Should We Stop Healthcare Reform Now?
After the election in Massachusetts many predict the collapse of the health care reform efforts. President Obama seems to seek a scaled back version, which is acceptable for Republicans who are blocking ANY reform efforts. But why do we need health care reform NOW? Lets look at the facts: If nothing will happen healthcare spending will continue to outpace the growth in the rest of the domestic product by at least 2.5% annually. Despite the overall slowdown in national health spending growth in 2008, increases in this spending continue to outpace the growth in the resources needed to pay for it! At that rate health spending will absorb 40% of GDP by 2050! The suggested reform proposal will provide 30 Million uninsured Americans adequate coverage requiring about $800 Billion to $1 Trillion in federal subsidies over the next decade. This represents only 3% of the $35 Trillion projected by actuaries to be spent on U.S. health care in the coming decade in the ABSENCE of reform. The relatively small $ 1 Trillion investment in preventing the surge of neglected chronic disease will save Trillions of healthcare dollars normally spent for the emergency room care needed to serve the growing numbers of uninsured! We need to invest money in order to save money!!!
Furthermore, health care insurance companies know very well that the initial rise in health care stocks, on expectations that the Massachusetts’s vote might derail health care reform, may symbolize a pyrrhic victory only! Even though, the reform package included mandated coverage for everyone, regardless of health status, it also offered to heavily subsidize the health care for 30 million Americans who are currently uninsured. This potential financial windfall may not materialize. Insurance companies are very well aware that selling insurance package to employers has slowed because of rising premiums, which reflect rising health care expenditures. The insurance companies must have an interest to bend the cost curve and to expand insurance coverage to offer competitive products. Insurers may gamble with their financial future by supporting the Naysayer because without an overhaul of the insurance industry and the health care market they may face an even bleaker future, which will force draconian government intervention to cut costs.
Therefore, we must support rational reform efforts and President Obama should stop pandering to the opponents of any meaningful reform efforts. We have to act now to avoid a future financial crisis!
Bernd Wollschlaeger,MD,FAAFP,FASAM
Saturday, January 23, 2010
Wednesday, December 30, 2009
Pain Clinics
Attached a great article from today's Miami Herald highlighting the issue of pain clinics and Buprenorphine use. The author points out that
"A Miami Herald review of 353 Suboxone-approved doctors in Miami-Dade, Broward and Palm Beach counties found at least 53 of them have been disciplined by state health officials or have been charged with a crime -- about one of every seven doctors."
This is a grave issue of concern!
Yours
Bernd
PS: Have a Happy New Year.
Posted on Tue, Dec. 29, 2009
South Florida pain-clinic doctors also treat drug addicts
BY SCOTT HIAASEN
shiaasen@MiamiHerald.com
CARL JUSTE / MIAMI HERALD STAFF
One of many pain clinics that have sprung up all over South Florida. In the past two years, the region has emerged as the pill-mill capitol of the United States.
State regulators stripped Dr. Michael I. Rose's power to write prescriptions two months ago, after health officials found that the pain-clinic doctor had prescribed enough painkillers to put one patient ``at risk of death from overdose.''
The health department findings are all the more alarming given the North Miami physician's other specialty: drug-addiction treatment.
Rose is one of at least 41 South Florida doctors who straddle the fence between two seemingly opposite disciplines: They treat drug addicts while at the same time giving pain patients addictive drugs that have been blamed for a spike in overdose deaths statewide. Rose declined to comment for this article.
Some of the same clinics offering addiction treatment are often targeted by out-of-state drug couriers seeking painkillers for an illicit black market stretching from South Florida to Appalachia and the northeastern United States.
Many of these doctors who serve as both pain and addiction specialists have been disciplined by state health officials for improper prescribing of drugs -- and some have been convicted of crimes, a Miami Herald review found.
Yet these doctors retain approval from the federal government to prescribe a narcotic called buprenorphine -- a drug used to help wean people addicted to opiates such as oxycodone.
Addiction experts say this mixing of two delicate medical fields has potentially dangerous consequences: Instead of receiving the therapy they need, addicts seeking to get off drugs may simply end up alongside users and drug peddlers who frequently skip from clinic to clinic seeking narcotics to be sold illegally.
`ADDED RISK'
``If you have an environment where you have drug access and availability, then you have an added risk,'' said Dr. Ihsan Salloum, an addiction psychiatrist with the University of Miami's Miller School of Medicine.
``Offering services of this kind is a slap in the face,'' said Dr. Bernd Wollschlaeger, an addiction specialist and past president of the Dade County Medical Association. He suspects many pain clinics are seeking not to help addicts but to boost profits by selling drugs used to curb dependency -- in addition to selling large amounts of potent painkillers.
``It's just a fig leaf to conceal their true nature,'' Wollschlaeger said. ``These pain clinics are pure and simple pill mills. Their goals are pushing huge volumes of prescription pills.''
Clinics offering both pain medications and addiction treatment can also present difficulties for police investigating pill trafficking. Under federal law, doctors approved to provide addiction drugs are afforded special protection from narcotics investigators. Agents need a court order from a federal judge before pursuing undercover investigations of these doctors.
Over the past two years, South Florida has emerged as the pill-mill capital of the United States, the chief supplier of black-market painkillers that spawned an epidemic of overdose deaths in Kentucky, Ohio, West Virginia, Tennessee and other states.
The pills have flowed by the millions through storefront pain clinics that open up almost daily from Miami to Palm Beach County. Broward County alone has at least 115 pain clinics, and is home to 33 of the 50 doctors who dispense the most oxycodone in the country, according to U.S. Drug Enforcement Administration data.
Dozens of clinics entice patients with blaring advertisements in alternative newspapers, offering coupons and discounts and not-too-subtle appeals to out-of-state clients.
In the same ads, many clinics also promote treatment for drug addicts with Suboxone, whose primary ingredient, buprenorphine, is designed to help blunt the affects of heroin, oxycodone or other opiates.
Suboxone and similar drugs are considered highly effective for treating dependency and addiction. It's also proven safer than methadone, once commonly used to treat heroin addicts.
