(NIH) - 5/16/2014 - A national response to the epidemic of prescription opioid overdose deaths was outlined in the New England Journal of Medicine by leaders of agencies in the U.S. Department of Health and Human Services. The commentary calls upon health care providers to expand their use of medications to treat opioid addiction and reduce overdose deaths, and describes a number of misperceptions that have limited access to these potentially life-saving medications. The commentary also discusses how medications can be used in combination with behavior therapies to help drug users recover and remain drug-free, and use of data-driven tracking to monitor program progress.
The commentary was authored by leaders of the National Institute on Drug Abuse (NIDA) within the National Institutes of Health, the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Medicare and Medicaid Services (CMS).
“When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexone are safe and cost-effective components of opioid addiction treatment,” said lead author and NIDA Director Nora D. Volkow, M.D. “These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”
Research has led to several medications that can be used to help treat opioid addiction, including methadone, usually administered in clinics; buprenorphine, which can be given by qualifying doctors External Web Site Policy; and naltrexone, now available in a once-a-month injectable, long-acting form. The authors stress the value of these medications and describe reasons why treatment services have been slow to utilize them. The reasons include inadequate provider education and misunderstandings about addiction medications by the public, health care providers, insurers, and patients. For example, one common, long-held misperception is that medication-assisted therapies merely replace one addiction for another – an attitude that is not backed by the science. The authors also discuss the importance of naloxone, a potentially life-saving medication that blocks the effects of opioids as a person first shows symptoms of an overdose.
The article describes how HHS agencies are collaborating with public and private stakeholders to expand access to and improve utilization of medication-assisted therapies, in tandem with other targeted approaches to reducing opioid overdoses. For example, NIDA is funding research to improve access to medication-assisted therapies, develop new medications for opioid addiction, and expand access to naloxone by exploring more user-friendly delivery systems (for example, nasal sprays). CDC is working with states to implement comprehensive strategies for overdose prevention that include medication-assisted therapies, as well as enhanced surveillance of prescriptions and clinical practices. CDC is also establishing statewide norms to provide better tools for the medical community in making prescription decisions.
“Prescription drug overdoses in the United States are skyrocketing. The good news is we can prevent this problem by stopping the source and treating the troubled,” said co-author and CDC director Tom Frieden, M.D., M.P.H. “It is critical that states use effective prescription drug tracking programs so we can improve prescribing practices and help get those who are abusing drugs into treatment.”
Charged with providing access to treatment programs, SAMHSA is encouraging medication-assisted therapy through the Substance Abuse Prevention and Treatment Block Grant as well as regulatory oversight of medications used to treat opioid addiction. SAMHSA has also developed an Opioid Overdose Toolkit External Web Site Policy to educate first responders in the use of naloxone to prevent overdose deaths. The toolkit includes easy-to-understand information about recognizing and responding appropriately to overdose, specific drug-use behaviors to avoid, and the role of naloxone in preventing fatal overdose.
“SAMHSA’s Opioid Overdose Toolkit is the first federal resource to provide safety and prevention information for those at risk for overdose and for their loved ones,” said co-author and SAMHSA Administrator Pamela S. Hyde, J.D. “It also gives local governments the information they need to develop policies and practices to help prevent and respond appropriately to opioid-related overdose.”
CMS is working to enhance access to medication-assisted therapies through a more comprehensive benefit design, as well as a more robust application of the Mental Health Parity and Addiction Equity Act.
“Appropriate access to medication-assisted therapies under Medicaid is a key piece of the strategy to address the rising rate of death from overdoses of prescription opioids,” said co-author Stephen Cha, M.D., M.H.S., chief medical officer for the Center for Medicaid and CHIP [Children’s Health Insurance Program] Services at CMS. “CMS is collaborating closely with partners across the country, inside and outside government, to improve care to address this widespread problem.”
However, the authors point out that success of these strategies requires engagement and participation of the medical community.
