News
The ASAM Weekly for July 9th, 2024
This Week in the ASAM Weekly
If you’ve been too busy to set up your summer reading list this year, don’t worry, The ASAM Weekly has got you covered.
Extended-release ketamine is the star of an industry-sponsored, phase 2 enriched study for treatment-resistant depression. Without giving away too much, it ends positively, but is it too soon to tell whether the special tablet formulation will be able to deter misuse or diversion (Nature Medicine)?
The ADAPT-2 study keeps on giving, with previously unpublished data from an extended observation period. It’s great to know that further treatment with extended-release naltrexone + bupropion beyond the initial six-week period is associated with further reductions in methamphetamine use (Addiction). But if you’re someone who’s read many studies on methamphetamine use this year and are looking for something different, then a profile on the resilient life of First Lady Betty Ford may be just what you’re looking for (Mayo Clinic Proceedings).
A must-read topic and the focus of many publications is the cascade of care model for OUD. Although it was adapted from treatment models for HIV/AIDS, there are now more than five times as many Americans living with OUD than HIV, so it is “important for all clinicians to embrace the care cascade for OUD and their role in it,” especially when it comes to care transitions (JAMA).
The importance of supporting the cascade of care model and the associated treatment gap is highlighted by recent data from the Morbidity and Mortality Weekly Report. In 2022, only 25% of US adults with OUD received MOUD and 30% received only non-pharmacological treatment. Since many individuals with OUD also have a co-occurring psychiatric illness and are more likely to receive mental health care than SUD treatment. Community mental health facilities play an important role in closing the treatment gap. However, only about a third of these facilities in high-need states offer MOUD (JAMA Network Open).
When the time comes for a comprehensive, best-seller about the treatment gap, an effective subtitle might be, “Why you should ask your PCP about MOUD,” because apparently most people are still not aware that medications for OUD can be prescribed by their PCP (JAMA Network Open).
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD
Continuing Education Committee - Call for Volunteers
The Continuing Education Committee is seeking additional members to diversify the committee's professional representation in order to provide interprofessional education.
Lead Story
Nature Medicine
The safety and tolerability of racemic ketamine may be improved if given orally, as an extended-release tablet (R-107), compared with other routes of administration. In this phase 2 multicenter clinical trial, male and female adult patients with treatment-resistant major depression (TRD) and Montgomery–Asberg Depression Rating Scale (MADRS) scores ≥20 received open-label R-107 tablets 120 mg per day for 5 days and were assessed on day 8 (enrichment phase). On day 8, responders (MADRS scores ≤12 and reduction ≥50%) were randomized to receive double-blind R-107 doses of 30, 60, 120, or 180 mg, or placebo, twice weekly for 12 weeks. Nonresponders on day 8 exited the study. Tolerability was excellent, with no changes in blood pressure, minimal reports of sedation, and minimal dissociation. The most common adverse events were headache, dizziness, and anxiety. R-107 tablets were effective, safe, and well tolerated in patients with TRD, enriched for initial response to R-107 tablets.
Research and Science
Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France 🔓
The Lancet Public Health
This study collected data from all adult hospital discharges in France between 2018 and 2021 (n=25 million). Of these, 3.4% had a diagnosis of alcohol dependence. The strongest association was between hepatocellular carcinoma and untreated alcohol dependence (HR~19). The next strongest association was with upper digestive and respiratory tract cancers with hazard ratios ranging from 4 to 6, and then colorectal cancer with hazard ratios ranging from 1.3 to 1.5. A history of rehabilitation treatment or abstinence was noted in 38% of those with a diagnosis of alcohol dependence; this reduced the risk of alcohol-associated cancers by 40%. The authors conclude there are many with untreated alcohol dependence that could significantly reduce their risk of alcohol-associated cancers with rehabilitation treatment or abstinence.
Treatment for Opioid Use Disorder: Population Estimates — United States, 2022 🔓
Morbidity and Mortality Weekly Report
This CDC report presents data on opioid use disorder (OUD) prevalence and treatment in the US in 2022. The report estimates 3.7% of the US adult population have OUD and need treatment, of which only about half (55.2%) received any form of treatment. Among those who received any treatment, only 44.5% received medication for OUD (MOUD). Of note, a significant proportion of adults with OUD (44.7%) did not perceive a need for treatment. These findings highlight the importance of increased awareness of the effectiveness of MOUD among persons with OUD, the public, and providers. The authors also suggest providing support and mentoring for all providers to increase buprenorphine prescribing.