To encourage more addicts to seek treatment, federal regulators in 2002 began allowing doctors to dispense Suboxone from their offices -- unlike methadone, which must be administered in hospital or clinic settings.
But a doctor does not need to be a board-certified addiction specialist to distribute Suboxone. A doctor can receive approval simply by completing an eight-hour online course. About 17,000 doctors nationwide are approved to administer Suboxone, including almost 1,200 in Florida.
TREATMENT METHODS
Addiction experts and federal health officials warn that Suboxone should be given to patients along with counseling and other treatment methods -- methods rarely employed at many pain clinics, where pills are often the only remedy, critics say.
``Use of the medication in and of itself is not a substitute for full addiction treatment,'' said Dr. Louis Baxter, president of the American Society of Addiction Medicine. ``Some of these people that are advertising their services may not be certified, and may not be experienced to do what they say they can do.''
But some doctors say it can be difficult to get many addicts to attend counseling or psychological therapy, which is often more costly than Suboxone treatment.
``The No. 1 reason for someone coming in to do detox is that they can't afford their addiction,'' said Dr. James Milne, who offers both pain management and addiction treatment as part of his general family practice in Fort Lauderdale.
Milne said he believes the need for addiction treatment has increased with the explosion of pain clinics in South Florida. As many as half of his new patients come to him first seeking painkillers -- and many end up as addiction patients, he said.
``Some of these people convert there on the spot. They burst into tears and beg for help,'' he said.
At the Fort Lauderdale Pain Relief Center, the staff emphasizes its detoxification program to its pain patients who may feel they are becoming dependent on pills, said clinic attorney Sandy Topkin.
``They want people to get off these medications more than they want them on them,'' Topkin said.
Though buprenorphine is less dangerous than methadone, a patient could overdose or die if it is mixed with other drugs, Baxter said. The drug is sometimes sold illegally on the street as well, although it doesn't produce the highs of other drugs.
``You want to have it prescribed in legitimate settings, and these pain clinics are not legitimate settings. There is a high probability that they are using this medication inappropriately,'' Wollschlaeger said.
Records show many of the doctors working for South Florida pain clinics have no special certification in either addiction or pain management. And many of the doctors offering both services have troubling professional records.
53 DISCIPLINED
A Miami Herald review of 353 Suboxone-approved doctors in Miami-Dade, Broward and Palm Beach counties found at least 53 of them have been disciplined by state health officials or have been charged with a crime -- about one of every seven doctors.
Among those allowed to dispense drug-treatment narcotics are doctors disciplined for recklessly prescribing addictive drugs, including:
• Dr. Rachael Gittens of Wilton Manors. She was suspended for 90 days and fined $10,000 earlier this year after investigators found 33 blank prescriptions given to patients without including their names or addresses. At the time, Gittens was working at a pain clinic identified by Kentucky investigators as a prime source of illegal pills in that state.
• Dr. Robert Lentz of Lake Worth. He was fined $30,000 and placed on two years' probation earlier this month for prescribing ``very high dosages'' of painkillers to a patient without documenting the medical need. The health department found that Lentz increased the dosage of oxycodone when the patient should have been sent to addiction counseling, records show.
• Dr. Ricardo Sabates of Delray Beach. State health officials suspended his medical license in October for over-prescribing painkillers and anti-anxiety drugs to 10 patients, records show.
Federal officials say the law allows any doctor to prescribe Suboxone, regardless of any disciplinary history, as long as the physician has completed an eight-hour training course, and the doctor has a valid medical license and approval from the DEA to prescribe medications.
``If the physician has a license to practice medicine, we don't have the right to prevent them from prescribing Suboxone,'' said Nick Reuter, a senior policy analyst with the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services that oversees the Suboxone certification program.
The American Society of Addiction Medicine has pushed for greater scrutiny for doctors prescribing medications to drug addicts, and for doctors offering narcotics for pain management, Baxter said. For example, he said, some states like New Jersey require doctors to be board certified in pain management before they can dispense painkillers. Florida has no such requirement.
``There are some renegade physicians that are doing the medication harm by doing unregulated and unorthodox pain and addiction treatment,'' Baxter said.
"A Miami Herald review of 353 Suboxone-approved doctors in Miami-Dade, Broward and Palm Beach counties found at least 53 of them have been disciplined by state health officials or have been charged with a crime -- about one of every seven doctors."
This is a grave issue of concern!
Yours
Bernd
PS: Have a Happy New Year.
Posted on Tue, Dec. 29, 2009
South Florida pain-clinic doctors also treat drug addicts
BY SCOTT HIAASEN
shiaasen@MiamiHerald.com
CARL JUSTE / MIAMI HERALD STAFF
One of many pain clinics that have sprung up all over South Florida. In the past two years, the region has emerged as the pill-mill capitol of the United States.
State regulators stripped Dr. Michael I. Rose's power to write prescriptions two months ago, after health officials found that the pain-clinic doctor had prescribed enough painkillers to put one patient ``at risk of death from overdose.''
The health department findings are all the more alarming given the North Miami physician's other specialty: drug-addiction treatment.
Rose is one of at least 41 South Florida doctors who straddle the fence between two seemingly opposite disciplines: They treat drug addicts while at the same time giving pain patients addictive drugs that have been blamed for a spike in overdose deaths statewide. Rose declined to comment for this article.
Some of the same clinics offering addiction treatment are often targeted by out-of-state drug couriers seeking painkillers for an illicit black market stretching from South Florida to Appalachia and the northeastern United States.
Many of these doctors who serve as both pain and addiction specialists have been disciplined by state health officials for improper prescribing of drugs -- and some have been convicted of crimes, a Miami Herald review found.
Yet these doctors retain approval from the federal government to prescribe a narcotic called buprenorphine -- a drug used to help wean people addicted to opiates such as oxycodone.
Addiction experts say this mixing of two delicate medical fields has potentially dangerous consequences: Instead of receiving the therapy they need, addicts seeking to get off drugs may simply end up alongside users and drug peddlers who frequently skip from clinic to clinic seeking narcotics to be sold illegally.
