#1 Bing adopts LegitScript’s addiction treatment ad standards used by Google and Facebook
This week Bing announced that the search engine would adopt the LegitScript certification program of drug and alcohol addiction treatment centers for allowing paid advertisements. Google adopted this system in April of last year followed by Facebook in August. Several other companies/vendors have also embraced this set of certification standards including Visa and Mastercard.
To be allowed to advertise on Bing starting in mid March, addiction treatment centers have to be certified that they meet the LegitScript requirements for legitimacy, transparency, and accountability.
According to the LegitScripts website, their Addiction Treatment Certification applies to three types of entities:
- In-Person Addiction Treatment (Google, Bing, and Facebook): Any website, application, or merchant that provides information about in-person drug or alcohol addiction treatment, or facilitates in-person or online drug or alcohol treatment, other than at a private residence or non-clinical setting.
- Mutual Support Groups (Google and Bing): Any website, application, online forum, or merchant that does not offer treatment for drugs or alcohol, but that facilitates interactions between non-professional members engaged in recovery.
- Crisis Hotlines (Google): Any website, application, call center, chat feature, or telephone number that provides or purports to provide remote assistance or information to individuals who are in recovery or who are seeking information about addiction or addiction treatment, or to any person associated with such individuals, that does not identify particular treatment facilities or entities on the site itself.
For more information see: https://www.legitscript.com/service/certification/addiction-treatment/
#2 JAMA study: persistent post-op opioid use in teens linked to long-term substance use by family members
A study titled “Association Between Long-term Opioid Use in Family Members and Persistent Opioid Use After Surgery Among Adolescents and Young Adults” published on February 27, 2019 in JAMA Network shows that when young people are prescribed opioid analgesics or painkillers after surgery, the risk for longer-term persistent opioid abuse almost doubles if they have someone in the home already using opioids long term.
The study pulled data from insurance claims to track opioid usage for over 346,000 patients aged 13 to 21 of whom 257,000 had not been prescribed an opioid before. The teens and young adults were typically prescribed opioid painkillers for a few days following a routine dental or surgical procedure such as removal of appendix or a hernia repair.
Researchers defined “long-term use” as filling opioid prescriptions for four or more months in the past year before the young person’s procedure or filling three or more opioid prescriptions within 3 months.
They found that 4.1 percent of teens and young adults went on to have persistent opioid use, defined as one or more opioid prescriptions filled three or more months after surgery, if they had another individual living in their home who already had been using opioids on a long-term basis as defined above. That compared to 2.4 percent of young people who had persistent opioid use who didn’t have an individual with a history of opioid use in their homes.
The findings are consistent with what we already know. Previous studies have shown that a family history of substance use and misuse is a risk factor for an individual to develop a substance use disorder in the future.
And, another study published earlier in the week on February 25, 2019 in Pediatrics shows that teenagers were 42 percent more likely to misuse prescription opioids if one of their parents had done so. See #3 below.
The bottom line: Physicians and surgeons should screen young patients for long-term opioid use in their families before issuing a take-home prescription for opioid analgesics or painkillers, even if the prescription is only for a few days.
The University of Michigan Medical School study can be found here: https://jamanetwork.com/journals/jamasurgery/article-abstract/2726600
#3 Pediatrics study finds nonmedical prescription opioid use by teens linked to parents’ use
A study titled “Nonmedical Prescription Opioid Use by Parents and Adolescents in the US” published on February 25, 2019 in Pediatrics highlights the significant positive association between Nonmedical prescription opioid (NMPO) use by parents and adolescent aged 12-17 years.
13.9% of adolescents had used an NMPO in their lifetime if a parent had also done so compared with 8.1% when a parent had not done so. This is a difference of 42%.
The study looked at data from 35 000 parent-child dyads with an adolescent aged 12 to 17 years from the 2004–2012 National Surveys on Drug Use and Health (NSDUH) survey conducted annually by SAMHSA. Using multivariable logistic regression models, the researchers estimated the association between self-reported parental and adolescent lifetime NMPO use, controlling for other factors.
