ASAM Weekly for January 24, 2023
This Week in the ASAM Weekly
According to results from the 2021 National Survey on Drug Use and Health, nearly 1 in 3 adults in America had either a substance use disorder (SUD) or any mental illness (AMI) in the past year, almost half of all young adults had either a SUD or AMI, and for many with either (SUD or AMI) the COVID pandemic was a global stressor (NSDUH). Not often captured by NSDUH surveys, incarcerated individuals represent a broad population at high risk for opioid use disorder (OUD) and opioid-overdose deaths. Providing them with best practices in a continuum-of-care model would save many lives and reduce recidivism, which is especially important for counties highly impacted by the opioid epidemic (Health & Justice).
Individuals with OUD have unique perspectives on OUD treatment success, but study measures may not capture their quality of life concerns and so there is still much to learn by simply asking “are you happy?” (Substance Abuse Treatment, Prevention, and Policy). Contingency management (CM) works on the seemingly simple principle of operant conditioning yet has historically been held back by the complexities of human leadership. As such, Northwest ATTC developed an online training course that helps community-based programs implement this empirically supported, yet under-utilized therapy (JSAT).
Just in time for people to break their Dry January fasts from alcohol (NY Times), leading experts discuss how mocktails and fake beer can be a healthy choice for many but a cue-induced risk for individuals with AUD (Washington Post). Whether these alcohol-free trends will sustain healthier outcomes remains to be surveyed.
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
Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S. 🔓
Health & Justice
This study investigated OUD best practices in US jails in those counties heavily impacted by overdose. Core best practice domains included screening, clinical assessment by qualified treatment provider, medically managed withdrawal, medication for opioid use disorder (MOUD) administration, services for pregnant women, counseling/wrap-around services, collaboration with community MOUD providers, assistance with Medicaid/insurance coverage, re-entry services, and overdose prevention. Some 92% reported some MOUD availability, but only 20% provided it to persons assessed with OUD. Best practices were more common in counties with larger populations, a higher percentage of Hispanic residents, fewer people living below the poverty line, and fewer jail admissions. A number of challenges including MOUD funding, training, and addressing stigma were reported. This study highlights the impact of lost opportunities for reducing disease, death, and recidivism that result from the lack of greater MOUD availability and accessibility.
Mark Your Calendars for this Annual Conference 2023 Session
Bridging the Gap between Science and Clinical Practice in Addiction Medicine
Saturday, April 15, 2023 | 3:45 PM – 5:00 PM
Dr. Geetha A. Subramaniam, MD, DLFAPA, DFAACAP, will provide a brief overview of the National Drug Abuse Treatment Clinical Trials Network. In this presentation, she will review ongoing and recently completed trials in the area of treatment and early intervention of substance use disorders.
Research and Science
Cannabis companies and the sponsorship of scientific research: A cross-sectional Canadian case study 🔓
This cross-sectional, descriptive, meta-research study describes the characteristics of research that reports funding from, or author conflicts of interest with, Canadian cannabis companies. The companies were found to likely be analogous to peer industries by sponsoring research related to product development, expanding indications of use, and supporting key opinion leaders. Given the recent legalization of cannabis in Canada, there is ample opportunity to create a policy climate that can mitigate the harms of criminalization as well as the impacts of the “funding effect” on research integrity, research agendas, and the evidence base available for decision-making. Importantly, policies should promote high-priority and equity-oriented independent research.
Sorting through life: evaluating patient-important measures of success in a medication for opioid use disorder (MOUD) treatment program 🔓
Substance Abuse Treatment, Prevention, and Policy
This study conducted semi-structured interviews with 28 people receiving MOUD in Philadelphia. The authors note that traditional measures of success for MOUD include retention in treatment, adherence to MOUD, and refraining from use of opioid and other drug use. This study identified items the people in MOUD themselves felt were indicators of success. Items identified as having high importance included stable housing, not using opioids, being happy, and a sense of self-worth. Items identified as of low or no importance included abstinence from all drugs, decreasing OD, and decreasing ED or hospital visits. The authors conclude that measures of success for people in MOUD are complex and multi-dimensional.
