Report from Italy

The Dreaded Transition from Prescription Pain Medications to Heroin Still Seems Almost Non-Existent

Written by Matteo Pacini and Icro Maremmani G. De Lisio Institute of Behavioral Sciences, Pisa, Italy EU

In Italy, opioid compounds are authorized for two indications: pain control and opiate addiction (in this latter case, just oral methadone and buprenorphine. Currently, there is no major issue of pharmaceutical opiate abuse, nor has there ever been one. It may be though that this kind of abuse is subtly growing since cases of primary pharmaceutical opiate abuse have been documented, as well as the case of switching abuse from street opiates to pharmaceutical opiates {Maremmani, 2015 #780}.

Literature data show that slow-acting compounds have no abuse liability property. Italian pain specialists instead complain about the opposite problem. Because of prejudice about the possibility to have to do with abusing patients, Italian doctors tend to avoid opiate prescription, when possible. The fact that such prescriptions are subject to monitoring is also a barrier and may justify the reluctant attitude of physicians to engage in repeated opioid prescription, especially to new patients. As a consequence, opiate prescription in Italy is mostly limited to chronic pain of terminal diseases or severe pain which has not shown response to other painkillers, along with a pyramid algorithm of choice, topped by opiates. Tramadol and codeine (in a combo with paracetamol) may be the only exceptions, also because of more available prescription modalities (low potency opiates). Although cases of chronic abuse of such products are possible, no evidence of an increased treatment demand was registered. Such an index is reliable since private doctors and GP’s would not be able to handle opiate addiction treatment on their own, without collaborating with public centres. Physicians do not seem so aware of the safety of abuse-proof preparations, nor they are willing to deepen their knowledge of opiate pharmacology and clinical use.

Private prescription, on the other hand, would not include opiates on general grounds, and people can obtain non-opioid painkiller prescription quite quickly for free through the public health system. Diversion of prescriptions is possible but would be addressed to people who already abuse, or concern single cases of abuse. Diversion from fake prescriptions to the black market has not become an issue yet, probably due to the possibility to resort to the deep web and leave no trace.

Eventually, the use of high potency opiates, such as fentanyl, is usually limited to health professionals, who supply themselves from their workplace or through fake prescriptions.

References:
Maremmani I., Guareschi M., Deruvo G., Somaini L., Maremmani A.
G. I., Green J., Mcbride K., Dart R. C. (2015): Prescription opioids (substitution medications and pain medications) in patients looking for Opioid
Agonist Treatment in Northern and Southern Italy, using a 18-month survey methodology. Heroin Addict Relat Clin Probl. 17(1): 33-42.

Visit the aatod conference website for more details…www.aatodconference.com.

@aatod1984
  • 3/28 Expanding Access to #Methadone in Correctional Facilities will focus on opportunities to expand access to methadone in correctional facilities, including recent developments with the SAMHSA 2024 final rule on the use of methadone.

Register ➡️ bit.ly/3Vz1RPE
  • Invitation to SAMHSA Webinars on 42 CFR Part 8 💻 

On February 2, 2024, the final rule for 42 CFR Part 8 was published. The effective date for these regulations is April 2, 2024, with an implementation date of October 2, 2024. 

In preparation for implementation of the revisions, SAMHSA will provide two preliminary webinars for OTPs.  The first will focus on administrative areas; the second will focus more on clinical content. These will be held on March 20th (from 2-3pm EST) and March 27th, 2024 (from 2- 3pm EST).  

REGISTER ➡ https://conta.cc/3TF9CSQ

View the final rule ➡ https://lnkd.in/e_iu-AtG.

There will be an opportunity to receive an overview of the rule changes and discuss with SAMHSA the implications of the changes. 

We encourage you to attend these important meetings to assist you in determining how you will need to prepare for full implementation of these regulations. 

This webinar series will be moderated by Mark W. Parrino, MPA (AATOD President). Speakers include Yngvild Olsen, MD, MPH (Director - CSAT), Robert Baillieu, MD, MPH, FAAFP (Physician and Senior Advisor - SAMHSA/CSAT, and Patti Juliana, PhD, LCSW
(Director - CSAT’s Division of Pharmacologic Therapies).

The presentations will be followed by Q&A, and these webinars will become available to the public for On-Demand viewing via the AATOD website. Certificates of Attendance will be provided per request.
  • Don’t miss out on the chance to show your support, share your products/services and secure your sponsorship at the AATOD 2024 Conference, �The world’s premier training conference event for the Treatment of Opioid Use Disorder. #aatod2024

The 2024 AATOD Conference will attract over 1,600 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. The registrants are decision-makers with purchasing power for their treatment centers and are looking for new products, services, and information to improve their patient treatment.

To become an exhibitor today —> https://bit.ly/48ZKMRX
  • TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION

💻 View the latest Conference Video Message from AATOD's President, Mark W. Parrino bit.ly/48y815w,
for the most up-to-date details regarding the upcoming #aatod2024 Conference -
The world's premier training conference event for the treatment of Opioid Use Disorder. #OUD 

Registration ➡️ www.aatodconference.com
  • TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
  • #aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
  • Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
  • Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
  • Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
  • Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
3/28 Expanding Access to #Methadone in Correctional Facilities will focus on opportunities to expand access to methadone in correctional facilities, including recent developments with the SAMHSA 2024 final rule on the use of methadone.

