News
The ASAM Weekly for August 27th, 2024
This Week in the ASAM Weekly
“Young people communicate the warning signs of our modern world, and are indicating that our society and world are in serious trouble.” (The Lancet Psychiatry Commission on youth mental health). This is an alarming call to action from a commission tasked with understanding and addressing the “megatrends” that are harming "emerging adulthood." Surprisingly, there is not as much discussion about addiction as one might think.
Maybe it’s because the rates of adolescent use of some substances are going down. The director of NORML would argue that the kids are OK because “common sense regulations allowing for the legal, licensed commercial production and sale of cannabis best address adult consumers’ demand while keeping marijuana products largely out of the hands of young people” (The Hill).
Maybe it’s because young Americans are helping drive a more sensible and sobering view on alcohol use. Gallup polls indicate the largest gap ever between young and old regarding the negative health impacts of alcohol use (Gallup).
But we know there’s more to it. Young adults and youth who vape are at higher risk for initiating tobacco and cannabis use, and vaping is on the rise (Drug and Alcohol Dependence). Children from marginalized groups can be impacted more severely by substance use than the larger cohort; consider, for example, binge drinking in sexual and gender minority youth (Pediatrics), or tobacco-related environmental degradation in communities of low socioeconomic status (PLOS ONE). The opioid crisis has been so devastating to adults that several programs have used primary prevention in children as a means to reduce the harms when they grow up, and it seems to be working (The Conversation).
Deaths of despair showed us how consequential societal ills can be for the field of addiction. With that in mind, we should pay attention to the Lancet Commission's report on how societal ills impact emerging adulthood.
Thanks for reading,
Nicholas Athanasioux, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD
New Presidential Task Force Opportunity
The American Society of Addiction Medicine (ASAM) is now accepting applications for experts to serve on a new Presidential Task Force. This Task Force will be charged with writing an implementation guide on the integration of addiction treatment into hospital and emergency department care.
Writing Task Force members can expect to commit 1 hour per week for calls and approximately 4-6 additional hours per month to review materials and draft content, for a total of 8-10 total hours per month. This project is anticipated to be completed by March of 2025. Applicants are required to provide disclosures of interest. If you are interested in applying to join the writing Task Force, please complete this application form by Monday, September 9th.
For questions, please contact Taleen Safarian (tsafarian@asam.org). We look forward to your application.
ASAM Clinical Algorithm Subcommittee
As a part of ASAM’s mission to define and promote evidence-based best practices in addiction prevention, treatment, remission, and recovery, the ASAM Clinical Algorithm Subcommittee will collaborate with ASAM staff in refining the 4th Edition clinical algorithms for ASAM Criteria-based assessment tools. Applications are due by September 30th.
Lead Story
The Lancet Psychiatry Commission on youth mental health🔓
The Lancet Psychiatry
Mental ill health, which has been the leading health and social issue impacting the lives and futures of young people for decades, has entered a dangerous phase. Accumulating research evidence indicates that in many countries, the mental health of emerging adults has been declining steadily over the past two decades, with a major surge of mental ill health driven by the COVID-19 pandemic, the measures taken to contain it, and its aftermath. This alarming trend signals a warning that global megatrends (major, long-lasting societal changes such as environmental, social, economic, political, or technological changes) and changes in many societies around the world in the past two decades have harmed the mental health of young people and increased mental ill health among them.
Research and Science
Drug and Alcohol Dependence
This study utilized cohort data from adolescents (12-17) and young adults (18-25), followed over 8 years to examine the association between e-cigarette use and other substance initiation. Among adolescents, the study found e-cigarette use was associated with increased cigarette (aOR=21.66), marijuana (aOR=6.9), and other drug (aOR=1.72) initiation. The use of e-cigarettes and non-cigarette tobacco products was even more strongly associated with cigarette initiation (aOR=53.65). Similar associations were seen among the young adult population with increased initiation of cigarettes (aOR=11.37), marijuana (aOR=5.96), and other drugs (aOR=1.96). These findings support efforts to prevent e-cigarette initiation and use in this population.
