Showing papers on "Addiction medicine published in 2002"

Assessment for addiction in pain-treatment settings.

Abstract: The identification of the disease of addiction is important to safe and effective clinical management of pain in persons with addictive disorders. The disease of addiction affects approximately 10% of the general population, and its prevalence may be higher in subpopulations of patients with pain. The presence of active addiction may facilitate the experience of pain. Both active and recovering addiction may complicate the use of medications, such as opioids, important to the management of pain. There is, further, persistent misunderstanding among health care providers, regulators, and the general population regarding the nature and manifestations of addiction that may result in undertreatment of pain and stigmatization of patients using opioids for pain control. The author seeks to clarify understanding of addiction, to underscore the importance of identifying addiction in the context of pain treatment, and to provide a rational approach to assessment for addiction in patients with pain. Current scientific understanding of addiction as a chronic illness is briefly reviewed. Recent definitions related to addiction are presented. The impact of addictive disorders on pain and pain treatment are explored. The roles of medical interview, physical examination, laboratory studies, and standard addiction screening tools in assessing for addiction are outlined. Differential considerations in distinguishing therapeutic use of opioids for analgesia from addictive or other nontherapeutic use of opioids are discussed. In summary, the article provides salient background and a detailed approach to assessment for addictive disorders in the context of pain treatment.

Abuse liability in opioid therapy for pain treatment in patients with an addiction history.

Abstract: Patients may present to physicians with complaints of acute or chronic pain. Some of these patients will have a history of addiction to drugs or alcohol, and a few will have active addiction. Controlled-substance prescriptions, especially opioid pain medications, can be very beneficial for treatment of pain in patients. There are clear differences between physical dependence on medication, active addiction, addiction in remission, and pseudoaddiction. A search of the medical literature revealed different rates of addiction in patients with chronic pain because different criteria were used to define addiction and the types of chronic pain. It appears that rates of addiction in patient populations with chronic pain are no different than rates of addiction in the general population, according to some recent studies. "Drug-seeking behavior" may be seen with either active addiction or pseudoaddiction. A way to distinguish between these conditions is by giving the patient more pain medication and observing the patient's pattern of behavior. Some patients may be at higher risk to abuse prescription opioids, and some types of drug-seeking behavior may be more predictive of active addiction than pseudoaddiction. General guidelines can improve physicians' comfort level in prescribing opioids for patients with chronic pain, even those with a history of addiction. These include using a medication agreement or contract, setting appropriate goals with the patient, giving appropriate amounts of pain medication, monitoring with drug screens and pill counts, and documenting the case carefully. Even patients with a history of addiction can benefit from opioid pain medications if the patients are monitored appropriately.

Policy progress for physician treatment of opiate addiction.

Abstract: Medical treatment of heroin addiction with methadone and other pharmacotherapies has important benefits for individuals and society. However, regulatory policies have separated this treatment from the medical care system, limiting access to care and contributing to the social stigma of even effective addiction pharmacotherapy. Increasing problems caused by heroin addiction have added urgency to the search for policies and programs that improve the access to and quality of opiate addiction treatment. Recent initiatives aiming to reintegrate methadone maintenance and other addiction pharmacotherapies into medical practice may promote both expanded treatment capacity and increased physician expertise in addiction medicine. These initiatives include changes in federal oversight of the opiate addiction treatment system, the approval of physician office-based methadone maintenance programs for stabilized patients, and federal legislation that could enable physicians to treat opiate addiction with new medications in regular medical practice.

An integration of three approaches to addiction and methadone maintenance treatment: the self-medication hypothesis, the disease model and social criticism.

Abstract: The two models which have most affected theory and practice of addiction medicine have been the disease model and the self-medication hypothesis. The disease model's fundamental concept is that the addicted individual is sick and suffers from a disease. The self-medication hypothesis proposes that drug and alcohol users are attempting to cope with an underlying psychological or social disorder by means of self-medication. These two viewpoints are presented in the light of a number of specific methadone maintenance treatment and drug abuse related issues such as the question whether drug abuse is an illness of the body, the mind or society; whether the disease model really de-stigmatized drug abuse; what the correct methadone dosing policy should be; the place of psychotherapy in methadone maintenance treatment and drug abuse and how polydrug abuse should be treated. These issues are discussed and an integrated approach is suggested stressing the need for social criticism and a renewed social policy towards drug abuse in general and its treatment in particular.

