onto the coil, and the resulting vapor inhaled. The current study evaluated the prevalence rates and reasons for using e-cigarettes for dripping among high school students. Read More > February 7, 2017 Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data The Lancet Researchers analyzed trends in mortality in the US between 1999 and 2014 in people aged 25–64 years to identify specific causes of death. Although HIV treatment and smoking cessation have contributed to the declining premature mortality, this progress was negated in young and middle-aged individuals because of drug poisonings, suicide, and chronic liver disease. Read More >
January 31, 2017 Tobacco Product Standard for N-Nitrosonornicotine Level in Finished Smokeless Tobacco Products Federal Register The Food and Drug Administration (FDA) is proposing a tobacco product standard that would establish a limit of N-nitrosonornicotine (NNN) in smokeless tobacco products. Because products with higher NNN levels pose higher risks of cancer, FDA finds that establishing a NNN limit in smokeless tobacco products is appropriate for the protection of the public health. Read More > January 24, 2017 The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research The National Academies: Health and Medicine Division The report is a comprehensive review of recent research on the health effects of recreational and therapeutic cannabis use, including the current barriers to conducting cannabis research. The report puts forth recommendations to help advance the research field and better inform public health decisions. Read More > January 17, 2017 Substance Use Disorder Treatment for Adults and Adolescents National Commission on Correctional Healthcare NCCHC has passed a position statement to reflect scientific evidence and new national guidelines for treatment of opioid use disorder and is intended to ensure that people with substance use disorders in custody receive evidence-based care in accordance with national medical standards. This position statement primarily focuses on screening, evaluation, provision of evidence-based treatment, and coordination of care for all substance use disorders. Read More > January 10, 2017 What's Behind the Rise in Cocaine-Linked Deaths? US News The Centers for Disease Control and Prevention recently reported that cocaine was responsible for the second-most drug-overdose deaths in 2014. In recent years, mortality data show cocaine-related deaths gradually increasing following a steady decline, even as the drug’s availability for the most part did not appear to increase significantly. Read More > January 3, 2017 Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015 CDC: Morbidity and Mortality Weekly Report |
"The Real Cost of Substance Use to Employers" tool is an easy-to-use tool that provides business leaders with specific information about the cost of substance use in their workplace based on size of employee base, industry, and state.
Experts from across the country believe the death toll from the opioid epidemic will only get worse before it gets better and recent trends are producing alarming forecasts.
Dry January is gaining in popularity but so is low or no alcohol lifestyles. In the UK sales of low alcohol beverages are up almost 30% and the industry is responding with a wider selection of high-quality low-alcohol beers, wines, and even spirits. Read More>
According to a new report from two non-profit organizations, there is a disproportionate increase in drug deaths among racial and ethnic minority groups in America- along with other alarming findings. The authors are advocating to create a National Resilience Strategy that focuses on prevention, awareness and treatment.
December 27, 2016
Prescription Drug Monitoring Programs: Evidence-based practices to optimize prescriber use
The Pew Charitable Trusts
This report concludes that prescriber mandates increase utilization of Prescription Drug Monitoring Programs (PDMPs). However, mandating database queries does not guarantee effective use of the data in prescribing decisions. PDMP improvements such as delegation, unsolicited reporting, daily PDMP updates, streamlined enrollment, educational and promotional initiatives, health IT integration, and enhanced user interfaces can remove barriers to use and help insure that the data is well used to inform clinical decision-making. Read More >
December 20, 2016
Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015
CDC: Morbidity and Mortality Weekly Report
The Centers for Disease Control and Prevention (CDC) released new data that show that overdose deaths associated with prescription and illicit opioids increased to 33,091 in 2015. Congress is working to release new funding to States as quickly aspossible to expand access to treatment. Read More >
December 13, 2016
Substance Use Disorder Treatment for Adults and Adolescents
National Commission on Correctional Health Care
Substance use disorders represent a chronic, relapsing disease requiring effective treatment and long-term management. This position statement reflects new national guidelines for treatment of opioid use disorder and is intended to ensure that people with substance use disorders in custody receive evidence-based care. Read More >
December 6, 2016
Drug and alcohol addiction treatment results improved when teens stopped smoking, researcher finds
Science Daily
A Case Western Reserve University School of Medicine researcher has found that collective addiction treatment results improved when teens in a residential program stopped smoking. The findings are published in a new study in the November issue of the Journal of Substance Abuse Treatment. They further possibility of improved addiction treatment methodology, noting that up to three of four people with such disorders are smokers. Read More >
November 29, 2016
Nurse Practitioners and Physician Assistants Can Begin Buprenorphine Training
ASAM
The Department of Health and Human Services (HHS) announced on November 17 that nurse practitioners (NPs) and physician assistants (PAs) can begin taking the 24 hours of required training to prescribe buprenorphine to treat opioid use disorder. NPs and PAs who complete the required training and seek to prescribe buprenorphine for up to 30 patients will be able to apply to do so beginning in early 2017. HHS is also announcing its intent to initiate rulemaking to allow NPs and PAs who have prescribed at the 30-patient limit for one year to apply for a waiver to prescribe buprenorphine for up to 100 patients. SAMHSA is working quickly with training providers to help them adapt curricula and obtain continuing education credits for this training. Updates on training information and the waiver application will be available on the SAMHSA and ASAM websites.