Parents smoking, drinking alcohol, and using marijuana use have been documented to result in increased use of the same substances by their children. To date, the link between parent nonmedical opioid use and that of their children had been inferred from reports but not formally analyzed as this study does.
For more information the study can be reviewed here: https://pediatrics.aappublications.org/content/143/3/e20182354
#4 Cover MAT and Stabilize Formularies for Opioid Use Disorder, AAFP Responds to CMS
On March 1, 2019 the American Academy of Family Physicians (AAFP) publicly highlighted their February 19, 2019 letter to Dr. Alex Azar at HHS that responded to the CMS proposed rule on “HHS Notice of Benefit and Payment Parameters for 2020.”
As related to opioid use disorder, the federal policy put on the table for 2020 would “encourage” health insurance coverage for medication-assisted treatment (MAT). The AAFP asks for this to be taken a step further and for HHS to “require” comprehensive coverage of MAT and counseling in all public and private health insurance plans, noting that this is recommended by the FDA.
Among other points made, the AAFP also requested that mid-year generic introductions to drug formularies be done in a manner that doesn’t restrict access to the branded versions. The organization notes that stable formularies without frequent changes avoids confusion and frustration for patients and physicians and minimizes noncompliance, adverse reactions, and erosion of patients’ confidence.
For more information review the details of the response here:
#5 FDA outlines its 2019 agenda to combat opioid epidemic
On Tuesday February 26, 2019 the FDA commissioner Dr. Scott Gottlieb issued a statement outlining what he termed the agency’s “continued action to forcefully address the tragic epidemic of opioid abuse.”
The agency’s 2019 policy and regulatory agenda span four broad fronts:
1 Reduce Misuse and Abuse of Opioid Drugs
New steps that the FDA says they are taking in 2019 involve:
- Implementing steps to require unit of dose packaging in the first half of 2019. I.e., packaging opioid analgesics in smaller quantities in blister packs to cover a few days.
- Requiring manufacturers to develop and provide drug disposal options such as a mail-back pouch. This goes towards not having unused opioid analgesics stored in medicine cabinets making the medication susceptible to be stolen or misused by other members of the household. The primary source of misused opioids in 2017 was from a friend or relative.
- Developing a framework to assess new opioid drugs in terms of their “meaningful therapeutic differentiation” including their relative safety and effectiveness over existing treatments.
- Continuing evaluation of the effectiveness of REMS programs for opioid analgesics, including methods for data collection and assessment tools. In particular, the FDA has recently heard concerns with the REMS program associated with transmucosal immediate-release fentanyl (TIRF) medicines which was raised at an August 2018 public advisory committee meeting and needs addressing.
2 Support Addiction Recovery and Reduce Overdose Deaths
- The FDA is prioritizing supporting the development and use of safe and effective MAT or medication-assisted treatment for opioid use disorder. This encompasses both medications and medical devices such as digital health tools.
- The FDA is also encouraging development of an OTC or over-the-counter Naloxone product. In January, the agency took the unprecedented step of developing and posting in the public domain model consumer drug fact labels.
3 Research and Innovation in Non-Addictive Pain Treatments
- The FDA hopes to issue in 2019 updated guidelines for appropriate clinical endpoints and clinical trial design to develop non-opioid drugs to treat both acute and chronic pain.
- The agency will also take steps to promote the development of abuse-deterrent formulations of opioid analgesics including facilitating generic versions.
4 Strengthen Enforcement Against Illicit Opioids
- In 2019, the FDA is working in partnership with U.S. Customers and Border Protection to maximize each agency’s inspection and detection capabilities at the border by expanding information sharing such as real-time sharing of field-based testing of samples.
- The FDA is partnering with Google and other internet entities to prevent illegal sales of opioid analgesics online.
- Utilizing a $20 million allocation in the 2019 budget, develop a large-scale data warehouse to improve the agency’s analytic capabilities.
- Doing more to secure the legitimate supply chain by holding distributors, such as McKesson who was recently warned, accountable to have systems and processes in place to detect tampering and suspect packaging of opioids and other medications.
For more information see the press release at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632067.htm
IANA Health seeks to be that easy, one-stop online resource for opioid and other substance abuse and addiction information, clinicians, and support groups. https://ianahealth.com.