This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.
Read more online.
V. Yu. Skryabin MD & M. A. Vinnikova PhD, MD
Journal of Addictive Diseases
Published on 7/4/2019
Senators Markey and Murkowski Introduce Legislation to Support Access to Opioid Use Disorder Treatment in Correctional Facilities
Providing MAT in correctional facilities can help reduce opioid overdose deaths upon re-entry by 60 percent
Data indicates recently released individuals are 129 times more likely to die from opioid overdose in first two weeks of release
Washington (June 28, 2019) – Senators Edward J. Markey (D-Mass.) and Lisa Murkowski (R-Alaska) today introduced the Community Re-Entry through Addiction Treatment to Enhance (CREATE) Opportunities Act, legislation to help expand access to medication-assisted treatment (MAT) like Suboxone for justice-involved individuals. This legislation would create a new grant program within the Department of Justice for state and local governments to provide MAT in their correctional facilities. The program would require grantees to provide more than one MAT option and to develop a plan for connecting individuals to continued treatment upon release into the community. Data indicates recently released individuals are 129 times more likely to die from opioid overdose in first two weeks of release.
Companion legislation has been reintroduced in the House of Representatives by Rep. Ann McLane Kuster (NH-2).
“Our local jails are on the front lines of the response to the nation’s opioid overdose crisis,” said Senator Markey. “Too often, our local jails witness some of the most devastating impacts of the opioid crisis, but don’t have the resources to mount a robust and appropriate response. My bill would help change that. We know we cannot incarcerate our way out of this crisis. Instead, we must rehabilitate in order to reduce recidivism and save lives. Providing reliable access to evidence-based treatment within correctional facilities will help counties and states respond to this crisis like the public health issue that it is. I thank Senator Murkowski and Representative Kuster for their partnership in this endeavor.”
“Opioid use has skyrocketed in Alaska. And for those struggling with opioid abuse or a mental health disorder who are in the criminal justice system, the transition from incarceration into their community can be incredibly difficult. To truly break the vicious cycle of substance abuse, we must ensure those incarcerated have a path to treatment,” said Senator Murkowski. “By combining access to approved medications in combination with behavioral health therapy, we’re not just decreasing the rate of relapses, re-incarcerations, and overdoses, we’re giving those in the criminal justice system hope for a future that isn’t dictated by substance abuse.”
“Too many incarcerated individuals in our jails suffer from untreated mental health and substance use disorder, and most lack access to the treatment they need,” said Rep. Kuster. “Medication assisted treatment (MAT) has an important role to play in helping incarcerated individuals suffering from substance use disorder recover and reclaim their lives to become productive, contributing members of our society. Reducing recidivism is a win for our communities: it’s good for public safety, public health, and budgets. The CREATE Opportunities Act is commonsense legislation to provide a commonsense solution to put an end to the cycle between addiction and the criminal justice system.”
A copy of the CREATE Opportunities Act can be found HERE.
“Drugs do not know age, race, gender, religion or economic status and the cost of addiction is astronomical – it tears families apart, ransacks communities and undermines public safety,” said Major County Sheriffs of America (MCSA) President Sheriff Grady Judd. “On behalf of the largest Sheriff’s Offices in the U.S. we endorse Senator Markey’s effort to address the lack of access to medication-assisted treatment (MAT) in local correctional facilities. Through the creation of a new grant program within the Department of Justice, Sheriffs will have access to funds that provide a much-needed tool for corrections and can help reduce the likelihood of overdose deaths after release. We look forward to working with Senator Markey’s office to move this bill across the finish line.”
“People exiting the criminal justice system are at high risk of overdose deaths,” said Michael Collins, Director of the Office of National Affairs at Drug Policy Alliance. “Rhode Island’s jail system has shown that offering all three MATs is a successful way of reducing fatalities. We applaud Senators Markey and Murkowski for their work on this important bill.”
