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With her compassion and knowledge, Linda Hurley, CEO of CODAC Behavioral Healthcare in Rhode Island, is able to convince corrections staff of the benefits of methadone and buprenorphine. But it isn't easy. [ABSTRACT FROM AUTHOR]

Patients with insurance coverage under Medicare — in particular, Medicare Advantage — or Medicaid are less likely to receive medications for opioid use disorder (MOUD) because providers are just unwilling to treat them, according to a report released last month by the federal Department of Health and Human Services (HHS) Office of Inspector General (OIG). The report repeatedly refers to "behavioral health," so in this article, we do too. [ABSTRACT FROM AUTHOR]

Not just another meeting, the conference of the American Association for the Treatment of Opioid Dependence (AATOD) held last week in Las Vegas was a coming together of the minds of the only providers in the country who have ever treated patients with opioid use disorder (OUD) with methadone. And it was clearly time for this meeting to be a positive one, focused on the importance of comprehensive care to patients. ADAW has written about the challenge to opioid treatment programs (OTPs) posed by the Modernizing Opioid Treatment Access Act (MOTAA) many times (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34028, https://onlinelibrary.wiley.com/doi/10.1002/adaw.34003, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33951), and one key advocacy session on May 21 presented the case very clearly. [ABSTRACT FROM AUTHOR]

While artificial intelligence (AI) may have utility in some medical practices such as reading X‐rays, it is not going to be useful in diagnosing or treating conditions with nuances — notably, substance use disorders (SUDs) — experts suggested in a panel on the topic at last week's College on Problems of Drug Dependence (CPDD) annual conference in Montreal. [ABSTRACT FROM AUTHOR]

On Feb. 2 the Substance Abuse and Mental Health Services Administration (SAMHSA) released its final rule for opioid treatment programs and methadone, just as ADAW went to press (see SAMHSA issues final rule updating OTP methadone rules, ADAW Feb. 5; https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023). The American Association for the Treatment of Opioid Dependence (AATOD), which represents more than 1,300 opioid treatment programs (OTPs) in the United States, last week commended SAMHSA for the guidance, which it called "enlightened and thoughtful." In a Feb. 5 press statement, AATOD president Mark Parrino noted that the regulations have been reviewed by the Drug Enforcement Administration (DEA). For the final rule, go to https://www.federalregister.gov/documents/2024/02/02/2024‐01693/medications‐for‐the‐treatment‐of‐opioid‐use‐disorder. [ABSTRACT FROM AUTHOR]

The federal Department of Health and Human Services (HHS) has a policy, called the exclusion program, of banning health care providers from billing Medicare or Medicaid for five years, even if they are in recovery, cooperate with the courts, are abstinent, pass regular drug tests, have their medical licenses back, and have never harmed a patient. Last week, ADAW interviewed two such providers —a doctor and a nurse — who agreed to go public with their stories. [ABSTRACT FROM AUTHOR]

In a clear but measured and scientific dispute against standard practice today, the American Society of Addiction Medicine (ASAM) has called for an end to the standardization of doses of buprenorphine for opioid use disorder (OUD). The recommendations, published in the Journal of Addiction Medicine, ASAM's flagship journal, note that doses should be optimal based on the individual needs of the patient. This was never in question within medical circles, including ASAM, but insurance policies and the tyranny of what is expected have led to suboptimal doses, both in the induction phase and the maintenance phase, of treatment. [ABSTRACT FROM AUTHOR]

No longer can opioid treatment programs (OTPs) summarily discharge patients for non‐payment, use of drugs or other reasons having to do with anything other than safety, at least not in New York. Most OTPs never did this, especially in New York, but the publication last month of new guidance from the state's Office of Addiction Services and Supports (OASAS) clearly delineates the circumstances under which a patient can be discharged against their will. [ABSTRACT FROM AUTHOR]

Putting profits over public health is not endorsed by Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA). She had some choice words for commercial interests involved in the addiction field in a brave Sept. 26 blog. Preying on the vulnerable — with drugs, social media, gambling, processed food and other addictive products — is something she knows how to zone in on as an evil. [ABSTRACT FROM AUTHOR]

