The Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment recently
announced an error in the Treatment Improvement Protocol (TIP) 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. The correction is noted below as it appears in Chapter 13.

ERRATUM
In Treatment Improvement Protocol (TIP) 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (2005 printing), Chapter 13, page 219, incorrect information about medication treatment for neonatal abstinence syndrome (NAS) was published.

Column 1, line 9 from the bottom, reads “0.4 mg/kg/dose.” It should read “0.4 mg/kg/day.”

Column 1, line 6 from the bottom, reads “0.4 mg/kg/dose.” It should read “0.04 mg/kg/dose.”

In subsequent printings of TIP 43, page 219, the paragraphs regarding this topic have been changed to read:

“If pharmacological management is indicated, several methods have been found useful. The American Academy of Pediatrics Committee on Drugs policy statement on Neonatal Drug Withdrawal (1998) describes several agents for the treatment of NAS including methadone, tincture of opium, paregoric, and morphine. One method (J. Greenspan, Thomas Jefferson University Hospital, Philadelphia, personal communication, October 2006) uses neonatal opium solution (0.4 mg/mL morphine-equivalent; starting dosage, 0.4 mg/kg/day orally in six to eight divided doses [timed with the feeding schedule]). Dosage is increased by 0.04 mg/kg/dose until control is achieved or a maximum of 2.0 mg/kg/day is reached. If Neonatal Abstinence Scores stay high but daily dosage nears maximum, symptoms are reassessed and concurrent phenobarbital therapy considered. When control is achieved, the dosage is continued for 72 hours before pharmacological weaning, in which dosages are decreased 10 percent daily or as tolerated. When 0.2 mg/kg/day is reached, medication may be stopped. Decisions about dosage decrease during pharmacological weaning are based on Neonatal Abstinence Scores, weight, and physical exams.”

The Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, regrets any confusion these errors have caused and asks for your assistance to correct the text in all copies of the first (2005) printing of TIP 43 to which you have access. Please help ensure that word of this correction reaches as many TIP 43 readers as possible.

Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs Click here to download For hard copies, please contact SAMHSA's National Clearinghouse for Drug and Alcohol Information at 1-800-729-6686 or click here. We encourage every methadone treatment program and state regulatory oversight office, which has jurisdiction in this area to obtain as many copies as needed in order to ensure that all programs have the most current clinical information available.

SAMHSA Releases New Treatment Improvement Protocol (TIP) on Medication Assisted Treatment for Drug Abuse (October 25, 2005)

The Treatment Improvement Protocol (TIP 43) provides guidance to treatment providers, physicians and other medical personnel in using medication assisted treatment for individuals who are addicted to opiates. It is encouraged that all parties gain access to this valuable document, which combines four. We are grateful to SAMHSA/CSAT for their vision in providing the most current information to our treatment system previously published TIPs on the topic, beginning with the first TIP, which appeared in 1993 (State Methadone Treatment Guidelines). It is an extremely informative and well organized document and one that will assist treatment providers in ensuring that patients are getting access to the best care possible. For ordering instructions, please click here.

SAMHSA's Press Release This press release is clear in underscoring the importance of providing supportive services, such as counseling, mental health and other medical services in addition to being certain that the clinicians understand the basic principles of stabilizing the patient on therapeutic doses of medication to treat opiate addiction.

HBO Documentary Further Stigmatizes Methadone Treatment
The HBO documentary “Methadonia” follows the lives of eight people, who are struggling through various stages of their addiction and treatment. AATOD’s perspective is represented in its Press Statement of October 3, 2005. AATOD is of the judgment that the people, who are portrayed in the film, do not represent the majority of the patients, who are doing well in methadone treatment programs throughout the country. The majority are working, remaining drug-free and paying for their own care. These patients hold responsible jobs and are tax-paying citizens and community members. We are working with state provider associations, individual program members, patient advocacy groups and federal and state agencies as a means of responding to the negative message of this documentary.

	HBO Documentary Further Stigmatizes Methadone Treatment (AATOD Press Release – October 3, 2005)
	Model Letters to Patients - Joan E. Zweben, Ph.D. (Executive Director – The 14th Street   Clinic & Medical Group) - Michael Rizzi (President/CEO – CODAC Behavioral Healthcare)
	The Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center Perspective – Written by Robert G. Newman, M.D. (Director)

Hurricane Katrina
We have uploaded several documents to this website with regard to Hurricane Katrina and the continued treatment of methadone patients in the affected Gulf States.

We have worked with patient advocacy groups and treatment providers since the Hurricane occurred. Many program staff worked extremely long hours to admit such a large number of patients to their facilities. A number of state offices, especially in Texas and Louisiana, have provided great leadership in ensuring that patients will receive continued treatment until they will be able to return to New Orleans.

We also know that other programs outside of New Orleans were affected and we understand that similar arrangements have been made in treating such patients.

AATOD will be developing a comprehensive written report to the federal agencies and State Methadone Authorities.

	Letter from Todd Rosendale, M.A. (Public Health Advisor – CSAT/SAMHSA) regarding emergency medication for patients of programs impacted by Hurricane. (8/31/05).
	Guidance letter by Mark W. Parrino, M.P.A. (President – AATOD) to treatment programs through the country.
	Recommendations by Charles G. Curie, M.A., A.C.S.W. (Administrator – SAMHSA/CSAT) to treatment programs providing additional guidance in treating patients who have been displaced through Hurricane Katrina (September 9, 2005).
	Latest memo by Mark Parrino to the field, tracking which programs are treating patients and what services are being rendered. (September 28, 2005).

DEA Drug Theft and Loss Report (PDF)
The Drug Enforcement Administration (DEA) released a major report on the theft and loss of methadone hydrochloride products for calendar years 2001 through 2003. It is the first time that such information has been released into the public domain. It provides extremely useful data about the theft and loss of different methadone products and represents an extremely useful report for policymakers. Click here to view report.

Methadone Associated Mortality Report
This report was prepared by a panel of federal and state agency officials and experts in the addiction treatment field clearly documents that the overwhelming majority of the methadone attributed deaths were in fact associated with the improper use of methadone as an analgesic and distributed through pharmacies as opposed to properly medicated patients receiving comprehensive treatment services in federally licensed methadone programs. Please read the links below to learn more about these groundbreaking findings. Click here to view report.

	Methadone Deaths Not Linked to Misuse of Methadone from Treatment Centers (AATOD Press Release - Feb. 10, 2004)
	Remarks by Mark Parrino These remarks were made at the Pain and Chemical Dependency Conference on February 6, 2004, the location where the results of the report were unveiled.

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