America could relax opioid treatment access policies
Canada and the United States (U.S.) face an opioid use disorder and opioid overdose epidemic.
The most effective OUD treatment is opioid agonist therapy (OAT). It means buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited treatment access.
We did a non-systematic literature scan and reviewed all available policy documents. We studied and compared treatment policies and practice at the federal level in Canada vs. United States. And also at the local level in British Columbia (B.C.) vs. Oregon.
There are differences and similarities between federal and local OAT policies. This applies to access to treatment. In Canada, treatment policy control has shifted from federal to provincial authorities. But in the U.S., federal authorities maintain primary control of treatment regulations. Local OAT health insurance coverage policies differed between B.C. and Oregon. While B.C. had 5 treatment options, Oregon had only 2 OAT options with some limitations.
Relaxation of special federal regulatory policies
The Canadian and U.S. federal OAT policies differ. So do the local OAT access and coverage policies in B.C. and Oregon. And it’s also because of the relaxation of special federal OAT regulatory controls in Canada. Our paper also highlights the complicating contributions and likely policy solutions. For example, the prescription regime and drug control regime within the drug policy sub-domain. Or, the constitutional rights within the broader policy domain.
U.S. policy makers and health officials could consider adopting Canada’s regulatory policy approach to expand treatment access.
Better access mitigates the harms of the ongoing opioid overdose epidemic.
Reference: Priest, K. C., Gorfinkel, L., Klimas, J., Jones, A. A., Fairbairn, N., & McCarty, D. (2019). Comparing Canadian and United States opioid agonist therapy policies. Int J Drug Policy. doi:10.1016/j.drugpo.2019.01.020
If you enjoyed reading this article, you may also enjoy reading about the role of treatment monitoring via drug testing:
New paper out now: Psychosocial Interventions for Alcohol use among problem drug users
May 18th: Many people in methadone treatment receive it through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care.
What have we found: Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who screened positive for problem alcohol use, five received a brief intervention by a GP, and none were referred to specialist treatment.
Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful and dependent drinking to be 25% (n=26), 6% (n=6), and 16% (n=17) respectively.
Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/ no problem alcohol use. Regular use of primary care was evident, as 25% had attended their GP more than 12 times during the past three months.
What does this mean: Comparing clinical records with patients’ experience of SBIRT can shed light on the process of care. Alcohol screening of people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.
To read the full article, go to the website of the Journal of Dual Diagnosis: http://www.tandfonline.com/doi/full/10.1080/15504263.2015.1027630#.VVtIBpO6eJY
Cite as: Klimas, J., Henihan, AM., McCombe, G., Swan, D., Anderson, R., Bury, G., Dunne, C., Keenan, E., Saunders, J., Shorter, GW., Smyth, B., Cullen, W. (2015) Psychosocial INTerventions for Alcohol use among problem drug users (PINTA): Baseline feasibility data. Journal of Dual Diagnosis 11(2):96-106
Cite as: Klimas, J., Henihan, AM., McCombe, G., Swan, D., Anderson, R., Bury, G., Dunne, C., Keenan, E., Saunders, J., Shorter, GW., Smyth, B., Cullen, W. (2015) Psychosocial INTerventions for Alcohol use among problem drug users (PINTA): Baseline feasibility data. Journal of Dual Diagnosis 11(2):96-106
Answer to Ethan #38: how to write a science blog
Ethan Siegel posed challenging questions in his post about science blogging. They prompted me to think about my own blog. If you’d ever been thinking about your own blog too, my thoughts might help.
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| Figure 1 Ethan’s blog. Photo credit scienceblogs.com |
1) What is it that you’d like to write about?
I started my blog without careful planning. Shortly after the start, I’ve read someone else’s blog and I realized that I could write about the research I’m doing and about our research group. Blogging was my way of publicising and highlighting my research work. There wasn’t much research to write about at that time. Or, perhaps, as a starting writer, I didn’t see the writing opportunities as I see them now. I started to write about many other topics, including my personal life, hobbies and interests. Sometimes midway my evolution as a blogger, I took stock and divided my topics into three main categories: science, academic and creative. The science and academic categories differed mainly by the language and style of writing. Creative group was everything else. For instance, travel, concerts, poetry, etc.