“In jails across America, sheriffs see first-hand the devastating impacts that the mental health crisis and the opioid epidemic have on their communities,” said NSA’s Executive Director, Jonathan Thompson. “This common-sense legislation introduced by Senator Markey provides a solution to inmates lack of mental health care/medically assisted treatment, when they need it most. We commend Senator Markey’s efforts to create a grant program that can be widely accessed by both urban and rural sheriffs.”
“Counties experience the human toll of addiction every day in our communities. We are the nation’s first responders and deliver services to residents in our emergency rooms, public health departments and justice systems. As we pursue proven solutions in our fight against addiction, greater access to medication-assisted treatment is important,” said National Association of Counties Executive Director Matthew Chase.“NACo applauds Senators Markey and Murkowski’s efforts to strengthen resources available to local officials, and we look forward to working with our congressional partners to reduce overdoses and addiction-related fatalities.”
“Today ASAM commends Senators Markey and Murkowski for their efforts to provide evidence-based addiction treatment to people with opioid use disorder who have been incarcerated,” said Paul H. Earley, MD, DFASAM, president of the American Society of Addiction Medicine (ASAM). “The CREATE Opportunities Act would establish a much-needed federal grant program that can provide addiction treatment access during incarceration and warm handoffs to community-based care upon release that will significantly reduce the risk of opioid-related overdose. In short, this legislation will save lives.”
“Harm Reduction Coalition welcomes the bipartisan CREATE Act that recognizes that the provision of evidence-based medication treatment is critical to preventing painful withdrawal symptoms, relapse, overdose and increased risk of death that occurs with incarcerating people with opioid use disorder,” said Kimberly Sue, MD, PhD, Medical Director, Harm Reduction Coalition. “Provision of medication for opioid use disorder is both compassionate and the community standard of care; not providing medication such as buprenorphine or methadone therapy has been found by several judges across multiple states to be a violation of the Americans with Disabilities Act (ADA) as well as a violation of the Eighth Amendment of the Constitution prohibiting cruel and unusual punishment. This legislation is an important first step in addressing structural harms contributing to the American opioid overdose crisis.”
“Research has shown that psychosocial interventions in combination with medications provide the greatest chance for success in treating substance use disorders,” CEO, Dr. Arthur C. Evans, American Psychological Association. “The American Psychological Association applauds this legislation, which will help inmates increase access to this effective form of treatment so that they can initiate and maintain recovery, increasing their chance of successful and safe reentry to their communities.”
“Sheriffs across the country are on the front lines of the opioid epidemic. Substance use is a major driver of crime and individuals leaving prison in Massachusetts are 120 times more likely to die of a fatal overdose compared to others suffering from substance use disorders,” said Middlesex Sheriff Peter J. Koutoujian.“It is critically important sheriffs have the resources necessary to support initiatives like our Medication Assisted Treatment And Directed Opioid Recovery (MATADOR) program, which has shown proven results in increasing public safety, reducing recidivism and improving health outcomes since its launch nearly four years ago. I want to thank Senator Markey for recognizing the urgent need to provide direct federal resources to address this public health and public safety crisis.”
Organizations endorsing the legislation include: American Society of Addiction Medicine, National Sheriffs’ Association, Major County Sheriffs of America, Drug Policy Alliance, Harm Reduction Coalition, AIDS United, National Association for Behavioral Healthcare, National Council for Behavioral Health, SMART Recovery, Center on Addiction + Partnership for Drug-Free Kids, Young People in Recovery, National Alliance for Medication Assisted Recovery, American Psychological Association, CADA of Northwest Louisiana, Connecticut Certification Board
Twelve States Pass “Right to Know” Laws
Utah and Washington are the latest states to pass a Patient Notification Law. The laws require all practitioners to have a conversation with their patients on the addictive nature of opioids before they are prescribed and discuss possible non-opioid alternatives that are available.
According to the advocacy campaign Prevent Opioid Abuse , versions of the legislation have passed in California, Connecticut, Maryland, Michigan, New Jersey, Nevada, Oklahoma, Ohio and Rhode Island and West Virginia. Efforts to adopt it are currently underway in six other states and Puerto Rico. In New Jersey the law takes it a step further and requires physicians, physician assistants, dentists and optometrists to complete one Continuing Medical Education credit on topics that include responsible prescribing practices, as well as risks and signs of opioid abuse, addiction and diversion.