A new report suggests that environments that would be expected to be the most compassionate toward people who use drugs or are in recovery can often be the most stigmatizing. Based on an online survey conducted last June, the report states that only around 1 in 3 health care workers consider a person who currently uses substances problematically as having a high chance of maintaining recovery. [ABSTRACT FROM AUTHOR]

The Notice of Proposed Rulemaking (NPRM) issued in December (https://onlinelibrary.wiley.com/doi/10.1002/adaw.33643) that liberalized many of the federal rules governing opioid treatment programs (OTPs) — the only treatment provider allowed to treat opioid use disorder (OUD) with methadone — has drawn key comments from the field. This NPRM concerned Part 8 of 42 CFR Part 2. Don't confuse it with the NPRM also in process concerning Part 2 (confidentiality of substance use disorder treatment records), which ADAW has covered as well (https://onlinelibrary.wiley.com/doi/10.1002/adaw.33661). We have been publishing selected comments to both NPRMs out of concern that they be included in the public record, as previously the federal government in summaries has cherry‐picked comments supportive of its proposals (https://onlinelibrary.wiley.com/doi/10.1002/adaw.32640). [ABSTRACT FROM AUTHOR]

CADCA's Annual National Leadership Forum will be held February 3‐6 in National Harbor, Maryland. For more information, go to https://www.cadca.org/events/cadcas‐35th‐annual‐national‐leadership‐forum/ [ABSTRACT FROM AUTHOR]

CADCA's Annual National Leadership Forum will be held February 3‐6 in National Harbor, Maryland. For more information, go to https://www.cadca.org/events/cadcas‐35th‐annual‐national‐leadership‐forum/ [ABSTRACT FROM AUTHOR]

Mark Parrino, founder and President of the American Association for the Treatment of Opioid Dependence (AATOD), highlighted some of the reasons for the current outlook on opioid treatment programs (OTPs) – which for a few months or years, depending on your perspective, has not been great. The main reason is the American Society of Addiction Medicine (ASAM), which used to be a solid partner of AATOD and OTPs (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.30330), but which in recent years has had a change in leadership and advocacy. What ASAM wants now is for MOTAA to pass – a bill which would allow ASAM‐certified physicians to prescribe methadone for opioid use disorder (OUD) to their patients. Under current federal law and regulation, only federally certified OTPs can provide (prescribe and dispense) methadone, and they do a lot more than just provide the medication. [ABSTRACT FROM AUTHOR]

The National Institutes of Health (NIH) last month announced the grant awardees for its new initiative representing its largest funding commitment yet to evaluating harm reduction approaches to reducing fatal overdoses. Among the concepts to be tested as part of NIH's harm reduction research network are mobile van‐delivered naloxone, contingency management strategies and "secondary distribution" of harm reduction supplies from one drug user to another. [ABSTRACT FROM AUTHOR]

Groups Recover Together (Groups), founded in 2014, is a quickly expanding enterprise. It is a bricks‐and‐mortar buprenorphine treatment program, funded mainly by venture capital and with a business model that can't fail: If patients don't recover, the payer gets their money back. Now relying on this "value‐based contracting" method, an easy sell to many Medicaid authorities, the organization has 12 facilities and treats 20,000 patients a week, according to Cooper Zelnick, chief revenue officer. [ABSTRACT FROM AUTHOR]

Craving is a great measure for outcomes for substance use disorders (SUDs) with one exception: how to measure it? Researchers at last week's College on Problems of Drug Dependence (CPDD) conference discussed the important topic. [ABSTRACT FROM AUTHOR]

Responding to an increasingly punitive approach nationally toward pregnant and postpartum women who use substances, the American Society of Addiction Medicine (ASAM) this month released a public policy statement calling for a reversal in the direction of comprehensive and evidence‐based care. Treatment leaders said they hope ASAM's detailed report and its 39 recommendations will help to steer the policy dialogue away from a criminalization mindset made even more concerning since the U.S. Supreme Court's ruling last June in the Dobbs v. Jackson Women's Health Organization abortion case. [ABSTRACT FROM AUTHOR]

