CARF and ASAM award first 7 level‐of‐care certifications

Under the pilot for its new certification program for substance use disorder treatment, the American Society of Addiction Medicine (ASAM) has awarded the first seven certifcaitions. The ASAM level‐of‐care certification was created in partnership with CARF International and announced earlier this year (see “CARF adds OBOT accreditation and ASAM certification,” ADAW, Feb. 4, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32246 ).     

Analysis: The so‐called ‘Freedom Model’ of addiction treatment

The below comments were originally posted, in shortened form, on the Facebook Broken No More page. We asked the author to revise for ADAW, and he did. He refers to the article “Widespread Use of Medically Assisted Treatment (MAT) Has Not Resulted in Less Overdoses” (and we resisted the almost overwhelming temptation to change “less” to “fewer”). For the article, go to https://www.thefreedommodel.org/suboxone‐has‐not‐reduced‐deaths‐in‐the‐us/ .     

Briefly Noted

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf     

Briefly Noted

Internalizing and externalizing problems predicted onset of any tobacco use in youth; however, findings differed for internalizing and externalizing problems across tobacco products, researchers found in analyzing the Population Assessment of Tobacco and Health Study of 12‐ to 24‐year‐old never‐users. Self‐reported internalizing and externalizing symptoms were assessed at wave 1 (45,971 subjects), and past‐12‐month use of tobacco products was assessed at wave 2 (38,443 subjects). The researchers found that high‐severity internalizing symptoms at wave 1 increased the risk by 1.5 times of using tobacco by wave 2, and that high‐severity externalizing problems increased the risk of tobacco use by 1.3 times at wave 2. Low‐ and moderate‐severity problems did not predict tobacco onset. The study was funded by the National Institute on Drug Abuse and the Food and Drug Administration. Several authors declared conflicts of interest — one as an expert witness in a lawsuit against the tobacco industry. The article, “Mental Health Problems and Onset of Tobacco Use Among 12‐ to 24‐Year‐Olds in the PATH Study,” was published in the December 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.     

Failed Securitisation Moves during the 2015 ‘Migration Crisis’

The EU has tried to distinguish itself as respecting human rights in its migration policies. In 2015, mass drownings at sea of refugees from war‐torn and despotic countries like Syria and Eritrea started to rise with the end of Mare Nostrum, the Italian navy's search and rescue operation in the Mediterranean. One EU response was to declare a war on “criminal gangs” of smugglers and traffickers, reportedly responsible for the surge in refugee deaths. Equating smugglers’ activities with a “new slave trade”, this “securitization move” failed to gain legitimacy from EU publics and media. Military solutions to refugee flight continued to be proposed, and a second securitization move continued to target smugglers and traffickers, but this time the “referent object” became the West itself, and the EU.     

Hill Day: The three big ‘asks’ from NAATP

At the “Hill Day” event that marked the end of the annual leadership conference of the National Association of Addiction Treatment Providers (NAATP), 120 association members went to the Senate and House of Representatives to make their case. “I felt it would be successful if we had 50 members who stayed the extra day and did the Hill visits,” Mark Dunn, NAATP policy representative, told ADAW of the May 8 visits. So he was thrilled that so many went.     

NAATP keeps focus on parity

We need to move beyond the principle of parity into the practice of parity.” These words from Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), in an interview with ADAW last week are a sign of the frustration with how parity — the Mental Health Parity and Addiction Equity Act (MHPAEA), which guarantees that substance use disorders (SUDs) will be treated no differently from medical and surgical claims in the world of reimbursement — has been a real‐world disappointment to patients and providers alike.     

Accounting for surveillance

This contribution discusses the ways people hold themselves and others accountable for everyday practices of surveillance. It analyses three examples: (1) the “breeching experiments” of the video artist “Surveillance Camera Man,” (2) a “stop and frisk” incident involving a 17‐year‐old boy in Harlem, and (3) the pop‐up windows on websites that ask for users’ consent to use “cookies.” Understanding the relationship between language and securitization, it is argued, requires that we pay attention to the interactional basis of surveillance and the ways rights and responsibilities are negotiated, ratified, challenged, or ignored in the moment‐by‐moment unfolding of communication.     

Letter to the Editor

In “COMBINE follow‐up: Some heavy use of alcohol compatible with recovery” (see ADAW, Aug. 17, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32806 ), we wrote about a study by Katie Witkiewitz, Ph.D., published in Alcoholism: Clinical and Experimental Research, showing that some people can be in recovery but still drink heavily. We received the following commentary from Annie Peters, Ph.D., director of research and education at the National Association of Addiction Treatment Providers (NAATP).     