November 22, 2016
ASAM Applauds Release of Historic Surgeon General Report on Substance Use and Addiction
ASAM Magazine
On Thursday November 17th, Surgeon General Vivek Murthy released the first-ever Surgeon General's Report presenting the state of the science on substance use, addiction, and health. The American Society of Addiction Medicine (ASAM) applauds this historic examination of the health effects of drug and alcohol misuse and commends Dr. Murthy for taking action to raise awareness about this critical public health issue. Read More >
November 15, 2016Sensitive periods of substance abuse: Early risk for the transition to dependence
Developmental Cognitive Neuroscience
Early adolescent substance use dramatically increases the risk of lifelong substance use disorder (SUD). An adolescent sensitive period evolved to allow the development of risk-taking traits that aid in survival; today these may manifest as a vulnerability to drugs of abuse. Building onto the current theories of the etiology of addiction, the current review explored the risk factors that increase vulnerability from early recreational use to addiction. Read More >
November 8, 2016
Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders
Biological Psychiatry
Because of advances in technology and our understanding of neuromechanisms of addiction, meshing neuroscience-based assessments with clinical measures appears feasible and imperative. This article proposes a heuristic framework for the Addictions Neuroclinical Assessment (ANA) that incorporates key functional domains derived from the neurocircuitry of addiction. By collecting multidimensional information, we can improve our understanding of the heterogeneity of addictive disorders as well as tailor treatment more effectively to the individual. Read More >
November 1, 2016
The Demand for Cigarettes as Derived from the Demand for Weight Loss: A Theoretical and Empirical Investigation
Health Economics
There is considerable evidence that smoking does in fact promote weight loss. Using data from the national Health Behavior in School-aged Children (HBSC) survey, researchers tested this hypothesis and found that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight. Read More >
October 25, 2016
Black communities hit hardest by reduced availability of public addiction treatment
Recovery Answers
This study highlights the importance of monitoring geographical locations of addiction treatment facilities. Using national data from The National Survey of Substance Abuse Treatment Services (N-SSATS) from 2002-2010 and the Health Resource Files, researchers found that counties with large percentage of black residents were disproportionately burdened by the decline in public facilities. Allocation of resources to provide monitoring in treatment infrastructure, particularly for vulnerable communities, could help prevent the creation of treatment system gaps. Read More >
October 11, 2016
The 4 Traits That Put Kids at Risk for Addiction
The New York Times
Prev
enture, an antidrug program developed by Dr. Conrod, addresses personality traits that may create pathways to addiction. Recognizing that most teenagers who try drugs and alcohol do not become addicted, the program focuses on what’s different about the minority who do. Risk factors include sensation-seeking and anxiety sensitivity traits. Impulsiveness and hopelessness are also important risk factors. Read More >October 4, 2016
From AIDS to Opioids — How to Combat an Epidemic
The New England Journal of Medicine
The United States is facing a vast epidemic of opioid-related deaths. More than 2.4 million Americans have a severe opioid-use disorder (OUD) involving dependence on pain medications, heroin, or both, and rates of drug-overdose deaths in this country have outpaced mortality from motor vehicle accidents since 2013. The rising death toll has been rivaled in modern history only by that at the peak of the AIDS epidemic in the early 1990s. Although these epidemics differ in nature, the large-scale, highly coordinated response to AIDS that was eventually mounted may be instructive for combating the opioid epidemic. Read More >
September 27, 2016
The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services
Fair Health, Inc.
FAIR Health, a national nonprofit organization, has analyzed data from over 21 billion privately billed healthcare claims to identify trends and patterns in opioid treatment costs and services. From 2011 to 2015, the national value of charges for opioid-related diagnoses rose over 1000 percent. Read More >
September 23, 2016
The more alcohol ads kids see, the more alcohol they consume
CNN
Using a sample of 13- to 20-year-olds, a recent nationwide study found that the more exposure children had to alcohol ads, the greater the amount they consumed of those brands. Parents need to be mindful of what ads they are watching with their children, especially during sport games. Read More >
September 13, 2016
FDA requires strong warnings for opioid analgesics, prescription opioid cough products, and benzodiazepine labeling related to serious risks and death from combined use
FDA News Release
The U.S. Food and Drug Administration just announced that it is requiring class-wide changes to drug labeling, including patient information, to help inform health care providers and patients of the serious risks associated with the combined use of certain opioid medications and benzodiazepines. Read More >
September 6, 2016
What Level of Care Does My Patient Need?
