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ASAM Weekly for April 4th, 2023

This Week in the ASAM Weekly

In 2018, Scotland imposed minimum unit pricing on alcoholic drinks sold to the public, which seemingly led to a 13% reduction in alcohol-attributable deaths. Most notably, the largest reductions occurred in some of the most socio-economically disadvantaged regions in Scotland (The Lancet). The socio-behavioral processes underlying such outcomes can be understood through the conceptualization of “harm per litre,” which has demonstrated that groups of lower socioeconomic status have incurred much higher disease burden and mortality (International Journal of Drug Policy). Don’t worry, it converts to about “harm per 34 oz.”

A randomized, controlled study in normal-weight individuals demonstrated that exposure to high-fat, high-sugar snacks directly affects neurobehavioral adaptations that could lead to increased overeating and weight gain ( Cell Metabolism). Similar to the above considerations, obesity can disproportionately harm groups of lower socioeconomic status. 

Ultimately, these studies are related to managing access. For example, having opioids in the home can increase the odds of an opioid overdose by 60% (JAMA Network Open). Such odds are staggering and appear to make the case of controlling supply straightforward, but it isn’t. A boldly framed opinion from the NY Times connects a stimulant shortage with the DEA’s telehealth proposal to argue that the law enforcement agency has failed its public health mission and cost taxpayers millions of dollars. The author isn’t arguing to defund the DEA but to at least transfer the healthcare responsibilities back to the FDA.

We hope to see you all next week at the ASAM 54th Annual Conference in Washington D.C. 

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 

Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders ðŸ”“

Nature Mental Health

Recent large-scale genome-wide association studies (GWASs) show that the genetic architecture of substance use disorders (SUDs) is characterized by a high degree of commonality, i.e., a general addiction genetic factor likely conveys vulnerability to multiple SUDs. Genetic liability to SUDs can be parsed into loci that confer general or substance-specific addiction risk. This is a multivariate genome-wide association meta-analysis that disaggregates general and substance-specific loci from published summary statistics of SUDs. Findings provide insight into genetic risk loci for SUDs that could be leveraged as treatment targets.


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

Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study ðŸ”“

The Lancet

Scotland has the highest level of health harms related to alcohol use in the UK. This study sought to assess whether a measure that increased the price of a beverage containing alcohol had an impact on alcohol-attributable deaths and hospitalizations in Scotland. Results demonstrate nearly a 14% reduction in alcohol-attributable deaths during the study period; hospitalizations decreased by more than 4%. The largest reductions were in subgroups known to be experiencing disproportionately higher levels of alcohol-related harms to health. 

 

Habitual daily intake of a sweet and fatty snack modulates reward processing in humans ðŸ”“

Cell Metabolism

In this study, 49 healthy weight individuals were asked to eat two snacks daily in addition to their regular diet for a period of 8 weeks. They received either a snack high in fat and high in sugar (HF/HS) or low in fat and low in sugar (LF/LS) but equal in calories. At the end of the 8 weeks the HF/HS group had a reduced preference for low fat foods as well as a decreased preference for juices low in sugar. Next, fMRI was performed during a “milkshake test.” The HF/HS group had increased neural response to both anticipation and consumption of the milkshake as compared to the LF/LS group. This study shows that exposure to HF/HS foods alone, can shift food preferences and increase the sensitivity of brain reward circuits to food cues in ways that may increase the risk for overeating. The study describes HF/HS foods as “like addictive drugs.”

ASAM review course
 

Development and Validation of an Overdose Risk Prediction Tool Using Prescription Drug Monitoring Program Data

Drug and Alcohol Dependence

All states have prescription drug monitoring programs (PDMP) and in Pennsylvania clinicians receive alerts for risk of overdose based on total opioid dose and overlapping benzodiazepine use. This study used machine learning to develop a model that more accurately predicted overdose risk. Pennsylvania PMDP data from 2018 to 2020 and overdose death data were used to train the model, and data from 2020 to 2021 were used for validation. The model used 20 variables from the PMDP (examples: age, opioid dose, early refills, number of prescribers and pharmacies, etc.). The model was more accurate at predicting overdose risk than the existing system. Some of the variables found to be important were age, total opioid dose, and number of prescriptions for benzodiazepines and for buprenorphine. The authors note that overdose risk was low, around 0.1%, in all groups.

Association of Household Opioid Availability With Opioid Overdose ðŸ”“

JAMA Network Open

In this cohort study of 1,691,856 Oregon adults in 1,187,140 households, the odds of opioid-related overdose increased significantly when another household member had opioid fills in the preceding 6 months. The odds also increased when both the individual and another household member had opioid fills in the preceding 6 months. The findings of this cohort study underscore the importance of educating individuals about the risks of keeping opioids in the household.


Learn More

Disparities in the provision of perinatal care based on patient race in the United States ðŸ”“

Birth Issues in Perinatal Care

In this retrospective review of EMR data, this study sought to identify potential differences in perinatal care based on patient ethnicity. Compared with NH White women, NH Black women were more likely to undergo urine drug testing (UDT) when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), but less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]). Compared with NH White women, Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a UDT completed when denying use. Diagnostic and treatment differences were most profound for NH Black women who had twice the odds of White women undergoing UDT despite denying drug use. Further research should focus on the specific biases of providers, and how evidence-based guidelines may improve systems of providing care.

"Harm per litre” as a concept and a measure in studying determinants of relations between alcohol consumption and harm ðŸ”“

International Journal of Drug Policy

Methods to examine the association between alcohol consumption and harm have been primarily per capita alcohol sales and community alcohol related mortality or patterns of drinking (heavy/light, frequent/infrequent) at individual level versus harms. The idea of examining the actual volume of alcohol consumed in relation to harm is relatively new. Under this concept, researchers utilize the amount of pure alcohol in relationship to harms, which allows for making comparisons across types of alcohol beverage. This concept has been helpful when looking across populations (countries) and socioeconomic status (SES). Notably, they have identified that there is greater harm experienced among those from lower SES groups, despite consuming the same or less alcohol than those from higher SES groups. Overall, the authors support the usefulness of this measure in alcohol use research.

Biochemical Validation of Dependence on JUUL and Other E-Cigarettes Among Youth

Pediatrics

In a previous study in 2013 and 2014, there was a weak association between e-cigarette use and urinary nicotine levels. However, with the release of high-nicotine JUUL e-cigarettes the authors reexamined the association. The authors examine the association between electronic nicotine product dependence (ED) and urinary nicotine biomarkers (TNE-2) in youth. The Spearman correlation between ED and TNE-2 was stronger among JUUL users (r=0.46) and non-JUUL users (r=0.25). In linear regression modeling there was a 14.4% (CL: 5.9-23.6) increase in TNE-2 per point increase in ED scores. Overall, the correlation between ED and TNE-2 among JUUL users was similar to that previously found in cigarette smokers. The authors suggest that high-nicotine e-cigarettes may be associated with increased nicotine addiction among youth.