The growing availability of prescription opioids has increased risks for people undergoing treatment for pain and created an environment and marketplace of diversion, where people who are not seeking these medications for medical reasons abuse and sell the drugs because they can produce a high.
More than 16,000 people die every year in this country from prescription opioid overdoses, more than heroin and cocaine combined. According to SAMHSA’s 2012 National Survey on Drug Use and Health External Web Site Policy, almost 2.1 million people in the United States were dependent upon or abusing opioid pain relievers. More information on prescription opioid abuse can be found at: www.drugabuse.gov/publications/research-reports/prescription-drugs.
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA’s DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse.gov. NIDA’s media guide can be found at http://drugabuse.gov/mediaguide, and its new easy-to-read website can be found at http://www.easyread.drugabuse.gov.
Source: National Institutes of Health
Justice Department Clemency Criteria Praised
WASHINGTON, D.C. -- (ACLU) - 4/23/2014 - Deputy Attorney General James Cole announced on April 23 a new set of criteria the Justice Department and White House will use when considering clemency petitions from federal prisoners. The new criteria will help the Justice Department identify federal prisoners who, if sentenced under current sentencing laws and policies, would likely have received a substantially lower sentence.
"Our federal sentencing laws have shattered families and wasted millions of dollars," said Vanita Gupta, ACLU deputy legal director. "Too many people—particularly people of color—have been locked up for far too long for nonviolent offenses. The President now has a momentous opportunity to correct these injustices in individual cases.
If we're ever going to see truly systemic and smart reform of the federal criminal justice, however, we need Congress to step up and pass the Smarter Sentencing Act."
Clemency Project 2014, a working group composed of the Federal Defenders, the American Civil Liberties Union, Families Against Mandatory Minimums, the American Bar Association, and National Association of Criminal Defense Lawyers, as well as individuals active within those organizations, wholeheartedly supports Cole’s announcement and the Justice Department's plans to restore the integrity of the clemency process.
"The doors of the Office of the Pardon Attorney have been closed to petitioners for too long. This announcement signals a truly welcome change; the culture of "no" that has dominated that office is being transformed," said Mary Price, FAMM General Counsel. "We stand ready to assist in any way we can to support petitioners and bring their cases to the attention of the President."
Clemency Project 2014 launched in January after Deputy Attorney General James Cole asked the legal profession to provide pro bono assistance to federal prisoners who would likely have received a shorter sentenced if they'd been sentenced today.
"Clemency Project 2014 marks the beginning of the end of the age of mass incarceration. We must seize this historic opportunity to start the process of remedying decades of cruel and unnecessarily harsh sentencing policies. I call upon the nation’s lawyers, especially the criminal defense bar, to rise to this challenge in an unprecedented effort to restore hope and the prospect of an early return to freedom for the countless deserving individuals who are languishing in federal custody.," NACDL President Jerry Cox said.
Clemency Project members will collaborate to recruit and train attorneys on how to screen for prisoners who meet the criteria laid out by the deputy attorney general. Pursuant to the criteria announced today, candidates eligible for clemency must be:
While Clemency Project 2014 will focus on those cases that clearly fit the broad criteria described by Deputy Attorney General Cole, the groups stress that there are many other federal prisoners whose sentences are grossly disproportionate to the crimes for which they were convicted. The groups will continue to urge the Department of Justice and President Obama to vastly expand use of the clemency power to correct widespread injustice. Similarly, each organization participating in the Project supports legislative action to curtail sentencing laws that continue to cause unjust sentences.
Clemency Project 2014 looks forward to support and participation from other legal and community advocacy groups, and gratefully recognizes the early support of the National Action Network, the Lawyers Committee for Civil Rights and the National Asian Pacific American Bar Association, as well as state bar associations, including the New York State Bar Association, before which Deputy Attorney General Cole first announced this initiative last January.
Lawyers interested in volunteering for the project may do so by writing to clemencyproject@nacdl.org
"Our federal sentencing laws have shattered families and wasted millions of dollars," said Vanita Gupta, ACLU deputy legal director. "Too many people—particularly people of color—have been locked up for far too long for nonviolent offenses. The President now has a momentous opportunity to correct these injustices in individual cases.