Community implementation of contingency management to address stimulant use 🔓
Journal of Substance Use & Addiction Treatment
Stimulant use, and its involvement in overdose, has been increasing in recent years. To address this, an interagency partnership was developed in Oregon to design and implement a contingency management (CM) program within opioid treatment programs. Implementation of this program was said to have improved patient outcomes. For example, 28% of clients in the CM program were stimulant negative, an 11% improvement from prior to program implementation (P<0.01). In addition, 6-month treatment retention improved from 76% to 90% (P<0.05). After the implementation phase, the teams decided to continue the program utilizing grant funding with intention to seek longer term funding, which could be a limiting factor.
How does a clinician approach the pharmacological management of opioid use disorders in pregnant women and pregnant people? 🔓
Expert Opinion on Pharmacotherapy
Rates of OUD in pregnant people mirror those who are not pregnant, but the harms of untreated OUD in this population also include increased odds of maternal cardiac arrest, preterm labor, placental abruption, premature rupture of membranes, cesarean delivery, and death. In this article, the authors considered measures to reduce harm and promote healthy outcomes throughout pregnancy and the first 12 weeks postpartum. These include shared decision-making, ensuring access to MOUD, and continuity of care in the early postpartum period. Future efforts should consider the policies that actually improve health, safety, and well-being for the mother and baby, along with those that bring about other improved outcomes.
Experiences of Listening to Icaros during Ayahuasca Ceremonies at Centro Takiwasi: An Interpretive Phenomenological Analysis 🔓
Anthropology of Consciousness
Research into the therapeutic use of psychedelics has been increasing in recent years. In this paper, the authors explore the use of music in conjunction with ayahuasca. In traditional practices music was part of the ayahuasca ceremonies and the authors look at the use of specific songs called Icaros and associated experiences. Patients reported feeling that the Icaros helped shape, control, and guide their experiences and that they modulated their emotional states and elicited experiences of healing. Given the importance of music and its use with psychedelics in traditional ceremonies, the authors suggest that additional research is needed to better understand the role of psychedelics and the cultural context in which these substances are traditionally used.
SnapShot: Psychedelics and serotonin receptor signaling
Serotonin (5-hydroxytryptamine; 5HT) signaling regulates processes in every major organ system, but it is most widely known for its role as a neurotransmitter in modulating a plethora of human behaviors. Psychedelics target the 5HT2A receptor and represent potentially transformative therapeutics for neuropsychiatric disorders. However, designing subtype-selective compounds that distinguish between 5HT2A/B/C remains desirable as 5HT2B or 5HT2C receptor activation produces unwanted side effects. The ability to design 5HT2A-selective compounds will help refine the use of psychedelics for treatment of neuropsychiatric disorders while avoiding suppressing the potential consequences of broad 5HT2 activation.
Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies
New England Journal of Medicine
This letter to the New England Journal of Medicine described a pilot trial of buprenorphine induction of 100 patients by pharmacists in outpatient pharmacies. The pharmacists evaluated the patients and then collaborated with an addiction medicine physician to derive a buprenorphine regimen for unobserved “take-home” induction. Patients returned to the pharmacy for dose-adjustment until a stable dose had been reached. The 58 patients who were stabilized were randomized to receive either pharmacy-based follow-up care or usual care. Of the pharmacy-based care patients 89% continued to attend visits at one month compared to 17% of the usual care patients. This pilot is part of a phase 3 trial of pharmacy-based medication treatment for addiction.
Articles Available for CME in ASAM's eLearning Center
In The News
Do mocktails really help you drink less alcohol?
The Washington Post
A Colorado library is closed after meth contamination. What will it take to clean it?
It’s Dry January. Pour One Out for the Bar Owners
The New York Times
2021 National Survey of Drug Use and Health (NSDUH) Releases
Bill to bring oversight to addiction recovery homes sees first hearing
Independent Record/Montana Free Press
The addiction crisis is causing a spike in endocarditis cases. Hospitals are struggling to respond
Justice Department files complaint after officer fired for opioid use disorder