News
The ASAM Weekly for January 7th, 2025
This Week in the ASAM Weekly
Dear readers,
Please enjoy a recap of the 2024 guest editorials.
Happy new year,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM; Jack Woodside, MD; John A. Fromson, MD
History Repeats Itself: Psychedelics Are Promoted Today the Way Opioids Were Promoted in the Early 2000s (1/23/24)
By Anna Lembke, MD, FASAM
After more than two decades as a practicing psychiatrist, I’ll be the first to admit that we need new and innovative treatments to treat depression, anxiety, and other psychiatric disorders. Psychedelics like LSD, psilocybin, and MDMA (Ecstasy) are being researched and promoted as ground-breaking advances for combatting mental illness. Multiple jurisdictions have already relaxed laws or policies related to these substances, often with an eye toward therapeutic use.
Bringing Racial Justice to US Drug Policy Promotes Equity and Access to Addiction Treatment (2/6/24)
By Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
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.
Are Headlines, Crises, and the Innocence of Youth Distracting Us from the Realities of Addiction Later in Life? (2/27/24)
By Bethea (Annie) Kleykamp, MA, PhD
The question was simple: Do people still smoke cigarettes?
They asked because none of their friends or family smoked, they didn’t see people do it in public, and they hadn’t seen a cigarette butt since the 90s.
They also asked because they had heard alarming news stories about nicotine vaping alongside warnings from public health agencies, including a congressional testimonial from FDA leadership on the youth vaping “epidemic” and a 295-page Surgeon General’s report on e-cigarette use among young people (my thoughts on the low quality of the latter are published in Nicotine and Tobacco Research).
Vaping was the new smoking, and youth were its victims, right?
A Radical Advance in the Integration of Co-Occurring Mental Health Care Within the Addiction System (3/19/24)
By Kenneth Minkoff, MD
As an addiction psychiatrist and community psychiatrist, I have worked on improving integrated systems and services for 40 years. Most recently, I helped to develop the updated standards in the 4th Edition of The ASAM Criteria that encourage all addiction treatment programs to be co-occurring capable, at minimum. (See Chapter 12: Integrating Care for Co-occurring Mental Health Conditions.)
I want you to be inspired and excited about the opportunity for everyone in the addiction field to learn how to be more successful, and have more fun, working with individuals with co-occurring mental health (MH) needs, who are the expectation (not the exception) among the people we serve.
Confronting Addiction from Prevention to Recovery (4/30/24)
By Petros Levounis, MD, MA
Over the past year as president of the American Psychiatric Association (APA), my presidential theme has been “Confronting Addiction from Prevention to Recovery.” This initiative has focused on four of the biggest areas—three persistent and one emerging—in addiction medicine: vaping & tobacco, opioids, alcohol, and technological addictions. Each of these issues has been addressed in quarterly educational campaigns that have seen APA member experts creating resources aimed at the general public and physicians alike.
Substance Use Prevention – A Comprehensive Approach to Meet the Moment (5/7/24)
By Christopher M. Jones, PharmD, DrPH, MPH
The United States is in the midst of an evolving and dynamic overdose crisis, driven by the proliferation of fake pills that contain illicitly made fentanyl and other synthetic opioids. Recently released data from the Centers for Disease Control and Prevention (CDC) show more than 107,000 lives lost to overdose in 2022 – the largest number of deaths reported to date. CDC also published data estimating the number of lives lost due to excessive alcohol use – nearly 178,000 each year – an often-overlooked dimension of our nation’s substance use challenges.
To Address the Fentanyl Crisis, Greater Access to Methadone Is Needed (7/23/24)
By Nora D. Volkow, MD
Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl.
Does Rescheduling Cannabis Make Sense? (7/30/24)
By Stuart Gitlow, MD, MPH, MBA, DFAPA, DFASAM
On May 16, the Department of Justice (DOJ) proposed moving marijuana from Schedule I to Schedule III of the Controlled Substances Act. Between now and November’s election, there will be considerable discussion regarding rescheduling. Of importance in this discussion is the fact that marijuana remains at this moment illegal in all 50 states under federal law, so, for example, a dispensary selling marijuana products is acting criminally whether or not such sales are permitted under state law.
Rapid Initiation of Injectable Extended-Release Naltrexone for Opioid Use Disorder: A Time for Paradigm Shift in Treatment Protocols (8/6/24)
By Matisyahu Shulman, MD; Edward V. Nunes, MD; Adam Bisaga, MD
The opioid crisis remains a critical public health issue in the United States, contributing to over 80,000 opioid overdose deaths in 2023 alone. Addressing this problem necessitates effective treatment options for individuals with opioid use disorder (OUD) that reduce the risk of relapse and overdose. Injectable extended-release (XR)-naltrexone is an FDA-approved treatment for OUD, particularly for populations less inclined towards agonist-based therapies such as methadone or buprenorphine, and otherwise attempting to remain abstinent without the help of medications. However, the conventional approach to initiate XR-naltrexone poses a significant hurdle due to the necessity of an extended opioid-free period to avoid precipitated withdrawal.
Physicians Not Widely Adopting Evidence-Based Practices to Help Reduce Addiction Morbidity and Mortality (8/13/24)
By Melinda Campopiano von Klimo, JBS International, Inc.; Laura Nolan, JBS International, Inc.; and Wilson M. Compton, National Institute on Drug Abuse, National Institutes of Health
By now, addiction specialists understand the depth and impact of the drug overdose death crisis in the United States. We’ve read that, “Drug overdoses are one of the leading causes of injury death in adults and have risen over the past several decades… In 2022, 107,941 drug overdose deaths occurred.” Studies published in the past year alone highlight the toll overdose is taking on communities and families, with health disparities and inequities in care often exacerbating negative health outcomes for those most in need.
Addressing the Addiction Treatment Gap (10/29/24)
By Gary Tsai, MD, FAPA, FASAM
If the data around substance use disorder (SUD) treatment-seeking teach us anything, it’s that most people with these conditions are not actually interested in the services we offer.
A big part of the reason for this is not because the SUD field doesn’t have an amazingly dedicated workforce or offer lifechanging services. Instead, the fact that readiness for SUD treatment is often defined as synonymous with readiness for complete abstinence from substances has set a treatment bar that is too high and unrealistic for most. While the influences of stigma and the criminalization of addiction on treatment-seeking cannot be ignored, it is generally easier to shape our practices than to solve these bigger societal issues.