PLOS ONE
Cigarette butts pose a variety of environmental risks such as the poisoning of small children, pets, and wildlife; the release of phthalates into soil and water; and the release of microplastics. This study used a variety of data to estimate the density of cigarette butt litter in census tracts across the United States. Census data included cigarette consumption in each census tract and previous research estimates that 65% of cigarette butts are littered. Cigarette butt density ranged from 0 to 46 butts/m² with densities 96 times higher in urban compared to rural census tracts. When compared to Social-Environmental Risk (SER), researchers found cigarette butt density was 5.6 times higher in census tracts with the highest SER. Therefore, cigarette butts present the greatest environmental risk in areas already suffering high SER, raising concerns about environmental justice.
Binge Drinking Disparities by Grade, Race and Ethnicity, Sexual Orientation, and Gender Identity
Pediatrics
Prior studies have shown that sexual and gender minorities (SGM) have higher rates of binge drinking compared to their heterosexual and cisgender peers, but this study seeks to further examine those disparities by race, ethnicity, and grade. Using data from 2017-2019 in California, the authors found SGM had higher rates of binge drinking across all grades, down to 6th grade. In addition, they found that SGM, particularly transgender students, from racial and ethnic minorities had even higher rates of binge drinking. The authors suggest that prevention and intervention strategies are needed that are culturally and developmentally appropriate to address these disparities.
Harm Reduction and Treatment Among People at High Risk of Overdose 🔓
JAMA Network Open
This cross-sectional study of 1240 people who use drugs in 3 states explored whether access to treatment and harm reduction differ by overdose history and drug type in a racially and ethnically diverse population of people who use drugs. The proportion of respondents reporting the use of fentanyl test strips was 36.8% among past year overdose survivors and 23.5% among those not experiencing an overdose—a significant difference. Approximately half (47.9%) of all participants received treatment in the past 30 days. The findings of this study suggest there are substantial gaps in the use of evidence-based treatment and harm reduction services that could reduce overdose risk.
Childhood sleep is prospectively associated with adolescent alcohol and marijuana use
Annals of Epidemiology
Associations between adolescent sleep and substance use have previously been found in cross-sectional studies, but there is limited data about earlier sleep patterns and later substance use. In this study, researchers use longitudinal data from children, followed from 1 year of age, to examine associations between sleep patterns and alcohol and marijuana use. The study found a later sleep start at 15 was associated with increased odds of alcohol and marijuana use and a shorter duration of sleep was associated with increased odds of alcohol use. In addition, they found later sleep times at age 9 were prospectively associated with alcohol use, and later sleep times at age 5 and shorter sleep duration at age 9 were prospectively associated with marijuana use. The authors note these findings, along with prior evidence, suggest childhood sleep may have implications for adolescent substance use.
Learn More
Journal of Addiction Medicine
This study concerned 58 patients with drug use-associated infective endocarditis who received cardiac surgery for valve replacement at a large medical center in Boston. Starting in September 2017, all patients (n=23) received a consult from an addiction consult team (ACT). Previously, patients (n=35) received consults from a general psychiatry service without specific addiction expertise. Patients receiving an ACT consult had a lower risk of readmission at 1 month (24% lower, p=0.005) and 3 months (34% lower, p=0.005). The ACT patients were almost 5 times as likely to receive MOUD at discharge and less likely to receive a non-MOUD opiate at discharge. Receipt of a non-MOUD at discharge was associated with 12 times the risk of death or readmission at 3 months (p=0.04). The authors conclude that a consult from an ACT resulted in less readmission at 1 and 3 months.
Aging and Disease
This study used a multiplex preclinical mouse model to compare markers of cellular senescence and age-related outcomes induced by maternal, paternal, and dual-parental alcohol exposures. Researchers found that chronic parental alcohol use causes enduring mitochondrial dysfunction in offspring, resulting in a reduced NAD+/NAHD ratio and altered expression of the NAD+-dependent deacetylases SIRT1 and SIRT3. These observations suggest that some aspects of fetal alcohol spectrum disorders (FASDs) may be linked to accelerated aging due to programmed changes in the regulation of mitochondrial function and cellular bioenergetics.
In The News
National Institute on Drug Abuse (NIDA)
Early prevention programs for children could help end the opioid crisis
The Conversation
NBC News
Alcohol Consumption Increasingly Viewed as Unhealthy in U.S.
Gallup
A decade into states legalizing marijuana, the kids are alright
The Hill
To Battle The Fentanyl Overdose Epidemic, Modernize Methadone Treatment
Health Affairs