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.

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💻 View the #aatod2024 Conference Video Message from Ann Jamieson, MS,LADC/MH - AATOD’s Plenary Chair.

😊 We couldn’t be more excited about what we have in store for you next week in the spectacular city of Las Vegas where we will convene our conference!

🎤 You will not want to miss the three impressive plenary sessions that have been organized to deliver you extraordinary presentations for your educational purposes. These Plenary Sessions will cover a range of topics that highlight our conference theme, “Treating Opioid Use Disorder: So Much More Than Medication.” We have packed a lot of information into the plenary sessions and are excited to present the policies and strategies in Nevada and nationally.

Join us in Las Vegas by registering for the #aatod2024 Conference ➡️ www.aatodconference.com.
  • Register for the #aatod2024 Conference ➡️ www.aatodconference.com

⭐️ Conference Program Spotlight ⭐️
We know that opioid use disorder (OUD) knows no geographic boundaries. And, while there are countless initiatives, projects, policy reviews, opportunities, and challenges here in the United States, others around the world are facing and dealing with these same issues as well as successes that will be shared at the conference. 
 
Because we believe it is important and imperative to understand the good and essential work that is being done world-wide, Dr Maremmani and Mike Rizzi (AATOD International Chair) invite you to not only come to the conference but to join us at our Sunday (5/19) International Symposium. Respected international colleagues will address responses and findings related to treatment, recovery, and research in their countries. There will also be a special International Workshop on Tuesday, 5/21.
Welcome to Las Vegas. We invite you to attend this evening’s AATOD Board meeting ➡️ bit.ly/4apbmVt #aatod2024
Welcome to Las Vegas. We invite you to attend this evening’s AATOD Board meeting ➡️ bit.ly/4apbmVt #aatod2024
2 days ago
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Join us for the highly acclaimed 8-hour clinician’s course which convenes on Sunday, May 19, 2024 ➡️ bit.ly/3UOKtVi
#aatod2024
Join us for the highly acclaimed 8-hour clinician’s course which convenes on Sunday, May 19, 2024 ➡️ bit.ly/3UOKtVi #aatod2024
3 days ago
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📰 AATOD Unites Global Leaders in Opioid Use Disorder Treatment for Pivotal Las Vegas Summit 
➡️https://prn.to/3wEvR2G #OUD #somuchmorethanmedication #aatod2024
📰 AATOD Unites Global Leaders in Opioid Use Disorder Treatment for Pivotal Las Vegas Summit ➡️https://prn.to/3wEvR2G #OUD #somuchmorethanmedication #aatod2024
4 days ago
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💻 Welcome Message from Dr. Dinita Smith, Psy.D, MSW - #aatod2024 Conference Chair Thank you to our generous Conference Sponsors, Hosts, Exhibitors, Keynote Speakers, Presenters, Volunteers, and the entire Conference Planning Committee. Online registration is still available. We look forward to welcoming you to Las Vegas!
4 days ago
View on Instagram |
4/10
Post & Hashtag 📸 
We would love to hear about your #aatod2024 conference experience on social media.
Post & Hashtag 📸 We would love to hear about your #aatod2024 conference experience on social media.
5 days ago
View on Instagram |
5/10
Conference Program Spotlight - Exhibits
The #aatod2024 Conference will attract over 1,600 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. Visit the AATOD Exhibit Hall for networking opportunities, to learn about new products & services and for guidance on how to improve patient treatment ➡️ bit.ly/3yi8T1M.
Conference Program Spotlight - Exhibits The #aatod2024 Conference will attract over 1,600 physicians, social workers, nurses, counselors, program administrators, executive directors, and other treatment providers from many countries. Visit the AATOD Exhibit Hall for networking opportunities, to learn about new products & services and for guidance on how to improve patient treatment ➡️ bit.ly/3yi8T1M.
6 days ago
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6/10
May 7, 2024 = #NationalFentanylAwarenessDay #JustSayKNOW
➡️ fentanylawarenessday.org

As many of you know, the #aatod2024 Conference is just one week away. Our impressive conference program consists of 2 Pre-Conference sessions, 4 Poster Author sessions and 1 Hot Topic Roundtable addressing the urgent problem of illicit fentanyl. These educational sessions are open to all conference attendees. 

