American Society of Addiciton Medicine
Jan 29, 2025 Reporting from Rockville, MD
The ASAM Weekly for January 28th, 2025
https://www.asam.org/news/detail/2025/01/29/the-asam-weekly-for-january-28th--2025
Jan 29, 2025
Beyond Buprenorphine in the ED: Leveraging Lessons From 10 Years of Implementation

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American Society of Addictin Medicine

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The ASAM Weekly for January 28th, 2025

Jan 29, 2025

This Week in the ASAM Weekly

Beyond Buprenorphine in the ED: Leveraging Lessons From 10 Years of Implementation

Nikki Bozinoff, MD, MSc
Elizabeth Schoenfeld, MD, MS
Csilla Kalocsai, MPhil, PhD

The opioid toxicity crisis remains an urgent public health priority across the US and Canada. Since the seminal randomized controlled trial published in 2015 found that buprenorphine initiation in the emergency department (ED) was superior compared with referral to treatment alone, buprenorphine initiation in the ED has been hailed as an important mechanism for addressing the overdose crisis. However, now, nearly 10 years after the initial publication, the use of medications for opioid use disorder following an ED visit for overdose remains low with only 3-15% of individuals filling a prescription across diverse jurisdictions. We recently published a scoping review in Lancet Regional Health – Americas, in which we wedded a popular implementation science framework, the Consolidated Framework for Implementation Research, with critical theory to try to untangle the complex web of factors that facilitate and challenge buprenorphine induction in the ED, including the power structures that may undergird the implementation gap. We reflect on the tremendous scholarly and human resource effort to implement buprenorphine in the ED and try to unpack its implications for addiction medicine.

Read the full editorial here.

ASAM Criteria Fourth Edition Assessment Guide

The ASAM Criteria® Fourth Edition Level of Care Assessment Guide, developed by ASAM and pilot tested by UCLA Integrated Substance Use and Addiction Programs (ISAP), is a streamlined tool that helps clinical interviewers collect just enough information to make an appropriate level of care recommendation. The Guide promotes standardized decision-making by helping clinicians apply ASAM’s Dimensional Admission Criteria. It also supports identification of immediate needs and documentation for utilization review.

Download Here

Lead Story 

Association of State Cannabis Legalization With Cannabis Use Disorder and Cannabis Poisoning

JAMA Psychiatry

This longitudinal cohort study examined the association of state-level medical and recreational cannabis laws with cannabis use disorder (CUD) and cannabis poisonings in the adult population with employer-sponsored health insurance. The study showed that from 2011 to 2021, states with legalized medical cannabis experienced 42.7% and 88.6% increases in CUD and cannabis poisoning, respectively, compared to states without legalized medical cannabis. States with legalized recreational cannabis experienced a 31.6% increase in cannabis poisoning compared to states without legalized recreational cannabis. Thus, state medical cannabis legalization was associated with increased CUD and cannabis poisonings, and state recreational cannabis legalization was associated with increased cannabis poisoning in the adult population with employer-sponsored health insurance.

Research and Science

Emergency department utilization of the methadone “72-hour rule” to bridge or initiate and link to outpatient treatment

The American Journal of Emergency Medicine

Emergency departments (ED) are a significant point of contact to initiate treatment for patients with opioid use disorder (OUD), with recommendations to initiate buprenorphine already in place. Recommendations do not exist for initiating methadone in the ED. In this study, researchers examined ED-based dispensing of methadone under the “72-hour rule” over 8 months in 2021. Overall, 300 patients were given methadone in the ED during the study period, with the majority already established patients in an opioid treatment program (OTP). Fifty-six patients not in treatment were initiated on methadone in the ED and referred to a partner OTP, with 56% completing admission and 100% of those still in treatment at 30 days. These findings support engaging patients with OUD presenting to the ED in treatment and potentially offering methadone as a treatment option. 

Cannabis vaping elicits transcriptomic and metabolomic changes in inflammatory, oxidative stress and cancer pathways in human bronchial epithelial cells

American Journal of Physiology-Lung Cellular and Molecular Physiology

Cannabis use is increasing worldwide amid broad acceptance and legalization. The prevalence of traditional smoking is diminishing in favor of vaping dry flower. This is the first study to provide initial evidence that cannabis aerosol contains carcinogenic, teratogenic, and respiratory toxicants that induce transcriptional responses in epithelial cells analogous to those from cannabis smoke, suggesting potential adverse pulmonary effects. 

Learn More

Interventions for quitting vaping ðŸ”“

Cochrane Database of Systematic reviews

Use of electronic cigarettes has increased significantly over the last several years, but there is limited guidance about how to best assist patients to quit vaping. This Cochrane review included 9 randomized controlled trials in a meta-analysis examining both pharmacologic and behavioral interventions. Researchers found low-certainty evidence for varenicline and a text message-based intervention to help people stop nicotine vaping. The data were inconclusive for combination nicotine replacement therapy, cytisine, and other behavioral interventions. Of note, none of the studies assessed transition to or initiation of combustible tobacco. The authors note more research is needed and should include both long-term cessation and transition to combustible tobacco products. 

Identification and Treatment of Alcohol Use Disorder 

The New England Journal of Medicine

This review article is a comprehensive discussion about most aspects of alcohol use disorder (AUD), including the neurobiology and definition of AUD, diagnostic criteria, and screening instruments. The authors describe biological markers useful for detecting and monitoring alcohol use, and medical complications with a focus on liver disease. Also included is a wide-ranging discussion around the multitude of treatments for AUD, including pharmacotherapies and their mechanisms of action. This is a well-written and useful overview of the disease and its management.

Structural and functional alterations in hypothalamic subregions in male patients with alcohol use disorder

Drug and Alcohol Dependence

This study included 24 patients (all male) with AUD who were currently abstinent, as well as 24 healthy controls. Those with AUD had a mean duration of heavy drinking of 24 years and a mean duration of abstinence of 79 months. All patients had an MRI to measure hypothalamic volumes and a functional MRI to measure functional connectivity of the hypothalamus with other brain regions. Patients with AUD had lower total volumes of 5 subregions of the hypothalamus as well as lower total hypothalamic volume. This volume reduction correlated with the severity and duration of alcohol use. In addition, the duration of abstinence correlated with higher volumes. Similar changes were seen in functional connectivity. The authors concluded that patients with AUD have alterations in the hypothalamus that can reverse with abstinence.