`ADDED RISK'
``If you have an environment where you have drug access and availability, then you have an added risk,'' said Dr. Ihsan Salloum, an addiction psychiatrist with the University of Miami's Miller School of Medicine.
``Offering services of this kind is a slap in the face,'' said Dr. Bernd Wollschlaeger, an addiction specialist and past president of the Dade County Medical Association. He suspects many pain clinics are seeking not to help addicts but to boost profits by selling drugs used to curb dependency -- in addition to selling large amounts of potent painkillers.
``It's just a fig leaf to conceal their true nature,'' Wollschlaeger said. ``These pain clinics are pure and simple pill mills. Their goals are pushing huge volumes of prescription pills.''
Clinics offering both pain medications and addiction treatment can also present difficulties for police investigating pill trafficking. Under federal law, doctors approved to provide addiction drugs are afforded special protection from narcotics investigators. Agents need a court order from a federal judge before pursuing undercover investigations of these doctors.
Over the past two years, South Florida has emerged as the pill-mill capital of the United States, the chief supplier of black-market painkillers that spawned an epidemic of overdose deaths in Kentucky, Ohio, West Virginia, Tennessee and other states.
The pills have flowed by the millions through storefront pain clinics that open up almost daily from Miami to Palm Beach County. Broward County alone has at least 115 pain clinics, and is home to 33 of the 50 doctors who dispense the most oxycodone in the country, according to U.S. Drug Enforcement Administration data.
Dozens of clinics entice patients with blaring advertisements in alternative newspapers, offering coupons and discounts and not-too-subtle appeals to out-of-state clients.
In the same ads, many clinics also promote treatment for drug addicts with Suboxone, whose primary ingredient, buprenorphine, is designed to help blunt the affects of heroin, oxycodone or other opiates.
Suboxone and similar drugs are considered highly effective for treating dependency and addiction. It's also proven safer than methadone, once commonly used to treat heroin addicts.
To encourage more addicts to seek treatment, federal regulators in 2002 began allowing doctors to dispense Suboxone from their offices -- unlike methadone, which must be administered in hospital or clinic settings.
But a doctor does not need to be a board-certified addiction specialist to distribute Suboxone. A doctor can receive approval simply by completing an eight-hour online course. About 17,000 doctors nationwide are approved to administer Suboxone, including almost 1,200 in Florida.
TREATMENT METHODS
Addiction experts and federal health officials warn that Suboxone should be given to patients along with counseling and other treatment methods -- methods rarely employed at many pain clinics, where pills are often the only remedy, critics say.
``Use of the medication in and of itself is not a substitute for full addiction treatment,'' said Dr. Louis Baxter, president of the American Society of Addiction Medicine. ``Some of these people that are advertising their services may not be certified, and may not be experienced to do what they say they can do.''
But some doctors say it can be difficult to get many addicts to attend counseling or psychological therapy, which is often more costly than Suboxone treatment.
``The No. 1 reason for someone coming in to do detox is that they can't afford their addiction,'' said Dr. James Milne, who offers both pain management and addiction treatment as part of his general family practice in Fort Lauderdale.
Milne said he believes the need for addiction treatment has increased with the explosion of pain clinics in South Florida. As many as half of his new patients come to him first seeking painkillers -- and many end up as addiction patients, he said.
``Some of these people convert there on the spot. They burst into tears and beg for help,'' he said.
At the Fort Lauderdale Pain Relief Center, the staff emphasizes its detoxification program to its pain patients who may feel they are becoming dependent on pills, said clinic attorney Sandy Topkin.
``They want people to get off these medications more than they want them on them,'' Topkin said.
Though buprenorphine is less dangerous than methadone, a patient could overdose or die if it is mixed with other drugs, Baxter said. The drug is sometimes sold illegally on the street as well, although it doesn't produce the highs of other drugs.
``You want to have it prescribed in legitimate settings, and these pain clinics are not legitimate settings. There is a high probability that they are using this medication inappropriately,'' Wollschlaeger said.
Records show many of the doctors working for South Florida pain clinics have no special certification in either addiction or pain management. And many of the doctors offering both services have troubling professional records.
53 DISCIPLINED
A Miami Herald review of 353 Suboxone-approved doctors in Miami-Dade, Broward and Palm Beach counties found at least 53 of them have been disciplined by state health officials or have been charged with a crime -- about one of every seven doctors.
Among those allowed to dispense drug-treatment narcotics are doctors disciplined for recklessly prescribing addictive drugs, including:
• Dr. Rachael Gittens of Wilton Manors. She was suspended for 90 days and fined $10,000 earlier this year after investigators found 33 blank prescriptions given to patients without including their names or addresses. At the time, Gittens was working at a pain clinic identified by Kentucky investigators as a prime source of illegal pills in that state.
• Dr. Robert Lentz of Lake Worth. He was fined $30,000 and placed on two years' probation earlier this month for prescribing ``very high dosages'' of painkillers to a patient without documenting the medical need. The health department found that Lentz increased the dosage of oxycodone when the patient should have been sent to addiction counseling, records show.
• Dr. Ricardo Sabates of Delray Beach. State health officials suspended his medical license in October for over-prescribing painkillers and anti-anxiety drugs to 10 patients, records show.
Federal officials say the law allows any doctor to prescribe Suboxone, regardless of any disciplinary history, as long as the physician has completed an eight-hour training course, and the doctor has a valid medical license and approval from the DEA to prescribe medications.
``If the physician has a license to practice medicine, we don't have the right to prevent them from prescribing Suboxone,'' said Nick Reuter, a senior policy analyst with the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services that oversees the Suboxone certification program.
The American Society of Addiction Medicine has pushed for greater scrutiny for doctors prescribing medications to drug addicts, and for doctors offering narcotics for pain management, Baxter said. For example, he said, some states like New Jersey require doctors to be board certified in pain management before they can dispense painkillers. Florida has no such requirement.
``There are some renegade physicians that are doing the medication harm by doing unregulated and unorthodox pain and addiction treatment,'' Baxter said.
Saturday, November 21, 2009
Pain Clinics: Immediate Action Required
Attached two recent articles from the Miami Herald and Sun Sentinel highlighting the continuous and growing problem with pain clinics in South Florida.