The Fix
Dr. David Mee-Lee, Chief Editor of the ASAM criteria, clears up some misconceptions about the patient placement criteria and shares his goal to optimize use of the criteria among clinicians. Read More >
August 30, 2016
Individuals with Serious Mental Illnesses in County Jails: A Survey of Jail Staff’s Perspectives
Public Citizen’s Health Research Group and The Treatment Advocacy Center
The criminalization of individuals with serious mental illnesses (SMI) places a huge burden on the county jails that house them. Unless a better functioning public mental health treatment system is implemented in the US, this problem will only get worse. This survey study provides the perspectives of county jail sheriffs, deputies and other staff on the challenges and possible solutions to this significant problem. Read More >
August 16, 2016
U.S. will affirm its prohibition on medical marijuana
The Washington Post
The Federal Government refused to allow the use of marijuana for medical purposes, reaffirming its conclusion that the drug’s therapeutic value has not been scientifically proven. The Drug Enforcement Administration also turned down requests to remove marijuana from “Schedule I,” which classifies it as a drug with “no currently accepted medical use” and precludes doctors from prescribing it. The DEA did agree to expand the number of places allowed to grow marijuana for research studies such as relief of pain and treatment for epilepsy. Read More >
August 9, 2016
Many More People Seek Medical Help For Opioid Abuse
Kaiser Health News
According to a recent study that analyzed insurance records, health care claims for people with opioid dependence diagnoses rose more than 3,000 percent - from 217,000 to 7 million medical services - between 2007 and 2014. The study also suggests that 1) across all age groups, men were more likely than women to be diagnosed with dependency and 2) women were more likely than men to overdose. These findings suggest that prevention and treatment should be more widely available. Read More >
August 2, 2016
Opioid Addiction Guidelines From British Columbia Featured in Leading Medical Journal
British Columbia Centre for Excellence In HIV/AIDS
A A new Canadian Guideline for the Clinical Management of Opioid Addiction is featured in the Journal of the American Medical Association (JAMA). This guideline aims to improve health professionals' knowledge of the range of evidence-based treatments available for opioid addiction. Read More >
July 12, 2016
Studying addiction at the cellular level to find treatment for binge behavior
The Baltimore Sun
In preclinical research, neuroscientists at Johns Hopkins University found that neurons within a small, little-studied structure in the lower brain — the ventral pallidum — respond far more robustly than expected to cue-driven reward-seeking task. The ventral pallidum may have an underappreciated role in the pleasure-seeking system. Read More>
July 5, 2016
NSC Report Says 28 States Fail to Protect Their Residents from the Opioid Crisis
The National Safety Council
In a troubling report released last week, National Safety Council-sponsored research shows 28 states thus far fail to provide a comprehensive, proven plan to eliminate prescription opioid overdoses. Prescription Nation, a definitive ranking of how states are tackling the worst (non-alcohol) drug crisis in recorded U.S. history, assigned a “Making Progress” rating to only four states – Kentucky, New Mexico, Tennessee and Vermont. Of the 28 failing states, three – Michigan, Missouri, and Nebraska – do not have a single strategy in place to save lives. Read More>
June 28, 2016
AMA Drops Pain as Fifth Vital Sign
Pain News Network
The nation’s largest medical society is recommending that pain be removed as a “fifth vital sign” in professional medical standards. The American Medical Association’s new president said physicians played a key role in starting the opioid epidemic by overprescribing pain medication, and now must do their part to end it. The announcement has been met with criticism from leaders of the American Academy of Pain Medicine and the Academy of Integrative Pain Management, who say the change will make it even more difficult for pain sufferers to have their pain properly diagnosed and treated. Read More>
June 21, 2016
Study Shows Opioids Increase Risk of Death When Compared to Other Pain Treatments
The Vanderbilt University Reporter
This timely study compares all-cause mortality for patients with chronic non-cancer pain who were prescribed either long-acting opioids or alternative medications for moderate to severe chronic pain. The finding that long-acting opioids were associated with a significantly increased risk of all-cause mortality should be considered when evaluating harms and benefits of treatment of chronic pain. Read More >
June 19, 2016
Substance Use Screening, Brief Intervention, and Referral to Treatment
American Academy of Pediatrics
This report from the American Academy of Pediatrics, Committee on Substance Use and Prevention, guides clinicians in implementing substance use detection, assessment, and intervention and prevention practices for adolescents across various clinical settings. Find out more about a simplified adolescent SBIRT approach and review their updated policy statement which includes recommendations for confidentiality practices. Read More >
June 14, 2016
Study Shows Long-Term Marijuana Use Changes Brain's Reward Circuit
The Authors Human Brain Mapping
This study shows that marijuana disrupts the natural reward circuitry of the brain. According to Dr. Francesca Filbey, Associate Professor in the School of Behavioral and Brain Sciences at UT Dallas, "these brain alterations could be a marker of transition from recreational marijuana use to problematic use." Read More >
June 7, 2016
Loperamide Abuse Associated With Cardiac Dysrhythmia and Death
Annals of Emergency Medicine
Loperamide is an over-the-counter antidiarrheal with μ-opioid agonist activity. Central nervous system opioid effects are not observed after therapeutic oral dosing because of poor bioavailability and minimal central nervous system penetration. However, central nervous system opioid effects do occur after supratherapeutic oral doses. Recently, oral loperamide abuse as an opioid substitute has been increasing among patients attempting to self-treat their opioid addiction. Read More >
May 31, 2016
The Potential That Electronic Nicotine Delivery Systems Can be a Disruptive Technology
Nicotine and Tobacco Research
What are the reasons for use of Electronic Nicotine Delivery Systems (ENDS) among current and former cigarette smokers? This study assesses the reasons for use and if ENDS will become a satisfying alternative to cigarettes. Read More >
May 24, 2016
Ketamine Lifts Depression via a Byproduct of its Metabolism
National Institute of Mental Health