Dostoevsky and Freud: Autonomy and Addiction in Gambling

In this paper the modern ideal of “autonomous” or “pure” gambling is put forward in an analysis of Dostoevsky's gambling behavior, his novel The Gambler (1866) and Freud's psychoanalysis of Dostoevsky. The significance of The Gambler lies in the way conceptions of gambling are related to the social conditions of gamblers. Furthermore, the author demonstrates that Dostoevsky and Freud express contradictory views on gambling addiction. While Dostoevsky primarily appreciated roulette as a means of making money, Freud mistakenly interpreted this as a “pathological passion”. In different ways, however, both approaches toward excessive gambling presuppose and reinforce “gambling‐for‐its‐own‐sake” – Le jeu pour le jeu.     

Briefly Noted

Last month, the American Society of Addiction Medicine (ASAM) released a plan for advocacy, focusing on strengthening the addiction treatment workforce and standardizing the delivery of treatment. “We need comprehensive solutions to address such a complex problem,” said Paul H. Earley, M.D., ASAM president, in releasing the plan. “With the Advocacy Roadmap as our guide, ASAM will continue to advocate for equitable access to and coverage for evidence‐based addiction treatment services, increased funding for addiction research, and better education among professionals and the public to challenge the stigma and discrimination surrounding individuals with addiction.” Noting that there are still challenges in the field of addiction treatment, Earley said progress has been made, adding that “ASAM remains dedicated to treating addiction compassionately and effectively and, by doing so, saving lives.” There are 6,000 physician members of ASAM. For the “roadmap,” go to https://www.asam.org/docs/default‐source/advocacy/asam_report_feb2020_final.pdf?sfvrsn=f73f51c2_2 .     

Commercial marijuana could learn from tobacco: California

California legalized marijuana but didn't adopt the lessons already known from tobacco control to prevent youth use and reduce demand, according to a study published last week in JAMA Network Open. The harm caused by tobacco is well known; the risk of harm from marijuana is less well known, as is the best regulatory practice for the new drug. All this means that the population is exposed to “significant potential harm,” the researchers wrote.     

NAATP to court: AAC doesn't have a case

Citing “actions that it had every right to take, statements of opinion it had every right to make, and the actions and the conduct of third parties” for which it had no control or responsibility, the National Association of Addiction Treatment Providers (NAATP) filed a motion to dismiss the complaint against it by American Addiction Centers (AAC) filed in May (see ADAW, May 13, May 20).     

AAC statement on NAATP lawsuit

As the National Association of Addiction Treatment Providers (NAATP) was beginning its annual leadership meeting May 6, American Addiction Centers sued the organization in federal court (see “AAC sues NAATP for defamation,” ADAW, May 13, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32362 ). We wanted to provide further information on the lawsuit (which we linked to in our story last week). Below is a statement provided exclusively to ADAW by AAC May 15.     

Eighteen‐Month‐Old Infants Correct Non‐Conforming Actions by Others

At around their third birthday, children begin to enforce social norms on others impersonally, often using generic normative language, but little is known about the developmental building blocks of this abstract norm understanding. Here, we investigate whether even toddlers show signs of enforcing on others interpersonally how “we” do things. In an initial dyad, 18‐month‐old infants learnt a simple game‐like action from an adult. In two experiments, the adult either engaged infants in a normative interactive activity (stressing that this is the way “we” do it) or, as a non‐normative control, marked the same action as idiosyncratic, based on individual preference. In a test dyad, infants had the opportunity to spontaneously intervene when a puppet partner performed an alternative action. Infants intervened, corrected, and directed the puppet more in the normative than in the non‐normative conditions. These findings suggest that, during the second year of life, infants develop second‐personal normative expectations about their partner's behavior (“You should do X!”) in social interactions, thus making an important step toward understanding the normative structure of human cultural activities. These simple normative expectations will later be scaled up to group‐minded and abstract social norms.     

Briefly Noted

We asked Jerry Rhodes, former top executive at CRC (now Acadia) and a leader in opioid treatment program management, what he thinks of methadone as a medication to be used in primary care to treat opioid use disorder (OUD), as some people — including former Office of National Drug Control Policy Director Michael Botticelli — recommended last year (see ADAW, July 16, 2018). “I take issue with that,” said Rhodes. “Methadone is a dangerous drug in an unregulated environment,” he told ADAW. Buprenorphine is prescribed this way, but “buprenorphine is a relatively safe drug, and methadone isn't,” he said. A veteran of many battles over methadone, including the near‐elimination of opioid treatment programs, Rhodes told ADAW that “you don't give unfettered access to methadone” to patients with OUD. “Be careful what you wish for” is his advice. This has the potential to cause harm, he said. “Only people who don't understand the history of its utilization would recommend this.”     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.