Wednesday, May 25, 2016

National Organizations Band Together to Ensure that Congress Passes Comprehensive Policies to Combat the U.S. Opioid Epidemic

The Coalition to Stop Opioid Overdose Launches to Advance Legislation that Will Address this Public Health Crisis

WASHINGTON, May 25, 2016 -- More than 10 million Americans report misusing opioids. In response to this unprecedented and growing epidemic in the United States, the Coalition to Stop Opioid Overdose launched today, uniting diverse stakeholders around the common goal of achieving meaningful legislative solutions to address opioid misuse and overdose.

The Coalition is composed of leading state and national groups that are committed to advancing meaningful legislative and regulatory policies.

Congress, the Administration, public health agencies and a number of state legislatures have taken important initial steps to combat the opioid epidemic.

Last week the House passed 18 bills. In March, a wide-ranging bill was passed by the full Senate and the Senate Committee on Health, Education, Labor and Pensions (HELP) approved additional important legislation, which is pending before the full Senate.

Now is the critical time to build on this progress and ensure that comprehensive legislation aimed at addressing opioid misuse, overdose and addiction is passed and funded appropriately, according to R. Corey Waller, MD, DFASAM, Chair of the American Society of Addiction Medicine's Legislative Advocacy Committee.

"There remains an urgent need for simple and achievable prevention, treatment and recovery policies that can reduce opioid overdose," says Dr. Waller.

"Now is the time for us to come together as a unified group to ensure that Congress sends meaningful legislation to the President's desk this year."
The Coalition's efforts will focus around five key strategies to combat the opioid epidemic:

  • Improving access to medication-assisted treatment for those with opioid addiction
  • Expanding availability of naloxone in health care settings and beyond
  • Implementing enhanced prescription drug monitoring programs that track the dispensing and prescribing of controlled substances
  • Raising the level of opioid prescriber education
  • Enacting the Comprehensive Addiction and Recovery Act
Addiction is a chronic disease that too often goes untreated. More than half of Americans (56 percent) say that they or someone they know has misused, been addicted to, or died from prescription pain medications, according to a recent Kaiser Health Tracking Poll.

When patients can't access treatment and recovery support services, addiction can lead to disability or premature death.

According to the U.S. Centers for Disease Control and Prevention, the rate of death from opioid-related overdose has quadrupled since 2000.

Drug overdoses are the leading cause of accidental death in the United States, surpassing even traffic fatalities. And emergency room visits linked to misuse of prescription opioids are up by more than 50 percent since 2004.

"Emergency physicians see first-hand the devastating consequences of opioid misuse. We often pick up the pieces, from first-contact psychiatric care to acute resuscitation after overdose," says Jay Kaplan, MD, FACEP, President of the American College of Emergency Physicians.

"We need to do more to prevent these life-shattering, or even life-ending, events."

The epidemic is compounded by the vast gap in access to opioid addiction treatment. There are three FDA-approved medications approved to treat opioid use disorder.

Patients need access to all available options so they can find what works for them; however, current prescribing limits restrict access to one of these treatment options. Additionally, there is a lack of access to medication that can help prevent and reverse opioid overdose.

The Coalition held its inaugural meeting at the U.S. Capitol Visitor Center in Washington D.C. where speakers, including Dr. Kaplan, Justin Luke Riley, Advocate, Young People in Recovery and Yngvild Olsen, MD, MPH, Director at Large of the American Society of Addiction Medicine, discussed strategies for addressing the opioid epidemic.

The following organizations have joined the Coalition to date, including:
  • American Academy of PAs
  • American Association of Nurse Practitioners
  • American College of Emergency Physicians
  • American Congress of Obstetrics and Gynecology
  • American Medical Student Association
  • American Society of Addiction Medicine
  • Association of Women's Health, Obstetric and Neonatal Nurses
  • Facing Addiction
  • National Association of Clinical Nurse Specialists
  • National Association of Social Workers
  • The Association of Recovery Schools
  • The National Center on Addiction and Substance Abuse
  • Young People in Recovery
For more information about the Coalition to Stop Opioid Overdose, please visit . 

About the Coalition to Stop Opioid Overdose
The Coalition to Stop Opioid Overdose is an organization of state and national groups that are committed to advancing meaningful legislative and regulatory policies in response to the opioid epidemic.

The Coalition seeks to address the U.S. opioid epidemic by engaging policy makers, public health leaders, chronic pain and addiction specialists, individuals in and seeking recovery and family members, so that legislation and policies get the support needed to pass Congress this year and become law.

Financial support for the Coalition is provided by the following: Adapt Pharma, The American Society of Addiction Medicine, CleanSlate Centers, Indivior, Merck and Proove.

Thursday, May 12, 2016

Alcohol-Induced Blackouts: The Last Five Years of Research

Alcohol-induced blackouts consequences
Newswise, May 12, 2016— Alcohol-induced blackouts, defined as memory loss of all or a portion of events that occurred during a drinking episode, are reported by approximately 50 percent of drinkers, and are associated with a wide range of negative consequences, including injury and death.

Identifying the factors that contribute to and result from alcohol-induced blackouts is critical for developing effective prevention programs.