A chemical byproduct, or metabolite, created as the body breaks down ketamine likely holds the secret to its rapid antidepressant action, National Institutes of Health (NIH) scientists and grantees have discovered. This metabolite singularly reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine. Read More >
May 17, 2016
Buprenorphine Prescribing: To Expand or Not to Expand
Journal of Psychiatric Practice
As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacological and nonpharmacological. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. Read More >
May 3, 2016
Changes in Life Expectancy by Race and Hispanic Origin in the United States, 2013–2014
Centers for Disease Control and Prevention
How much longer do I have, Doc? This report presents changes in life expectancy by race, Hispanic origin, and sex in the United States between 2013 and 2014. Read more >
April 26, 2016
A Systematic Review on the Use of Psychosocial Interventions in Conjunction with Medications for the Treatment of Opioid Addiction
From Journal of Addiction Medicine
There are effective medications (imethadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction, approved for use in conjunction with psychosocial treatment. However, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. This review provides a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction. Read more >
April 19, 2016
Gamblers Anonymous as a Recovery Pathway: A Scoping Review
Journal of Gambling Studies
Given the preponderance of Gamblers Anonymous, there has been relatively little effort to explore the existing evidence base on its effectiveness as a recovery approach for problem gambling. To remedy this gap in the literature the authors conducted a scoping review of the literature on mutual aid for individuals experiencing problem gambling published between 2002 and 2015. Read more >
April 12, 2016
Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies
New England Journal of Medicine
Nora Volkow, MD, Director of NIDA and Thomas McLellan, PhD, Founder of Treatment Research Institute, penned this review article summarizing the current state of affairs regarding the opioid epidemic and effects on chronic pain patients. They provide three practice and policy changes that can reduce abuse-related risks and improve the treatment of chronic pain. Read more >
April 5, 2016
Obama Administration Announces Additional Actions to Address the Prescription Opioid Abuse and Heroin Epidemic
The White House
At the National Rx Drug Abuse and Heroin Summit last week, President Obama announced the following Administration actions: expanding access to treatment, establishing a Mental Health and Substance Use Disorder Parity Task Force, implementing parity in Medicaid, a funding opportunity for states purchasing and distributing naloxone, expanding public health-public safety partnerships to combat the spread of heroin, and more. Read more >
Related: ASAM Applauds Important Step by Obama Administration and Calls for Increased Congressional Pressure to Expand Treatment Access (ASAM)
March 29, 2016
Mindfulness-Meditation-Based Pain Relief is Not Mediated by Endogenous Opioids
The Journal of Neuroscience
Endogenous opioids have been repeatedly shown to be involved in the cognitive inhibition of pain. This article examines whether the beneficial effects of mindfulness meditation on pain can be blocked by naloxone. Read more >
Related: Editorial: Mindfulness Meditation Relieves Pain, but Works Differently Than Opioids in the Body (National Center for Complementary and Integrative Health)
March 22, 2016
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Journal of the American Medical Association
The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy. Read more >
March 15, 2016
Cannabis Use and Risk of Psychiatric Disorders
JAMA Psychiatry
With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use. An analysis of a national longitudinal study examines the correlation between cannabis use and the risks of mental health and other substance use disorders. Read more >
March 8, 2016
Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality
Journal of General Internal Medicine
Focusing on a large Veteran’s Affairs treatment population from 2000-2010, the study objective was to determine the association between receipt of guideline-concordant LtOT and 1-year all-cause mortality. For patients receiving long-term opioid therapy (LtOT), the impact of guideline-concordant care on important clinical outcomes—notably mortality—is largely unknown, even among patients with a high comorbidity and mortality burden (e.g., HIV-infected patients). Read more >
March 1, 2016
The Alcohol Harm Paradox: How Alcohol May Disproportionately Impact Health in Deprived Individuals
BMC Public Health
Similar levels of alcohol consumption cause more harm in deprived communities compared to affluent communities. This study examined several hypotheses to explain this finding: more combined health challenges such as smoking, and obesity; more harmful consumption patterns; and disproportionately under-reporting alcohol consumption. Read more >February 23, 2016
Effect of US Drug Enforcement Administration’s Rescheduling of Hydrocodone Combination Analgesic Products on Opioid Analgesic Prescribing
JAMA Internal Medicine
Did the rescheduling of hydrocodone combination analgesic products from Schedule III to the more restrictive Schedule II have any impact on prescribing habits? This study looks at US prescription data to examine the trends. Read more >
February 16, 2016
Rethinking Syringe Exchanges
The Journal of the American Medical Association
In decades past, trading drug users’ contaminated injection equipment for sterile needles and syringes contributed to drastic reductions in HIV infection among people who inject drugs. However, the same success hasn’t extended to the more recent wave of injection drug use, and a study by the CDC suggests that a geographical disconnect may be to blame. Read more >
February 9, 2016
Neurobiologic Advances from the Brain Disease Model of Addiction
The New England Journal of Medicine
This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. Neuroscience research in this area not only offers new opportunities for the prevention and treatment of substance addictions and related behavioral addictions (e.g., to food, sex, and gambling) but may also improve our understanding of the fundamental biologic processes involved in voluntary behavioral control. Read more >
January 26, 2016
Relationship Between Nonmedical Prescription-Opioid Use and Heroin Use
The New England Journal of Medicine
According to national surveillance data, heroin use increased 145% between 2007 and 2014, and mortality due to heroin overdose more than quintupled between 2000 and 2014. Some researchers suggest that the very policies and practices that have been designed to address inappropriate prescribing are now fueling the increases in rates of heroin use and death. This is the key question addressed in this review.
