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ASAM officially favors empirical research findings over experiential anecdotes for opioid treatment.

ASAM officially favors empirical research findings over experiential anecdotes for opioid treatment.

http://www.asam.org/magazine/read/article/2015/06/02/asam-releases-national-practice-guideline-for-the-use-of-medications-in-the-treatment-of-addiction-involving-opioid-use


ASAM Releases National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use
by ASAM Staff | Jun 02, 2015

FOR IMMEDIATE RELEASE

Contact: Beth Haynes, 301-547-4123 CHEVY CHASE, MD, June 2, 2015 – ASAM announces the release of its National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (Practice Guideline). 

The Practice Guideline will assist clinicians prescribing pharmacotherapies to patients with addiction related to opioid use. It addresses knowledge gaps about the benefits of treatment medications and their role in recovery, while guiding evidence-based coverage standards by payers.The Practice Guideline is a timely resource as the United States is currently experiencing an opioid epidemic. 

According to the National Institute on Drug Abuse (NIDA), 2.1 million Americans live with pain reliever opioid addiction disease, while 467,000 Americans live with heroin opioid addiction disease. Overdose deaths are now comparable to the number of deaths caused by motor vehicle crashes, and the societal costs of opioid misuse is estimated to be above $55 billion per year.Medications are both clinical and cost-effective interventions. 

While the effectiveness of medications has been researched and documented, their utilization is low and coverage varies dramatically. Less than 30% of treatment programs offer medications and less than half of eligible patients in those programs receive medications.According to Dr. Jeffrey Goldsmith, ASAM President, “Opioid addiction is a chronic, life-threatening disease with significant medical, emotional, criminal justice and societal costs. This guideline is the first to address all the available medications to treat opioid addiction. It will help save lives.”

ASAM worked with Treatment Research Institute (TRI) to develop thePractice Guideline using the RAND/UCLA Appropriateness Method (RAM), a consensus process that combines scientific evidence with clinical knowledge. A Guideline Committee, made up of experts from multiple disciplines, including addiction medicine, psychiatry, obstetrics/gynecology and internal medicine, participated in the consensus process and helped write the guideline. Dr. Kyle Kampman chaired the Guideline Committee and served as TRI’s Principal Investigator. 

“The Practice Guideline is the most current document of its kind combining review of existing guidelines, current literature and a systematic process for developing practice recommendations.”ASAM has been working on a number of quality improvement initiatives. The Practice Guideline builds upon several other recent ASAM clinical documents, including the "Standards of Care: For the Addiction Specialist Physician" and “Performance Measures for the Addiction Specialist Physician.”

According to Dr. Margaret Jarvis, chair of the Quality Improvement Council, ASAM’s guideline oversight committee, “The Practice Guidelineis an invaluable document for the addiction medicine field. It will assure a more uniform delivery of quality patient care. We are making a copy of the full guideline available now but are planning publication and a summary article for the Journal of Addiction Medicine and the release of derivative products and educational activities later this summer and fall. 

We want the Practice Guideline to be widely used and accepted.”The National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use can be accessed HERE, on ASAM’s website: 

Does professional allegiance to12 step treatment discriminate against 92%-95% of substance abusers?




"The Bottom Line: Examining Our Growing Epidemic of Prescription Drug Addiction"


Addiction Expert, Scott W. Stern, Interviewed 
by CBS News Correspondent, Dr. Max Gomez 
and host, Sarah Hiner About Our Growing 
Epidemic of Prescription Drug Addiction 


"The Bottom Line"
Scott W. Stern, Addiction Expert, Interviewed By CBS News Correspondent, Dr. Max Gomez and host, Sarah Hiner About Prescription Drug Addiction Epidemic.
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Why the polarizing of addiction professionals regarding abstinence versus harm reduction therapy is so absurd.



"Why the polarizing of addiction professionals regarding abstinence versus harm reduction therapy is so absurd."

--by Scott W. Stern, Psychotherapist/Empowerment Professional

Focused on Addictions, Anxiety, OCD, Trauma & PTSD

Private and Corporate Services 

During the past 20 years I've been in practice, I have found that all addiction treatments are, in fact, some form of harm reduction. We've yet to find an infallible treatment for addictions and substance use disorders. 

However, the change in the DSM terminology is very significant. It differentiates diagnoses of substance abuse and chemical dependency from it's evolved diagnosis of substance use disorder - mild, moderate or severe. Those with severe diagnoses (co-morbidity involving diabetes, liver damage, severe psychiatric conditions, dementia, legal, etc) would certainly be appropriate candidates for abstinence over moderation. But as I see it, at the end of the day, from moderation to abstinence it's all harm reduction.

For every patient who repeatedly relapses and is referred to the "higher level of care," this, too, is about harm reduction. We've learned how poor the success rates are at inpatient facilities that practice abstinence-only 12-step model approaches. Without guarantees, this too is a harm reduction approach.

In this regard, I believe the term "harm reduction" is obsolete. It is a "given" in any treatment to practice some form of harm reduction. The professional who believes relapse prevention techniques and behavior modification are not a form of harm reduction is terribly misinformed. Even the Hippocratic oath clearly states "Do no harm."

But I will state for the record, I believe more substance users will be attracted to treatment facilities that are not abstinence-only, where clients' lives will be saved by being medically monitored by trained professionals. Once stabilized, every patient--regardless of their clinical needs, has the right to have reasonable access and education regarding current evidence-based treatment.

Ultimately, it is the patient's right to be empowered to make choices regarding his or her own health and treatment. Unfortunately, the polarizing of professionals who see harm reduction and abstinence as opposing treatment models often do not empower clients with education of all current treatment options for substance use disorders.

This is a serious bias in our field that dis-empowers patients ("knowledge is power"), with potential to cause more harm to those substance users at risk.

CDC: "Most people who drink to excess may not be alcoholics."

The New York Times (11/21, Parker-Pope) “Well” blog reports that according to a report released Nov. 20 by the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration in the CDC’s Preventing Chronic Disease journal, the majority of “people who drink to get drunk are not alcoholics.” The conclusions of “a government survey of 138,100 adults counters the conventional wisdom that every ‘falling-down drunk’” has an addiction to alcohol. Rather, “the results from the National Survey on Drug Use and Health show that nine out of 10 people who drink too much are not addicts, and can change their behavior with a little – or perhaps a lot of – prompting.”





The Washington Post (11/21, Izadi) “To Your Health” blog points out that approximately “10 percent of people who drank excessively also met the clinical definition for alcohol dependence.” The report also found that “the vast majority of excessive drinking is binge drinking, a pattern of behavior where men consume roughly five or more drinks and women consume four or more within a short period of time.” Also covering the story are the NPR (11/21, Aubrey) “The Salt” blog, HealthDay(11/21, Reinberg) and Reuters(11/21, Beasley) also cover the story.




Clarification


Alcohol dependence was defined as past-year drinking, 3 or more (of 7) dependence criteria, and consuming at least 1 drink on 6 or more days in the past 12 months (11). The alcohol dependence questions in the NSDUH align with the diagnostic criteria for alcohol dependence in the fourth edition of the DSM (DSM-IV) (7). 



These include tolerance, withdrawal, impaired control, unsuccessful attempts to cut down or stop drinking, continued use despite problems, neglect of activities, and time spent in alcohol-related activity. The classification of alcohol dependence in this study is based on self-reported responses to the NSDUH and is not based on a diagnosis in a clinical setting or from medical records; therefore, alcohol dependence in this study is based on respondents’ survey data.