Please visit our conference program for more details ➡️ bit.ly/3Ue57Q6
May 7, 2024 = #NationalFentanylAwarenessDay #JustSayKNOW ➡️ fentanylawarenessday.org As many of you know, the #aatod2024 Conference is just one week away. Our impressive conference program consists of 2 Pre-Conference sessions, 4 Poster Author sessions and 1 Hot Topic Roundtable addressing the urgent problem of illicit fentanyl. These educational sessions are open to all conference attendees. Please visit our conference program for more details ➡️ bit.ly/3Ue57Q6
1 week ago
View on Instagram |
7/10
You won’t want to miss these 3 POWERFUL Plenary Sessions ready to set the stage in Las Vegas less than 2 weeks. Register today for the #aatod2024 Conference, the world's premier training conference event for the Treatment of Opioid Use Disorder ➡️www.aatodconference.com⬅️
You won’t want to miss these 3 POWERFUL Plenary Sessions ready to set the stage in Las Vegas less than 2 weeks. Register today for the #aatod2024 Conference, the world's premier training conference event for the Treatment of Opioid Use Disorder ➡️www.aatodconference.com⬅️
You won’t want to miss these 3 POWERFUL Plenary Sessions ready to set the stage in Las Vegas less than 2 weeks. Register today for the #aatod2024 Conference, the world's premier training conference event for the Treatment of Opioid Use Disorder ➡️www.aatodconference.com⬅️
You won’t want to miss these 3 POWERFUL Plenary Sessions ready to set the stage in Las Vegas less than 2 weeks. Register today for the #aatod2024 Conference, the world's premier training conference event for the Treatment of Opioid Use Disorder ➡️www.aatodconference.com⬅️
2 weeks ago
View on Instagram |
8/10
📣 Announcing the AMAZING Line-Up of Plenary Speakers 💻 View the #aatod2024 Conference Video Message from Ann Jamieson, MS,LADC/MH - AATOD’s Plenary Chair. 😊 We couldn’t be more excited about what we have in store for you next week in the spectacular city of Las Vegas where we will convene our conference! 🎤 You will not want to miss the three impressive plenary sessions that have been organized to deliver you extraordinary presentations for your educational purposes. These Plenary Sessions will cover a range of topics that highlight our conference theme, “Treating Opioid Use Disorder: So Much More Than Medication.” We have packed a lot of information into the plenary sessions and are excited to present the policies and strategies in Nevada and nationally. Join us in Las Vegas by registering for the #aatod2024 Conference ➡️ www.aatodconference.com.
2 weeks ago
View on Instagram |
9/10
Register for the #aatod2024 Conference ➡️ www.aatodconference.com

⭐️ Conference Program Spotlight ⭐️
We know that opioid use disorder (OUD) knows no geographic boundaries. And, while there are countless initiatives, projects, policy reviews, opportunities, and challenges here in the United States, others around the world are facing and dealing with these same issues as well as successes that will be shared at the conference. 
 
Because we believe it is important and imperative to understand the good and essential work that is being done world-wide, Dr Maremmani and Mike Rizzi (AATOD International Chair) invite you to not only come to the conference but to join us at our Sunday (5/19) International Symposium. Respected international colleagues will address responses and findings related to treatment, recovery, and research in their countries. There will also be a special International Workshop on Tuesday, 5/21.
Register for the #aatod2024 Conference ➡️ www.aatodconference.com ⭐️ Conference Program Spotlight ⭐️ We know that opioid use disorder (OUD) knows no geographic boundaries. And, while there are countless initiatives, projects, policy reviews, opportunities, and challenges here in the United States, others around the world are facing and dealing with these same issues as well as successes that will be shared at the conference. Because we believe it is important and imperative to understand the good and essential work that is being done world-wide, Dr Maremmani and Mike Rizzi (AATOD International Chair) invite you to not only come to the conference but to join us at our Sunday (5/19) International Symposium. Respected international colleagues will address responses and findings related to treatment, recovery, and research in their countries. There will also be a special International Workshop on Tuesday, 5/21.
2 weeks ago
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10/10

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