December 20, 2016
January 24, 2017
Substantive Changes to Prescription Monitoring Program
Posted: November 26, 2014On November 12, 2014, the DPH Public Health Council approved these final Prescription Monitoring Program (PMP) regulations, which will go into effect on December 5, 2014. The PMP is the electronic, statewide database that stores dispensing data on controlled substances (Schedules II-V); it was developed to give patient prescription history to aid in clinical decisions before prescriptions are written.
The regulations build on the governor’s declared public health emergency of opioid addiction in the commonwealth. The final regulations include the following specific changes to an individual prescribers’ responsibilities when prescribing certain drugs:
• Automatically grants authority to use the PMP to registered individual practitioners (except for veterinarians) holding a Mass. Controlled Substance Registration.
• All such registered individual practitioners must use the PMP prior to prescribing for the first time: (a) a narcotic drug in controlled substances schedule II or III; (b) a benzodiazepine; or (c) a schedule IV or V controlled substance outlined in any DPH-issued guidance;
• Requires using the PMP prior to prescribing commonly abused and addictive Schedule II and III drugs as outlined in any DPH issued guidance; and•Removes the requirement on physician assistants to include the name of the supervising physician on written prescriptions, although the physician assistant must still work under the supervision of a physician.
• Exceptions to the aforementioned rules include: practitioners providing care and ordering prescriptions for use by hospital inpatients or for those in a hospice; emergency situations; in an emergency department if prescribed for five or fewer days; treatment of children under 96 months; when it is not reasonably possible to use the PMP (e.g. technical or electrical failure); other exceptions determined by DPH.
The final regulations do provide several exceptions to the mandated PMP review, including providers who:
• Only prescribe/dispense Schedule VI drugs;
• Care for only hospice, inpatient, or immediate treatment;
• Treat patients in the emergency department and either do not expect to write a prescription for, or will provide a prescription for, a five-day or less supply of a Schedule II-V controlled substance;
•Are unable to use the system due to operational/system level failures;•Care for patients under 96 months of age;
•Meet other exceptions as issued by DPH.
In addition, the final regulations affect facility (hospitals, clinics, physician practices) operations in the following ways:
• Creates a new class of PMP user accounts, called “Delegates” (such as support staff), who may use the system on behalf of an individual prescriber;•Allows hospitals to serve as a primary account holder for the purposes of permitting interns and residents to be delegates of the hospital;
• Updates disciplinary and investigatory procedures by DPH for any granted controlled substance registration (including for manufacture, distribution, dispensing, or possession of a controlled substance). DPH may suspend or revoke access to the PMP if a user violates the terms and conditions for use of the system or if there is a complaint filed related to inappropriate use of the PMP; and
• Develops a waiver process that facilities may request from any of the above new criteria.
DPH also finalized regulatory changes for prescription formats, which are also included in the link above. This change enables naloxone to be prescribed to someone other than the direct user so that person can have it on hand in the event that a known drug user overdoses. Presumably, such a prescription is intended for friends or family members of known drug users. When a bystander prescription is written, the end-user patient’s name and address is not required; the prescriber may write in the name of the person taking delivery of naloxone.
Drug Epidemic in Plymouth and South Shore
Click here to access the video "Drug Epidemic in Plymouth and South Shore" by Plymouth North High School.
ASAM Expresses Concern over President's Comments Re: Marijuana
President Comments on Marijuana Use, ASAM Expresses Concern
CHEVY CHASE, MD, JANUARY 21, 2014 – The American Society of Addiction Medicine (ASAM) expresses its concern that the President’s comments regarding marijuana use, in the January 27, 2014 edition of The New Yorker magazine, may contribute to the growing misperception among America’s youth that marijuana is harmless.
ASAM, the largest American medical professional society dedicated to the treatment and prevention of addiction, has examined both the medical and recreational use of marijuana and the public health consequences of both. In neither case, did the Society find sufficient evidence to support the notion that the public health benefits of using the illicit drug outweighed the dangers to users and to their communities. According to the National Institute on Drug Abuse, marijuana is an intoxicating drug that impairs memory, motor function, and, when smoked, respiratory health. And, for nearly one in ten habitual users, marijuana is addictive.
“Addiction is a chronic brain disease that can affect people at any age. In fact, the younger one initiates alcohol or drug use, the greater the likelihood that he or she has addictive disease,” says Dr. Stuart Gitlow, ASAM’s President. “The addicted brain doesn’t care if the substance is alcohol or marijuana; both can be very dangerous, particularly to the naïve user.”
ASAM respects the President’s concerns regarding inequitable drug-related criminal sentencing policies and has long held a policy that treatment is a more appropriate response to minor drug-related criminal offenses than incarceration. “Public policies that support prevention and treatment for addiction should be the basis of our government’s response to a chronic disease that affects 23 million Americans,” offers Dr. Gitlow. “This requires, however, that substances of abuse are not made more easily available or made to seem less dangerous than they really are.”