Last week we asked the American Society of Addiction Medicine (ASAM), which is spearheading the call for methadone reform, to respond to questions about their proposal. Specifically, there is a bill in Congress that would allow pharmacies to fill prescriptions for methadone for opioid use disorder (OUD) providing that the prescribers were either from opioid treatment programs (OTPs) or certified by ASAM. Currently, only OTPs are allowed to prescribe and dispense methadone for OUD. The bill is called the Opioid Treatment Access Act (OTAA). For more on the history of this proposal, see NASEM workshop focuses on nonlegislative expansion of methadone, ADAW March 14; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33371. [ABSTRACT FROM AUTHOR]

I support all options being made available and allowing individuals to choose their path. The whole approach should be about choice – harm reduction, treatment, and self‐help. [ABSTRACT FROM AUTHOR]

When the American Association for the Treatment of Opioid Dependence (AATOD) released its five‐year plan for 2022‐26 last month, opioid treatment programs (OTPs) were already on the brink of massive changes, which some call reform, and others call deregulations. The AATOD and OTPs embrace most of these changes, because they benefit patients and providers alike, freeing up more space for treatment with methadone as well as comprehensive services during an opioid overdose crisis that seems to have no end. [ABSTRACT FROM AUTHOR]

Representative Donald Norcross (D‐N.J.), normally a champion of addiction treatment, caused outrage in methadone treatment field last month when he referred to the opioid treatment program (OTP) model as a "cartel" in his official press statement supporting the Modernizing Opioid Treatment Access Act, which would allow office‐based addiction physicians to prescribe methadone for opioid use disorder (OUD). The proposed legislation would, like the OTAA (Opioid Treatment Access Act) proposed last year (see "Mammoth bipartisan bill would revamp SAMHSA programs," ADAW, May 16, 2022; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33428) threaten the "turf" of OTPs. ADAW wrote about the introduction of the bill last month (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33428). [ABSTRACT FROM AUTHOR]

A combination of residential treatment for substance use disorders (SUDs) and the cessation of drinking resulted in increased abstinence rates from drugs in general, a recent study of "situational factors" linked to abstinence from drugs has found. In addition, even for patients not in residential treatment, employment and the cessation of drinking were linked to increased abstinence rates. The patients in the study excluded those with alcohol use disorders (AUD). The study was conducted in Japan, where drug use is illegal and strictly enforced. [ABSTRACT FROM AUTHOR]

At last week's meeting of the College on Problems of Drug Dependence, the primary gathering of researchers funded by the National Institute on Drug Abuse (NIDA), there were many sessions on buprenorphine but none devoted to methadone, and when methadone was mentioned, it was about the need to expand it beyond opioid treatment programs (OTPs). In one session we attended, even MOTAA, the bill which would allow physicians to prescribe methadone for opioid use disorder, was lambasted as being restricted to addiction medicine physicians. Methadone in primary care was the main ideology propounded. Interesting, as there is no research on how effective or safe this would be. As one expert asked us later, "If they had cancer, wouldn't they want to go to an oncologist?" There is also the fact that only OTPs have used methadone; no one else in the United States has any experience treating opioid use disorder with the medication. We are reminded of the words of Sigmund Freud to his audience at Clark University in 1909: "We have heard a large number of judgements on psycho‐analysis from people who know nothing of this technique and do not employ it." [ABSTRACT FROM AUTHOR]

The annual meeting of the College on Problems of Drug Dependence (CPDD) will be held June 15‐19 in Montreal. For more information, go to https://cpdd.org/ [ABSTRACT FROM AUTHOR]

Corrections are made to the articles "Delegate to the AATOD board from New York reported highlights from key initiatives for her state," published on May 27, and "Looking Ahead to No Stigma: Better Access, Better Integration of Methadone," featured in the May 21, 2024 issue.

