Notice of Erratum: Treatment Improvement Protocol 43
SAMHSA's Center for Substance Abuse Treatment (CSAT) has issued corrections to Chapter 13, page 219, of Treatment Improvement Protocol (TIP) 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs (2005 printing).
Typographical errors and some confusing wording are on page 219. If left uncorrected, these text errors could lead to mistakes in treatment of neonatal abstinence syndrome.
The following erratum details the errors in TIP 43 (2005 printing) and their correction:
Chapter 13, page 219:
Column 1, line 9 from the bottom, reads "0.4 mg/kg/dose." It should read "0.4 mg/kg/day."
Column 1, line 6 from the bottom, reads "0.4 mg/kg/dose." It should read "0.04 mg/kg/dose."
In subsequent printings of TIP 43, page 219, the paragraphs regarding this topic have been changed to read:
"If pharmacological management is indicated, several methods have been found useful. The American Academy of Pediatrics Committee on Drugs policy statement on Neonatal Drug Withdrawal (1998) describes several agents for the treatment of NAS including methadone, tincture of opium, paregoric, and morphine. One method (J. Greenspan, Thomas Jefferson University Hospital, Philadelphia, personal communication, October 2006) uses neonatal opium solution (0.4 mg/mL morphine-equivalent; starting dosage, 0.4 mg/kg/day orally in six to eight divided doses [timed with the feeding schedule]). Dosage is increased by 0.04 mg/kg /dose until control is achieved or a maximum of 2.0 mg/kg/day is reached. If Neonatal Abstinence Scores stay high but daily dosage nears maximum, symptoms are reassessed and concurrent phenobarbital therapy considered. When control is achieved, the dosage is continued for 72 hours before pharmacological weaning, in which dosages are decreased 10 percent daily or as tolerated. When 0.2 mg/kg/day is reached, medication may be stopped. Decisions about dosage decrease during pharmacological weaning are based on Neonatal Abstinence Scores, weight, and physical exams."
CSAT regrets any confusion these errors have caused and requests your assistance to correct the text in all copies of the first (2005) printing of TIP 43 to which you have access. Please help us ensure that word of this correction reaches as many TIP 43 readers as possible. To see the revised text of TIP 43 (pdf format) in place visit http://download.ncadi.samhsa.gov/Prevline/pdfs/bkd524.pdf.
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