Category: Drugs

Changing the ways of CPDD – College on Problems of Drug Dependence – June 12-16, #CPDD2016

Change is the ultimate law of life. Those that do not change and adapt, do not survive. In the life of scientific meetings, this means constantly improving the organisation of the events and tailoring them to the changing needs of the conference delegates. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) introduced several improvements and more are on the way in next years.

cpdd logo

photocredit: cpdd.org

 

Bye Bye Tote Bags

Many of us were used to the traditional design of the CPDD tote bags. Each year had a different colour. For years when conference visited a warm region, such as Phoenix, AR, the tote bag included a special layer for keeping the contents cool. The non-bag policy brought the desired recognition of sustainability and (un-)expected diversity among the conference bags – everyone was different.

Bye Bye Printed Programs

For years, the conference book was a comprehensive bible for the conference week. Everybody read it and most followed it. Although the College printed a limited number of copies, this year, the e-programs drained participants smartphones’ batteries. What more, they offered note-taking and photograph uploading that many appreciated. Welcome to the digital age.

Hello Mentors

Since the early days, the senior delegates offered mentorship to junior delegates. Mostly informal. Following the new trends adopted at other conferences, such as AHSR or NAPCRG, the CPDD sent out emails to all Members in Training (MIT), offering to match them with a potential mentor (mentor bios included). If both parties agreed, the match-maker introduced them via email. I have learned a lot from my mentor. Especially that the decision makers may not read addiction journals, also that the team identity strengthens sense of ownership among team members and that the road to the research success can be long and winding. Let’s hope that the beneficial mentoring program continues in future.

Hello Shorter Conference

With the increasing demands on scientists’ workloads, there is a chance that the upcoming conferences will be shorter.

See also my previous blog posts about CPDD from the previous years:

2015Getting the most out of the Conference of the College on Problems of Drugs Dependence #CPDD2015

2014: 76th Annual Conference of College on Problems of Drug Dependence: Decide to be fearless& fabulous 

2013: My itinerary for the Conference – College on Problems of Drug Dependence, San Diego, June 15-20 

Need more skilled addiction specialists? New paper out now

photocredit: Wolters Kluwer

Training in addiction medicine gives clinicians early intervention tools, prevents the escalation of addiction and prevents costly and lengthy treatment. The problem is that very little information exists on the treatment workforce. It seems that most health systems do not have enough providers trained in addiction medicine to reduce the public health consequences of this increasing societal problem. In 2014, the Boston-based Advocates for Human Potential, Inc., developed a so-called Provider Availability Index. It measures the gap between the need for and availability of trained healthcare providers, but similar efforts have not been done in Canadian setting. This paper briefly describes mathematical estimates of the number of skilled addiction care providers in British Columbia, Canada, and offers recommendations for steps that can be taken immediately to increase provider availability. The article was published ahead of print in the Journal of Addiction Medicine on May 13, 2016 and the suggested citation is: 
McEachern, J., Ahamad, K., Nolan, S., Mead, A., Wood, E., & Klimas, J. (9000). A needs assessment of the number of comprehensive addiction care physicians required in a canadian setting. J Addict Med, Publish Ahead of Print. doi:10.1097/adm.0000000000000230

New paper out now: Primary care distributes life-saving medication for 17 years

The year was 1996 and Ireland was recovering from a recent heroin epidemic. Methadone, a medical replacement drug for heroin, was jut making its way into specialised clinics in Dublin.

Professor Gerard Bury and colleagues had a revolutionary idea that people who use drugs can receive agonist drugs, like methadone, from their family doctors.

photocredit: tandfonline.com/loi/igen20#.VlO9bHarTrc

The opioid agonist treatment has substantially changed the course of the drug use epidemic. Yet, many continue to die and suffer from chronic diseases. In Ireland, everybody who’s prescribed this medication has to be registered with the Central Treatment List.

In this new study, we wanted to revisit a group of people who were the first to receive their agonist medication, i.e., methadone in the primary care in Ireland.
At follow-up in 2013, 27 (27.6%) of the 98 people had died in Ireland and had relevant entries in the Register of Deaths, 19 (19.4%) were currently in OAT and the status of the remaining 52 (53%) was ‘alive,’ as per the Irish death registry.
The 52 patients ‘alive’ had left the Central Treatment List, but no further information was available on their status.

“Our inability to establish the interval data for the retention in treatment is a significant study limitation, but the overall retention of 19 out of the surviving 71 patients is comparable to previous research.”


The deceased died of multiple causes; only six had a single cause. Drug toxicity, overdose, or both, were the most common causes of death.