Linking mental health and addiction services: a continuity-of-care team model.

Abstract: Reorganization of mental health care delivery services at a Department of Veterans Affairs medical center addressed problems with the coordination of addiction treatment and mental health programming for patients with significant psychiatric and addiction comorbidity. Clinical services were organized into interdisciplinary continuity-of-care teams that follow patients across different levels of care. The teams provide addiction treatment through “universally available” resources such as a partial hospital addiction rehabilitation module. Continuity of care remains within the team structure as clinicians follow patients throughout their rehabilitation course. Patient and staff satisfaction focus on improved accessibility of addiction services and continuity of care providers across time and levels of care. Overall inpatient utilization and recidivism decreased after model implementation.

NAOMI—Her time has come

Abstract: Illicit opiate use is a significant public health problem in North America and elsewhere around the world. The affected population is estimated to be around 600,000 in the United States and 60,000–90,000 in Canada. Untreated opiate addiction can lead to overdose, infectious diseases such as human immunodeficiency virus (HIV) and hepatitis, loss of regular social and economic functioning, and extensive engagement in both drug-related and drug acquisition crime. At a societal level, there are the respective costs to the public health, health care, and welfare and criminal systems contending with these risk and harm phenomena. A recent Canadian study on cost of illness found a total social cost burden of US $30,000 per untreated user per year due to lost productivity, health and health care, and crime and criminal justice costs. The North American Opiate Medication Initiative (NAOMI) is meant to help address this major health problem. Methadone maintenance therapy (MMT), the mainstay of opiate addiction treatment, has proven effective for some, but not all, opiate users. It is well established that while MMT can be beneficial to many opiate users, a considerable subset will not be attracted into MMT for a variety of reasons or will not be retained in such programs even if initially attracted. Complementary and alternative treatment modalities are thus needed for those opiate addicts who cannot be reached by, attracted into, or productively retained in conventional forms of opiate addiction treatment. For these reasons, attention has turned in recent years to the use of medically prescribed heroin as an adjunctive therapy for treatment-refractory opiate users. An uncontrolled study conducted in Switzerland since 1994 has shown very promising results. A report on a much-anticipated Dutch trial involving both injectable and inhaled heroin is due this year, and in Germany, a multisite heroin-assisted treatment trial will start in 2002. There are two protocols in Spain for heroin trials that have recently been approved by federal authorities. But not all initiatives go forward as planned. In Australia, a protocol for a heroin trial was approved by the Ministerial Council on Drug Strategy in 1997, but was subsequently blocked by political decision makers. A trial protocol was submitted to French health authorities as far back as 1999 and is still awaiting a decision. So who (or what) is NAOMI? NAOMI is a collaborative effort of a team of addiction medicine specialists, epidemiologists, clinical trial specialists, social scientists, and health economists from across the continent; its aim is to conduct a rigorous randomized controlled trial of heroin-assisted therapy in the North American setting. In essence, the trial will compare an optimized MMT program with a medically prescribed injectable heroin program. Primary outcomes will include examination of treatment retention as well as treatment response based on the Addiction Severity Index on an intent-to-treat basis. A comprehensive health economics component will examine the cost-effectiveness of the treatment options. NAOMI was

A survey of addiction training programming in psychiatry residencies.

Abstract: The authors surveyed 50 psychiatry residency training programs to examine the current status of addiction training and the impact of the new Residency Review Committee addiction training criteria for general psychiatry residencies. Only 5 programs did not already meet the new 1-month full-time equivalent addiction training requirement,and those programs anticipated only modest changes. The modal full-time equivalent addiction experience was actually 2 months,with great diversity in timing and settings. Respondents, however, often felt that their programs relied on one key addiction supervisor and that affiliated PGY-5 addiction residents usually had only limited roles in teaching and supervising the general psychiatry residents.

Simple fairness: ending discrimination in health insurance coverage of addiction treatment.

