American Society of Addiciton Medicine

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The ASAM Weekly for September 10th, 2024

This Week in the ASAM Weekly

September is National Recovery Month, and according to SAMHSA, 20.9 million adults who ever had a substance use problem consider themselves to be recovering or in recovery. Provisional 2022 data from CDC, released early this year, suggests a 3% decrease in drug overdose deaths from the prior year, which would be the first annual decrease since 2018.

In honor of National Recovery Month and for all that goes into treating addiction and supporting recovery, we’d like to share with our readers some valuable resources about recovery.

National Recovery Month Partner Toolkit | Overdose Prevention | CDC

National Recovery Month | SAMHSA

A Proclamation on National Recovery Month, 2024 | The White House

Biden-Harris Administration Kicks Off National Recovery Month with Walk for Recovery and Gallery of Hope | HHS.gov

International Recovery Day | Celebrating Recovery Globally

Recovery Month - Faces & Voices of Recovery | facesandvoicesofrecovery.org

ASAM Clinical Algorithm Subcommittee

As a part of ASAM’s mission to define and promote evidence-based best practices in addiction prevention, treatment, remission, and recovery, the ASAM Clinical Algorithm Subcommittee will collaborate with ASAM staff in refining the 4th Edition clinical algorithms for ASAM Criteria-based assessment tools. Applications are due by September 30th. 


Lead Story 

State-level racial and ethnic disparities in buprenorphine treatment duration in the United States ðŸ”“

The American Journal on Addictions

National trends reveal a concerning escalation in racial and ethnic disparities in buprenorphine treatment duration for opioid use disorder. This study examined such disparities at the state level. Analyzing 9,040,620 buprenorphine prescriptions dispensed between January 2011 and December 2020 from IQVIA Longitudinal Prescription data, the study revealed substantial statewide variations in racial and ethnic disparities. Specifically, 21 states showed longer treatment durations for White people across all episodes, and 8 states displayed similar trends among episodes lasting ≥180 days. Longer treatment durations for White people in both overall and long-term episodes were exhibited in 5 states, and 15 states showed no racial and ethnic disparities.

Research and Science

A Pharmacologic Evaluation of Buprenorphine in Pregnancy and the Postpartum Period

Journal of Addiction Medicine

The authors reference their previous work showing that, at the same dose, plasma levels of buprenorphine were lower in pregnant patients. They have also observed that pregnant patients often choose to divide their daily dose into smaller, more frequent doses. For this study, the authors measured plasma buprenorphine concentrations at multiple points during the dosing interval in 22 pregnant patients. The providers chose the total daily dose, and patients chose the dosing interval. Plasma buprenorphine was 29% lower during pregnancy than the postpartum period and lowest (45% lower) during the second half of pregnancy. Patients chose dosing intervals that corresponded to the return of plasma concentrations to the baselines, and suppression of craving and withdrawal. The authors conclude that pregnant patients require higher buprenorphine doses and benefit from more frequent dosing intervals.


Interventions to reduce harms related to drug use among people who experience incarceration: systematic review and meta-analysis ðŸ”“

The Lancet Public Health

Mortality, suicide, self-harm, and substance use are elevated among people who are incarcerated. This systematic review and meta-analysis examined the effect of interventions delivered to people who use drugs during incarceration or after release from incarceration, on a wide range of outcomes. Receiving opioid-agonist treatment (OAT) in prison reduced the risk of death in prison, whereas receiving OAT in the first 4 weeks following release reduced risk of death in the community. Therapeutic community interventions reduced rearrest at 6–12 months and reincarceration at 24 months. There was scarce evidence that OAT and syringe service provision are effective in reducing injecting risk behaviors and needle and syringe sharing.

Distinct Trajectories of Prescription Opioid Exposure in Pregnancy and Risk of Adverse Birth Outcomes

Journal of Addiction Medicine

This study examined the effect of various patterns of prenatal opioid exposure with birth outcomes. There were 138,123 Medicaid-covered pregnancies in Wisconsin between 2011 and 2019, and 20% had prenatal prescription opioid exposure. The 5 patterns of exposure and odds ratio for neonatal opioid withdrawal syndrome (NOWS) were stable MOUD (OR=22), inconsistent MOUD (OR=15), chronic analgesic opioid use (OR=19), intermittent analgesic opioid use (OR=6), and low level opioid use (OR=2). The majority of patients (78%) fit into the low level opioid use pattern. Although stable MOUD had a higher risk of NOWS than inconsistent MOUD, stable MOUD had greater birth weight (54 grams) and longer gestation (0.2 weeks).

Learn More 

Reported Non–Substance-Related Mental Health Disorders Among Persons Who Died of Drug Overdose — United States, 2022 ðŸ”“

Morbidity and Mortality Weekly Report

Persons with non-substance-related mental health disorder (MHD) are at increased risk for nonfatal and fatal overdoses. This study found that, in 2022, 21.9% of persons with fatal overdoses had an MHD. Those who overdosed with an MHD were more likely to be female, non-Hispanic White, and have a history of known opioid use or misuse. Overall, 82.2 % of overdose deaths involved opioids, but among those with an MHD, a greater proportion involved antidepressants (9.7% vs 3.3%), benzodiazepines (15.3% vs 8.5%), and prescription opioids (16% vs 11.6%). In addition, 24.5% of those with an MHD had at least one interaction with potential for intervention within the month prior to overdose. These findings reinforce the need for screening for MHDs and substance use disorders (SUDs) and linkage to and integration of treatment for MHDs and SUDs. 

Household Compositions and Substance Use among Young Adults in the U.S. ðŸ”“

International Journal of Environmental Research and Public Health

US young adults (age 21-29) have the highest prevalence of past-month tobacco, alcohol, and illicit drug use, and while marriage and having children have been associated with reduced risk of substance use, recent generations of young adults are reaching these milestones at later ages than previous generations. Given these changes, the study examined household composition among young adults and associations with substance use and found that those living with their children and spouse/partner had the lowest rates of substance use, while those living only with unrelated other individuals had the highest rates of use. The authors suggest that evidence-based substance use prevention and intervention strategies focused at the household level and accounting for shifting household composition may be indicated.