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ASAM Weekly for November 21, 2023

Nov 22, 2023

This Week in the ASAM Weekly

If you're a little apprehensive this year about having awkward or even anxiety-provoking Thanksgiving conversations, then we’ve got you covered.

You’re sure to catch everyone's attention with an age-old adage: the faster a drug enters the brain, the more addictive it is. You’ll even enlighten the table when you explain that researchers from NIDA and NIAAA found strong evidence that this is because of the salience network (Nature Communications). Similarly, the default mode network may help explain why nicotine is so often paired with alcohol and opioids. The discussion could get really interesting if an astute guest asks you whether this means nicotine replacement could be an adjunctive treatment for AUD or OUD (Neuropsychopharmacology). Be ready with something like “that’s a great question and further research is needed.”

If you happen to be in New York City (or a few other major cities), some guests might want to talk about self-injection sites. A few might even claim they breed crime and more drug use like needle exchange programs. You can easily refute this and cite a study that was recently featured in the New York Times. Most guests like citing the NY Times.

Almost everyone at the table should agree that the opioid crisis seems to be getting worse. You can provide some nuance to the conversation by explaining how it affects US life expectancy and most notably, a widening gap between men and women (JAMA Internal Medicine).

Keep in mind, too much talk of despair might provoke some to become nostalgic for straightforward interventions like “Just Say No,” while others may add that D.A.R.E. actually backfired. Either way, you can take it to the next level by quoting Dr. Nora Volkow and explaining how kids are ready to be taught harm reduction (NPR).

If the conversation gets a little stale, you can always talk about psychedelics. The VA is warming to the idea of using them to treat PTSD (CBS) and NPR has a thought-provoking profile on Roland Griffins that bridges meditation, psilocybin, and mortality. But don’t be surprised if one of your guests feels compelled to share their own experience with psychedelics -- even if it’s Grandma.

In the end, this holiday is about giving thanks and sharing an experience of gratitude. I’d like to thank the incredibly talented ASAM Weekly Co-Editors and the ASAM Weekly staff for everything they do — fifty-two weeks a year. Thank you!

Enjoy the holiday,

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

Journal of Addiction Medicine Call for Papers: “Research funded through the HEAL Initiative”

The Journal of Addiction Medicine is soliciting papers funded through the Helping to End Addiction Long-Term (HEAL) initiative. Papers should present results of HEAL-funded research, although narrative and systematic review articles conducted as part of HEAL-funded research will also be considered. To be considered for this special collection, potential authors of reviews should submit an outline to the editorial office for approval before submitting a manuscript. The outline can be sent to JAMReviewOutline@gmail.com. Please copy marends@scripps.edu. The editors will provide feedback on the outline and a recommendation regarding whether to write and submit a manuscript.

Lead

Neural circuit selective for fast but not slow dopamine increases in drug reward🔓

Nature Communications

The authors note that rapid delivery to the brain when drugs are injected or smoked results in more severe substance use disorders. They used functional MRI and PET scans to monitor dopamine increases while subjects (n=20) received methylphenidate either orally or intravenously. Intravenous methylphenidate caused a more rapid increase in dopamine than oral. Activity in the medial prefrontal cortex decreased in both groups but was more pronounced with intravenous methylphenidate. However, only intravenous methylphenidate produced increased activity in the dorsal anterior cingulate cortex and insula that was reflected in the subjective rating of “high.” This brain region was activated only by intravenous methylphenidate and the associated rapid increase in dopamine.

Research and Science

Disrupted brain state dynamics in opioid and alcohol use disorder: attenuation by nicotine use

Neuropsychopharmacology

This study investigated brain state dynamics in individuals with opioid use (OUD) and alcohol use disorder (AUD) and assessed how concomitant nicotine use, which is frequent among individuals with OUD and AUD, affects brain dynamics. OUD and AUD non-smokers displayed similar changes in brain state dynamics including decreased fractional occupancy or dwell time in default mode network (DMN)-dominated brain states and increased appearance rate in visual network (VIS)-dominated brain states, which were also reflected in transition probabilities of related brain states. Interestingly, co-use of nicotine affected brain states in an opposite manner by lowering VIS-dominated and enhancing DMN-dominated brain states in both OUD and AUD participants.