I also witnessed a new phenomenon: one pain clinic in my area was finally shut down but reopened several days later calling itself "MedClinic" offering ALL medical services INCLUDING pain management. That means they will restart the SAME activities with the SAME management!! Its really frustrating! We have to focus on promoting tough measures as outlined in the grand jury recommendations. Therefore, I ask FSAM to issue a press release supporting the following recommendations and to contact the legislators asking them for their support.
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
• Preventing pain clinics from distributing drugs on site until the state database is up and running next year.
• Limiting prescriptions from pain clinics to no more than a three-day supply.
Looking forward to your comments.
Yours
Bernd
Bernd Wollschlager,MD,FAAFP,FASAM
Member of the PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE
Posted on Fri, Nov. 20, 2009
Broward grand jury recommends pain clinic reforms
BY SCOTT HIAASEN
shiaasen@MiamiHerald.com
A Broward County grand jury issued a damning report Thursday bemoaning the explosion of illegal painkillers sold through Broward pain clinics -- and warning that reforms passed by the Legislature may not be enough.
Echoing a Miami Herald investigation earlier this year, the report details how lax state laws spawned a cottage industry of storefront pain clinics across South Florida, which have become the primary source of illegal painkillers in the eastern United States.
In just the past two years, the number of pain clinics in Broward County grew from four to 115, the grand jury found. In one six-month span, Broward pain-clinic doctors dispensed more than 9 million tablets of oxycodone, one of the most powerful and dangerous painkillers on the market -- far more than any other part of the country.
Addicts and drug peddlers routinely hop from clinic to clinic using bogus medical records to pass off fake injuries and obtain prescriptions -- a practice known as ``doctor shopping,'' the grand jury found. The proliferation of clinics attracts carloads of illegal drug buyers from other states, notably Kentucky, Ohio, West Virginia and Tennessee.
While some pain clinics offer legitimate medical services, most are ``rogue clinics putting out pills for cash,'' the report found.
``By the time law enforcement initiates and completes a successful investigation leading to the arrest of a doctor, user or dealer, several new clinics have opened,'' the report said.
WEAKNESSES
In response to the growing problem, state lawmakers approved a new law this spring placing pain clinics under greater scrutiny, and creating a database of prescription drugs sold, so prescribing doctors can better detect ``doctor shopping'' patients.
But the grand jury highlighted weaknesses in the law -- most notably, that the database program has no dedicated source of funding. State officials plan to seek grants to pay for the $4 million program.
The grand jury also criticized a section of the law that allows doctors to record prescriptions in the database within 15 days of their distribution. The grand jurors said drug traffickers could have come and gone by the time their prescriptions are recorded.
CLOSING LOOPHOLES
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
• Preventing pain clinics from distributing drugs on site until the state database is up and running next year.
Many clinics advertise that they both prescribe and sell pills on site to attract clients -- another practice the grand jury would ban.
• Limiting prescriptions from pain clinics to no more than a three-day supply.
Clients at pain clinics typically receive a 30-day supply of drugs -- 150 to 240 tablets of oxycodone, often coupled with the painkiller roxycodone and anti-anxiety drugs such as Xanax -- after only one doctor's visit.
CRIMINAL RECORDS
• Barring people with criminal records from owning pain clinics. The Miami Herald investigation found several examples of clinic owners with criminal records, including the owner of a Boca Raton pain clinic who once pleaded guilty to possession of steroids with intent to sell.
• Limiting the number of pain-relief patients to 100 per clinic, and placing limits on the number of out-of-state patients a clinic may have.
Narcotics investigators have said that some pain clinics have as many as 65 patients per day. One Coral Springs doctor indicted on trafficking charges last year had nearly 500 patients from Kentucky.
======================================================================================================================
sun-sentinel.com/news/broward/flgrand-jury-pill-mill-20091119,0,1892598.story
South Florida Sun-Sentinel.com
Grand jury recommends pill mill cleanup
In two years, number in Broward jumped from four to 115, panel finds
By Scott Hiaasen, The Miami Herald
November 19, 2009
A Broward County grand jury issued a damning report Thursday bemoaning the explosion of illegal painkillers sold through Broward pain clinics — and warning that reforms passed by the Legislature may not be enough.
Echoing a Miami Herald investigation earlier this year, the report details how lax state laws spawned a cottage industry of storefront pain clinics across South Florida, which have become the primary source of illegal painkillers in the eastern United States.
In just the past two years, the number of pain clinics in Broward County grew from four to 115, the grand jury found. In one six-month span, Broward pain-clinic doctors dispensed more than 9 million tablets of oxycodone, one of the most powerful and dangerous painkillers on the market — far more than any other part of the country.
Addicts and drug peddlers routinely hop from clinic to clinic using bogus medical records to pass off fake injuries and obtain prescriptions — a practice known as "doctor shopping," the grand jury found. The proliferation of clinics attracts carloads of illegal drug buyers from other states, notably Kentucky, Ohio, West Virginia and Tennessee.
While some pain clinics offer legitimate medical services, most are "rogue clinics putting out pills for cash," according to the report.
"By the time law enforcement initiates and completes a successful investigation leading to the arrest of a doctor, user or dealer, several new clinics have opened," the report said.
In response to the growing problem, state lawmakers approved a new law this spring placing pain clinics under greater state scrutiny, and creating a database of prescription drugs sold, so prescribing doctors can better detect "doctor shopping" patients.
But the grand jury highlighted weaknesses in the law — most notably, that the database program has no dedicated source of funding. State officials plan to seek grants to pay for the $4 million program.
The grand jury also criticized a section of the law that allows doctors to record prescriptions in the database within 15 days of their distribution. The grand jurors said drug traffickers could have come and gone by the time their prescriptions are recorded.
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
Preventing pain clinics from distributing drugs on site until the state database is up and running next year. Many clinics advertise that they both prescribe and sell pills on site to attract clients — another practice the grand jury would ban.
Limiting prescriptions from pain clinics to no more than a three-day supply. Clients at pain clinics typically receive a 30-day supply of drugs — 150 to 240 tablets of oxycodone, often coupled with the painkiller roxycodone and anti-anxiety drugs such as Xanax — after only one doctor's visit.