ASAM encourages the President and our nation’s policy makers to build public awareness for addiction prevention and treatment, whether the addictive substance is alcohol, nicotine, marijuana or prescription opioids. ASAM looks forward to working with the Administration and state and federal policymakers to advance science-based policies that deter unhealthy substance use and promote access to treatment for those that need it.
The American Society of Addiction Medicine is a national medical specialty society of over 3,000 physicians. Its mission is to increase access to and improve the quality of addiction treatment, to educate physicians, and other health care providers and the public, to support research and prevention, to promote the appropriate role of the physician in the care of patients with addictive disorders, and to establish Addiction Medicine as a specialty recognized by professional organizations, governments, physicians, purchasers and consumers of health care services and the general public. ASAM was founded in 1954, and has had a seat in the American Medical Association House of Delegates since 1988.
Urgent Public Policy Issue!
December 2013
Hello MASAM Members,
We have an urgent Public Policy issue and we are late to the game. It came to my attention last week that the Ma Senate had passed a bill putting the prescribing and use of buprenorphine for opioid addiction under the regulation of the Ma Dept of Public Health. The text of the bill is below under “Chapter 94C of the General Laws”. Not only does this threaten access to care, but is totally contrary to the DATA 2000 intent to make buprenorphine treatment available in a doctor’s office setting and would require that all “treaters” be licensed as a DPH licensed facilities. Whether this even could be implemented by the DPH seems dubious.
The bill is now in the House and we need to take several actions to prevent its passage into law.
At the bottom of this email I have pasted in several items in blue:
Time frame of the law with a few commentaries in parenthesis. Some of the terminology I do not understand such as “passed to be engrossed”
- Testimony by the bill’s sponsor Sen Downing from Pittsfield
- The text of the bill
- The State House Press Release
MASAM is actively working with MMS, AMA, MPS, APA to oppose passage of this legislation in the House.
WHAT WE ASK YOU TO DO!!!
We ask that all MASAM members contact their house and senate state representatives to discuss your opposition to this bill as soon as possible. We do not know when the House will vote on the measure, but it could be any day. We hope to provide you with some talking points to assist you, but do not hesitate to go ahead and make the call. This could bring to a halt the buprenorphine treatment of patients already in treatment as well as those needing treatment, lead to thousands of patients developing acute opioid withdrawal, and cause a public health care crisis. You can search for state legislators here. Click here to access talking points, which should be helpful when discussing or writing to your legislators about the proposed regulation in senate bill 1296.
WE NEED YOUR HELP!
Time frame for Massachusetts Bill Senate Bill (SB) 1296/SB907
1/18/13 S bill filed in Senate by Sen Downing (usual course of events to file bills at start of 2 year session)
1/22/13 S Referred to Joint Committee on Mental Health and Substance Abuse
1/22/13 H Concurred in committee referral
3/26/13 S Hearing Scheduled
JMH-6/11/13 A-2 (there was a public hearing held but no public testimony was heard)
9/26/13 S Reported favorably Joint Committee on Mental Health and Substance Abuse
9/26/13 S Referred to Joint Committee on Health Care Financing
11/07/13 S Reported favorably by Joint Committee on Health Care Financing
11/07/13 S Referred to Senate committee on Ethic and Rules
SUNDAY, NOVEMBER 17TH, 2013
NEW YORK TIMES ARTICLE
11/19/13 S Placed in Orders of the Day for the next session (2 days after NYT Article) ( this process would usually take a week)
11/19/13 S Amendment(s) adopted (Sen Downing) (there was an amendment but no text in the amendment?)
11/19/13 S New draft substituted see SB1926 (Senate Bill 1296)
11/19/13 S New Draft of Bill – see SB907
11/19/13 S Ordered to a third reading
11/19/13 S Passed to be engrossed
11/20/13 H Received in the House
11/20/13 H Referred to the House Committee on Steering, Policy and Scheduling
Testimony by the bill’s sponsor Sen Downing from Pittsfield
SUBOXONE: The Senate adopted a Sen. Downing amendment and ordered to a third reading S 907 regulating the use of buprenorphine in opioid dependence treatment.
Sen. Tarr said, I'd like to hear a brief explanation. I do think it's important we understand it, and I thank the gentleman for his work.
Sen. Downing said, As many of us know over the better part of the last decade, the communities we live in have dealt with the scourge that is opiods. Constituents have reached out to us. One of the many ways to address opiate and heroin abuse is buprenorphine, which is also known as Bupe. As it has come onto the market, we have seen more and more clinics making the drug available. In my hometown of Pittsfield, we have a serious opiate abuse problem. We found there were more prescriptions in Berkshire County than people. In Pittsfield we've had a Suboxone treatment facility without problems. However other clinics opened without notice. Authorities said the number one drug they are seeing was Suboxone. They were scared by the amount of people getting the drug. This would give the Department of Public Health the ability to regulate the drug to avoid diversion. This would make sure those providing it are providing it as part of that continuum of care, not simply to make money. The legislation simply seeks to make sure DPH has a role in the process. The current law is such that someone needs to take a one-day training at the Drug Enforcement Agency. The number of patients under one clinic has been increased. I hope the legislation is adopted and I look forward to working with my colleagues for any other steps we can take. We owe a debt to Sen. Flanagan, and the chairs of Public Health and Health Care Financing. We can address the scourge that is opiate abuse.
