This Week in the ASAM Weekly

The Future of Addiction Treatment Lies in Narrowing the Treatment Gap
Brian Hurley, MD, MBA, DFASAM
President, American Society of Addiction Medicine

In the time of the worst overdose crisis in American history, those of us who work in the field of addiction medicine have the responsibility of bringing treatment to where patients with addiction are. The addiction treatment gap refers to the approximately 94% of people with one or more DSM-5 defined substance use disorders (SUDs) who did not receive any addiction treatment (according to the SAMHSA’s National Survey on Drug Use and Health (NSDUH) conducted in 2021). ASAM is committed to establishing universal access to addiction treatment for everyone with addiction, and major opportunities to solve these access issues that remain ahead of us. We also have additional opportunities to engage people with SUD who are not currently engaged in treatment, as approximately 97% of NSDUH survey respondents who had SUDs but did not seek treatment did not feel that they needed treatment.

Read the full editorial here.

Lead

Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies 🔓

Hypertension

Employing a systematic search of longitudinal studies, the authors investigated links between blood pressure and alcohol intake. A considerable linear positive association was found between baseline alcohol intake and changes over time in both systolic blood pressure (SBP) and diastolic blood pressure (DBP). Average SBP was 1.25 and 4.90 mm Hg higher for 12 or 48 grams of alcohol compared with no drinking. The differences for DBP were 1.14 and 3.10 mm Hg. There was no evidence of a threshold for this connection.

Research and Science

Methamphetamine use and utilization of medications for opioid use disorder among rural people who use drugs

Drug and Alcohol Dependence

This study recruited participants from rural areas in 10 states who had, in order “to get high,” either recent (past 30-day) use of opioids or recent injection of any drug. Between January 2018 and March 2020, 2,899 participants were recruited. Recent methamphetamine use was reported by 75%. Those with recent methamphetamine use were more likely to have injected drugs than those without recent methamphetamine use (91% v. 66%). Recent methamphetamine use was associated with lower odds of having methadone treatment in the past 30 days (aOR=0.66), but not associated with past 30-day treatment with buprenorphine. The results indicate that recent use of methamphetamine is a barrier to receiving MOUD treatment with methadone. This may result from OTPs requiring abstinence to enter and/or stay in methadone treatment.

Urine Drug Screening in a Telehealth Setting for the Treatment of Opioid Use Disorder 🔓

JAMA Health Forum

This study described 3,395 patients who received opioid treatment by telehealth. Patients were mailed UDS kits, and they collected (off camera) urine samples during telehealth visits. Then clinicians inspected the results and discussed them with patients by video. A UDS was completed by 82% of patients during the first 30 days of treatment. For those patients retained in treatment for 180 days, the positive rate for buprenorphine was over 97% and the positive rate for several other drugs decreased over the period. Specifically: opioids (7.9% to 3.3%, p<.001), cocaine (3.4% to 2.2%, p=.008), and benzodiazepines (8.8% to 6.6%, p=.002). No decrease was seen for use of methamphetamine (3.8% to 3.1%), alcohol (12.2% to 12.1%), or cannabis (38.8% to 37.3%). The authors conclude that remotely administered UDS was feasible.

Impact of personalized alcohol intake and cognitive feedback on alcohol use behavior in hazardous drinkers: A quasi-randomized trial 🔓

Alcohol Clinical and Experimental Research

This proof-of-concept study showed that hazardous drinkers respond well to brief electronic interventions that incorporate cognitive feedback. Personalized normative and health consequences feedback about alcohol consumption, plus individualized information about impulsivity reduce intake among hazardous drinkers. Reductions in drinking in this cohort were such that, following the intervention, they could not be distinguished from non-harmful drinkers. Further research is required to determine how best to make impulsivity-related brain-health consequences of drinking manifest and how to maximize the potential of smartphones apps.

Effects of nicotine content and preferred flavor on subjective responses to e-cigarettes: A randomized, placebo-controlled laboratory study

Nicotine and Tobacco Research

Previous evidence has shown that flavor and nicotine concentration in e-cigarettes are important in initiation and maintenance of e-cigarette use (vaping). In this randomized placebo-controlled study, the authors examine the joint and interactive effects on subjective response to vaping utilizing flavored versus unflavored and with or without nicotine e-cigarettes in combinations. The study found independent effects with flavor associated with increased satisfaction and taste independent of nicotine content, while nicotine was associated with increased psychological reward and reduced cravings independent of flavor. While additional research is needed to assess how these independent effects motivate vaping behavior, these findings are important to developing regulatory policy.

Learn More

Situational Confidence and Recovery Capital Among Recovery Residents Taking Medications for Opioid Use Disorder in Texas 🔓

Journal of Addiction Medicine

Situational confidence (SC) is the confidence of one to resist substance use when in high-risk situations, while recovery capital (RC) are the resources that support persons in recovery and can be drawn upon by those persons. The authors conducted a cross-sectional study to evaluate associations between total, social, and personal RC and SC. In the multivariate analysis, they found higher education and higher personal, social, and total RC were all associated with higher SC. While the authors do note that patients in this study had relatively high SC overall, they support assessing RC and SC of patients to help guide decisions about treatment needs and intensity of support. The authors also note further research is needed to evaluate SC and RC over time in the recovery process.

Microbial short-chain fatty acids regulate drug seeking and transcriptional control in a model of cocaine seeking

Neuropsychopharmacology

Cocaine use disorder represents a public health crisis with no FDA-approved medications for its treatment. A growing body of research has detailed the important connections between the brain and the resident population of bacteria in the gut -- the gut microbiome -- in psychiatric disease models. Acute depletion of gut bacteria results in enhanced reward in a mouse cocaine place preference model, and repletion of bacterially-derived short-chain fatty acid (SCFA) metabolites reverses this effect. In the absence of a normal microbiome, repletion of bacterially-derived SCFA metabolites reversed the behavioral and transcriptional changes associated with microbiome depletion. These findings suggest that gut bacteria, via their metabolites, are key regulators of drug-seeking behaviors, positioning the microbiome as a potential translational research target.

Use of Medication for Opioid Use Disorder Among Adults With Past-Year Opioid Use Disorder in the US, 2021 🔓

JAMA Network Open

Data on prevalence of MOUD receipt among persons with OUD in the US are limited. Using data from the 2021 National Survey on Drug Use and Health (NSDUH), this study sought to provide rates of MOUD receipt among adults with past-year OUD. Among the estimated 2.5 million persons with OUD in the past year, 22.3% received MOUD. Groups least likely to receive treatment included Black adults, women, the unemployed, and those living outside of metropolitan areas. Conversely, receiving telehealth services was associated with an increased likelihood of receiving MOUD, emphasizing its critical place in accessing treatment.

In The News