Barring people with criminal records from owning pain clinics. The Miami Herald investigation found several examples of clinic owners with criminal records, including the owner of a Boca Raton pain clinic who once pleaded guilty to possession of steroids with intent to sell.
Limiting the number of pain-relief patients to 100 per clinic, and placing limits on the number of out-of-state patients a clinic may have. Narcotics investigators have said that some pain clinics have as many as 65 patients per day. One Coral Springs doctor indicted on trafficking charges last year had nearly 500 patients from Kentucky.
I also witnessed a new phenomenon: one pain clinic in my area was finally shut down but reopened several days later calling itself "MedClinic" offering ALL medical services INCLUDING pain management. That means they will restart the SAME activities with the SAME management!! Its really frustrating! We have to focus on promoting tough measures as outlined in the grand jury recommendations. Therefore, I ask FSAM to issue a press release supporting the following recommendations and to contact the legislators asking them for their support.
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
• Preventing pain clinics from distributing drugs on site until the state database is up and running next year.
• Limiting prescriptions from pain clinics to no more than a three-day supply.
Looking forward to your comments.
Yours
Bernd
Bernd Wollschlager,MD,FAAFP,FASAM
Member of the PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE
Posted on Fri, Nov. 20, 2009
Broward grand jury recommends pain clinic reforms
BY SCOTT HIAASEN
shiaasen@MiamiHerald.com
A Broward County grand jury issued a damning report Thursday bemoaning the explosion of illegal painkillers sold through Broward pain clinics -- and warning that reforms passed by the Legislature may not be enough.
Echoing a Miami Herald investigation earlier this year, the report details how lax state laws spawned a cottage industry of storefront pain clinics across South Florida, which have become the primary source of illegal painkillers in the eastern United States.
In just the past two years, the number of pain clinics in Broward County grew from four to 115, the grand jury found. In one six-month span, Broward pain-clinic doctors dispensed more than 9 million tablets of oxycodone, one of the most powerful and dangerous painkillers on the market -- far more than any other part of the country.
Addicts and drug peddlers routinely hop from clinic to clinic using bogus medical records to pass off fake injuries and obtain prescriptions -- a practice known as ``doctor shopping,'' the grand jury found. The proliferation of clinics attracts carloads of illegal drug buyers from other states, notably Kentucky, Ohio, West Virginia and Tennessee.
While some pain clinics offer legitimate medical services, most are ``rogue clinics putting out pills for cash,'' the report found.
``By the time law enforcement initiates and completes a successful investigation leading to the arrest of a doctor, user or dealer, several new clinics have opened,'' the report said.
WEAKNESSES
In response to the growing problem, state lawmakers approved a new law this spring placing pain clinics under greater scrutiny, and creating a database of prescription drugs sold, so prescribing doctors can better detect ``doctor shopping'' patients.
But the grand jury highlighted weaknesses in the law -- most notably, that the database program has no dedicated source of funding. State officials plan to seek grants to pay for the $4 million program.
The grand jury also criticized a section of the law that allows doctors to record prescriptions in the database within 15 days of their distribution. The grand jurors said drug traffickers could have come and gone by the time their prescriptions are recorded.
CLOSING LOOPHOLES
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
• Preventing pain clinics from distributing drugs on site until the state database is up and running next year.
Many clinics advertise that they both prescribe and sell pills on site to attract clients -- another practice the grand jury would ban.
• Limiting prescriptions from pain clinics to no more than a three-day supply.
Clients at pain clinics typically receive a 30-day supply of drugs -- 150 to 240 tablets of oxycodone, often coupled with the painkiller roxycodone and anti-anxiety drugs such as Xanax -- after only one doctor's visit.
CRIMINAL RECORDS
• Barring people with criminal records from owning pain clinics. The Miami Herald investigation found several examples of clinic owners with criminal records, including the owner of a Boca Raton pain clinic who once pleaded guilty to possession of steroids with intent to sell.
• Limiting the number of pain-relief patients to 100 per clinic, and placing limits on the number of out-of-state patients a clinic may have.
Narcotics investigators have said that some pain clinics have as many as 65 patients per day. One Coral Springs doctor indicted on trafficking charges last year had nearly 500 patients from Kentucky.
======================================================================================================================
sun-sentinel.com/news/broward/flgrand-jury-pill-mill-20091119,0,1892598.story
South Florida Sun-Sentinel.com
Grand jury recommends pill mill cleanup
In two years, number in Broward jumped from four to 115, panel finds
By Scott Hiaasen, The Miami Herald
November 19, 2009
A Broward County grand jury issued a damning report Thursday bemoaning the explosion of illegal painkillers sold through Broward pain clinics — and warning that reforms passed by the Legislature may not be enough.
Echoing a Miami Herald investigation earlier this year, the report details how lax state laws spawned a cottage industry of storefront pain clinics across South Florida, which have become the primary source of illegal painkillers in the eastern United States.
In just the past two years, the number of pain clinics in Broward County grew from four to 115, the grand jury found. In one six-month span, Broward pain-clinic doctors dispensed more than 9 million tablets of oxycodone, one of the most powerful and dangerous painkillers on the market — far more than any other part of the country.
Addicts and drug peddlers routinely hop from clinic to clinic using bogus medical records to pass off fake injuries and obtain prescriptions — a practice known as "doctor shopping," the grand jury found. The proliferation of clinics attracts carloads of illegal drug buyers from other states, notably Kentucky, Ohio, West Virginia and Tennessee.
While some pain clinics offer legitimate medical services, most are "rogue clinics putting out pills for cash," according to the report.
"By the time law enforcement initiates and completes a successful investigation leading to the arrest of a doctor, user or dealer, several new clinics have opened," the report said.
In response to the growing problem, state lawmakers approved a new law this spring placing pain clinics under greater state scrutiny, and creating a database of prescription drugs sold, so prescribing doctors can better detect "doctor shopping" patients.
But the grand jury highlighted weaknesses in the law — most notably, that the database program has no dedicated source of funding. State officials plan to seek grants to pay for the $4 million program.