The bill was ENGROSSED
The text of the bill
Chapter 94C of the General Laws is hereby amended by inserting, after section 6, the following section:-
Section 6A. The department of public health shall promulgate regulations relative to the treatment of opioid dependency through the prescribing and use of buprenorphine and its variants. These regulations shall include, but not be limited to: (i) defining the entities or health care providers governed by these regulations and shall seek approval from the department to provide the services; (ii) establishing the approval and licensure process; (iii) establishing appropriate staffing, training and reporting requirements; (iv) establishing and defining patients’ rights, including termination from treatment and appropriate continuity of care; and (v) establishing treatment requirements, including routine toxicology screens of clients, medication call-backs, maximum take-home dosages and any other diversion control mechanism necessary to limit the diversion of buprenorphine and its variants.
The State House Press Release
SENATE SEEKS TO REGULATE "BUPE"
With nationwide concern over the potential abuse of buprenorphine, a drug designed to salve opiate withdrawal, the Senate approved legislation Tuesday that would place the drug under the regulatory control of the Department of Public Health. The drug is often sold under the brand name Suboxone, with a nickname Bupe, and its potential for abuse was the subject of a front page New York Times story on Sunday. "We have seen more and more clinics making this drug available. In many cases, those clinics have been well run. However, where they haven't been well run, there has been serious issues around diversion," Sen. Ben Downing said from the Senate floor Tuesday evening. "In my hometown in Pittsfield, and in Berkshire County writ large, we have a serious opiate abuse problem." Downing said there were more prescriptions in Berkshire County than people, and he said Pittsfield has had a clinic that uses buprenorphine without problems associated with the drug being used outside the clinic's strictures. "However, several smaller clinics came in, opened up unbeknownst to anyone in the community, and all of a sudden, the Berkshire County House of Correction, the Berkshire Drug Task Force, the Pittsfield chief of police, said that the number one drug that they were seeing in crime scenes, in our schools, in the jail, outside of other treatment facilities, was Suboxone," Downing said. The bill (S 1926) requires DPH to promulgate rules establishing licensing requirements and establishing treatment requirements, including "toxicology screens of clients, medication call-backs, maximum take-home dosages and any other diversion control mechanism necessary to limit the diversion of buprenorphine and its variants." - A. Metzger/SHNS
Jacquelyn Starer, MD, FACOG, FASAM
President, Massachusetts Society of Addiction MedicineLetter to Attorney General Martha Coakley
Click HERE to read a letter to Attorney General Martha Coakley in regards to the "Black Box Warning" on narcotic analgesic medication for use during pregnancy.
Click HERE to access "Lets Talk: Pregnancy, Substance Abuse & Neonatal Abstinence Syndrome (NAS)" from ACOG's 2013 State Legislative Roundtable.
IN MEMORIAM
Dr. Michael Palmer
Michael S. Palmer, MD, one of the nation’s leading authorities on physician health and a founding associate director of Physician Health Services, died yesterday. He was 71 years old.
In addition to his trailblazing work on physician health, Dr. Palmer was an accomplished author of 17 suspense novels, including several New York Times bestsellers. His work has been translated into 35 languages.
At the time of his death, Dr. Palmer was an associate director emeritus of Physician Health Services, and was still very actively involved in the organization.
He spoke openly about his own recovery from drug and alcohol abuse. In a 1996 New York Times article he said, “You’re taught from the day you start medical school that you’re a god, that you can have power over life and death. So when your life starts to crumble and the highest power you see is looking back in the mirror — and you know that power is flawed — it is very hard to get past that. …The doctor’s intelligence is often a barrier to recovery. But once he gets into recovery, it’s a huge asset because he sees the logic.”
Dr. Palmer served as a clinical instructor in medicine at Tufts University and was on the faculties of Harvard Medical School and the University of Cincinnati School of Medicine. He graduated from Wesleyan University in Middletown, Conn., and received his M.D. degree with honors from Case Western Reserve University. Following an internship and residency on the Harvard Medical Service of Boston City Hospital, he completed a senior residency at Massachusetts General Hospital.
Funeral for Michael S. Palmer
2PM Sunday 11/3
Stanetsky-Hymanson Memorial Chapel
#10 Vinnin Street
Salem, MA 01970 | 781-581-2300Reception to follow at:
38 Outlook Road
Swampscott, MAIN MEMORIAM
Peter Ofner, PhD
We have received the sad news that Dr. Peter Ofner passed away last Friday, May 24 in Cambridge, MA. Funeral services were held on Sunday, May 26.
The obituary for Dr. Ofner is published in today's Boston Globe, where you can also leave some comments if you wish:
http://www.legacy.com/obituaries/bostonglobe/obituary.aspx?n=peter-ofner&pid=164974832&fhid=8784#fbLoggedOut
You may donate in honor of his memory to the Pine Street Inn, c/o Development Office, 444 Harrison Avenue, Boston, MA 02111.
I have some brief comments to pass on in reference to Peter's legacy that I am sure do not do him justice and we will be looking as a graduate program for ways to further honor his memory.