Dear Representative Kuster and Senator Markey,
The undersigned organizations in the Coalition to Stop Opioid Overdose (CSOO) are writing today to voice our support for your bill – the Community Re-entry through Addiction Treatment to Enhance (CREATE) Opportunities Act. CSOO is a coalition of diverse organizations united around common policy goals to reduce opioid overdose deaths. CSOO members aim to elevate the national conversation around opioid overdose and work to enact meaningful and comprehensive policy changes that support evidence-based prevention, treatment, harm reduction, and recovery support services.
The morbidity and mortality statistics related to addiction, and in particular addiction involving opioid use, are grim. In 2017, there were a record 70,237 drug overdose deaths in the United States, two-thirds of which have been linked to opioids. i. Furthermore, those who report opioid use are significantly more likely to interact with the criminal justice system than those who do not report opioid use. ii. It is vital that those who are incarcerated while suffering from opioid use disorder (OUD) receive the treatment they need to improve their health outcomes and decrease recidivism. Fortunately, medication-assisted treatment (MAT) has proven to be successful in treating OUD. Those receiving MAT as part of their treatment are 75% less likely to experience a mortality related to addiction than those not receiving MAT, and are more likely to maintain gainful employment. iii. Additionally, MAT has been shown to reduce recidivism, illegal drug overdose deaths, and infectious disease transmission.iv Given the positive impact of MAT, we appreciate your leadership in the introduction of the CREATE Opportunities Act. Read more.
AOAAM supports the Opioid Workforce Act of 2019 (H.R. 3414).
Dear Chairman Neal and Ranking Member Brady:
On behalf of the organizations below, we write to express our support for the Opioid Workforce Act of 2019 (H.R. 3414). This thoughtful, bipartisan legislation would provide Medicare support for an additional 1,000 graduate medical education (GME) positions over five years in hospitals that have, or are in the process of establishing, accredited residency programs in addiction medicine, addiction psychiatry, or pain medicine. We greatly appreciate the Committee’s commitment to advancing policies that would strengthen the health care workforce serving on the front lines of the nation’s opioid epidemic.
According to the Substance Abuse and Mental Health Services Administration, in 2016 approximately 21 million people needed treatment for a substance abuse disorder, however only 11% of those received any treatment at all. Part of the reason for this disparity is a shortage of physicians trained in addiction medicine, addiction psychiatry, or pain management. The lack of physicians trained in these specialties reflects the nation’s larger physician shortages. Funding new, targeted residency positions will strengthen the health care workforce and help mitigate the effects of the overall physician shortage.
The Opioid Workforce Act of 2019 is a targeted and important step that Congress must take to help ensure a robust physician workforce that can deliver high-quality care to those suffering from substance abuse disorders.
We encourage all members of the Committee to support this bipartisan bill.
View the full letter.
A new National Health Service Corps Program, the Rural Community Loan Repayment Program, will expand and improve access to quality opioid and substance use disorder (SUD) treatment in our rural, underserved areas nationwide. Health care clinicians qualified to provide SUD treatment may be eligible for this loan repayment in return for service at an NHSC-approved SUD treatment facility. For more information and to apply, visit the Rural Community LRP website.
The application cycle closes Thursday, July 18, 2019 at 7:30 p.m. ET.
A group shot from the ORN Summit in Kansas City (May 15-17). During this summit Technology Transfer Specialists and Partners worked collaboratively on how to streamline and optimize our efforts. Summaries from select presentations are included in this issue of the ORN Impact Bulletin.
With recent data from our evaluator, RTI International, the Opioid Response Network will be releasing our first year summary. See preliminary information below.
More community trainings are scheduled. ORN community trainings are free two-day meetings focusing on the opioid crisis. The purpose is to share ORN resources , provide opioid use disorder training and help participants develop technical assistance requests and action plans for their communities. Select upcoming trainings will be hosted in Indianapolis, IN; Montgomery, AL; Reno and Las Vegas, NV; and Juneau, AK.
