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ASAM Cautions White House Against Over-Hasty Approval of Tobacco Settlement G Newsletter of The American Society of Addiction Medicine ASAM Cautions White House Against Over-Hasty Approval of Tobacco Settlement G. Douglas Talbott, M.D. On behalf of the officers and members of munity be able to examine what is being rec­ the Society, I have sent the following letter ommended. to President Clinton, commenting on the proposed tobacco settlement: The health of the nation is too important for this deal to be done in haste. Any legislative Dear President Clinton: proposal which comes out of the discussions the Administration is having with the liti­ Tobacco is both the leading cause of pre­ gants in the state suits should be fully aired ventable death and the leading cause of ad­ and carefully, deliberately reviewed. More­ diction in the United States today. Working over, the state litigation should be encour­ out a solution to this problem is too impor­ aged to continue to unfold. The state case in tant for it to be done in haste, and it seems Minnesota is scheduled to begin in January, -olly to do it before all the facts are known. and it promises to show more clearly than any other the way these companies behave The manufacturers of tobacco products have and the degree to which they can be trusted. never been accountable for the harm their products cause. The main objective of any The tobacco industry must become account­ legislation in this area must be, finally, to G. Douglas Talbott, M.D. able. Legislation to resolve the tobacco is­ hold the industry accountable. This is the sues now on the public agenda should be most certain way to reduce the terrible toll turbed by the seeming haste with which considered with great deliberation. Hasty of illness and death from these products. things are moving forward on this matter. action will lead to needless illness and death. Unfortunately, the Proposed Resolution ne­ Artificial early deadlines to complete action gotiated by some of the states' Attorneys The Society is especially concerned that on this matter only work to the advantage of General with the larger manufacturers falls some of the short-term gains, such as the tobacco product manufacturers. They are far short of this goal. changes in advertising, are being oversold not in the public interest. to members of Congress and the public as While the American Society of Addiction being of greater public health importance (Copies ofthis letter also were delivered to Medicine is open to the possibility that new than they actually are. Vice President Gore, ONDCP Director Gen. federal legislation might make the industry Barry McCaffrey, members of Congress, and accountable, the Society is profoundly dis- The Proposed Resolution has been found John Slade, M.D., FASAM, Chair of the seriously wanting by every medical and pub­ ASAM Nicotine Dependence Committee.) lic health group of which the Society is I N S I D E aware. Rumors abound of negotiations which are leading to changes in the terms, "The Society is especially • Practice Guidelines I page 2 but there has yet been no public examina­ • Addiction Medicine News I page 3 tion of these new terms. concerned that some of the • Money for Treatment II/ page 4 short term gains ... are being • Spirituality and HIV I page 5 Any revision to the original proposal will oversold to members of • New in Print I page 6 have to be examined by all interested par­ • Alcohol Withdrawal Guideline I page 7 ties with great care. There is a profound im­ Congress and the public A· ASAM On Line I page 15 balance here: the tobacco companies are in­ as being of greater public •• Chapter Update/ page 16 timately involved in the present discussions, health importance than they • Pain Management Resources I page 17 but the public health community is not. Only • Ruth Fox Fund I page 18 after the industry reaches agreement with the actually are." • Career Opportunities I page 19 Administration will the public health com- o PRACTICE GUIDELINES JAMA PUBLISHES ASAM PRACTICE GUIDELINE ON MANAGEMENT OF ALCOHOL WITHDRAWAL Michael Mayo-Smith, M.D. Significant advances in the management of alcohol withdrawal and treatment of alcohol American Society dependence were signaled with publication in the Journal of the American Medical Asso­ of ciation of a clinical practice guideline developed by ASAM on the "Pharmacologic Man­ Addiction Medicine agement of Alcohol Withdrawal: A Meta-analysis and Evidence-Based Practice Guide­ line" (lAMA 1997;278(2):144-151). The ASAM Guideline was developed by a group of ASAM is a specialty society of physicians physicians including specialists in addiction medicine, primary care physicians and re­ concerned about alcoholism and other searchers in alcohol withdrawal drawn from institutions around