Register ➡️ bit.ly/3Vz1RPE
3/28 Expanding Access to #Methadone in Correctional Facilities will focus on opportunities to expand access to methadone in correctional facilities, including recent developments with the SAMHSA 2024 final rule on the use of methadone. Register ➡️ bit.ly/3Vz1RPE
1 day ago
View on Instagram |
1/10
Invitation to SAMHSA Webinars on 42 CFR Part 8 💻 

On February 2, 2024, the final rule for 42 CFR Part 8 was published. The effective date for these regulations is April 2, 2024, with an implementation date of October 2, 2024. 

In preparation for implementation of the revisions, SAMHSA will provide two preliminary webinars for OTPs.  The first will focus on administrative areas; the second will focus more on clinical content. These will be held on March 20th (from 2-3pm EST) and March 27th, 2024 (from 2- 3pm EST).  

REGISTER ➡ https://conta.cc/3TF9CSQ

View the final rule ➡ https://lnkd.in/e_iu-AtG.

There will be an opportunity to receive an overview of the rule changes and discuss with SAMHSA the implications of the changes. 

We encourage you to attend these important meetings to assist you in determining how you will need to prepare for full implementation of these regulations. 

This webinar series will be moderated by Mark W. Parrino, MPA (AATOD President). Speakers include Yngvild Olsen, MD, MPH (Director - CSAT), Robert Baillieu, MD, MPH, FAAFP (Physician and Senior Advisor - SAMHSA/CSAT, and Patti Juliana, PhD, LCSW
(Director - CSAT’s Division of Pharmacologic Therapies).

The presentations will be followed by Q&A, and these webinars will become available to the public for On-Demand viewing via the AATOD website. Certificates of Attendance will be provided per request.
Invitation to SAMHSA Webinars on 42 CFR Part 8 💻 On February 2, 2024, the final rule for 42 CFR Part 8 was published. The effective date for these regulations is April 2, 2024, with an implementation date of October 2, 2024. In preparation for implementation of the revisions, SAMHSA will provide two preliminary webinars for OTPs.  The first will focus on administrative areas; the second will focus more on clinical content. These will be held on March 20th (from 2-3pm EST) and March 27th, 2024 (from 2- 3pm EST).  REGISTER ➡ https://conta.cc/3TF9CSQ View the final rule ➡ https://lnkd.in/e_iu-AtG. There will be an opportunity to receive an overview of the rule changes and discuss with SAMHSA the implications of the changes. We encourage you to attend these important meetings to assist you in determining how you will need to prepare for full implementation of these regulations. This webinar series will be moderated by Mark W. Parrino, MPA (AATOD President). Speakers include Yngvild Olsen, MD, MPH (Director - CSAT), Robert Baillieu, MD, MPH, FAAFP (Physician and Senior Advisor - SAMHSA/CSAT, and Patti Juliana, PhD, LCSW (Director - CSAT’s Division of Pharmacologic Therapies). The presentations will be followed by Q&A, and these webinars will become available to the public for On-Demand viewing via the AATOD website. Certificates of Attendance will be provided per request.
1 week ago
View on Instagram |
2/10
Don’t miss out on the chance to show your support, share your products/services and secure your sponsorship at the AATOD 2024 Conference, �The world’s premier training conference event for the Treatment of Opioid Use Disorder. #aatod2024

The 2024 AATOD Conference will attract over 1,600 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. The registrants are decision-makers with purchasing power for their treatment centers and are looking for new products, services, and information to improve their patient treatment.

To become an exhibitor today —> https://bit.ly/48ZKMRX
Don’t miss out on the chance to show your support, share your products/services and secure your sponsorship at the AATOD 2024 Conference, �The world’s premier training conference event for the Treatment of Opioid Use Disorder. #aatod2024 The 2024 AATOD Conference will attract over 1,600 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. The registrants are decision-makers with purchasing power for their treatment centers and are looking for new products, services, and information to improve their patient treatment. To become an exhibitor today —> https://bit.ly/48ZKMRX
2 weeks ago
View on Instagram |
3/10
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION

💻 View the latest Conference Video Message from AATOD's President, Mark W. Parrino bit.ly/48y815w,
for the most up-to-date details regarding the upcoming #aatod2024 Conference -
The world's premier training conference event for the treatment of Opioid Use Disorder. #OUD 

Registration ➡️ www.aatodconference.com
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION 💻 View the latest Conference Video Message from AATOD's President, Mark W. Parrino bit.ly/48y815w, for the most up-to-date details regarding the upcoming #aatod2024 Conference - The world's premier training conference event for the treatment of Opioid Use Disorder. #OUD Registration ➡️ www.aatodconference.com
1 month ago
View on Instagram |
4/10
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024 TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD. For registration and hotel information ➡️ bit.ly/3Ue57Q6. We look forward to seeing you in Las Vegas!
2 months ago
View on Instagram |
5/10
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6. The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment. The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders. We hope to see you in Las Vegas!
2 months ago
View on Instagram |
6/10
Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
Patient access to OTPs saves lives every day. AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
4 months ago
View on Instagram |
7/10
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. “Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA Read More ➡️ bit.ly/3tKb1gy
5 months ago
View on Instagram |
8/10
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery. Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1 For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
6 months ago
View on Instagram |
9/10
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. Register ➡️ bit.ly/461CkkG
6 months ago
View on Instagram |
10/10

Invitation to SAMHSA Webinars on 42 CFR Part 8 💻
In preparation for implementation of the revisions, #SAMHSA will provide two preliminary #webinars for #OTPs - administrative areas & clinical content. Register ➡️ https://conta.cc/3TF9CSQ.

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