An Aug. 11 webinar hosted by the American Association for the Treatment of Opioid Dependence (AATOD) featured speakers from the opioid treatment program (OTP) community who have been operating methadone vans for years, as well as the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Both agencies just announced the approval of methadone vans, providing such vans are part of brick‐and‐mortar OTPs (see 'Mobile methadone now approved for licensed OTPs,' ADAW July 4; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33120). [ABSTRACT FROM AUTHOR]

Abstinence is not a necessary requirement for improving measures of health and recovery among people with stimulant use disorder, according to a study published last week in Addiction. The study, "Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials," analyzed trials for treatment for methamphetamine and cocaine use disorders. The National Institute on Drug Abuse (NIDA) funded the study. [ABSTRACT FROM AUTHOR]

In a study funded by Camurus, which makes the depot versions of buprenorphine, patients receiving the medication had better satisfaction with the treatment than those receiving oral buprenorphine, highlighting the importance of patient‐reported outcomes as alternative endpoints to traditional markers of treatment outcome. The depot version is injected subcutaneously in weekly or monthly doses. Oral (sublingual) buprenorphine is taken daily. [ABSTRACT FROM AUTHOR]

It's no secret that addiction has a genetic component. But researchers have been focusing on ways to actually test people for propensity for addiction, for which medications might work best for them, and more. In the science of "prescription medicine," the National Institutes of Health is working on what is sometimes called personalized medicine, sometimes called precision medicine and sometimes called personalized precision medicine in the field of addiction. This began in general medicine but has moved to include mental and substance use disorders. [ABSTRACT FROM AUTHOR]

You have almost never read about psychoanalysis or its less intense relative, psychodynamic psychotherapy, in these pages. It's because it doesn't work to treat active substance use disorders (SUDs). But psychodynamic psychotherapy, with all of the psychoanalytic underpinnings, can be very helpful to patients in recovery, because in fact many of these patients are self‐medicating a past trauma. [ABSTRACT FROM AUTHOR]

At a time when the most time‐honored component of addiction recovery support has had to suspend traditional operations and establish connection in a new way, leaders have become keenly interested in whether virtual recovery meetings can duplicate the meaningful interaction of the in‐person group. It could take years to see sound data that illustrates the precise impact of virtual support groups, but anecdotal information suggests some challenges and a few bright spots. [ABSTRACT FROM AUTHOR]

Many individuals who would be good candidates for methadone treatment for opioid use disorder (OUD) live closer to a chain pharmacy than to an opioid treatment program (OTP), and that holds true in urban as well as rural communities. A newly published study focusing on five states hit hard by the opioid overdose crisis suggests that pharmacy‐based methadone dispensing would make a major difference in improving access to the evidence‐based OUD treatment. [ABSTRACT FROM AUTHOR]

The annual meeting of the College on Problems of Drug Dependence (CPDD) will be held June 15‐19 in Montreal. For more information, go to https://cpdd.org/ [ABSTRACT FROM AUTHOR]

The AATOD conference was a great success, noted Allegra Schorr, B.S., who is President of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA) and owner and vice president of West Midtown Medical Group, an opioid treatment program (OTP), outpatient substance use disorder treatment program, and primary care program in New York City. The board meeting centered on changes to the guidelines (42 CFR Part 8) for OTPs, with widespeard agreement that the federal changes are "extremely positive," Schorr told ADAW. "There was some discussion regarding interpretation of the change to the counseling requirement," she said, adding that there is a need for greater clarification. [ABSTRACT FROM AUTHOR]

At the American Association for the Treatment of Opioid Dependence (AATOD) meeting in Las Vegas last week, Allegra Schorr, M.S., delegate to the AATOD borad from New York, presented highlights from key initiatives for her state. Schorr is President of the Coalition of Medication Assisted Treatment Providers and Advocates (COMPA) and owner and vice president of West Midtown Medical Group, and opioid treatment program (OTP), outpatient substance use disorder treatment program, and primary care provider. [ABSTRACT FROM AUTHOR]

The annual meeting of the College on Problems of Drug Dependence (CPDD) will be held June 15‐19 in Montreal. For more information, go to https://cpdd.org/ [ABSTRACT FROM AUTHOR]

Starting buprenorphine treatment for opioid use disorder (OUD) through telehealth was associated with an increased likelihood of staying in treatment longer compared to starting treatment in a non‐telehealth setting, according to a new study analyzing Medicaid data from 2019–2020 in Kentucky and Ohio. Published in JAMA Network Open, the study, "Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees," by Lindsey R. Hammerslag, Ph.D., and colleagues, was released Oct. 18. The research adds to what the National Institute on Drug Abuse (NIDA) calls a "growing body of evidence" supporting telehealth initiation of buprenorphine treatment. [ABSTRACT FROM AUTHOR]

