This Week in the ASAM Weekly

If there ever was a week in which The ASAM Weekly tells you to just read the Journal of Addiction Medicine instead, this might be that week. 

On the other hand, the Journal’s Editor-in-Chief Dr. Fiellin balances the commentaries with considerations about neuroscientific correlates vs clinical consensus, the variability and under-availability of addiction treatment, and how stigma could fill the gap between treatment-refractory terminology and treatment infrastructure. In this case, a more cautious approach is encouraged. 

Across multiple articles, the Journal is providing a discourse on the challenge of calibrating a message and its meaning, as is the case with pre-addiction. Introduced by directors from NIDA and NIAAA, the term intends to act like pre-diabetes, but several editors from the ASAM Principles of Addiction Medicine raise concern about the pre-addiction paradigm and propose instead using “unhealthy substance use,” for which they provide a convincing and thorough explanation. 

The commentaries mentioned above are not only thought-provoking, they will ultimately shape our field because addiction terminology is simply that important. In fact, it's so important that if we don't get it right the first time, we’ll end up spending many years trying to fix it. 

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD

Recordings Available: The ASAM Annual Conference 

Every year this conference explores a wide variety of important, exciting, and popular addiction medicine topics relevant for healthcare providers of all types. Whether you work in private practice or in the emergency room, whether you're an addiction medicine fellow or you teach fellows, whether you see patients in the criminal legal system or you see pediatric patients, this conference has something for you.

Lead Story 

Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors 🔓

JAMA Network Open 

This British study included 135,103 older (median age 64) adults and compared drinking patterns with mortality during a median follow-up of 12 years. Compared to occasional drinkers, low-risk drinkers had higher cancer mortality (HR, 1.11), moderate-risk drinkers had higher all-cause and cancer mortality (HRs, 1.10 and 1.15), and high-risk drinking had higher all-cause, cancer, and cardiovascular mortality (HRs, 1.33, 1.39, and 1.21). These results contrast with earlier studies showing protective effects of low- to moderate-risk drinking. Researchers used occasional drinkers as the control group, where previous studies used abstainers including former drinkers with residual health effects. There was a small protective effect of drinking only with meals and drinking wine. In conclusion, the authors failed to find a protective effect of low-risk drinking on mortality.

Research and Science

Structure of the human dopamine transporter in complex with cocaine

Nature

Dopamine signaling is the prime mode for the reward and addictive effects of cocaine, which is mediated through cocaine’s effect on the dopamine transporter (DAT). The human DAT (hDAT) is responsible for the reuptake of dopamine in the axon terminus after release, but it is inhibited by cocaine. While this is well established, the exact configuration and mechanism of the cocaine inhibition of hDAT is less well understood. In this study, the authors detail the structure of the hDAT complex with cocaine as an outward-open conformation. The authors note that this detail of the complex may now help inform the development of targeted medications to address the addictive properties of cocaine.

Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes: Target Trial Emulation Using Real-World Data:  

Annals of Internal Medicine

Using a nationwide EHR database, this study identified 222,942 patients with type 2 diabetes (T2DM) and tobacco use disorder (TUD) who received a new prescription for medication for T2DM - either semaglutide (n=5967) or one of 7 other classes of diabetes medications. The outcome measure was health care visits related to TUD after the diabetes medication was initiated. Semaglutide was associated with significantly fewer TUD encounters than the other diabetes medications. The greatest effect was semaglutide compared with insulin (HR 0.68), and significant reductions were seen compared with all other diabetes medications. Semaglutide is a glucagon-like peptide receptor agonist (GLP-1RA) and was more effective than other GLP-1RA medications in reducing TUD encounters. The authors call for research on semaglutide as a treatment for TUD.

Prevalence of problematic pharmaceutical opioid use in patients with chronic non‐cancer pain: A systematic review and meta‐analysis 🔓 

Addiction 

This comprehensive systematic literature review and meta-analysis aimed to measure the prevalence of pharmaceutical opioid use (POU) in chronic non-cancer pain (CNCP) patients treated with opioid analgesics. It included studies from all settings with participants aged ≥ 12 with non-cancer pain of ≥ 3 months duration, treated with opioid analgesics. Problematic POU appears to be common in chronic pain patients treated with opioid analgesics, with nearly one in 10 experiencing dependence and opioid use disorder, one in three showing signs and symptoms of dependence and opioid use disorder, and one in five showing aberrant behavior.