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The ASAM Weekly for February 6, 2024

Feb 6, 2024

This Week in the ASAM Weekly

Bringing Racial Justice to US Drug Policy Promotes Equity and Access to Addiction Treatment
By Stephen M. Taylor, MD

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. He is president-elect of the American Society of Addiction Medicine (ASAM). He served as co-chair of ASAM’s Public Policy Committee’s writing subcommittee on advancing racial justice.

Right now in the US, a Black man is living with the disease of addiction after being released from prison for possession of cocaine (for which there has long been a racist sentencing disparity between its rock and powder forms). Chances are, he did not receive evidence-based addiction treatment while incarcerated. Furthermore, notwithstanding the physical and emotional trauma he likely endured while in prison, he returns to the community without any resources to secure housing, health care, or employment.

Unfortunately, recurrence of drug use and recidivism are probable outcomes for him. As he applies for a new apartment, a loan, or a job, he is asked to disclose his conviction for drug possession. Often, he is discriminated against — denied the means to improve his lot in life — for he lives in a country that elects to punish their disease’s core symptom. Feeling despair from the lack of opportunities and continuing to remain untreated, he may use illegal drugs again. The stigma that people like him face every day can perpetuate a vicious cycle in which their punishment is prioritized over their well-being.

Structural barriers like these affect millions of Americans with substance use disorders. Combined with the enduring impact of policies and practices like redlining, segregation, racial discrimination, xenophobia, and voter suppression, however, it’s clear that people of color with addiction face even more inequities caused by systemic racism and entrenched structural stigma. Despite similar rates of illegal drug use across racial groups, people of color are more likely to experience drug-related arrests and convictions — and, thus, bear the brunt of their subsequent impacts.

Read the full editorial here.

Lead Story

Polysubstance mortality trends in White and Black Americans during the opioid epidemic, 1999–2018 🔓

BMC Public Health

The CDC characterizes the opioid epidemic in three waves: first, prescription opioids (1999-2010); second, heroin (2011-2013); and third, synthetic opioids (2013-present). The authors examine the epidemic, looking at trends in multiple substances involved in overdoses and differences by race. Psychostimulant and benzodiazepine involvement were more common among White persons, while cocaine-related deaths were higher among Black persons. Overdose deaths have increased faster among Black persons since 2013. Overall, overdose deaths frequently involve multiple substances and can’t simply be attributed to opioids. The authors give three policy implications for their findings: 1) polysubstance use should be considered the norm, 2) addressing racial disparities requires interventions across primary, secondary, and tertiary prevention, and 3) the importance of measures to address fentanyl specifically.

Research and Science

A qualitative exploration of the potential role of using online social media support communities to increase initiation of Medications for Opioid Use Disorder (MOUD)

Journal of Substance Use

In this qualitative study, the authors interviewed persons with opioid use disorder (OUD), family members of persons with OUD, and key stakeholders to assess the potential for a peer-led online community for persons with OUD. All three groups supported an online peer-led community, believing peers would be more empathetic, and persons with OUD expressed that only peers could truly understand them. Potential benefits indicated by interviewees included convenience, sense of anonymity, and ease of speaking online to others versus in person. Interviewees expressed interest in getting information about treatment options and where to access treatment, and other topics such as mental health and treatment for pain other than opioids. Overall, there was a strong interest in and conveyed need for such a community.

Substance Use Overdose Deaths Among Black and Indigenous Women in Wisconsin: A Review of Death Certificate Data From 2018 to 2020

Journal of Addiction Medicine

In Wisconsin, overdose deaths increased 11-fold from 2000 to 2020, with over 1200 deaths in 2020. Because of disparities in substance use initiation, relapse, and treatment success among racially minoritized women, this study investigated overdose death rates among Black and Indigenous women in Wisconsin from 2018 to 2020. Death rates (per 100,000) in 2018 were 14.1 for White women, 20.8 for Black women, and 26.5 for Indigenous women; these rates increased in 2020 to 16.4, 32.5, and 59.9 for White, Black, and Indigenous women, respectively. Regression findings illustrated that being Black or Indigenous and aged 15 to 44 or 45 to 64 years were significantly more likely to die from most causes of death (any drug, any opioid, prescription opioid, heroin, synthetic opioids, and cocaine). This study confirms that deaths in Wisconsin are disproportionately higher in female minoritized populations.