First it was the plant, cannabis. How could this be made into a saleable profit‐making commodity when it grows in the ground? Witness the marijuana (a chemical from the plant) industry, which lobbied to make sure laws in states that legalized it banned people from growing more than a few plants. [ABSTRACT FROM AUTHOR]

At the COMPA (Coalition of Medication‐Assisted Treatment Providers and Advocates) Symposium last month in Albany, New York, officials from the New York Office of Addiction Services and Supports (OASAS) presented information on the effects of xylazine, increasingly present in the street supply of opioids, especially fentanyl. Pamela Mund, M.D., OASAS associate medical officer, and Sarah Gorry, M.S., an Empire State Fellow with OASAS, shared the following information. Xylazine is [ABSTRACT FROM AUTHOR]

When growing drug problems give rise to new sources of funding that in turn attract fledgling or expanding treatment facilities, it would stand to reason that regulators' capacity to oversee these operations should grow as well. State officials in Pennsylvania say they have struggled to keep up, however, and they would like to be able to use their licensing authority to ensure more accountability in the state's substance use treatment provider community. [ABSTRACT FROM AUTHOR]

Research findings are shedding new light on the role of both positive and negative reinforcement in drinking behavior and the development of alcohol use disorders, as well as highlighting the challenges in identifying viable treatment strategies to reduce alcohol use. [ABSTRACT FROM AUTHOR]

As they work doggedly to elevate the standing of the addiction counseling profession, the national and regional leaders of NAADAC, the Association for Addiction Professionals continue to encounter industry trends that, if unchecked, threaten to diminish the perceived value of counselors. From the proliferation of medication treatment delivered absent counseling to the embrace of peer support services that lawmakers often confuse with therapy, many of today's hot‐button issues in addiction services would appear to make the task of counselors' advocates that much harder. [ABSTRACT FROM AUTHOR]

Last month, the federal Centers for Disease Control and Prevention (CDC) took what many view as a first step toward retracting its now‐infamous "Guideline for Prescribing Opioids for Chronic Pain" issued in 2016. [ABSTRACT FROM AUTHOR]

The Rx and Illicit Drug Summit will be held April 1‐4 in Atlanta. For more information, go to https://www.hmpglobalevents.com/rx‐summit/rates [ABSTRACT FROM AUTHOR]

Last week, the Food and Drug Administration (FDA) announced it is requiring an update to the boxed warning on benzodiazepines to include the risks of abuse, misuse, addiction, physical dependence and withdrawal reactions. [ABSTRACT FROM AUTHOR]

Buprenorphine prescriptions that were dispensed — the medication given to patients — increased 9.1% from 2017 to 2018, a study published last month has found. Nurse practitioners (NPs) and physician assistants (PAs) accounted for most of the increase, especially in rural counties. [ABSTRACT FROM AUTHOR]

The opioid hearing by the House Energy and Commerce Committee March 3 gave everyone a chance to ask questions and answer them, but lawmakers got the lion's share of the limelight as they promoted their respective bills. And the grandstanding wasn't limited to bills on the table: Politicians have never been shy about expressing their opinions on the best way to approach addiction. Still, it was a productive hearing, thanks in large part to the skillful management by Rep. Anna G. Eshoo (D‐California), chair of the Health Subcommittee of the House Energy and Commerce Committee. [ABSTRACT FROM AUTHOR]

In "Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta‐analysis of randomized and observational studies," authors Louisa Degenhardt and colleagues reviewed studies to compare the effectiveness of methadone with buprenorphine. Their study, published in the June 2023 issue of Lancet Psychiatry, found that treatment retention was better with methadone than buprenorphine. The study was a meta‐analysis that identified 32 randomized controlled trials (RCTs) of 5,800 participants and 69 observational studies of 323,340 participants. Primary outcomes were. [ABSTRACT FROM AUTHOR]

The NAADAC annual conference will be held October 6‐12 in Denver, Colorado. For more information, go to https://www.naadac.org/annualconference [ABSTRACT FROM AUTHOR]