the country including addictions and who care for persons Harvard, Yale, and Johns Hopkins Medical Schools. The evidence-based process used in affected by these illnesses. developing the Guideline incorporated the latest recommendations on clinical practice guidelines from such organizations as the Institute of Medicine, the Agency for Health ASAM News Care Policy and Research, and the American Medical Association. is an official publication of the American Society of Addiction Medicine, The review demonstrated that a certain class of medications, the benzodiazepines, have and is published six times a year. been proven to both lessen the severity of alcohol withdrawal and prevent major complica­ Please direct all editorial and advertising tions including seizures and delirium tremens. In addition, it was found that individualiz­ ,I' inquiries to ASAM News, c/o the ASAM office. ing therapy using objective withdrawal seve1ity scores greatly reduced the amount of medi­ cation needed, and the duration of treatment, without lessening safety. Surveys have shown Officers that this approach is largely underutilized in the field. President I! G. Douglas Talbott, M.D. For your copy of ASAM's new Practice Guideline on the Pharmacologic Management of Alcohol Withdrawal, i President-Elect Marc Galanter, M.D., FASAM see the pull-out section beginning on page 7 of this issue of ASAM News. II Immediate Past President David E. Smith, M.D., FASAM The Guideline, derived from a careful analysis of published scientific studies, is strongly A I' evidence-based. All scientific studies published in the medical literature regarding phar-­ Secretary macologic management of alcohol withdrawal were identified and carefully reviewed. While Andrea G. Barth well, M.D. previous individual studies have suggested that benzodiazepines lessened the severity of Treasurer alcohol withdrawal and prevent major complications, the opportunity to pull together a James W. Smith, M.D. large number of studies from the literature and combine their results, allowed this finding I to stand out in a striking way. The review also found that, although dozens of other medi­ Chair, Publications Committee I Elizabeth F. Howell, M.D. cations have been used to treat alcohol withdrawal, none have been proven to be as effec­ tive as the benzodiazepines. Newsletter Review Board LeClair Bissell, M.D. This Guideline is one of several evidence-based guidelines being developed by ASAM's Sheila B. Blume, M.D. Committee on Practice Guidelines to strengthen the scientific foundation of addiction treat­ Max A. Schneider, M.D. ment and improve the care of patients with these disorders throughout the country. Marvin Seppala, M.D. Executive Vice PresidenUCEO James F. Callahan, D.P.A. VOTE 425 ON THE AMA SPECIALTY SOCIETY BALLOT Founding Editor, 1985-1995 Michael M. Miller, M.D., ASAM Delegate to the AMA Lucy Bany Robe The American Medical Association is again asking AMA member physicians to indi­ cate the medical specialty society they want to represent them in the AMA House of Editor Delegates. Bonnie B. Wilford Ballots must be received by December 31 , 1997. Voting can be done in several ways: Subscriptions Free to ASAM members; 0 Faxing a ballot reply card that was attached to the October 13 issue of AMNews; $25 a year (6 issues) to non-members. Order from the ASAM office at 0 Calling a toll-free phone number: 888/200-5309; or 30 l/656-3920, or Fax 301/656-3815. E-Mail: [email protected] 0 E-mailing the choice to [email protected]. e , http://www.asam.org However you cast your ballot, remember to "Vote 425" for ASAM as your representa­ 4601 North Park Avenue Upper Arcade, Suite 101 tive medical specialty society! Chevy Chase, MD 20815 - ASAMNews 2 October I November 1997 ADDICTION MEDICINE NEWS MILITARY MANAGED CARE HEROIN USE IN U.S. DOUBLED SINCE 1994 ewiLL USE ASAM Heroin use has never been higher in the U.S., and it is spreading rapidly from small towns to major cities, according to a report pub­ "GOLD STANDARD" lished in USA Today. Heroin is cheap, pure and plentiful in the U.S., . · .. lements of the military heath care sy tem could be with purity of the street drug at record levels--10 times higher [f the V~U ' I US "' . · . b · b · than it was in 1980. This more potent form is easy and inexpensive · ed . Ldie1 marchmg 10 um. on, then su tance a u e treat- view . asd't' so ally ba been the recrUit· h av ·m g trou bl. e k·eep ·m g up to smoke, making it more attractive to new users. The U.S. Drug mcnttJaJIOO , d lJ 1 b "[j with the group. But as 1 ~1anage.d care gra u~ y enve ~pdi L. e ~11 - Enforcement Administration reports that twice as many people . · treatment l expected to evo 1ve mto a mu 11 sctp mary smoked heroin in 1995 as in 1994. Heroin deaths also are at their la1y, a ddJC11 0 11 .
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