News
The ASAM Weekly for September 3rd, 2024
This Week in the ASAM Weekly
A news release from the National Institute on Drug Abuse highlights some important findings from the latest Monitoring the Future (MTF) survey (NIDA). Young and mid-life adults continue to use cannabis and hallucinogens at historically high levels, while tobacco use remains low. But the generations differ regarding vaping and binge drinking which tend to occur most often in young and mid-life adults, respectively.
A notable example of this is the significant reductions in alcohol use among young adults in Ireland. Although a recent BBC article acknowledges increasing health-literacy around alcohol use, it seems to reflect more excitement around the increasing market share of non-alcoholic drinks.
There is something to be said then about how the market influences substance use behavior. The DEA has effectively delayed the decision about reclassifying cannabis until after the election, and the cannabis industry is not happy (Forbes). But if we consider data from MTF, it’s hard not to see a temporal relationship between cannabis use and legalization.
Even geo-political macrotrends, such as supply chains and shipping routes, play a significant role in substance use. The US government is courting Pacific nations to counter the undue influence Chinese firms have in the US opioid and methamphetamine crises (Reuters).
In that regard, public health officials in San Francisco are responding to the methamphetamine crisis with a mix of pharmacology and marketing. Rather than using a pragmatic name like “Packages of Olanzapine,” they’ve opted for the more clever “chill packs” which help mitigate some of the adverse effects of methamphetamine use, like psychosis and emergency service utilization, in high-risk populations (SF Chronicle).
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
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.
Please contact Taleen Safarian (tsafarian@asam.org) with any questions. 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
Annals of Medicine
Mindfulness-Oriented Recovery Enhancement (MORE) uses mindfulness training to address dysregulation in brain reward systems. MORE has been shown to reduce drug cue reactivity and in an RCT reduced opioid misuse 45% at 9 months. Face-to-face MORE requires significant time of trained clinicians, and this study explored the feasibility of delivering MORE by virtual reality (VR). Treatment consisted of 8 weekly, one-hour MORE-VR sessions. Patients could choose the VR setting for their meditation (beach, forest, waterfall) and interact with virtual drugs and paraphernalia during session 5, which was devoted to examining and managing craving. Of 38 patients, 68% completed 4 or more sessions and 50% completed all sessions. Opioid use decreased significantly (p =.04), as well as craving (p<.001), and results showed a significant increase in positive affect (p<.001).
Research and Science
International Journal of Medical Informatics
This study examined the effect of self-help group attendance on completion of treatment for patients receiving MOUD. Data came from SAMHSA’s Treatment Episode Data Set for the years 2015-2019, where 157,885 patients receiving MOUD were identified and 29% completed treatment (CT). Because of the large number of potential confounding variables, it is impractical to find a perfectly matched control group. The paper describes a complex machine learning process used to identify and account for variables that affect treatment completion. Patients participating in self-help groups had 51% CT compared to 19% CT among the rest (p<0.0001). The overall self-help group participation was 31% and varied geographically from 40% in New England to 4% in Puerto Rico. Treatment setting also affected outcome: residential treatment had 86% CT, intensive outpatient had 47% CT, and ambulatory non-intensive outpatient had 22% CT.
Journal of Substance Use and Addiction Treatment
This study examined availability of opioid agonist treatment (OAT) in residential SUD treatment facilities in North Carolina. Researchers identified 94 residential treatment facilities in the state and were able to collect data on 66. Data were obtained from websites and calls made by research staff posing as prospective patients. OAT was provided on site by 11% of facilities, 14% allow OAT from an outside provider, and the rest barred the use of OAT. Callers to half of the facilities received negative comments about OAT, such as statements like “trading one addiction for another.” OAT availability was associated with facilities holding a state license (p=0.002) and offering 12-step programs (p=0.02). OAT availability was negatively associated with facilities incorporating faith-based programs (p=0.001). The authors conclude that “stigma against OAT remains pervasive.”
Journal of Substance Use and Addiction Treatment
This study examined availability of opioid agonist treatment (OAT) in residential SUD treatment facilities in North Carolina. Researchers identified 94 residential treatment facilities in the state and were able to collect data on 66. Data were obtained from websites and calls made by research staff posing as prospective patients. OAT was provided on site by 11% of facilities, 14% allow OAT from an outside provider, and the rest barred the use of OAT. Callers to half of the facilities received negative comments about OAT, such as statements like “trading one addiction for another.” OAT availability was associated with facilities holding a state license (p=0.002) and offering 12-step programs (p=0.02). OAT availability was negatively associated with facilities incorporating faith-based programs (p=0.001). The authors conclude that “stigma against OAT remains pervasive.”
Learn More
Alcohol, Clinical and Experimental Research
This paper reviews research that identifies empirically supported mediators of alcohol and other drug use and related outcomes and then evaluates their potential as being alcohol and other drug (AOD) treatment mechanisms of behavioral change (MOBC). The implementation of self-efficacy, social support, and craving into clinical practice and training is warranted. The authors present six directions for future research to solidify and generalize empirical support for the case that self-efficacy, social support, and craving are MOBC; they also offer five implications for clinical practice and training.
BMJ
This systematic review and Bayesian network meta-analysis evaluated the comparative effectiveness and acceptability of oral monotherapy using psychedelics and escitalopram in patients with depressive symptoms, considering the potential for overestimated effectiveness due to unsuccessful blinding. Placebo response in psychedelic trials was lower than that in antidepression trials of escitalopram. Of the available psychedelic treatments for depressive symptoms, patients treated with high dose psilocybin showed better responses than those treated with placebo in the antidepressant trials, but the effect size was small.
Buprenorphine for Opioid Use Disorder—An Essential Medical Treatment
JAMA Internal Medicine
Since 2023, all clinicians with a DEA license can prescribe buprenorphine for opioid use disorder, although this practice is still uncommon outside of addiction treatment specialists. In this article, the authors provide a short overview of buprenorphine, its formulations, and its use in treatment to provide non-addiction clinicians with knowledge to initiate and continue buprenorphine treatment. The article provides direction for traditional initiation approaches and micro-dosing, as well as reference to guidance for precipitated withdrawal. In addition, it provides guidance for dosing based on a patient's substance use history, including high-potency synthetic opioids (unregulated fentanyl).
Impaired vascular function among young users of anabolic–androgenic steroids 🔓
Scientific Reports
Anabolic-androgenic steroids (AAS) are known to be associated with adverse cardiovascular events, but the effect on vascular function is less clear. In this study, researchers examined carotid artery reactivity (CAR%) and flow-mediated dilation (FMD), both markers of endothelium function, in men with >1 year AAS use versus men with no history of AAS use. Men with AAS use had significantly lower CAR% (3.58 vs 6.33, p<0.001) and lower FMD response (3.99% vs 6.72%, p<0.001). These findings are similar to patterns in other groups at increased risk of cardiovascular disease and shed light on the increased risk of myocardial infarction and sudden cardiovascular death observed in young men who use AAS.
In The News
Cannabis and hallucinogen use among adults remained at historic highs in 2023
National Institute of Drug Abuse (NIDA)
Why is S.F. giving ‘chill packs’ to homeless meth users?
San Francisco Chronicle
As xylazine wounds rise, volunteers are filling gaps in care
The Philadelphia Inquirer
Medical College of Wisconsin
Why are people in Ireland drinking less alcohol?
British Broadcasting Corporation (BBC)
DEA Delays Marijuana Rescheduling Decision Until After The Election
Forbes
US to step up work with Pacific nations to halt drug trafficking
Reuters