Of particular interest to ASAM membership, Peter has been one of the pioneers who synthesized opioids that could substitute for morphine and heroin and documented their analgesic properties, a development that directly led to the use of synthetic opioids as treatment for chronic pain and to the methadone treatment for opioid dependence in the United States and around the world. Such therapeutic interventions currently benefit millions of patients worldwide. In tribute to his memory, I include below a sample list of Peter's seminal papers from the 1940s reporting on synthetic opioids and I attach a copy of one of them:
Analgesic activity in compounds related to amidone (later renamed methadone).
THORP RH, WALTON E, OFNER P.
Nature. 1947 May 17;159(4046):679.
PMID: 20239733
Optical isomers of amidone, with a note on isoamidone.
THORP RH, WALTON E, OFNER P.
Nature. 1947 Nov 1;160(4070):605.
PMID: 20271556
A new analgesic drug analogous to isoamidone.
OFNER P, THORP RH, WALTON E.
Nature. 1949 Mar 26;163(4143):479.
PMID: 18124931
Following the award of the MRSC degree from the Royal Society of Chemistry of Great Britain and Northern Ireland and the PhD degree from the University of London, Peter proceeded to study the role of steroids in prostate and other cancers as evidenced in numerous publications. Throughout his productive scientific career and amazing personal and family story from his childhood during World War II to the present, Peter has remained an unsung hero who rarely talked about his work and accomplishments and tirelessly engaged our students in critical thinking and evaluation of scientific work.
Peter further developed additional interests in the promotion of cancer research in the Boston area as President of the Boston Cancer Research Association and peace throughout the world through Amnesty International and remained active in academics, community and world affairs until very recently.
We will terribly miss Peter in the Pharmacology program and we are proud he was a member of the Tufts community.
If ASAM members or leadership wish to pass on comments for us to distribute to the Tufts community regarding Dr. Ofner, please feel free to let me know.
With best wishes,
Emmanuel N. Pothos, Ph.D.
Associate Professor
Director, Graduate Program Program in Pharmacology and Experimental Therapeutics
Sackler School of Graduate Biomedical Sciences
Department of Molecular Physiology and Pharmacology
Tufts University School of Medicine
John C. Wolfe, M.D.
John C. Wolfe, M.D.
Born in Oakland, California on Dec. 26, 1942
Departed on May 8, 2013 and resided in Gloucester, MAA life well lived has ended too soon. On Wednesday, May 8th, John C. Wolfe passed unexpectedly, at his home near Stage Fort Park in West Gloucester.
John was a man of many loves. He had a deep passion for science and medicine and the good it could accomplish. He dearly loved his family and was a source of strength and inspiration in their lives. He very much loved the house he and Susannah bought in 1974. His plan was to live there till the day he died.
After finishing his service in the Army in 1974, John and Susannah, along with their young son Stefan, moved to Gloucester. One year later, Matthew Tye was brought home from Addison Gilbert Hospital. In 2000 Jennifer Henry joined the family as a much loved daughter in-law. When his grandson William was born, he knew that life could not get better than this. The house was always filled with love, joy, the challenges of raising a family, and a busy medical practice.In 2001 John received the first Physician Leadership Award ever presented by Partners Health Care. Partners presented him a silver bowl engraved with the qualities his colleagues recognized in him: vision, courage, energy, resilience, and integrity.
For almost 35 years Dr. Wolfe served the community of Cape Ann. He was honored and humbled to be part of his patients' lives. As the President of Cape Ann Medical Center for many years, he successfully led the group through difficult and trying times in the field of medicine. He retired in 2008.
John loved and cared for Cape Ann and greatly appreciated the many opportunities it provided for him to be of service. He served as the Chairman of the Gloucester Board of Health, and more recently worked with the Healthy Gloucester Collaborative. Through these activities and more, he was able to keep the promise he made himself to "make a difference" in life.
Always a serious man, during his five years of retirement John recaptured the joy he felt as a young man traveling around Europe on $5 a day. Winters in Puerto Rico with Susannah were a time of exploration, beauty, and enjoying being alive. A few months ago, his niece Biata and her daughter Ainne visited them for what would be his last winter in Puerto Rico. The pleasure he took in guiding them around the island was a gift.
Lastly, John loved the camaraderie of Alcoholics Anonymous. He treasured the peace, wisdom, and the deep connectedness he received from this fellowship.
Although there was no forewarning of John's passing, before he died he locked eyes with his wife of 43 years and told her the principles that guided his life: Be the adult – through patience, perseverance, or persistence. Live and accept the truth in the Serenity Prayer. Be patient; we don't always know the meaning of bad news.
John aspired to live by high principles, and succeeded. As his family struggles to make sense of his passing, they are comforted that they were blessed with his life for so long, but are immeasurably saddened by his departure from their lives.
The Wolfe family invites anyone who knew John to visit their house this Wednesday from 4:30 – 7:30, at 3 Old Salem Rd in Gloucester. His ashes will be distributed in a private ceremony later this week.
Arrangements are by the Greely Funeral Home, 212 Washington Street, Gloucester. For online condolences, please visit greelyfuneralhome.com.
MASAM - Massachusetts Society of Addiction Medicine
860 Winter Street
Waltham, MA 02451
masam