ACMT Position Statement: Addressing the Rising Cost of Prescription Antidotes

Antidotal therapy is an essential component of poisoning management. In recent years, there have been unprecedented increases in the costs of antidotes. The American College of Medical Toxicology calls upon providers, hospitals, formularies pharmaceutical industry, government, insurance companies, and pharmacy benefit managers to adopt practices to ensure that antidotes are available to our patients and price are based on value and cost.     

ACMT Position Statement: Alternative or Contingency Countermeasures for Acetylcholinesterase Inhibiting Agents

First responders and health care providers must prepare to provide care for patients poisoned by acetylcholinesterase (AchE) inhibitor chemical warfare agents or pesticides. However, pre-deployed medical countermeasures (MCMs) may not be sufficient due to production and delivery interruption, rapid depletion of contents during a response, expiration of MCM components, or lack of local availability of approved MCMs. To augment supplies of community-based and forward-deployed nerve agent countermeasures, the American College of Medical Toxicology (ACMT) supports several strategies: (1) The use of expired atropine, diazepam, and pralidoxime auto-injectors and vials if non-expired drugs are unavailable; and (2) Investigation, development, and identification of alternative countermeasures—commonly stocked drugs that are not approved for nerve agent poisoning but are in the same therapeutic class as approved drugs.     

Serum Methadone as an Aid in Managing Methadone Maintenance Patients

Serial serum methadone levels were obtained in two patients who were experiencing significant difficulties (including subjective and objective evidence of the opiate withdrawal syndrome) while on methadone maintenance. A precipitous drop in blood levels of methadone was recorded 2 to 6 hours after ingestion. It was during this same time period that withdrawal symptoms were most severe. When methadone was administered on a divided dosage regimen, there was a dramatic clinical improvement in both patients and a marked flattening of the curve of serum methadone levels. This pilot study suggests that the current practice of administering methadone as a single daily dose to all patients needs reconsideration; serial serum methadone levels may be helpful in determining which patients do better on a divided dosage regimen.     

The Validity of Methadone Clients' Self-Reported Drug Use

Drug use self-reports were compared with urinalysis for 248 clients in four methadone treatment programs. The validity of self-reporting based on urinalysis as a criterion depended on the type of drug examined. Opiate reporting was least valid, while benzodiazepine and cocaine reporting were moderately and highly valid, respectively. EMIT^® urinalysis was far more useful as a criterion of validity than TLC urinalysis. Self-reports helped identify drug users who were missed by urinalysis because of the latter's limited detection period, but urinalysis in turn detected an equal number of drug users missed by the interviews. The age of clients and the type of interviewer directly affected the rate of underreporting. Some respondents systematically denied disvalued behaviors (i.e., drug use and criminality), leading to a spurious correlation between these behaviors. This has important implications for future research.     

Diminished Illicit Drug Use as a Consequence of Long-Term Methadone Maintenance

In the twenty-five years since its introduction as a treatment for opiate addication, methadone mainentance has generated considerable controversy regarding both its appropriateness as a treatment modality and its efficacy in diminishing opiate abuse. Given current concenrs regarding the spread of HIV amongst IV drug abusers, the role of methadone maintenance may be more important than ever. The present study was designed to examine continued illicit substance abuse by 229 patients enrolled in methadone treatment. Specifically, while 35% of the patients enrolled for less than 12 months were opiate free for the 3 month period, that value increased71% for patients enrolled for more than 4 years, and 85% for paients remaining in treatment for over 10 years. These results based on urinalysis support the conclusion of Ball and Ross (1991), based on ASI scores and criminally data, that methadone is an effective treatment modality for opiate addicted individuals.     

The Adjunctive Use of Tricyclics in a Methadone Program

Abstract

The hepatitis-C virus (HCV) spreads rapidly among injection drug users (IDUs) because each act of sharing injection equipment carries a high risk of transmission. IDUs are hard to reach, especially in the early stages of their drug-using careers. IDUs are also poorly organized for self-help. For these three reasons, prevention campaigns that worked against the spread of HIV among gay men will be far less effective against the spread of HCV among IDUs. The best hope for such HCV prevention lies in (1) education of middle and high school youth on parenteral risks, and (2) normalization of needle exchange.     

Development of a Brief Treatment Instrument for Routine Clinical Use with Methadone Maintenance Treatment Clients: The Methadone Treatment Index

Routine measurement of treatment outcome between clinician and client in alcohol and drug user treatment services is an important quality improvement initiative. It is particularly important for clients receiving long-term treatment such as methadone maintenance treatment, as fluctuations in substance use, functioning, and health are to be expected. Although there are a number of standardized alcohol and drug user treatment outcome instruments available for research and clinical use, a key challenge is to develop clinical instruments that will actually be used routinely in busy practice settings by a range of staff. Such instruments need to be brief, acceptable to staff and clients, easy to use, provide immediate feedback, and meet adequate psychometric requirements. This report describes development work undertaken in three studies of the Methadone Treatment Index (MTI). The MTI is a brief instrument comprising measures of recent substance use, aspects of social and behavioral functioning, and physical and psychological health. The MTI was designed in consultation with clinicians and clients for use in monitoring treatment progress with clients receiving methadone maintenance treatment. Key findings were that the MTI was acceptable to clients, produced clinically relevant information, and has satisfactory psychometric properties, although it was not used to measure change in this study. Further evaluation of the MTI on a longitudinal basis is supported.