Esketamine for depression faces real‐world barriers

Like its predecessor intravenous ketamine, an anesthetic that has been used off‐label to treat depression, esketamine has shown great promise in treating a disease that can destroy quality of life and lead to suicide. The Food and Drug Administration (FDA) approved esketamine (Spravato) last spring for treating depression that is resistant to traditional treatments.     

State attorneys general join effort to make 42 CFR Part 2 like HIPAA

In a sign‐on letter released last week, 38 state attorneys general (AGs) called for weakening 42 CFR Part 2, the federal regulation that requires substance use disorder (SUD) treatment providers to obtain written consent from patients before releasing their information to anyone.     

New theories of nicotine‐psychosis link challenge the old

For some time, the link between cigarette smoking and schizophrenia has been clear. For decades, it has been assumed that this was due to one of two causes: “reverse causation” (smoking relative to the illness, by self‐medication or institutionalization) or by confounding (such as social factors or cannabis use).     

FDA: Avoid THC‐containing vaping products

Last week, as respiratory illnesses linked to vaping spread, some resulting in deaths, the Food and Drug Administration on Sept. 6 issued an alert focusing on tetrahydrocannabinol (THC)‐containing products (see story, page 1).     

NASADAD: The view from SAMHSA,from a state and from CMS

Last week, state directors and other attendees of the annual meeting of the National Association of Alcohol and Drug Abuse Directors (NASADAD) were treated to a stunning opening reception by the delegation from Hawaii, including entertaining, dancing, music and delicious food. The next morning, they heard from federal and state officials about important issues they are dealing with — starting with how to use the STR and SOR grants.     

Is generic buprenorphine film as good as Suboxone?

When Indivior's popular Suboxone film went off patent, Dr. Reddy's was ready with the generic, and there are more companies now providing it as well — including Indivior itself (distributed by Sandoz). The point of generics, from a patient or payer point of view, is that they are less expensive than brand. But there can be problems — with quality, including of active ingredients. Patients frequently complain when their agonist medications are switched — whether it's from one type of methadone to another or, now, from Suboxone film to a generic.     

The best and worst of 2018, and hopes and fears for 2019

With public understanding growing every day about the need to address substance use disorders (SUDs) with the full array of health responses our nation deploys for other major illnesses, we hope to see great progress in the coming year. Progress should include dramatic expansion of all quality prevention, treatment services and medications, and recovery supports, with financial investment increased sufficiently to meet the need; full coverage of all SUD treatment services and medications by every state's Medicaid program and by Medicare; much stronger enforcement of federal and state requirements for parity in commercial insurance and Medicaid, including prohibitions on prior authorization, fail‐first, overly burdensome utilization review and inadequate reimbursement for care; availability of all effective and quality SUD treatment and medications at every level of the criminal justice system and throughout the child welfare system; and elimination of discriminatory barriers facing people still suffering or in recovery from SUD, including those with criminal histories, as they seek employment, housing, government benefits, the right to vote and other necessities of life.     

House changes parties,Senate plans oversight of STR/SOR

So now that we have a Democratic House of Representatives, has the landscape changed for substance use disorders (SUDs) on Capitol Hill?     

AATOD paper confronts methadone controversies

A policy paper released this month by the American Association for the Treatment of Opioid Dependence (AATOD) focuses on some of the challenges facing opioid treatment programs (OTPs) today. For example, it cites an article published in the New England Journal of Medicine (July 5, 2018) by Michael Botticelli that promotes the idea of methadone being available in primary practice settings for the treatment of opioid use disorder (OUD) (see ADAW, July 16, 2018). “AATOD recommends that this proposal should only be considered after careful, conservative, and thoughtful evaluation,” according to the policy paper. “As history and our policies have shown, we do not reject the public health model for increasing access to care for OUD, nor are we ignoring what has been learned about clinical standards of care to treat this illness. It is important to understand, however, the complexity of inducting a new patient into methadone maintenance treatment when developing policies for increasing access to medication assisted treatment.”     

MAP adds peer recovery as insurance benefit

MAP Health Management is getting health care plans to cover peer recovery as a health care benefit, but it hasn't been easy. “You're talking to a guy who's been thrown out of more health insurance plan offices than anyone you've ever met,” said Jacob Levenson, founder and chief executive officer of MAP, in an interview with ADAW last month. The early response from insurance companies was “You want us to pay addicts to talk to addicts?” recalled Levenson.