2) Who is your audience?
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| Figure 2 William Zinsser, photo credit: npr.org |
The first time I have been asked this question was when I talked to Rachel Dresbeck, PhD. I didn’t like that question because I was reading William Zinsser and he said to forget about writing for somebody. “Write for yourself”, I’ve read in his book (On writing well). I told Rachel that I’m writing for academics and psychiatrists who get bored on conferences and who check social media for amusement. She laughed. I laughed too. But there’s a grain of truth in that answer. I write for everybody who likes my posts and who shares my passions. As I grow, my passions develop too. With them, my target audience changes too – from enthusiast researchers and potential researchers to free spirits, artists and life lovers.
3) what are the goals of your writing?
To write a lot.
Some writing leads to more writing. It’s an amazing discovery; one topic leads to another.
To enjoy writing and like its results.
Some topics are easier to write about – on some days, my thoughts flow better. I find it really surprising to read posts that were difficult to write and see that I like them.
To share my ideas and see whether they spark some discussion.
In agreement with my point #1, I don’t write for a particular person or group. Nevertheless, I still want, need, and urge to share my writing with someone. Maybe it’s just the residual momentum from my blogging youth, or a continuing need for highlighting my work/life. Regardless of the motivation, I continue to write a public blog and assume that the silence of commentators = agreement and that “the vast majority of them simplywon’t comment or engage you.“
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| Figure 3 Portland, Oregon guide by Rachel Dresbeck photo credit abebooks.com |
4) what else is Ethan advising to science bloggers?
This is merely a summary of Ethan’s useful tips, some of which I mentioned above:
- write often
- be self-critical and honest about your own writing
- find your own style
- share your work with the online community
- be a real person
- be prepared for the kind of negativity that only the internet can heap upon you
Dennis McCarty won the 2014 NIDA International Program Award of Excellence
June 14, 2014 ― Professor Dennis McCarty, Ph.D., professor in the Department of Public Health and Preventive Medicine at Oregon Health & Sciences University (OHSU), and director of the Substance Abuse Policy Center in the Center for Health Systems Effectiveness, has been awarded by the 2014 National Institute on Drug Abuse (NIDA) International Program.
The award is for Excellent Mentoring. Dr. McCarty mentors clinicians and researchers who test emerging drug abuse treatments in community settings through the Western States Node of the NIDA Clinical Trials Network, which he codirects. He extends his mentoring to state and local policymakers through his role as director of the Substance Abuse Policy Center in the Center for Health Systems Effectiveness, which works to link policy, practice, and research on substance abuse treatment.
Dr. McCarty also is scientific director of the University of Amsterdam Summer Institute on Alcohol, Drugs and Addiction. I met Dennis in Amsterdam in 2011. He lectured for several days on different policy models and evidence based treatments. Two years later, on March 1, 2013, I joined Dennis as a NIDA CTN INVEST Fellow. INVEST is International Visiting Scientists & Technical Exchange Program for drug abuse research. Oregon Health & Sciences University hosted my six months fellowship during which I assessed the use of Screening and Brief Intervention (SBIRT) for alcohol use disorders among patients receiving agonist medication for opioid use disorders. Visit this post to read more about how I got here. I did not think that the summer school would lead to a fellowship in Portland, OR and I’m most grateful that it did.
With Dennis, I have learned about things I thought did not exist. For example, about researchers who enjoy writing. Writing up research projects is a task that many new researchers fear the most. Dennis is a master writer and his craft is contagious; I’ve discovered a need in me, a strong urge to write a lot and in many different formats. Dennis received the award today, at the 19th annual NIDA International Forum in San Juan, Puerto Rico. The 2014 Forum focused on “Building International Collaborative Research on Drug Abuse.”