Presentation and Outcomes of Adults with Overdose-Related Out-of-Hospital Cardiac Arrest 🔓

JAMA Network Open

This study of overdose-related out of hospital cardiac arrests (OD-OHCA) analyzed EMS data from a metropolitan county in Washington State from 2015 to 2021. During the 7-year study period there were 6790 OHCA and of these 702 were OD-OHCA. The incidence of OD-OHCA increased significantly during this period (5.2 to 13.0/100,000 person-years). The greatest increase (almost 4-fold) was in combined opioid and stimulant OHCA. Only 8% of OD-OHCA had a shockable rhythm (25% for non-OD-OHCA). Stimulant only OD-OHCA were more likely to have a shockable rhythm (24%) than opioid only OD-OHCA (4%). Survival to hospital discharge was lowest for combined stimulant and opioid OD-OHCA (10%) compared to opioid only (23%) or OD-OHCA due to other drugs (26%). The authors conclude that OD-OHCA are increasing, particularly for combined opioid and stimulant which also have the poorest survival to hospital discharge.

Conversational artificial intelligence interventions to support smoking cessation: A systematic review and meta-analysis 🔓

Journal of School Nursing

Digital platforms have enabled expanded access to care and conversational artificial intelligence (AI) can provide tailored support and has great potential. In this meta-analysis, the authors review the current evidence for AI use in smoking cessation. They included 5 articles in their analysis and there was significant increase in abstinence at 6-month follow-up for those who received AI intervention versus control conditions (RR=1.29, P<0.001). The authors acknowledge the limited number of studies and express concerns about potential bias, emphasizing the need for caution in interpreting these findings. Nonetheless, the results provide valuable support for guiding future research endeavors. In addition, they note there are significant ethical and legal considerations that will need to be addressed.

Trends in Cannabis and Alcohol Use by Sexual Identity in the 2015-2019 National Survey on Drug Use and Health

Journal of Studies of Alcohol and Drugs

Sexual minority individuals are at substantially elevated risk for both cannabis use disorder (CUD) and alcohol use disorder (AUD). The purpose of this study was to examine sexual identity differences in trends for CUD and compare them to trends for AUD. All groups except lesbian females experienced significant increases in cannabis use rates from 2015 to 2019. Heterosexual males, heterosexual females, and bisexual females also experienced significant increases in CUD rates. In contrast, no group exhibited significant increases in heavy episodic drinking or AUD rates. Bisexual women exhibited some of the largest year-specific disparities in cannabis use and CUD as well as the largest growth in disparities across time.

Learn More

Contingency Management for the Treatment of Substance Use Disorders: Enhancing Access, Quality, and Program Integrity for an Evidence-Based Intervention 🔓

US Health and Human Services

Contingency management (CM), an evidence-based therapeutic treatment for stimulant use disorder, has been underutilized for many years despite its utility for management of this disease. Section 4127 of the 2023 Consolidated Appropriations Act included a requirement for the Secretary of Health and Human Services (HHS) and the Inspector General to “submit to Congress recommendations... for improving access to evidence-based contingency management interventions…” As a result, the HHS Workgroup on Implementation Strategies for Contingency Management has prepared this report, which provides a framework for CM implementation.

Optimising a product standard for banning menthol and other flavours in tobacco products

Tobacco Control

After reviewing the evidence and various policies and bans around the world, the authors argue that policies addressing flavors in tobacco products, particularly menthol, are likely not adequate. Bans often address flavor, but menthol and its analogues can evoke cooling effects that can smooth the harshness of tobacco at levels below the need to taste the product. The authors suggest policy should not only ban additives with the flavor, but also those that induce sensory effects. In addition, to avoid workarounds the bans should not only address tobacco, but all components of tobacco products or potential add-ons, such as filters, papers, and capsules. Robust policies are needed to minimize legal challenges or industry ability to circumvent the policy intentions.

Widening Gender Gap in Life Expectancy in the US, 2010-2021 🔓

JAMA Network

This cross-sectional study compared gender-specific changes in cause-specific mortality vs. life expectancy from 2010-2021. During the pre-COVID period (2010-2019), the gap in gender-specific life expectancy increased 0.23 years; from 2019 to 2021, it increased even further to 0.70 years. Prior to COVID-19 in 2020, the largest contributors to worsening life expectancy were unintentional injuries; from 2010 to 2021, unintentional poisonings -- most notably as a result of drug overdoses -- along with other unintentional injuries contributed 0.44 (86.3%) and 0.06 (11.8%) respectively to the 0.51-year decrease in life expectancy. Drug overdoses were a significant contributor to this widening gender-specific gap.