If we're ever going to see truly systemic and smart reform of the federal criminal justice, however, we need Congress to step up and pass the Smarter Sentencing Act."
Clemency Project 2014, a working group composed of the Federal Defenders, the American Civil Liberties Union, Families Against Mandatory Minimums, the American Bar Association, and National Association of Criminal Defense Lawyers, as well as individuals active within those organizations, wholeheartedly supports Cole’s announcement and the Justice Department's plans to restore the integrity of the clemency process.
"The doors of the Office of the Pardon Attorney have been closed to petitioners for too long. This announcement signals a truly welcome change; the culture of "no" that has dominated that office is being transformed," said Mary Price, FAMM General Counsel. "We stand ready to assist in any way we can to support petitioners and bring their cases to the attention of the President."
Clemency Project 2014 launched in January after Deputy Attorney General James Cole asked the legal profession to provide pro bono assistance to federal prisoners who would likely have received a shorter sentenced if they'd been sentenced today.
"Clemency Project 2014 marks the beginning of the end of the age of mass incarceration. We must seize this historic opportunity to start the process of remedying decades of cruel and unnecessarily harsh sentencing policies. I call upon the nation’s lawyers, especially the criminal defense bar, to rise to this challenge in an unprecedented effort to restore hope and the prospect of an early return to freedom for the countless deserving individuals who are languishing in federal custody.," NACDL President Jerry Cox said.
Clemency Project members will collaborate to recruit and train attorneys on how to screen for prisoners who meet the criteria laid out by the deputy attorney general. Pursuant to the criteria announced today, candidates eligible for clemency must be:
- serving a federal sentence;
- serving a sentence that, if imposed today, would be substantially shorter;
- have a non-violent history with no significant ties to organized crime, gangs or cartels;
- have served at least 10 years;
- have no significant prior convictions;
- and have demonstrated good conduct.
While Clemency Project 2014 will focus on those cases that clearly fit the broad criteria described by Deputy Attorney General Cole, the groups stress that there are many other federal prisoners whose sentences are grossly disproportionate to the crimes for which they were convicted. The groups will continue to urge the Department of Justice and President Obama to vastly expand use of the clemency power to correct widespread injustice. Similarly, each organization participating in the Project supports legislative action to curtail sentencing laws that continue to cause unjust sentences.
Clemency Project 2014 looks forward to support and participation from other legal and community advocacy groups, and gratefully recognizes the early support of the National Action Network, the Lawyers Committee for Civil Rights and the National Asian Pacific American Bar Association, as well as state bar associations, including the New York State Bar Association, before which Deputy Attorney General Cole first announced this initiative last January.
Lawyers interested in volunteering for the project may do so by writing to clemencyproject@nacdl.org
Atlas details gene activity of prenatal brain
(NIH) - 4/12/2014 - A comprehensive three-dimensional atlas of the developing human brain that incorporates gene activity along with anatomical reference atlases and neuroimaging data has released its first major report online in Nature. This National Institutes of Health (NIH)-funded resource, available to the public, enables researchers to answer questions related to the early roots of brain-based disorders such as autism and schizophrenia.
This big science endeavor, which highlights the transcriptome — when and where genes are turned on in the brain — and anatomy of the human brain during mid-term pregnancy, was undertaken at the Allen Institute for Brain Science in Seattle. It is the first installment of a consortium project funded by the National Institute of Mental Health (NIMH), part of the NIH, called the BrainSpan Atlas of the Developing Human Brain, which aims to profile gene activity throughout the course of brain development.
“Many neuropsychiatric diseases are likely the result of abnormal brain development during prenatal life,” said lead author Ed Lein, Ph.D., of the Allen Institute. “An anatomically precise molecular atlas of the brain during this time period is a first step to understanding how the human brain develops normally and what can go wrong.”