Are you participating in an ORN event? We need your help! We want to see your smiling faces at ORN events across the country. Please take photos at your events and share with firstname.lastname@example.org and email@example.com so we can post in the Bulletin and on our website.
The 2019 Opioid Response Network Summit was held from May 15-17 in Kansas City. Technology Transfer Specialists and Partners worked collaboratively on how to streamline and optimize our efforts across the country and locally. Stay tuned for a recap.
Read more news including: Lessons Learned, Consulting Spotlight, CORE Team Snapshots, Filed Updates, Upcoming Webinars and In the News.
COMPREHENSIVE ADDICTION RESOURCES EMERGENCY
Senator Elizabeth Warren, Representative Elijah E. Cummings and 94 of their colleagues in the Senate and House are reintroducing the Comprehensive Addiction Resources Emergency (CARE) Act, the most ambitious legislation ever introduced in Congress to confront the opioid epidemic. Senator Warren and Rep. Cummings' CARE Act would provide state and local governments with $100 billion in federal funding over ten years.
Life expectancy in the United States has now dropped three years in a row—and drug overdoses are the single biggest reason why. In 2017, more than 70,000 Americans died from drug overdoses—the highest rate of drug overdose deaths ever in the United States. Opioids were a cause of 47,600 of these deaths—68% of all drug overdose deaths. But only about 10% of those in need of specialty treatment for substance use disorders are able to access it.
This is not the first time we have faced a public health crisis of this scale. During the 1980s and 1990s, deaths from HIV/AIDS grew rapidly, and the country’s medical system was ill-equipped to provide effective, evidence-based care. In 1990, Congress passed the bipartisan Ryan White Comprehensive AIDS Resources Emergency Act to provide funding to help state and local governments combat this epidemic.
The CARE Act is modeled directly on the Ryan White Act, supporting local decision-making and federal research and programs to prevent drug use while expanding access to evidence-based treatments and recovery support services. Funding allocated under the CARE Act would empower local leaders to tailor their approaches to their communities’ needs, and be targeted to places that have been hit the hardest by the opioid epidemic.
The updated CARE Act of 2019 includes provisions targeted to help workers who are at greater risk for, or are currently struggling with, addiction to get treatment, and to maintain or find employment while undergoing treatment.
The CARE Act would provide $100 billion over ten years to fight this crisis, including:
Click here for state-by-state information about funding that states and counties would receive under the CARE Act. (PDF)
Over 200 organizations have endorsed the CARE Act. Click here to view the full list. (PDF)
Click here for a letter signed by the American Osteopathic Academy of Addiction Medicine, as part of the Coalition to Stop Opioid Overdose, to Representatives Cummings and Warren in support of their bill.
FDA News Release:
The U.S. Food and Drug Administration today granted final approval of the first generic naloxone hydrochloride nasal spray, commonly known as Narcan, a life-saving medication that can stop or reverse the effects of an opioid overdose. The agency is also planning new steps to prioritize the review of additional generic drug applications for products intended to treat opioid overdose, along with the previously announced action to help facilitate an over-the-counter naloxone product.
“In the wake of the opioid crisis, a number of efforts are underway to make this emergency overdose reversal treatment more readily available and more accessible. In addition to this approval of the first generic naloxone nasal spray, moving forward we will prioritize our review of generic drug applications for naloxone. The FDA has also taken the unprecedented step of helping to assist manufacturers to pursue approval of an over-the-counter naloxone product and is exploring other ways to increase the availability of naloxone products intended for use in the community, including whether naloxone should be co-prescribed with all or some opioid prescriptions to reduce the risk of overdose death,” said Douglas Throckmorton, M.D., deputy center director for regulatory programs in the FDA’s Center for Drug Evaluation and Research. “All together, these efforts have the potential to put a vital tool for combatting opioid overdose in the hands of those who need it most – friends and families of opioid users, as well as first responders and community-based organizations. We’re taking many steps to improve availability of naloxone products, and we’re committed to working with other federal, state and local officials as well as health care providers, patients and communities across the country to combat the staggering human and economic toll created by opioid abuse and addiction.”
