What's happening with OTPs: Report from AATOD

October's conference of the American Association for the Treatment of Opioid Dependence (AATOD) in Orlando featured some important policy developments and initiatives for opioid treatment programs (OTPs).     

Nuggets from AATOD: New CSAT director comments

Here are more reports from last month's American Association for the Treatment of Opioid Dependence (AATOD) conference in Orlando — in particular, insights from Louis Trevisan, M.D., the new director of the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).     

AATOD in Florida: The view from the SSA

Florida was the focus of the first plenary session of the conference of the American Association for the Treatment of Opioid Dependence (AATOD), held last week in Orlando. It's customary for the host state of this gathering, which happens every 18 months, to showcase its successes, and indeed, there have been successes for opioid use disorder (OUD) treatment across the country. But Florida, the epicenter for pill mills a decade ago, is an important case study.     

Parrino perspective from 2019 AATOD conference: Positives and negatives

Opioids have put the American Association for the Treatment of Opioid Dependence (AATOD) front and center when it comes to medication‐assisted treatment with methadone in particular, but also with buprenorphine and naltrexone. Mark W. Parrino, AATOD president, told the 2,000 or so attendees at the AATOD conference in Orlando last week about the positives and negatives that have occurred in the past year. Amid all the festivity and “magic” of Disney and the deluxe Coronado Springs Resort, there are very serious issues facing the field in terms of growth and patient care.     

FDA orders addition to boxed warning for benzodiazepines

Last week, the Food and Drug Administration (FDA) announced it is requiring an update to the boxed warning on benzodiazepines to include the risks of abuse, misuse, addiction, physical dependence and withdrawal reactions.     

AATOD,supporter of the MATE Act,fact‐checks the MAT Act

It's no secret that the American Association for the Treatment of Opioid Dependence (AATOD) is opposed to the Mainstreaming Addiction Treatment (MAT) Act — S. 2074 and H.R. 2482.     

Older people and poverty in rural Britain: Material hardships,cultural denials and social inclusions

This paper explores the relations between older people, poverty and place in rural Britain. It develops previous work on rural poverty that has pointed both to the significance of older people within the rural poor population and to their denials of poverty. The paper also connects with recent discussions on the complexity of relations between poverty and social exclusion in later life, as well as key themes emerging from studies of older people in disadvantaged urban neighbourhoods. Drawing on findings from a survey of 4000 households in rural Wales and interviews with older people in poverty in three rural places, the paper provides a detailed examination of the materialities and experiences of poverty among older people in rural places. In particular, it highlights how older poor groups construct their lives in complex terms with references made to both social inclusions and exclusions. The research also points to the significance of the socio-cultural contexts of place in shaping older people's understandings of poverty in rural areas.     

Study: Don't implement CIWA protocol (benzodiazepines) unnecessarily

In an article published April 27 in JAMA Internal Medicine, “Challenges in Prediction, Diagnosis, and Treatment of Alcohol Withdrawal in Medically Ill Hospitalized Patients: A Teachable Moment,” Thomas D. Brothers, M.D., and Paxton Bach, M.D., write about the case of a man admitted to the hospital for planned bowel resection. The patient said he drank 8 to 10 ounces of whiskey a day but that his last drink was three days prior to admission. There were no symptoms of alcohol withdrawal during the first week. But he required an urgent reoperation on day 6, and on day 9, he became disoriented and inattentive, with large intra‐abdominal abscesses. On day 13, he became more agitated and confused, and clinicians implemented withdrawal treatment protocol using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale. He scored high — anxiety, agitation, hallucinations and disorientation — and was given 10 mg of diazepam, with improvement in his symptoms requiring no further medication. However, the next day he was even more confused and agitated, again scoring high. After another 10‐mg dose of diazepam, he became sedated and had to be transferred to a monitored unit. “In this case, poor understanding of the natural history of alcohol withdrawal led the inpatient team to misdiagnose alcohol withdrawal and inappropriately implement a CIWA protocol,” the researchers wrote. “Alcohol withdrawal symptoms generally begin 6 to 12 hours after the last drink and peak at 24 to 72 hours. Although withdrawal‐related seizures can occur at any time during this course, delirium tremens tends to occur three to seven days after the last drink, and only after progressing through more mild symptoms. For this patient, acute onset of severe alcohol withdrawal more than 1 week after the last drink would be highly unusual, especially without first demonstrating mild withdrawal.” Patients do become agitated under certain medical conditions, including pain and intubation. In this case, the patient was unnecessarily given high doses of benzodiazepines. He was not in alcohol withdrawal.     

No free lunch,buddy: past housing transfers and informal care later in life

Previous empirical literature on the relation between intergenerational transfer of assets and services has mostly focused on contemporary exchanges. By contrast, we provide novel evidence showing that parents who helped their adult children in the past are rewarded by higher chances of receiving informal care later in life. To this end we use Italian data containing precise retrospective information about the help with housing that couples received from their parents when they got married, such as a real estate donation or down payment. Our estimates show that this type of past help is positively associated with the current provision of informal care to the parents. This result is robust to controlling for a large set of individual and family characteristics and is only partially due to increased geographical proximity. We suggest that this finding can be explained by mixed self-interest motives, related to theories based on either bilateral exchange or the presence of a third generation (grandchildren), such as the demonstration effect model or the family constitution model.     

Training for No Secrets : A strategic initiative

Current Department of Health guidance on multi-agency policy and procedure to protect vulnerable adults from abuse requires the design and implementation of comprehensive training programmes. This paper identifies three issues of critical significance to the development of a local training strategy, namely, language ('vulnerability' versus 'rights'), the relative significance of 'awareness', and the scheduling of training in relation to overall policy development. These issues are illustrated by a local training course which, in addition to imparting basic information on the new agenda and locating the latter within the wider context of adult welfare services generally, actively facilitated practitioners' contributions to multi-agency policy development. The outcomes of this initiative are reported in terms of the Department of Health's radical vision of 'mainstreaming' staff involvement.