The grand jury also criticized a section of the law that allows doctors to record prescriptions in the database within 15 days of their distribution. The grand jurors said drug traffickers could have come and gone by the time their prescriptions are recorded.
The grand jury recommended to the Legislature 18 new reforms to curb the pain-clinic problem, including closing several loopholes the new state law failed to address. They include:
Preventing pain clinics from distributing drugs on site until the state database is up and running next year. Many clinics advertise that they both prescribe and sell pills on site to attract clients — another practice the grand jury would ban.
Limiting prescriptions from pain clinics to no more than a three-day supply. Clients at pain clinics typically receive a 30-day supply of drugs — 150 to 240 tablets of oxycodone, often coupled with the painkiller roxycodone and anti-anxiety drugs such as Xanax — after only one doctor's visit.
Barring people with criminal records from owning pain clinics. The Miami Herald investigation found several examples of clinic owners with criminal records, including the owner of a Boca Raton pain clinic who once pleaded guilty to possession of steroids with intent to sell.
Limiting the number of pain-relief patients to 100 per clinic, and placing limits on the number of out-of-state patients a clinic may have. Narcotics investigators have said that some pain clinics have as many as 65 patients per day. One Coral Springs doctor indicted on trafficking charges last year had nearly 500 patients from Kentucky.
Thursday, November 12, 2009
Governor Crist Appointment
Governor Crist appoints Past FSAM President to the Prescription Drug Monitoring Program Implementation and Oversight Taskforce.
http://www.flgov.com/release/11150
GOVERNOR CRIST APPOINTS NINE TO THE PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE
November 12, 2009
Contact:
GOVERNOR'S PRESS OFFICE
(850) 488-5394
TALLAHASSEE – Governor Charlie Crist today announced the following appointments:
Prescription Drug Monitoring Program Implementation and Oversight Task Force
· Andre Benson, 62, of Tampa, physician, Operation PAR Inc., appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Lora “Lorrie” Brown, 44, of St. Petersburg, pain physician, Coastal Orthopedics, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Kristen Cortes, 45, of Panama City, Florida Department of Law Enforcement agent, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· David Craig, 41, of Tampa, clinical pharmacist specialist, H. Lee Moffitt Cancer Center and Research Institute, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Joel Kaufman, 57, of Ft. Lauderdale, vice president, United Way of Broward County, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Nilesh Patel, 45, of Bradenton, interventional pain management physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Donnie Reynolds, 41, of Weston, chief operating officer, Automated Healthcare Solutions, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Paula “Pepper” Wakeland-Hewitt, 60, of Sarasota, pharmacy manager, Davidson Drugs, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Bernd Wollschlaeger, 51, of Miramar, self-employed primary care physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
http://www.flgov.com/release/11150
GOVERNOR CRIST APPOINTS NINE TO THE PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE
November 12, 2009
Contact:
GOVERNOR'S PRESS OFFICE
(850) 488-5394
TALLAHASSEE – Governor Charlie Crist today announced the following appointments:
Prescription Drug Monitoring Program Implementation and Oversight Task Force
· Andre Benson, 62, of Tampa, physician, Operation PAR Inc., appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Lora “Lorrie” Brown, 44, of St. Petersburg, pain physician, Coastal Orthopedics, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Kristen Cortes, 45, of Panama City, Florida Department of Law Enforcement agent, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· David Craig, 41, of Tampa, clinical pharmacist specialist, H. Lee Moffitt Cancer Center and Research Institute, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Joel Kaufman, 57, of Ft. Lauderdale, vice president, United Way of Broward County, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Nilesh Patel, 45, of Bradenton, interventional pain management physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Donnie Reynolds, 41, of Weston, chief operating officer, Automated Healthcare Solutions, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Paula “Pepper” Wakeland-Hewitt, 60, of Sarasota, pharmacy manager, Davidson Drugs, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
· Bernd Wollschlaeger, 51, of Miramar, self-employed primary care physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.
Thursday, September 24, 2009
JCAHO and Screeing Issues
Attached an important e-mail and message from our ASAM Regional Director.
We must make every effort to submit our comments.
Yours
Bernd
=============================================================================
Richard Soper wrote:
>
>
>
>
> Richard Soper wrote:
>
> Chapter Presidents and colleagues;
>
> Last year, the Joint Commission on the Accreditation of Hospitals (JCAHO) called for comments on whether it should create standards for tobacco, alcohol and drug screening and referral for all hospitals. Many of us then wrote to the Joint Commission with our comments. Our efforts were successful. JCAHO has now published a set of proposed standardsfor tobacco, alcohol and drug screening, brief intervention, referral and treatment.
> In my view, publication and adoption of these standards is a fundamentally important recognition that alcohol, tobacco and other drug problems should be identified and treated in all hospital patients as a routine part of care. If adopted, the tobacco, alcohol and drug reporting standards would be among those that hospitals can select for monitoring their own quality and performance.
> Hospital administrators, boards and staff will know what they should be doing about tobacco, alcohol and drugs to help their patients get better.
>
> I am urging all of you to take personal action to achieve the final step in this long journey:
>
> Getting the draft standards adopted.
>
> Please do two important things now:
> 1. Submit Your Comments Online.The Commission has invited public comment until September 30, so you really need to do this NOW.
>
> You will find an online survey formthat asks whether you believe the proposed standards will improve patient care, are clear enough to be implemented, and meet other JCAHO goals for its hospital standards. Your answers will have an impact on whether the standards are adopted. There is a link to full text of the standards on the first page of the survey, and you can also read Join Together's recent feature story summarizing the proposal.
>
>
> 1. Send this Message To other ASAM members, a Colleague, friend. We need as many voices from the field as possible supporting SBI as the routine standard of care. Tell your colleagues about this major opportunity to affect the health care of millions of Americans.
> 2. WE can continue to make a difference and have impact of formation of policy with our combined efforts to guide this process.
>
> Onward,
>
> Rich Soper, JD, MD, FASAM
We must make every effort to submit our comments.