Structural indices of brain aging in methamphetamine use disorder

Drug and Alcohol Dependence

People with methamphetamine use disorder (MUD), recently abstinent (n=89), were matched with healthy controls. MRI images were used to assess overall brain volume, volume of white matter lesions, and choroid plexus volume. All three are known predictors of brain biological age and cognitive impairment. Increased white matter lesions are also a predictor of stroke, which can further impair cognition. Those with MUD had reduced brain volume, increased white matter lesions, and increased choroid plexus volume indicating increased brain age compared to controls. The authors note that the increased brain age and resulting cognitive impairment in those with MUD may impede the behavioral treatments for MUD.

Methamphetamine use shortens telomere length in male adults and rats

Drug and Alcohol Dependence

Prior studies suggest that methamphetamine (MA) use may accelerate aging. Telomeres are DNA sequences terminating chromosomes, and decreased telomere length (TL) is a marker of biological aging. This study examined the effect of MA use on TL in human users of MA (n=125) as well as rats provided MA (n=12). TL was measured in DNA from blood leukocytes. In human users of MA, TL was significantly shorter compared to matched controls (p<0.05). Furthermore, those with severe MA use had greater reductions in TL than those with less severe use (p<0.01). In rats, TL was significantly shorter after MA exposure than before (p<0.05). Rats with severe MA use had greater reductions in TL than those with less severe use (p<0.01). These results give insights into the accelerated aging associated with MA use and could offer an objective measure of MA use severity.

Learn More

Equity of overdose education and naloxone distribution provided in the Kentucky HEALing Communities Study 🔓

Drug and Alcohol Dependence Reports

As overdose education and naloxone distribution (OEND) programs are rolled out, there is concern that they may not equitably reach target populations. HEALing Communities Study (HCS) in Kentucky implemented OEND in a “Hub with Many Spokes” strategy with multiple community partners. In comparing the population that received OEND between 2020 and 2022 with the opioid overdose deaths population, this study found that the overall demographics between the two groups were similar, suggesting target populations were reached; however, there were significant differences by site. Males and non-Hispanic Black individuals were more likely to receive OEND in criminal justice settings, while females were more likely to receive OEND in treatment facilities. These differences likely reflect significant disparities in the criminal justice system, drug policy, and access to treatment.

Substance Use Disorders Among US Adult Cancer Survivors

JAMA Oncology

In this cross-sectional study of 6,101 adult cancer survivors who responded to the National Survey on Drug Use and Health for 2015 through 2020, the overall prevalence of active substance use disorder (SUD) (within the past 12 months) was approximately 4%, with higher prevalence in some subpopulations, including survivors of head and neck cancer (approximately 9%) and esophageal and gastric cancer (approximately 9%). Alcohol use disorder was the most common SUD. Findings of this study highlight subpopulations of adult cancer survivors who may benefit from efforts to integrate cancer and addiction care.

Effective Treatments for Opioid Use Disorder — Finding Recovery and Staying Safe 🔓

The New England Journal of Medicine

In this Double Take video from the New England Journal of Medicine and NEJM Knowledge+, Jennifer Foreman (Randolph Health Medical Group) and her son, Dylan Glover, recount their journey through Dylan’s addiction and recovery. Ms. Foreman, along with Sarah Bagley (Boston Medical Center) and Scott Hadland (Massachusetts General Hospital for Children), reviews available medications for opioid use disorder and their mechanisms. They emphasize that multiple types of health care providers, including those in primary care, can manage and treat opioid use disorder. L.J. Punch (the T St. Louis, a harm-reduction program) also offers suggestions for harm reduction and guidance on how best to respond to an overdose.

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