Availability of Medications for Opioid Use Disorder in Community Mental Health Facilities 🔓
JAMA Network Open
This study examined the availability of medications for opioid use disorder (MOUD) in a representative sample of community outpatient mental health treatment facilities in high-burden states due to the opioid crisis. A cross-sectional analysis of 450 community outpatient mental health treatment facilities in 20 states found that 34% of clinics offered MOUD, with 51% of Certified Community Behavioral Health Clinics (CCBHCs) and 33% of non-CCBHCs offering these medications. Despite high rates of opioid use disorder among people with co-occurring mental health disorders, only a third of community outpatient mental health treatment facilities in high-need states offer MOUD, indicating the need for improved scaling efforts.
Invitation to Review: ASAM Draft Clinical Practice Guideline on Benzodiazepine Tapering
Through July 19th, the American Society of Addiction Medicine (ASAM) has made available for public comment a draft of its Clinical Practice Guideline on Benzodiazepine Tapering. For more information and instructions to review, please click here.
CO*RE REMS/ASAM Striking a Balance: Podcast Series
This free series consists of three 45-minute podcasts designed to empower clinicians to confidently manage opioid analgesics, from patient assessment and therapy initiation to modification, discontinuation, and patient counseling.
Learn More
Knowledge, Attitudes, and Beliefs About Opioid Use Disorder Treatment in Primary Care 🔓
JAMA Network Open
This study investigated the public’s knowledge about primary care physicians (PCP) prescribing MOUD for OUD. A nationally representative sample of individuals (n=1234) was surveyed by telephone or online. Only 25% knew that PCPs could prescribe MOUD, 13% believed they could not, and 61% were uncertain. However, 76% agreed that PCPs should treat OUD in their office. Of those who had personally misused opioids (n=266), 81% would be comfortable seeking MOUD from their PCP. The authors conclude that a majority of the public does not know that PCPs can prescribe MOUD and suggest public messaging campaigns.
Addiction
In this secondary analysis of the ADAPT-2 trial, the authors examine changes in methamphetamine (MA) use based on urine drug screens from patients after receiving extended-release naltrexone and bupropion (NTX + BUPN). Patients who received NTX + BUPN had a 27.1% increase in negative urine drug tests at 12 weeks of treatment, a significantly greater percentage than placebo (p=0.006). These findings, while promising, support the need for additional clinical trials longer than 12 weeks to evaluate ongoing benefits and optimize treatment duration.
Major Gaps in the Cascade of Care for Opioid Use Disorder
JAMA
Many people with opioid use disorder (OUD) in the U.S. continue to not receive treatment, in particular medications for OUD (MOUD). In this paper, the authors discuss this gap in terms of a cascade of care from screening and diagnosis to initiation and retention in treatment. They suggest the following: 1) routine screening and diagnosis, 2) education about MOUD with patients, 3) all eligible prescribers offer buprenorphine, 4) use shared decision-making practices with patients, and 5) provide and reinforce harm reduction strategies. These processes, if routinely practiced in all health care settings, may be able to close these gaps in care.
First Lady Betty Ford: A Legacy of Transparency 🔓
Mayo Clinic Proceedings
On April 5, 2024, the US Postal Service issued a Forever Stamp (68 cents at the time of issue) honoring the former US First Lady Elizabeth “Betty” Ford. The Betty Ford stamp is the 7th US postage stamp to honor a First Lady. In this Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, Betty Ford is highlighted for disclosing both her breast cancer diagnosis and her subsequent treatment for a substance use disorder. That she did so in the 1970s, at a time when both diagnoses were rarely discussed by public figures and were associated with stigma, is extraordinary.
In The News
Seeking Justice for Victims of the Opioid Epidemic
Medpage Today
Fentanyl doesn't have to fuel another cycle of loss in L.A.
Los Angeles Times
Supreme Court to hear case over FDA's ability to ban e-cigarette flavors
UPI
Concerns grow over gambling addiction in the military
CNBC
Kratom company can’t dodge lawsuit over undisclosed addiction risk
Courthouse News Service