ASAM Weekly for March 28, 2023
This Week in the ASAM Weekly
Psychedelics offer a wealth of information for understanding the human experience and addiction. A study combining EEG and fMRI explores how N, N-dimethyltryptamine (DMT) desegregates the brain’s modeling of one’s environment (and consciousness) via 5-HT2A receptors (PNAS). An examination of NSDUH data found that lifetime exposure to MDMA was associated with lower odds of impaired social functioning outcomes. Several interesting explanations on causality are provided but the survey’s design cannot fully account for individual level characteristics (Scientific Reports).
A study of co-occurring psychiatric disorders in substance use treatment found that it wasn’t necessarily the severity of psychiatric distress that influenced the risk of relapse, but rather it was likely the challenges associated with having a COD diagnosis - such as adverse socio-economic experiences (BMC Psychiatry). A latent class analysis of survey data from JCOIN Amerispeak consolidated the characteristics of education, family dynamics, media influence, and racial stigma to suggest which groups of people would benefit from destigmatizing, public health messaging about OUD (IJERPH).
Technology is increasingly influencing our experiences. Tobacco advertising continues to be a global challenge as exposure to the internet opens new opportunities to connect with youth (Lancet Global Health). A text message-based smoking cessation intervention separated from the control group by developing an arsenal of seemingly personalized messages ( JAMA Network Open). With the onset of AI, the implications are noteworthy.
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD
Lead
Human brain effects of DMT assessed via EEG-fMRI 🔓
PNAS
Interest in psychedelics as potential treatment for depression has increased. In this study, researchers examine the effects of N,N-Dimethyltryptamine (DMT) on brain function using electroencephalography (EEG) and functional MRI (fMRI). The study found a dysregulating effect on activity in the transmodal association pole (TOP) an area with high expression of serotonin 2A receptors (5-HT2AR). The authors also found increased communication between TOP and the rest of the brain, which may be evidence of increased information processing and hyperassociative cognition. They were able to correlate their findings through simultaneous EEG, fMRI, and symptom reports from participants.
2023 Addiction Medicine Research Priorities Listening Session
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Agency for Healthcare Research and Quality (AHRQ) have requested input from addiction medicine specialists on how to improve the clinical relevance of their addiction medicine research portfolios.
Please provide input on their questions below and add any questions or comments you may have at the end of the form. We will also discuss these questions at the "Bridging the Gap between Science and Clinical Practice in Addiction Medicine" session during the ASAM 2023 Annual Conference.
If you have any questions, please email Ray Denny, PhD, Associate Director of Science, at rdenny@ASAM.org. Thank you!
Research and Science
BMC Psychiatry
This was a prospective study of 511 patients receiving inpatient treatment for SUD. A co-occurring psychiatric diagnosis (COD) was present in 47% of patients. The study found that patients with COD were more likely to be younger, have less education, and not have a permanent residence. Assessment for relapse at 3-month follow-up was completed by 70% of patients. Patients with a COD had a relapse rate of 40% compared to 26% for those without a COD (OR 1.85, 95% CI 1.23-2.78). The increase in the risk for relapse with a COD was greatest with stimulant use (OR 2.32, 95% CI 1.05-5.10) followed by cannabis use (OR 2.12, 95% CI 1.08-4.16). Patients receiving inpatient treatment for a SUD that also have a co-occurring psychiatric diagnosis have an increased risk of relapse.
A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis 🔓
International Journal of Environmental Research and Public Health
This study surveyed public attitudes about opioid use. Surveys were emailed to a random selection of households that are part of AmeriSpeak. AmeriSpeak is a group of 35,000 households who agree to receive surveys and were selected to be representative of the US household population. The 39-item survey included questions measuring stigma towards OUD and beliefs regarding a public health or punitive response. The response rate was 27% and 1036 surveys were analyzed. Responses fell into 3 groupings: 1. High stigma/high punitive (37%), 2. High stigma/mixed punitive and public health (38%), and 3. Low stigma/high public health (25%). College education was associated with a reduced probability of high stigma/punitive (aOR 0.35, p=0.01). There was concern that only a quarter of respondents had low stigma and supported a public health/medical response to OUD.
Scientific Reports
MDMA/ecstasy and classic psychedelics such as psilocybin, LSD, peyote, and mescaline represent two potential treatments for impairments in social functioning. Using a large-scale nationally representative
sample, this study investigated the connection between use of these substances and social impairment. Lifetime MDMA/ecstasy use was associated with lowered odds of the following difficulties: dealing
with strangers (aOR 0.92), participating in social activities (aOR 0.90), and being prevented from participating in social activities due to mental health issues (aOR 0.84). Lifetime mescaline use
was associated with lowered odds of difficulty dealing with strangers (aOR 0.85). Future studies might assess a better understanding of potential risks related to these compounds.
The Lancet Global Health
Universal proportions and trends to pro- and anti-tobacco advertisement exposure among young people around the world remains unknown. Using an analysis of repeated cross-sectional surveys, this study looked at data from 142 countries and found that exposure to tobacco advertisements remains high, and those to anti-tobacco advertisements is not high enough. However, the proportion of young adults exposed to both types of advertisements in most countries has decreased over time. These findings demonstrate the importance of stricter tobacco marketing worldwide.
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JAMA Network Open
This retrospective cohort study compared buprenorphine treatment initiation, response, and follow-up between CA Bridge emergency department patients who reported and did not report fentanyl use. Of some
896 patients with opioid use disorder (OUD), 87 (9.7%) reported fentanyl use. Of the 492 patients (54.9%) who were administered buprenorphine, 44 (9.5%) used fentanyl, with a dose of buprenorphine
of 8-32 mg. There were only 2 cases of precipitated withdrawal among the patients reporting fentanyl use. Results demonstrate that high-dose buprenorphine administered in the ED for patients in withdrawal
benefits those using fentanyl.
Assessment of a Text Message–Based Smoking Cessation Intervention for Adult Smokers in China 🔓
JAMA Network Open
In this randomized clinical trial of 722 current smokers in China, participants who received the behavior change theory–based smoking cessation intervention using personalized text messages had a 6-month quit rate that was twice that of participants who received an intervention using non-personalized text messages. These findings provide new evidence supporting the utility of mobile health methods for smoking cessation.
Addiction Biology
Overdose deaths involving cocaine have been increasing, but there are no approved pharmacological treatments available in the United States. Contingency management is the most effective behavioral intervention but has limited long-term effects. Given these limited options, the authors review the evidence for the use of prescription psychostimulants (PP) as potential treatment. PPs have similar pharmacological effects to cocaine, increasing monoamine levels, and in animal models have shown to decrease abuse-related behavior and self-administration of cocaine. There is also some evidence from human trials that they may reduce cocaine use and increase abstinence. While the data are limited, the authors suggest PP use as part of comprehensive treatment plans may increase patient initiation of and retention in treatment with improved outcomes.