This Week in the ASAM Weekly

It can be hard to read the scientific tea leaves of addiction, let alone the policy ones. So it should be taken as good fortune that the current director of the National Institutes of Health recently spoke glowingly about Dr. Nora Volkow’s leadership at the National Institute on Drug Abuse (STAT). It’s a testament to her all-around acumen.

Similarly, ASAM Immediate Past President Dr. Brian Hurley was recently quoted as being pleased to see the Trump administration prioritize making evidence-based SUD treatment readily available, while also advocating for several other agenda items (Medscape). But at the same time, the Trump administration is threatening the stability of medical school licensing committees, which could undermine the high standards of today's medical education system (MedPage Today).

What we need to consider in all of this is that today's standards in medicine were built up slowly over decades, absorbing norms, safeguards, and knowledge along the way. Dismantling SAMHSA, NSDUH, or the more than 40 affiliated mental health and substance use programs might only take a few months to complete -- but the impact could reverberate for years. What we’d be left with could be a collective experience more consequential than what has come before with the “deaths of despair” (STAT). But this time we risk being more vulnerable to interpretation (or divination) of the scientific evidence.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Jack Woodside, MD

Lead Story 

Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial 🔓

Journal of the American Medical Association

This 12-week randomized clinical trial in 261 treatment-seeking youth aged 16 to 25 years assessed if varenicline, when added to brief, remotely delivered behavioral support, was efficacious and well tolerated for nicotine vaping cessation in youth. Researchers found that continuous abstinence rates were higher in the varenicline group than in the placebo group in the last month of treatment (51% vs 14%) and at 6-month follow-up (28% vs 7%). Treatment-emergent adverse events did not differ significantly between groups. Varenicline, when added to brief cessation counseling, is well tolerated and promotes nicotine vaping cessation compared with placebo in youth with addiction to vaped nicotine.

Research and Science 

Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use 

Nicotine and Tobacco Research

People who use combustible cigarettes may attempt to transition to e-cigarettes only as a method of quitting but sometimes continue to use both (dual use) for prolonged periods of time. This study examines potential health risk of dual use relative to combustible cigarettes and e-cigarettes alone by measuring biomarkers of exposure (BOEs), including nicotine, volatile organic compounds (VOCs), and heavy metals in cohorts with these use patterns. BOEs in persons reporting dual use were not significantly different from those reporting combustible cigarette use and were higher in those reporting e-cigarette use alone. Authors note it is important to recognize that persons reporting dual use are still at high risk of health consequences, though they may think their risk is reduced from smoking alone. 

Risk of adverse obstetrical and neonatal outcomes in women consuming recreational drugs during pregnancy 🔓

BMC Pregnancy and Childbirth

This study examined obstetric and neonatal outcomes for 177 patients followed for addiction at a hospital in Switzerland between 2005 and 2014. Mothers using opioids and/or cocaine (n=80) were compared with mothers using only cannabis (n=97). Exposure to opioids and/or cocaine was associated with an increased risk of adverse neonatal outcomes (OR=3.88, p=.022) small for gestational age, respiratory distress syndrome, and neonatal withdrawal syndrome. Exposure to opioids and/or cocaine was also associated with a decreased risk of adverse obstetrical outcomes (OR=0.39, p=.026). However, when induced labor was excluded from adverse obstetrical outcomes the association was no longer significant (OR=0.70, p=.394). The authors conclude that prenatal use of opioids and/or cocaine is associated with adverse neonatal outcomes.

Characteristics associated with forced treatment discontinuation among people who use drugs in Rhode Island

Drug and Alcohol Dependence

The Rhode Island Prescription and Illicit Drug Study included 406 people with a history of SUD treatment, and 96 (24%) of them reported forced treatment discontinuation due to drug or alcohol use. Forced treatment discontinuation was most frequently from residential treatment programs (n=72, 75%) and most frequently involved crack cocaine (n=32, 33%) and heroin (n=22, 23%). When a statistical model was corrected for sociodemographic characteristics, only powder cocaine was significantly associated with forced treatment discontinuation. The authors conclude that forced treatment discontinuation is common.

Learn More 

CENTER-ing Black voices: incorporating lived experience across the research process to advance equity in drug treatment and outcomes 🔓 

Harm Reduction Journal 

This paper discusses the CENTER initiative, an academic--community partnership developed to address the drug overdose epidemic in a Black community. The authors describe the involvement of the community advisory board (CAB) of Black people with lived experience (PWLE) in the research process, from study design to recruitment, data collection and analysis, and dissemination. The authors report on lessons learned and make recommendations based on that experience, including the central role of relationships, flexibility around community priorities while still having structure, and needing financial and personnel support for sustainment. The authors highlight that such community partnerships with PWLE can mitigate potential harms and inefficiencies of research and increase impact. 

How Transparent and Reproducible Are Studies That Use Animal Models of Opioid Addiction? 🔓 

Addiction Biology

This study addresses concerns about reproducibility in preclinical addiction research, particularly in animal models of opioid addiction, in the context of the broader reproducibility crisis in psychology. Researchers analyzed 255 studies published between 2019 and 2023 for transparency and reporting quality. Key findings include very low adoption of transparency practices like preregistration, open data/code, and adherence to Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines. Researchers also found poor implementation of bias-reducing methods (eg, randomization, masking, sample size calculation). Most studies (76.5%) adjusted for multiple comparisons and about 50% of papers had inconsistencies between reported p-values and test statistics; 11% had statistical significance errors. The authors conclude that improved reporting and transparency are essential to enhance both reproducibility and the translational value of research.

Privacy and Digital Health: Causes for Concern and a Way Forward

Journal of Addiction Medicine

In this commentary, the authors note that digital addiction health apps and websites can address the treatment gap by connecting people with prescribers and provide behavioral health interventions. However, these apps and websites present significant risks to the privacy of health information. Surveillance techniques including tracking pixels, cookies, and GPS location can reveal pages viewed, information submitted on forms, and the user’s location. This information, returned to advertising companies, is made available for purchase by data brokers. For example, location data from overdose or craving apps could be used by law enforcement. The authors’ review of NIDA-funded digital health apps found only one free of privacy violation. They call on grant funders and Institutional Review Boards to assess privacy risks, noting, “Patients, providers, researchers, and funders must assume that these platforms are neither private nor secure…”

In the News 

Trump Order Targets Med School, Residency Accreditors Over 'Unlawful' DEI Standards 🔓

MedPage Today

White House Announces Drug Policy Priorities 🔓

 Medscape

Local government, the last line of defense against the scourge of sports gambling 🔓

The Hill

Trump is gutting more than 40 mental health, substance use programs 🔓

STAT

NIH director voices support for head of addiction research institute

 STAT

Elevated highs: the rise of luxury and designer cannabis strains 🔓

The Mercury News