This Week in the ASAM Weekly

Guest Editorial
An Antiracist, Justice-Guided ASAM: It’s Who We Are

by Stephen M. Taylor, MD, MPH, DFAPA, DFASAM
Incoming 2023 President-Elect

A patient recently said to me, “At this point in my life, recovery is not only how I live, it’s who I am.” Although I realize – and have helped him understand – that recurrences can occur in the course of the chronic disease that is addiction, I was able to celebrate with him that he is now “right where he needs to be.” It was a long, often painful journey to get there, and he will have to remain diligent to build on the gains he has made.

Click here to read the full editorial.

Lead

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic 🔓

JAMA Network Open

Questions remain about emergency authorizations permitting telehealth services for buprenorphine and whether these measures resulted in overdose deaths involving buprenorphine. This cross-sectional study examined 74,474 opioid-involved overdose deaths in 46 states and the District of Columbia prior to and during COVID-19. From July 2019-June 2021, there were 89,111 total overdose deaths and 74,474 opioid-involved overdose deaths. Buprenorphine was involved in 1,955 deaths, 2.2% of all drug overdose deaths and 2.6% of opioid-involved overdose deaths. Of these buprenorphine-involved overdose deaths, a higher proportion were female, non-Hispanic White, and lived in rural areas. While opioid-involved overdose deaths increased during this period, those involving buprenorphine did not increase.

Research and Science

Moderate Alcohol Consumption and Depression: A Marginal Structural Model Approach Promoting Causal Inference

The American Journal of Psychiatry

To compare the effects of consistent abstinence and occasional, moderate, and above-guideline alcohol consumption throughout early to middle adulthood on depression at age 50, this study analyzed the National Longitudinal Survey of Youth 1979 cohort and used a marginal structural model (MSM) approach. Both consistent occasional and consistent moderate drinkers were predicted to have reduced rates of probable depression compared with consistent abstainers. Consistent above-guideline drinkers were predicted to have slightly increased risk compared with consistent abstainers, but this was not significant. Results were similar for females and males. This is preliminary evidence that associations between moderate alcohol consumption and reduced risk for depression may reflect genuine causal effects.

Prevalence and Correlates of Unmet Mental Health Services Need in Adolescents with Major Depressive Episode in 2019: An Analysis of National Survey on Drug Use and Health Data

Journal of Adolescent Health

Using 2019 NSDUH data, this study sought to analyze estimates surrounding issues of mental health services among U.S. adolescents. Factors such as being of multiple races, female, and using alcohol, marijuana, and illicit drugs increased the odds of a past-year major depressive episode (MDE); being Hispanic, of multiple races, and using alcohol or illicit drugs increased odds of unmet need. Black adolescents and those who were privately insured had decreased odds. Close to 16% of adolescents had a MDE and nearly 46% of these did not receive care. Efforts toward improving access to treatment, diagnosing mental health crises, and treating those in need are a priority.

Racial/ethnic discrimination and tobacco and cannabis use outcomes among US adults

Journal of Substance Use and Addiction Treatment

Racial/ethnic discrimination is associated with use of individual tobacco and cannabis products. This cross-sectional study used data on adults (18+) from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III and sought to understand how discrimination affects dual/polytobacco and cannabis use and associated use disorders. Experiencing more discrimination was linked to dual/polytobacco and cannabis use. Discrimination was also associated with joint tobacco and cannabis use disorders. For each race/ethnicity, discrimination was linked to at least one-use outcome. Associations with more severe outcomes were stronger for White and Black adults.

Racial and Ethnic Disparities in Emergency Department-Initiated Buprenorphine Across 5 Healthcare Systems

Academic Emergency Medicine

Emergency departments (ED) offer an important opportunity to intervene and initiate treatment for patients with opioid use disorder (OUD). In this study, the authors conducted a secondary analysis of a prior study to evaluate racial and ethnic differences in initiation of buprenorphine (BUP) for patients presenting with an OUD-related ED visit. Overall, 12.2% of patients received BUP, but Black patients (8.9%) were less likely (OR 0.64, p<0.05) to receive BUP than White patients (13.1%). Hispanic patients were more likely (OR 1.41, p-=0.01) to receive BUP than non-Hispanic patients. However, these differences were attenuated when controlling for OUD discharge diagnosis. These findings are consistent with other studies and support additional focus on disparities in ED treatment and diagnosis of OUD.

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Race Differences in the Association Between Binge Drinking and Treatment Among First-Time Justice-System-Impacted Youth

Alcohol and Alcoholism

Participants were 1,216 males between ages 13 and 16 followed for 5 years after their first arrest. Face-to-face interviews were conducted within 6 weeks of arrest, every 6 months for 3 years, and yearly for years 4 and 5. Participants were asked about frequency of binge drinking (5 or more drinks at a time)and alcohol treatment, i.e., either a self-help group (AA, NA, or similar) or alcohol treatment by a therapist or in a hospital. Prevalence of both alcohol treatment and binge drinking frequency increased with age. Among occasional binge drinkers, Black youth were less likely to receive alcohol treatment than White or Hispanic youth. Black youth who binge drank frequently were as likely to receive treatment as White or Hispanic youth who only binge drank occasionally. The authors conclude that when binge drinking at similar frequencies, Black youth are less likely to receive alcohol treatment than White youth.

Adverse Childhood Experiences Are Associated With History of Overdose Among Patients Presenting for Outpatient Addiction Care 🔓

Journal of Addiction Medicine

In this study, the authors examine the association between childhood trauma and self-report of overdose. Utilizing the adverse childhood experiences (ACE) 10-point measure, the authors found that those with a history of overdose report a significantly higher score (4.0 vs 2.3), and in multivariate analysis higher ACE score was associated with increased odds of overdose (AOR 1.23, p=0.04). These findings are consistent with other studies. The authors suggest that given these findings prevention programs for at-risk youth could utilize the ACE to screen for highly vulnerable populations. In addition, they suggest that outpatients in dual-diagnosis treatment screened with higher ACE scores may benefit from trauma-informed care.

Amphetamines modulate fentanyl-depressed respiration in a bidirectional manner

Drug and Alcohol Dependence

This study measured the effect on respiration in mice of fentanyl plus either naloxone, d-amphetamine (AMPH) or methamphetamine (METH). The mice were placed in a whole-body plethysmograph and respiratory minute volume (MV) was recorded. Fentanyl alone reduced MV to 59% of baseline and this effect was reversed by naloxone in a dose dependent manner. The addition of AMPH in low and moderate doses increased the duration of respiratory depression produced by fentanyl. However, AMPH in high doses increased MV to 125% of baseline at 60 minutes. The effect of METH on fentanyl-induced respiratory depression was similar to AMPH. The authors conclude that combining AMPH or METH with fentanyl may worsen respiratory depression. This effect was bidirectional and both AMPH or METH increased fentanyl-induced respiratory depression at low and moderate doses but increased respiratory MV at high doses.