Yours
Bernd
=============================================================================
Richard Soper wrote:
>
>
>
>
> Richard Soper wrote:
>
> Chapter Presidents and colleagues;
>
> Last year, the Joint Commission on the Accreditation of Hospitals (JCAHO) called for comments on whether it should create standards for tobacco, alcohol and drug screening and referral for all hospitals. Many of us then wrote to the Joint Commission with our comments. Our efforts were successful. JCAHO has now published a set of proposed standardsfor tobacco, alcohol and drug screening, brief intervention, referral and treatment.
> In my view, publication and adoption of these standards is a fundamentally important recognition that alcohol, tobacco and other drug problems should be identified and treated in all hospital patients as a routine part of care. If adopted, the tobacco, alcohol and drug reporting standards would be among those that hospitals can select for monitoring their own quality and performance.
> Hospital administrators, boards and staff will know what they should be doing about tobacco, alcohol and drugs to help their patients get better.
>
> I am urging all of you to take personal action to achieve the final step in this long journey:
>
> Getting the draft standards adopted.
>
> Please do two important things now:
> 1. Submit Your Comments Online.The Commission has invited public comment until September 30, so you really need to do this NOW.
>
> You will find an online survey formthat asks whether you believe the proposed standards will improve patient care, are clear enough to be implemented, and meet other JCAHO goals for its hospital standards. Your answers will have an impact on whether the standards are adopted. There is a link to full text of the standards on the first page of the survey, and you can also read Join Together's recent feature story summarizing the proposal.
>
>
> 1. Send this Message To other ASAM members, a Colleague, friend. We need as many voices from the field as possible supporting SBI as the routine standard of care. Tell your colleagues about this major opportunity to affect the health care of millions of Americans.
> 2. WE can continue to make a difference and have impact of formation of policy with our combined efforts to guide this process.
>
> Onward,
>
> Rich Soper, JD, MD, FASAM
Friday, September 4, 2009
Updated Directory of Drug and Alcohol Abuse Treatment Programs Now Available
*FOR RELEASE:* *Contact: SAMHSA Press Office (240) 276-2130* August 6, 2009 http://www.samhsa.gov
*Updated Directory of Drug and Alcohol Abuse Treatment Programs Now Available*
A new, updated guide to finding local substance abuse treatment programs is now available from the Substance Abuse and Mental Health Services Administration (SAMHSA). *"National Directory of Drug and Alcohol Abuse Treatment Programs 2009"* provides information on thousands of alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico, and five U.S. territories.
The National Directory includes a nationwide inventory of public and private substance abuse and alcoholism treatment programs and facilities that are licensed, certified, or otherwise approved by substance abuse agencies in each state. The National Directory is organized in a state-by-state format for quick reference by health care providers, social workers, managed care organizations, and the general public and provides information on more than 11,000 community substance abuse treatment
programs.
The directory provides important information on levels of care and types of facilities, including those with programs for adolescents, persons with co-occurring substance abuse and mental disorders, individuals living with HIV/AIDS, and pregnant women. In addition, information is available on forms of payment accepted, special language services available with select providers, and whether methadone or buprenorphine therapy is offered.
The updated directory complements SAMHSA's internet-based *"Substance Abuse Treatment Facility Locator"* -- the online service, which is updated regularly and may contain more current information, provides searchable road maps to the nearest treatment facilities, complete addresses, phone numbers and specific information on services available. The electronic, searchable version of SAMHSA's updated *"National Directory of Drug and Alcohol Abuse Treatment Programs"* is available on the Web at
http://FindTreatment.samhsa.gov/
Hard copies of the National Directory may be obtained free of charge from SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number
*Updated Directory of Drug and Alcohol Abuse Treatment Programs Now Available*
A new, updated guide to finding local substance abuse treatment programs is now available from the Substance Abuse and Mental Health Services Administration (SAMHSA). *"National Directory of Drug and Alcohol Abuse Treatment Programs 2009"* provides information on thousands of alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico, and five U.S. territories.
The National Directory includes a nationwide inventory of public and private substance abuse and alcoholism treatment programs and facilities that are licensed, certified, or otherwise approved by substance abuse agencies in each state. The National Directory is organized in a state-by-state format for quick reference by health care providers, social workers, managed care organizations, and the general public and provides information on more than 11,000 community substance abuse treatment
programs.
The directory provides important information on levels of care and types of facilities, including those with programs for adolescents, persons with co-occurring substance abuse and mental disorders, individuals living with HIV/AIDS, and pregnant women. In addition, information is available on forms of payment accepted, special language services available with select providers, and whether methadone or buprenorphine therapy is offered.
The updated directory complements SAMHSA's internet-based *"Substance Abuse Treatment Facility Locator"* -- the online service, which is updated regularly and may contain more current information, provides searchable road maps to the nearest treatment facilities, complete addresses, phone numbers and specific information on services available. The electronic, searchable version of SAMHSA's updated *"National Directory of Drug and Alcohol Abuse Treatment Programs"* is available on the Web at
http://FindTreatment.samhsa.gov/
Hard copies of the National Directory may be obtained free of charge from SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number
Sunday, August 30, 2009
Controversial Treatment for Opioid Dependence
Attached an article which you probably have read already. Is anyone considering a response to the study? Its quite controversial and almost negating the current treatment approaches.
I found it especially troublesome that the authors claim that "It could be argued that another opioid-substitution medication, such as buprenorphine, might have been used as a comparison drug instead of methadone. The available evidence does not support this suggestion: a recent Cochrane review concluded that buprenorphine maintenance was significantly less effective than methadone maintenance.Thus, methadone maintenance remains the standard treatment and the proper comparison drug for an experimental substitution therapy."
Looking forward to your comments.
Bernd
Volume 361:777-786 August 20, 2009 Number 8
Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction
Eugenia Oviedo-Joekes, Ph.D., Suzanne Brissette, M.D., David C. Marsh, M.D., Pierre Lauzon, M.D., Daphne Guh, M.Sc., Aslam Anis, Ph.D., and Martin T. Schechter, M.D., Ph.D.
ABSTRACT
Background Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence.
