Thirty Years of TheASAMCriteria: A Report Card.

The American Society of Addiction Medicine Criteria (ASAM) Criteria has profoundly influenced addiction treatment and reimbursement, with its growing toolkit of ASAM CONTINUUM software, ASAM-CARF Level of Care Certification Program, educational programs, and publications. A retrospective accounting shows that the field has made considerable strides, but has far to go. Providers and payers still need to (1) improve consistency in their use of standardized, multidimensional patient assessment; (2) improve flexibility in providing and reimbursing person-centered, individualized services; (3) improve measurement in treatment planning for determination of progress; and (4) focus on outcomes and value in the care they deliver.

Safety and pharmacokinetics of the anti-orthopoxvirus compound ST-246 following a single daily oral dose for 14 days in human volunteers.

ST-246 is being evaluated as a treatment for pathogenic orthopoxvirus infections in humans. To this end, a phase 2, double-blind, randomized, placebo-controlled, multicenter trial was conducted to assess the safety, tolerability, and pharmacokinetics (PK) of ST-246 when administered as a single daily oral dose (400 mg or 600 mg) for 14 days in fed adult volunteers. ST-246 was safe and well tolerated, with no deaths or serious adverse events reported during the study.

Contribution of a heating element to topical anesthesia patch efficacy prior to vascular access: results from two randomized, double-blind studies.

Context: Pain associated with superficial procedures, including intravenous (IV) access procedures, should be prevented when possible, especially in children.

Objectives: To evaluate a topical local anesthetic patch containing lidocaine 70 mg/tetracaine 70 mg with a heating element designed to warm the skin and facilitate rapid delivery of local anesthetics into the skin. The pilot study was designed to provide data to inform the design of the definitive study to evaluate the impact of controlled heat on the efficacy of the lidocaine/tetracaine patch (patch) when applied before IV cannulation.

Ethnic sensitivity study of fingolimod in white and Asian subjects.

Objective: The authors compared the pharmacokinetics and pharmacological effects of the immunomodulator fingolimod in healthy white and Asian subjects for potential ethnic differences.

Methods: White and Asian (Japanese) healthy subjects were demographically matched for sex, age and weight. Subjects received single 1.

Rethinking patient placement: the human service matrix model for matching services to needs.

The improvements in both clinical and fiscal outcomes necessary for prosperity in the current healthcare environment require a rethinking of our conceptual approaches to patient assessment, treatment planning, and service delivery. Conventional practice rests in part on the Level of Care concept, which assigns intensities of both clinical services and treatment settings in a linked manner according to impairment severity. Although this approach has resulted in more efficient matching of resources to needs, it is overly restrictive, and does not speak directly to the need to match both healthcare and social services (including treatment setting) to human needs for treatment to be successful.

The effect of managed care on the treatment outcome of substance use disorders.

This study examined the effect of managed care and other reimbursement mechanisms on the outcome of substance abuse treatment at a single treatment facility. A retrospective review of 1594 patient records yielded treatment utilization, diagnostic, and demographic data. Recidivism rates for intensive managed care, traditional managed care, private pay, and state-funded groups of patients were compared.

Discriminating placebo and drug in generalized anxiety disorder (GAD) trials: single vs. multiple clinical raters.

A multisite, double-blind, placebo-controlled study was made of 177 patients with the diagnosis of generalized anxiety disorder. After a 1-week placebo lead-in, they were randomized to 4 weeks of treatment by placebo or one of two doses of a novel, nonsedating compound that had demonstrated reduction of fear-avoidance behavior in animals. Efficacy was not demonstrated at a significant level.

Treatment Issues in Adolescent Substance Use and Addictions: Options, Outcome, Effectiveness, Reimbursement, and Admission Criteria.

Cost-reduction strategies and a lack of overall perspective have created a potentially dangerous climate for the treatment of the various forms of adolescent substance abuse. The authors argue for a holistic approach that focuses on demographics, family issues, school functioning, and other related problems as well as on careful evaluation of treatment outcome and criteria for admission, continued stay, and discharge from treatment programs.

The first shall be last; but can the last be first?

The State of Hawaii has long prided itself on being a leader in the nation in its provision of mental health and other social and health services. In 1986, and again in 1988, the Public Citizen Health Research Group, a Ralph Nader affiliated entity, ranked Hawaii 51st among the states and the District of Columbia in its care of the seriously mentally ill. Initial reaction within the mental health community in Hawaii was primarily one of perplexity and disbelief.

An instrument for treatment progress and matching: the recovery attitude and treatment evaluator (RAATE).

Clinicians are under increasing pressure to contain costs and to justify their triage decisions and addiction treatment settings to third party payors. Treatment-effectiveness research points to the need for better patient/treatment matching decisions and systems of care. The Recovery Attitude and Treatment Evaluator (RAATE) is an instrument to develop a profile of the severity of the patient's illness.