Although animal studies have provided invaluable insights in the basic mechanisms of brain function, there are limitations that make studies based on human tissues, which are very difficult to obtain, incredibly important. One key area is the neocortex, the outermost brain region involved in higher functions such as action and thought. The neocortex is smooth in rodents; in humans and non-human primates, it is much more complexly organized, elaborately folded into grooves and wrinkles called sulci and gyri.
Further differences in developmental compartments of this area exist between humans and non-human primates. The aim of this highly detailed atlas was to analyze all genes at this level of granularity, allowing meaningful analysis of the molecular underpinnings of human cortical development. Many psychiatric disorders show altered gene activity in the cortex, possibly highlighting changes that occurred during development of this region.
Lein and other researchers studied four donated, intact, high-quality human prenatal brains from preterm stillbirths — two from 15–16 weeks and two from 21 weeks post-conception – as a framework for their atlas. Contributing labs provided data from a variety of genomic and imaging techniques.
The BrainSpan Atlas aims to inspire new hypotheses regarding human brain development, and has already led to some surprising findings. For example, the study authors found significant differences between mouse and human brains in the subplate zone, a developmentally transient structure critical for proper cortical development. On the other hand, the researchers expected to find a unique molecular signature for the outer portion of the subventricular zone, an area which is not found in mice and which contains a hugely expanded pool of neuronal stem cells that give rise to our greatly expanded neocortex. Surprisingly, despite its much larger size, no significant differences were found between this zone and the inner portion of this layer that is conserved from mouse to human.
“The BrainSpan Atlas becomes very powerful when one can understand where and when a particular gene is used — for instance, is it active in precursor cells or in the neurons derived from them?” Lein said, who gave the example that autism candidate genes are expressed very early in in the cortex. Knowledge of the time and location of these genes may lead to future treatment targets and early interventions for this brain disorder, he added.
The BrainSpan Atlas already is making inroads in research surrounding human brain development and disease.
“Although the many genes associated with autism and schizophrenia don’t show a clear relationship to each other in the adult brain, the BrainSpan Atlas reveals how these diverse genes are connected in the developing brain,” said NIMH Director Thomas R. Insel, M.D. “Findings of what goes on early in the prenatal brain can lead to the development of biomarkers for diagnosing brain disorders and for matching patients to treatment options most likely to be successful.
“This atlas is a clear example of the progress that can be made when the public and private sectors work together,” Insel said. “On this first anniversary of the BRAIN Initiative, we are encouraged to see the impact the BrainSpan Atlas is already making on brain research.”
The resource is freely available for viewing, searching, and data mining for gene activity patterns as part of the BrainSpan Atlas of the Developing Human Brain Developing Human Brain
, and can also be found via the Allen Brain Atlas data portal Allen Brain Atlas data portal .
Source: National Institutes of Health
This big science endeavor, which highlights the transcriptome — when and where genes are turned on in the brain — and anatomy of the human brain during mid-term pregnancy, was undertaken at the Allen Institute for Brain Science in Seattle. It is the first installment of a consortium project funded by the National Institute of Mental Health (NIMH), part of the NIH, called the BrainSpan Atlas of the Developing Human Brain, which aims to profile gene activity throughout the course of brain development.
“Many neuropsychiatric diseases are likely the result of abnormal brain development during prenatal life,” said lead author Ed Lein, Ph.D., of the Allen Institute. “An anatomically precise molecular atlas of the brain during this time period is a first step to understanding how the human brain develops normally and what can go wrong.”
Although animal studies have provided invaluable insights in the basic mechanisms of brain function, there are limitations that make studies based on human tissues, which are very difficult to obtain, incredibly important. One key area is the neocortex, the outermost brain region involved in higher functions such as action and thought. The neocortex is smooth in rodents; in humans and non-human primates, it is much more complexly organized, elaborately folded into grooves and wrinkles called sulci and gyri.
