News

ASAM Weekly for May 2nd, 2023

May 3, 2023

This Week in the ASAM Weekly

Although known colloquially as “the munchies,” the “hedonic amplification of feeding” phenomenon has an evolutionary history that connects the endocannabinoid system with caloric balance through an intricate coordination of the olfactory system, reward pathways, and junk food. Well-known in mammals, scientists have now demonstrated its presence in worms (Current Biology).

Researchers have also developed a recombinant probiotic that functions like alcohol dehydrogenase in the gut of mice, leading to reduced absorption and lower blood alcohol levels (Microbiology Spectrum). Whether this will see crossover success into humans is an important consideration, given the history of near-breakthroughs in translational research for the treatment of alcohol use disorders (Journal of Internal Medicine).

Xylazine happens to have a history of crossover from human research to animal use and back to the human drug supply. Given its threat to public health, urgent calls are being made to address it (NEJM). Even psilocybin has evolved; a synthetic, proprietary version is now undergoing clinical trials for depression (Medpage).

Thanks Mother Nature, but human ingenuity will take it from here…

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD

Lead

The conserved endocannabinoid anandamide modulates olfactory sensitivity to induce hedonic feeding in C. elegans 🔓

Current Biology

Laboratory worm Caenorhabditis elegans apparently gets the ‘munchies’ when exposed to cannabis. After soaking in an endocannabinoid bath, worms preferred to eat nutrient-rich, rather than nutrient-poor, bacteria. They fed for longer than worms not exposed to endocannabinoid or worms without working endocannabinoid receptors. This shared trait points to the deep evolutionary origin of cannabinoid receptors and behaviors influenced by the molecules.

Research and Science

Electronic cigarette menthol flavoring is associated with increased inhaled micro and sub-micron particles and worse lung function in combustion cigarette smokers 🔓

Respiratory Research

This study utilized a novel robotic platform, Human Vaping Mimetic Real-Time Particle Analyzer (HUMITIPAA), to identify the inhalation toxicological potential of electronic cigarettes (ECs). With the addition of menthol flavoring to e-liquid base, enhanced particle counts were found in participants using menthol vs. non-menthol ECs. Results indicate a link between enhanced inhaled counts from menthol and worsening lung function as well. This study further demonstrates the utility of HUMITIPAA as a technology that supports the reliable prediction of the pulmonary toxicity potential of emerging ECs.

Oral Probiotic Expressing Human Ethanol Dehydrogenase Attenuates Damage Caused by Acute Alcohol Consumption in Mice 🔓

Microbiology Spectrum

There are significant health effects from drinking alcohol. In this study, the authors evaluate the impact of an oral recombinant probiotic that secretes alcohol dehydrogenase. In a mice model, the probiotic had multiple effects, notably increased alcohol tolerance, increased threshold for intoxication, reduced recovery time from alcohol, and decreased alcohol absorption in the gastrointestinal tract. While early in development, the authors note the potential for use in humans to attenuate the effects of alcohol and decrease risk of poor outcomes like nonalcoholic fatty liver and cirrhosis.

Antecedents of Fatal Overdose in an Adult Cohort Identified through Administrative Record Linkage in Indiana, 2015-2022 🔓

Drug and Alcohol Dependence

This study identified 13,882 overdose deaths in Indiana between 2015 and 2022. The authors examined five statewide datasets for events that occurred in the 12 months prior to the overdose. The predominant event (65%) was experiencing an emergency department visit in the year prior, followed by prescription medication dispensing, EMS response, jail booking, and prison release. During the study period, rates of these events increased with the exception of a decrease in prescription medication dispensing. With regard to prison release, approximately 1 of 100 died from drug overdose within 12 months; for EMS response, the rate was 1 of 1000. These results identify opportunities for intervention to reduce overdose deaths such as providing care following prison release and providing MOUD following EMS response.

Expanding access to treatment for stimulant use disorder in a frontier state: A qualitative study of contingency management and TRUST program implementation in Montana

Journal of Substance Use and Addiction Treatment

Treatment for Individuals who Use Stimulants (TRUST)/contingency management (CM) was implemented throughout Montana, including rural and urban communities. Qualitative and quantitative data support that providers viewed the CM component as beneficial for treatment retention and improved outcomes for people with stimulant use disorder (stimUD). These study results provide insight into challenges and solutions for providers who are considering the implementation of CM within either a state-approved substance use treatment clinic or Federally Qualified Health Center (FQHC).

Learn More

Treating Opioid Use Disorder in Patients Who Are Incarcerated 🔓

JAMA

This viewpoint offers the case of an incarcerated patient admitted to the hospitalist service with an injection-related infection. Historically, jail staff do not interfere with treatment for these infections or other medical issues; yet this jail and many others restrict the use of buprenorphine. Instead, extended-release naltrexone -- the sole MOUD not shown to reduce mortality among persons with OUD -- may be the only option. With these prohibitions in place, while treatment is desired by the patient, when the desired medication reduces opioid withdrawal and cravings, and when such treatment is not a limited resource, the carceral system imposes a violation of medical ethics.

Journal of Internal Medicine

There are currently limited medications for treatment of alcohol use disorders, and the focus of treatment has been targeting the reward system and attenuating the positive reinforcement of alcohol use. In this perspective, the author suggests the alternative of targeting the negative reinforcement effects from the absence of alcohol that incentivize relapse and continued use. He presents 3 potential targets: the corticotropin-releasing factor, neurokinin receptors, and kappa-opioid receptors. While there are some limited studies for drugs to target these receptors, the author suggests there are significant potential targets to address the negative effects of alcohol abstinence. Combining these with medications focused on reward attenuation could be transformative for treatment.

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community 🔓

Substance Abuse Treatment, Prevention, and Policy

This study surveyed 338 residents of a rural county in northwestern South Carolina regarding their knowledge of OUD and their attitudes towards harm reduction services (HRS). Out of nine items regarding HRS, respondents, on average, agreed with only four. Support for syringe service programs was 42% (only 21% supported them in their neighborhood), and 45% supported safe consumption sites. Younger respondents were more likely to support HRS. Belief that OUD is a disease was the strongest predictor of support for HRS; belief in MOUD efficacy was the next strongest. The authors suggest education of the general public about OUD as a disease, targeting the older population.

In The News

Xylazine — Medical and Public Health Imperatives

The New England Journal of Medicine