Methods:
In an open-label, phase 3, randomized, controlled trial in Canada, we compared injectable diacetylmorphine with oral methadone maintenance therapy in patients with opioid dependence that was refractory to treatment. Long-term users of injectable heroin who had not benefited from at least two previous attempts at treatment for addiction (including at least one methadone treatment) were randomly assigned to receive methadone (111 patients) or diacetylmorphine (115 patients). The primary outcomes, assessed at 12 months, were retention in addiction treatment or drug-free status and a reduction in illicit-drug use or other illegal activity according to the European Addiction Severity Index.
Results:
The primary outcomes were determined in 95.2% of the participants. On the basis of an intention-to-treat analysis, the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group (rate ratio for retention, 1.62; 95% confidence interval [CI], 1.35 to 1.95; P<0.001). The reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group (rate ratio, 1.40; 95% CI, 1.11 to 1.77; P=0.004). The most common serious adverse events associated with diacetylmorphine injections were overdoses (in 10 patients) and seizures (in 6 patients).
Conclusions:
Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available. (ClinicalTrials.gov number, NCT00175357 [ClinicalTrials.gov] .)
DISCUSSION:
Discussion:
In this trial, patients assigned to receive injectable diacetylmorphine were more likely to stay in treatment and to reduce their use of illegal drugs and other illegal activities than patients assigned to receive oral methadone. These findings are consistent with the results of European studies that suggest greater effectiveness of diacetylmorphine than methadone as maintenance treatment for long-term, treatment-refractory opioid use.10,12,13 Two of these trials showed no differences between groups in the rate of retention in treatment for addiction. However, the fact that control patients were eligible to receive diacetylmorphine at the end of the study period may have introduced a bias in the observed retention rates. In addition, patients currently enrolled in methadone maintenance treatment were eligible for the European trials but not for the present study. Although the definitions of clinical response varied among the trials, all of them considered the same variables (drug use, illegal activities, health, and social adjustment) and showed greater effectiveness of diacetylmorphine than of methadone for maintenance treatment.
Secondary analyses showed that both groups had significant improvement in many of the variables that were evaluated. The diacetylmorphine group had greater improvements with respect to medical and psychiatric status, economic status, employment situation, and family and social relations. These results are particularly noteworthy in view of the nature of the population and the time frame. The fact that patients who received diacetylmorphine had significant improvement in these areas suggests a positive treatment effect beyond a reduction in illicit-drug use or other illegal activities.
I found it especially troublesome that the authors claim that "It could be argued that another opioid-substitution medication, such as buprenorphine, might have been used as a comparison drug instead of methadone. The available evidence does not support this suggestion: a recent Cochrane review concluded that buprenorphine maintenance was significantly less effective than methadone maintenance.Thus, methadone maintenance remains the standard treatment and the proper comparison drug for an experimental substitution therapy."
Looking forward to your comments.
Bernd
Volume 361:777-786 August 20, 2009 Number 8
Diacetylmorphine versus Methadone for the Treatment of Opioid Addiction
Eugenia Oviedo-Joekes, Ph.D., Suzanne Brissette, M.D., David C. Marsh, M.D., Pierre Lauzon, M.D., Daphne Guh, M.Sc., Aslam Anis, Ph.D., and Martin T. Schechter, M.D., Ph.D.
ABSTRACT
Background Studies in Europe have suggested that injectable diacetylmorphine, the active ingredient in heroin, can be an effective adjunctive treatment for chronic, relapsing opioid dependence.
Methods:
In an open-label, phase 3, randomized, controlled trial in Canada, we compared injectable diacetylmorphine with oral methadone maintenance therapy in patients with opioid dependence that was refractory to treatment. Long-term users of injectable heroin who had not benefited from at least two previous attempts at treatment for addiction (including at least one methadone treatment) were randomly assigned to receive methadone (111 patients) or diacetylmorphine (115 patients). The primary outcomes, assessed at 12 months, were retention in addiction treatment or drug-free status and a reduction in illicit-drug use or other illegal activity according to the European Addiction Severity Index.
Results:
The primary outcomes were determined in 95.2% of the participants. On the basis of an intention-to-treat analysis, the rate of retention in addiction treatment in the diacetylmorphine group was 87.8%, as compared with 54.1% in the methadone group (rate ratio for retention, 1.62; 95% confidence interval [CI], 1.35 to 1.95; P<0.001). The reduction in rates of illicit-drug use or other illegal activity was 67.0% in the diacetylmorphine group and 47.7% in the methadone group (rate ratio, 1.40; 95% CI, 1.11 to 1.77; P=0.004). The most common serious adverse events associated with diacetylmorphine injections were overdoses (in 10 patients) and seizures (in 6 patients).
Conclusions:
Injectable diacetylmorphine was more effective than oral methadone. Because of a risk of overdoses and seizures, diacetylmorphine maintenance therapy should be delivered in settings where prompt medical intervention is available. (ClinicalTrials.gov number, NCT00175357 [ClinicalTrials.gov] .)
DISCUSSION:
Discussion:
In this trial, patients assigned to receive injectable diacetylmorphine were more likely to stay in treatment and to reduce their use of illegal drugs and other illegal activities than patients assigned to receive oral methadone. These findings are consistent with the results of European studies that suggest greater effectiveness of diacetylmorphine than methadone as maintenance treatment for long-term, treatment-refractory opioid use.10,12,13 Two of these trials showed no differences between groups in the rate of retention in treatment for addiction. However, the fact that control patients were eligible to receive diacetylmorphine at the end of the study period may have introduced a bias in the observed retention rates. In addition, patients currently enrolled in methadone maintenance treatment were eligible for the European trials but not for the present study. Although the definitions of clinical response varied among the trials, all of them considered the same variables (drug use, illegal activities, health, and social adjustment) and showed greater effectiveness of diacetylmorphine than of methadone for maintenance treatment.
Secondary analyses showed that both groups had significant improvement in many of the variables that were evaluated. The diacetylmorphine group had greater improvements with respect to medical and psychiatric status, economic status, employment situation, and family and social relations. These results are particularly noteworthy in view of the nature of the population and the time frame. The fact that patients who received diacetylmorphine had significant improvement in these areas suggests a positive treatment effect beyond a reduction in illicit-drug use or other illegal activities.
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