Four other experts were awarded 2014 NIDA International Awards of Excellence. Mr. O’Keeffe, a professor at Virginia Commonwealth University, was honored for Excellence in International Leadership. The award for Excellence in Collaborative Research went to Dr. Chawarski, Ph.D., Yale School of Medicine, and Dr. Kasinather, Ph.D., Universiti Sains Malaysia. A special award was presented to Dr. Dewey, Ph.D., Virginia Commonwealth University, in recognition of his service to the addiction research community as founder of the Friends of NIDA, and his research on how opioids and marijuana change brain and contribute to tolerance and addiction.
NIDA International Awards of Excellence winners are selected based on contributions to areas essential to the mission of the NIDA International Program: mentoring, international leadership, and collaborative research. Anybody can suggest a nomination to NIDA. Read more at www.drugabuse.gov/international/awards-excellence.
The NIDA International Program connects people across continents to find evidence-based solutions for addiction, and drug-related HIV/AIDS. NIDA is part of the National Institutes of Health – the principal research agency of the U.S. Government and a component of the U.S. Department of Health and Human Services.
Story first released by OHSU Newsroom: http://www.ohsu.edu/xd/about/news_events/news/index.cfm
Three years post doctorate
27 April 2014
Transitions are life changes that allow us to pause, reflect and plan. Here’s a short history of my transition from the pre-doctoral to the post-doctoral stage. Read the full story here.
Hungary 2007. My Hungarian adventurewas a real turning point in my career. I had to commute to work and spent long hours in trams. Bored of watching cars and people, I started to read open-access articles about addiction. When I found something really relevant to my PhD, I felt like a gold miner who just dug his jewel out of piles of dirt. My passion grew stronger with every new paper.
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| Figure 1. Jano in transition |
Ireland 2008. When we arrived to Ireland in late 2008, I had a small EU grant, with a budget of 3000 euros, and an unclear host organization. We survived for almost a year living from my wife’s EVSstipend and seasonal part-time jobs. My PhD and the EU grant took most of my time, leaving only a couple of hours for job-hunting. When I eventually ran out of money, it was late winter and the job market had dried up. Finally, I found an academic job, initially advertised as a PhD in Translational Medicine but my potential boss – Prof Walter Cullen – told me at the interview that I should apply for a p/t job on the same project. That’s how I came to research drinking among methadone patients in primary care at UCD.
Oregon 2013. In July 2011, only two months after receiving PhD, I have attended a summer school on addiction in Amsterdam, Netherlands. Dr McCarty, the school director, lectured about various policy models and evidence-based treatments for several days. Two years later, I did a NIDA fellowship with Dr McCarty at Oregon Health& Sciences University. Read this post about how I got there.
Lessons learned from junior post-doc
1) Write a lot. Like some teenagers, I used to write poems, songs and short stories. Then I stopped for many years. In Oregon, my wife surprised me with a Prompt-based creative writing course for my birthday. She thought it would be good for me and that I would enjoy it. Dr McCartyencouraged me to submit an essay to the Wellcome Trust Science Writing competition and to write a lot. Since then, writing became the core of my work.
2) Learn a lot. If you think of life as a huge learning experience, you welcome trouble as a gift.
3) Keep at it. Perseverance is critical in science. Progress takes years. New knowledge accumulates slowly. And the desired change is uncertain. While I was distributing clean needles to injecting drug users in inner-city Bratislava, Slovakia, I could see the effect of my work immediately. Now I have to wait ages and the change may not come in my life.
I’ve learned many more lessons than just these three, but I’ve learned how to separate the weed from the wheat from the chaff too. I don’t write about the minor lessons.
Future plans for senior post-doc
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To stay true to myself
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To reach a position of independence by:
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conducting a randomized controlled trial
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supervising work of junior investigators
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To maintain a happy work-life balance
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To pass the accumulated knowledge and skills on other:
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Doctors and helping professions, by helping them become more competent and confident in addiction medicine research
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Medical students, by helping them discover and master addiction medicine research