Today’s approval is the first generic naloxone nasal spray for use in a community setting by individuals without medical training; however, generic injectable naloxone products have been available for years for use in a health care setting. The FDA also has previously approved a brand-name naloxone nasal spray and an auto-injector for use by those without medical training. While business and other considerations may impact how quickly this product becomes available, today’s approval is an important step for the agency as it works toward expanding access to this live-saving drug. The FDA also held a two-day advisory committee meeting in December to solicit input and advice on strategies to increase the availability of naloxone products intended for use in the community.
According to the Centers for Disease Control and Prevention, almost 400,000 people died from an opioid overdose from 1999 to 2017, and on average, more than 130 Americans die every day from overdoses involving opioids, a class of drugs that include prescription medications such as fentanyl, oxycodone, hydrocodone and morphine, as well as illegal drugs such as heroin or drugs sold as heroin. Drugs like heroin often contain fentanyl or derivatives of fentanyl. When someone overdoses on an opioid, it can be difficult to revive the person to full consciousness, and breathing may become shallow or stop completely – leading to death without medical intervention. If naloxone nasal spray is administered quickly, it can counter the overdose effects, usually within minutes. However, it is important to note that it is not a substitute for immediate medical care, and the person administering naloxone nasal spray should seek further immediate medical attention on the patient’s behalf.
As part of the U.S. Department of Health and Human Services’ ongoing efforts to combat the opioid crisis and expand the use of naloxone, in April 2017, the Department announced its 5-Point Strategy to Combat the Opioids Crisis. Those efforts include: better addiction prevention, treatment, and recovery services; better data; better pain management; better targeting of overdose reversing drugs; and better research. In April 2018, Surgeon General VADM Jerome Adams issued an advisory encouraging more individuals, including family, friends and those who are personally at risk for an opioid overdose to carry naloxone. In December 2018, ADM Brett P. Giroir, M.D., Assistant Secretary for Health and the Secretary’s Senior Advisor for Opioid Policy, released guidance for health care providers and patients detailing how naloxone can help save lives.
One of the ways the FDA is working to increase access to this life-saving treatment is through the approval of generic naloxone products. As part of HHS’ public health emergency to address the ongoing opioid crisis, the FDA will grant priority review to all abbreviated new drug applications for products indicated for the emergency treatment of known or suspected opioid overdose. As part of the priority review, sponsors will receive shorter goal dates or standard goal dates with earlier reviewer deadlines; enhanced agency communication with sponsors; and expanded agency engagement similar to Generic Drug User Fee Act enhancements for complex products, such as pre-submission and midcycle meetings. The FDA has determined that further expanding availability of and access to overdose reversal drugs could help address the public health emergency.
More generally, in an effort to promote competition to help reduce drug prices and improve access to safe and effective generic medicines for Americans, the agency is taking a number of new steps as part of its Drug Competition Action Plan. These steps include important work to improve the efficiency of the generic drug approval process and address barriers to generic drug development.
The FDA also remains focused on several additional priorities to address the opioid crisis, including: decreasing exposure to opioids and preventing new addiction; fostering the development of novel pain treatment therapies; supporting treatment of those with opioid use disorder; and improving enforcement and assessing benefit-risk.
Naloxone nasal spray does not require assembly and delivers a consistent, measured dose when used as directed. This product can be used for adults or children and is easily administered by anyone, even those without medical training. The drug is sprayed into one nostril while the patient is lying on his or her back and can be repeated if necessary.
The use of naloxone nasal spray in patients who are opioid-dependent may result in severe opioid withdrawal characterized by body aches, diarrhea, increased heart rate (tachycardia), fever, runny nose, sneezing, goose bumps (piloerection), sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness and increased blood pressure.
The FDA tentatively approved this generic drug product on June 8, 2018. Teva Pharmaceuticals USA Inc. has received final FDA approval to market generic naloxone nasal spray.
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