Abstract: Consider these facts: An often-debilitating brain disease afflicts millions of Americans. This disease is one of the country's greatest killers. Its victims frequently suffer from depression and many physical ailments, and often become unable to work effectively. The disease costs the U.S. economy hundreds of billions of dollars annually-more than cancer, more than heart disease.' Fortunately, although no cure exists, medical treatment can enable recipients to live normal, healthy, and productive lives. Treatment is cheap compared to many other common medical procedures and is highly cost-effective.2 Now consider this: For the vast majority of victims of this disease, effective treatment is inaccessible. Most health insurance plans either do not cover it or put a variety of limits on coverage that do not apply to other diseases. Unless they can pay out of pocket, victims cannot get the treatment they need. To make matters worse, they are often told that their condition is not a real disease, or that it is their fault, or that suffering from it makes them a criminal. The disease is drug and alcohol addiction, and the facts are real. Ubiquitous benefit caps on insurance coverage of substance abuse treatment put effective recovery out of reach for most addicts. In this Note, I assess the nature of this problem and some possible ways to address it. The general principle that I advocate is substance abuse treatment parity, which means that insurance plans should provide coverage for addiction treatment that is equivalent to that provided for analogous conditions. In some cases, failure to provide such parity should be considered illegal disability discrirmintion on the part of employers and insurers. Moreover, new laws should be adopted to require insurance parity explicitly.

Training family medicine residents for assessment and advocacy of older adults

Abstract: A review of the Basic Standards for Residency Training in Osteopathic Family Practice and Manipulative Treatment by the American Osteopathic Association and the American College of Osteopathic Family Physicians revealed that the family medicine residency curriculum in place at Riverside Osteopathic Hospital in Trenton, Mich, lacked formal didactic and clinical teaching in geriatric medicine. Therefore, a geriatric curriculum focusing on functional assessment strategies was developed and implemented. A three-part, 6-hour educational series was delivered to family medicine residents, interns, and medical students at Riverside Osteopathic Hospital. Content for the sessions addressed a variety of assessment and screening tools; concepts of abuse, neglect, and guardianship; available community resources to support the independent functioning of older adults; and, application of knowledge and skills. The geriatric medicine series concluded with a working session to prepare an individualized management plan for each of the patients evaluated. Each family medicine resident, the target learners, demonstrated his skill at performing a functional assessment of a geriatric patient at the community-based Horizon Family Medical Center in Taylor, Mich. Peers and faculty provided feedback. Family medicine residents were able to transfer knowledge and skills from the classroom to a geriatric patient. This teaching curriculum is the starting point for further development of clinical and community-based geriatric experiences for the family medicine residents at Riverside Osteopathic Hospital.

Prescription drug addiction: the hidden epidemic. A guide to coping and understanding.

Abstract: The book answers these questions: • How does addiction “rewire” the brain? • What happens if the drugs are stopped abruptly? • What are the symptoms of addiction? • Who’s at risk for addiction? • When does proper medical use become addiction? • How do most people become addicted? • What are the symptoms of withdrawal? • What is the difference between addiction and physical dependence? • What are the top 20 most-abused prescription drugs? • What is the proper use of benzodiazepines? How can you leave prescription drugs behind? • Learn how they become addicted. • Find out how they made it into recovery. • What were the turning points in their lives that made them seek recovery? • What is their advice to others who are struggling? Treatment for addiction—What’s involved? • What are the treatment options? • What is a medical detox? • What is in-patient treatment? • What is out-patient treatment? • What is a partial-day treatment plan? • What is rapid detox for opiate addiction? • Does insurance pay for treatment? • What is relapse prevention education? How can family members ease their pain? • What can family members do to help the addict and themselves? • What does it mean to enable an addict? • Find out if you’re enabling the addict. • What are the levels of enabling? • What is a family intervention? • How can you set up an intervention to get your loved one into treatment? • Understand that addiction is a progressive disease. Advice from addiction medicine specialists • Addiction is an illness. • How to build on hope. • Be cautious with benzodiazepines. • Stages of chemical dependency. • Addiction to pills means greater denial. • Addicts are not having fun. • Warning signs of addiction. • How to avoid isolating, a trigger for relapse. A helpful guide for overcoming prescription drug addiction [publisher description]