Further differences in developmental compartments of this area exist between humans and non-human primates. The aim of this highly detailed atlas was to analyze all genes at this level of granularity, allowing meaningful analysis of the molecular underpinnings of human cortical development. Many psychiatric disorders show altered gene activity in the cortex, possibly highlighting changes that occurred during development of this region.
Lein and other researchers studied four donated, intact, high-quality human prenatal brains from preterm stillbirths — two from 15–16 weeks and two from 21 weeks post-conception – as a framework for their atlas. Contributing labs provided data from a variety of genomic and imaging techniques.
The BrainSpan Atlas aims to inspire new hypotheses regarding human brain development, and has already led to some surprising findings. For example, the study authors found significant differences between mouse and human brains in the subplate zone, a developmentally transient structure critical for proper cortical development. On the other hand, the researchers expected to find a unique molecular signature for the outer portion of the subventricular zone, an area which is not found in mice and which contains a hugely expanded pool of neuronal stem cells that give rise to our greatly expanded neocortex. Surprisingly, despite its much larger size, no significant differences were found between this zone and the inner portion of this layer that is conserved from mouse to human.
“The BrainSpan Atlas becomes very powerful when one can understand where and when a particular gene is used — for instance, is it active in precursor cells or in the neurons derived from them?” Lein said, who gave the example that autism candidate genes are expressed very early in in the cortex. Knowledge of the time and location of these genes may lead to future treatment targets and early interventions for this brain disorder, he added.
The BrainSpan Atlas already is making inroads in research surrounding human brain development and disease.
“Although the many genes associated with autism and schizophrenia don’t show a clear relationship to each other in the adult brain, the BrainSpan Atlas reveals how these diverse genes are connected in the developing brain,” said NIMH Director Thomas R. Insel, M.D. “Findings of what goes on early in the prenatal brain can lead to the development of biomarkers for diagnosing brain disorders and for matching patients to treatment options most likely to be successful.
“This atlas is a clear example of the progress that can be made when the public and private sectors work together,” Insel said. “On this first anniversary of the BRAIN Initiative, we are encouraged to see the impact the BrainSpan Atlas is already making on brain research.”
The resource is freely available for viewing, searching, and data mining for gene activity patterns as part of the BrainSpan Atlas of the Developing Human Brain Developing Human Brain
, and can also be found via the Allen Brain Atlas data portal Allen Brain Atlas data portal . Source: National Institutes of Health
Drug Sentencing Guidelines May Be Reduced
WASHINGTON – 4/12/2014 - The U.S. Sentencing Commission voted on April 11 to reduce sentencing guidelines for certain people convicted of nonviolent drug offenses. The amendment would reduce the average sentence for drug traffickers by 11 months, by lowering the drug sentencing guidelines two levels. Attorney General Eric Holder endorsed the change during testimony before the commission last month.
"Our country is slowly but steadily reversing the damage done by the failed, racially biased war on drugs," ACLU Senior Legislative Counse Jesselyn McCurdy said. "The actions taken by the Sentencing Commission . . . are another positive move toward reducing unnecessarily long sentences that have led to bloated, overcrowded prisons. Our criminal justice system is smarter, fairer, and more humane than it was a year ago, and we need to make sure momentum continues in the right direction."
The amendment, along with several others that were passed, will go to Congress for its approval on May 1. Congress has six months to introduce and pass legislation to stop the proposed changes before they become law on November 1.
Source: American Civil Liberties Union
"Our country is slowly but steadily reversing the damage done by the failed, racially biased war on drugs," ACLU Senior Legislative Counse Jesselyn McCurdy said. "The actions taken by the Sentencing Commission . . . are another positive move toward reducing unnecessarily long sentences that have led to bloated, overcrowded prisons. Our criminal justice system is smarter, fairer, and more humane than it was a year ago, and we need to make sure momentum continues in the right direction."
The amendment, along with several others that were passed, will go to Congress for its approval on May 1. Congress has six months to introduce and pass legislation to stop the proposed changes before they become law on November 1.
Source: American Civil Liberties Union