Cited study:
Jan Klimas, Anna Keane, Walter Cullen, Fergus O’Kelly, and Gerard Bury (2015) Seventeen year mortality in a cohort of patients attending opioid agonist treatment in Ireland. European Journal of General Practice (http://dx.doi.org/10.3109/13814788.2015.1109076)

First European conference on dependencies 2015: Keynotes #LxAddictions15

A major new event in the addictions landscape – the organisers claimed. To date, there hasn’t been a Europe-wide meeting on addictions. Many smaller conferences took place around the old continent, including the Annual Symposium of the Society for the Study of Addiction in York – the oldest addiction society in the world (anno 1884).  I hoped that Lisbon can bring together people that attend the other meetings but never together. Here, I note my thoughts from three out of the 17 keynotes that I attended.

photocredit: lisbonaddictions.eu
Robert West  (@westr) on Wednesday 23 September 11:00 – 12:30,           Plenary Session I (other speakers: Anne Line Bretteville-Jensen, Gabriele Fischer, Mark Kleiman, Marina Picciotto). 

photo credit: rawest.co.uk

Speaking about the addictions from a multi-disciplinary perspective, Prof West highlighted that the tendency to monetize everything is destructive. We also tend to compartmentalize the models of addiction. Whether we think addiction is a self-medication or a social construct, all of those things have some validity, but we need to bring them together. Whether it’s speaking at a conference or dealing with an addictive behavior, three things are critical in order for change to happen: capability, motivation and opportunity (COM-B model of behavior). How hard can it be? The audience laughed. If we crack the addiction, we crack something that is at the heart of the human civilization. The taxation policies can be informed by the neuroscience, as they can be by counseling. West concluded his talk with a proposal for how we can deploy our resources better. He discouraged people from fighting over the money to be spent on addiction research. At the moment, we tend to direct addiction research towards our own interests, hunches and areas of expertise. This needs to change. A major review of research strategy underpinning approaches to combating addiction as the moment.
Keith Humphreys o (@keithNHumphreys) n Thursday 24 September 09:00 – 10:30,      Plenary Session II (other speakers: Linda Bauld, Felix de Carvalho, Marina Davoli, Margriet Van Laar). 

photo credit: stanford.edu

Translating research into policy and practice, Prof Humphreys reviewed the US science and policy on addiction in the last 7 years, especially the 2008 MHPEA, the 2010 “Obama care” and the 2008 MIPPA that eliminated the co-pays by 2014. Has the science affected the policy in any way? Is parity on everything possible? When kids reach 18, they leave their parents’ health insurance. The ACA changed it to 26 years. The addiction care providers cheered as this critical period in human development became covered. The welcome to Medicare exam introduced by MIPPA includes a depression and problem-drinking screen. Did scholarship in our field contribute to these policy changes? Is science supposed to decide policy by itself? The science doesn’t tell what we care about as a society. “Scientific evidence alone is not sufficient basis for health policy,” as Humphreys and Piot argue in a BMJ analysis. Just because we’re experts in science, it doesn’t make us experts in the governance. The fundamental political decisions are made outside of us and that’s good, because we’re not “Queens and Kings.” Humphreys went on to describe the four routes through which policy was translated into practice: press releases, professional organizations and grassroots advocates, scientists engaging the bureaucracy formally and informally, scientists in policymaking roles. In sum, the policy on alcohol and drugs related care in US is dramatically different than 7 years ago. Scientists didn’t cause that to happen by their own. On the other hand, the political will alone doesn’t guarantee smart policies (Figure 1).

Figure 1. Summary slide of Prof Humphrey’s presentation.


Thomas Babor on Thursday 24 September 16:00 – 17:45,           Plenary Session III (other speakers: Gerhard Bühringer, Henrique Lopes, Pia Mäkelä, Susana Jiménez Murcia).

photo credit: sea-addiction.org

Discovering, new frontiers in addiction research, Prof Babor asked why do we pay attention to infrastructure in addiction science? Starting in the 1970’s, there was a gradual increase in the number of addiction research centres. When medical temperance people began to publish articles for peer-reviewed journals, specialized journals emerged. Starting from the 1960’s the number of journals exploded. Large proportion of the article production comes from U.S. and other “developed” countries; hoverer, there’s the bias of the dominance of the English language in the scientific areas. Now, people are starting to think of themselves as addiction specialists, especially if they get specialised training in that area. We’ve got large numbers of people who can be identified as addiction scientists. The science of bibliometrics tells us that there are over from 130.000 Occasional contributors (Bronze league), to 250 Platinum contributors (The Invisible College), who are publishing large numbers of articles per year. Some troubling trends – the predatory publishers corrupt the peer-review process. Science has become interested in the private interest – business model. Industry funding biases and sets the agenda for research. Where does this leave us? It leads to the fact that policy makers seem to be looking for a different kind of science that we’ve been doing. If we put all these trends together, the population and the public health impact of our research has not been demonstrated.
Have you attended the fourth Plenary about Challenges of addiction in an interconnected world on Friday?  Post your thoughts below.