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Continued Decline in Youth Substance Abuse

Current illicit drug use among teens is continuing to decline, according to a new report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released today. The study also shows positive signs that teens are seeing the dangers of abusing prescription drugs and methamphetamine and are pushing back. Among youth ages 12-17, the 2007 National Survey on Drug Use and Health (NSDUH), the Nation's largest substance use survey, shows that the significant decline in overall past month illicit drug use that began in 2002 continued through 2007, from 11.6 percent to 9.5 percent.

The survey, released at the start of the 19th Annual National Alcohol and Drug Addiction Recovery Month, shows that the reductions in youth drug use occurred for nearly every type of illicit drug including marijuana, cocaine, hallucinogens, LSD, and Ecstasy. The survey also shows dramatic declines in meth use, down by 67 percent (from 0.3% to 0.1%) and prescription drug abuse among teens, which declined overall by 18 percent, from 4 percent to 3.3 percent between 2002-2007.

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AddictionCME.com: Focus on Opioid Addiction

Columns - On the Web

Thursday, 31 July 2003

In early May this year, the American Society of Addiction Medicine canceled its annual educational conference in Toronto. The threat of SARS had become so great that some of the exhibitors and attendees were canceling their own plans even before the conference was called off. As a result, some of the attendees are probably still looking for CME replacements. With that in mind, I turned my attention for this column to AddictionCME.com (www.Addictioncme.com), an opiate addiction education site created by Clinical Tools, Inc. under a grant from the National Institute on Drug Abuse.

AddictionCME.com, as of this writing, is not yet complete but as a work-in-progress is worthy of attention. The site is divided into several areas:

Addiction Science CME — This segment provides an introduction to heroin dependence, the epidemiology of addiction, as well as an overview of psychologic and physiologic effects of opioids. There are six independent CME courses that will be within this segment upon completion.
Best Practice — This segment discusses the role of primary care physicians in addiction, and includes coverage of, recognition of and screening for substance use disorders.
Medical Cases — This segment will feature case-based courses that will be educational in design and will undoubtedly include CME credit upon completion.
Buprenorphine — It is hoped that this online buprenorphine course will be sufficient to meet the standards currently requiring specialists to obtain live training.
Resources — A section of the site provides recent news in the field of addiction as well as useful resources for clinical practice.

Overall the site is well constructed and designed. Clinical Tools CEO T. Bradley Tanner, MD, has well over a decade of experience designing computer-based interfaces for patients and clinicians. The site shows clear evidence of both his experience and the creativity of his staff. Clinical Tools has a suite of courses regarding depressive illness, a course on the genetics of alcoholism, and a set of courses regarding genetic counseling all under development or complete. Given the title of AddictionCME.com, I hope that the site will eventually incorporate educational materials for the entire field rather than simply opioid-related education, but the site content indicates this is the direction the company plans.

My only gripe about the AddictionCME.com site is not specific to this site, but is more an ongoing annoyance at the term “Best Practice.” The term is designed to imply that there is an approach to patient care that is the Best approach and that should therefore be used with all patients. While there are many poor ways of providing treatment, there are also many acceptable ways, any one of which may be the Best for a single given patient, and any one of which may provide for a superior overall outcome for the population as a whole. Since a superior clinician can distinguish when a rarely used methodology may be the best treatment for a single patient, it is ridiculous for us to apply the lowest-common-denominator mentality to clinical practice by requiring expert clinicians to use a cookbook approach to patient care.

There is one other recommendation that I make for all online educational sites. Each page of the material should have a dateline indicating when the material was last updated. As time passes, old material will inevitably have a way of being found by search engines and then viewed as if it is contemporary. The presence of a dateline will protect viewers from considering five-year-old information as being the state-of-the-art.

Additional CME on the Web
Scanning the web for additional online CME offerings in the addiction field revealed CEU4U.com (www.CEU4U.com). Its online catalog is divided into multiple sections, including Counseling, Medical, and Psychology, among others. As I looked to see if they actually had addiction education online, as Google had said, I tried those sections in alphabetical order and finally found that addictions are included in the psychology section. Clicking on the addictions entry brought up a single course, “Coexisting Mood Disorders,” a 4-hour CME course that expires this November. A sample of the course indicates that the content is basic material that would be found in a book chapter introducing the material to the student. For $72, I would have a basic understanding of psychiatric disorders and their concurrent nature with addictive disease. That seems rather expensive given that a similarly priced textbook would contain far more information.

Another site, www.donetguide.com/cme.htm, led to two online courses of interest: The Truth About Pain Management: An Addictionologist’s Perspective, and The Role of Opioids in Managing Pain. These two courses, which expire in February 2004, are opened in a separate window that remained blank for me in Internet Explorer. Netscape solved the problem, revealing that the actual online CME is presented in the form of a slideshow with still video and streaming audio. Sponsored by several pharmaceutical companies, this CME is free to the
clinician. The content is from well-known clinical experts in the field. The presentations are professional and expertly programmed. Users without a broadband connection may wish to bypass this site, however, since the overhead requirements are significant. These presentations look like they were originally designed for CD-ROM distribution. While it is nice that they are being distributed without charge online, users should be alerted before the first click as to the equipment requirements. Both of these presentations are based on Pain.com, a site whose mission is to provide educational resources for healthcare professionals and consumers with an interest in pain management. Given the crossover between pain and addiction, this site is one to keep bookmarked.

What have your experiences been with online CME? Is this really a reasonable use of online bandwidth, or are textbooks and CD-ROMs better approaches?

Stuart Gitlow, MD, MPH, is the author of Substance Use Disorders: A Practical Guide, from Lippincott Williams & Wilkins. He will be speaking at the Psychiatric Congress in Orlando in November 2003.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2003, v.4, n.3, pp. 52-53.