This manuscript is an updated review of clinical research that has focused on alcohol-induced blackouts. It outlines practical and clinical implications of these findings and provides recommendations for future research.

The authors conducted a comprehensive, systematic literature review of all articles published from January 2010 through August 2015 that examined vulnerabilities, consequences, and possible mechanisms for alcohol-induced blackouts.

The review yielded 26 studies on alcohol-induced blackouts: 15 studies examined prevalence and/or predictors of alcohol-induced blackouts, six publications described the consequences of alcohol-induced blackouts, and five studies explored potential cognitive and neurobiological mechanisms underlying alcohol-induced blackouts.

The research suggests that individual differences, not just alcohol consumption, increase the likelihood of experiencing an alcohol-induced blackout, and the consequences of the blackouts extend beyond those related to the drinking episode to include psychiatric symptoms and neurobiological abnormalities.

The authors suggest that prospective studies and a standardized assessment of alcohol-induced blackouts are needed to fully characterize factors associated with them and to improve prevention strategies.

Using “Heavy Drinking Days” to Measure Treatment Effectiveness

Questions about Alcohol Abuse Treatment Effectiveness
Newswise, May 12, 2016 — One of the challenges in evaluating the effectiveness of alcohol treatment is determining what constitutes a “good” outcome or meaningful improvement. While abstinence at the end of treatment is clearly a good outcome, a focus on abstinence ignores the benefits of patients reducing their drinking to less problematic levels so that they can function better and incur fewer social costs.

This study estimates the relationship between drinking practices at the end of a treatment program and subsequent health-care costs, with an emphasis on heavy and non-heavy drinking levels.

Researchers used data from the COMBINE trial, which randomized 1,383 adult participants with alcohol dependence to nine different combinations of medications and psychosocial interventions.

For this study, the authors examined heavy drinking days (HDDs) – defined as five or more drinks for men, four or more for women – and non-heavy drinking days (non-HDDs) during the last 30 days of COMBINE treatment for 748 patients (524 men, 224 women) enrolled in the COMBINE Economic Study. Total costs were treated as a function of drinking indicators.

Results indicate that having HDDs at the end of treatment is associated with higher costs.

For example, patients with HDDs had 66.3 percent higher health-care costs than those who were abstinent, and having more than two HDDs was associated with the highest costs (76.1%). Furthermore, patients who had only HDDs at the end of treatment had worse subsequent outcomes than those who had both non-HDDs and HDDs.

These findings offer a new context for evaluating treatment outcomes and provide new information on the association of drinking with adverse consequences.

Patients Abusing Drugs and Alcohol Are Self-Medicating Chronic Pain

Addictive use of drugs, alcohol self-medicating chronic pain
 Newswise, May 12, 2016--With opioid addiction and prescription drug abuse considered one of the biggest public health threats of our time in the U.S., many are asking why so many Americans are struggling with addiction to illegal drugs and prescription medications. New research suggests that chronic pain may be part of the answer.

In a study that appears in the May issue of the Journal of General Internal Medicine, researchers at Boston University School of Medicine and Boston Medical Center have found that the majority of patients misusing drugs and alcohol have chronic pain and many are using these substances to "self-medicate" their pain.

According to the researchers, many illegal drugs such as marijuana and heroin have pain-relieving properties.

The researchers screened approximately 25,000 patients in primary care for illegal drug use and misuse of prescription medications.

Among these patients, 589 who screened positive for substance use were asked questions about chronic pain and their substance use. Substance use was defined as use of illegal drugs (heroin, marijuana, cocaine, etc.), use of prescription drugs in ways other than prescribed or high risk alcohol use.

They found that 87 percent of those who screened positive for illegal drug use, misuse of prescription drugs or heavy alcohol use suffered from chronic pain.

Half of these patients graded the pain as severe. In the subgroup that was using illegal drugs, 51 percent reported using one or more drug specifically to alleviate physical pain.

In those using prescription drugs without a prescription or using more than prescribed, 81 percent identified self-medication of pain as the reason for misuse. With regard to high risk alcohol use, the majority (79 percent) did so to manage pain.

"While the association between chronic pain and drug addiction has been observed in prior studies, this study goes one step further to quantify how many of these patients are using these substances specifically to treat chronic pain.

“It also measures the prevalence of chronic pain in patients who screen positive for illegal drug use and prescription drug abuse," explained corresponding author Daniel Alford, MD, MPH, associate professor of medicine and assistant dean of Continuing Medical Education and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program at BUSM. He is also the director of BMC's Clinical Addiction Research and Education Unit.

The results of this study suggest that counseling focused only on informing patients about the negative consequences of drug and alcohol use may miss a key aspect of why people are using these substances.

"Pain should be treated as part of the long-term strategy for recovery. If drugs are being used to self-medicate pain, patients may be reluctant to decrease, stop, or remain abstinent if their pain symptoms are not adequately managed with other treatments including non-medication-based treatments," added Alford.


This research was part of the ASPIRE study, which was funded by the National Institute on Drug Abuse (RO1 DA025068) and the Massachusetts Department of Public Health both of which received funding from the Center for Substance Abuse Treatment (TI018311). Other support included the National Center for Research Resources (UL1RR025771).