American Society of Addiciton Medicine

ASAM Weekly for September 20, 2022

by Bob Davis

This Week in the ASAM Weekly

A number of our publications this week touch upon the health, social, and legal impacts of substance use. Conceptualized around harm reduction, our modern-day approach aims to reduce risk without eliminating it entirely through universal principles and innovative approaches — an evolution in the history of cultural rituals and taboos (Psychiatric Clinics). In a related way, opiate agonist treatment (OAT) can have rituals - such as the lines outside a methadone clinic - which contribute to stigma, while extended-release buprenorphine may help free individuals of the stigma built by the social and material effects of OAT (International Journal of Drug Policy). Cultural effects can also create treatment barriers for people who use drugs. Creating lower-threshold treatment can be an innovative approach to reducing their risks (JAM). 

In a continuation of research from the ABCD study, prenatal exposure to cannabis continues to show increased risk for psychopathology persisting into adolescence, which is concerning given the age-of-onset for most mental health and substance use disorders (JAMA Pediatrics). Of similar concern, Connecticut’s system for reporting prenatal substance exposure (PSE) was initially developed with opioid use in mind but its implementation has revealed significant marijuana usage in pregnant individuals (Hospital Pediatrics). It has also demonstrated the problems of nonuniversal PSE screening in a culture with bias.

We also have several news articles covering modern day approaches and challenges for harm reduction that you don’t want to miss.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM

with Co-Editors: Brandon Aden, MD, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD


Lead Story

Association of Mental Health Burden With Prenatal Cannabis Exposure From Childhood to Early Adolescence

JAMA Pediatrics

In this study, the authors credit longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study and investigate whether associations with psychopathology last into early adolescence and past middle childhood. Prenatal Cannabis Exposure (PCE) was found to be associated with lasting vulnerability to psychopathology throughout early adolescence, and this did not change with age. Evidence that the impact of PCE on psychopathology does not improve as children enter adolescence is further warning against the use of this substance in pregnancy.


Call for Reviewers

The Journal of Addiction Medicine is seeking to expand its cadre of manuscript reviewers. We are seeking reviewers with expertise in the following areas: Stimulants, Psychiatric epidemiology, Qualitative methodology, Genetics, Neurology, Emerging substances, Kratom, Novel Psychoactive Substances, Psychedelics, New pharmaceutical treatments, Toxicology, Criminal justice and addiction medicine, Machine Learning, Pain and Palliative Care, Adolescent Medicine, Maternal Child Health, and Behavioral Addictions. View the full opportunity here.


Research and Science 

Novel Implementation of State Reporting Policy for Substance-Exposed Infants 🔓

Hospital Pediatrics

Prenatal substance use is a significant public health issue, severely impacting maternal and fetal outcomes. In 2019, Connecticut unveiled a statewide hospital reporting infrastructure to divert infants with prenatal substance exposure (IPSE) without safety concerns from child protective services (CPS) using a deidentified notification to CPS and a plan of safe care (POSC). This study found that over half of all identified infants were diverted to receive supportive services in the community. However, racial disproportionality in identification was apparent. The type of substance exposure was the most prominent factor associated with diversion. Alcohol exposure was significantly underidentified.


Opioid relapse and MOUD outcomes following civil commitment for opioid use

Journal of Substance Abuse Treatment

Across the US there has been an increase in the scope of civil commitment to include substance use disorders. This study collected outcome data on 81 individuals for the 12 weeks following commitment for OUD. Among the 121 participants, 87% reported using fentanyl and 68% reported injecting drugs. Over half reported diagnoses of major depression (51%) or anxiety (59%). Of the 121 participants, 98 provided some follow-up and 84 provided follow-up for the full 12 weeks. During follow-up, 10 were incarcerated, 10 re-committed, and none died. Also during follow-up, 64% reported some opioid use and 41% some MOUD use. Persons with major depression or anxiety initiated MOUD sooner. The authors conclude that civil commitment may be a viable option as treatment for severe opioid use.



Predictors of Crystal Methamphetamine Use Initiation or Re-initiation among People receiving Opioid Agonist Therapy: A Prospective Cohort Study

Drug and Alcohol Dependence

This Canadian study sought to identify predictors of crystal methamphetamine initiation or re-initiation among people on opioid agonist therapy (OAT) to expedite effective prevention strategies. High rates for crystal meth initiation and re-initiation among those on OAT were identified and those continued to rise over the study period. Younger age, unprotected sex, unstable housing, history of crystal meth use, as well as recent cocaine, prescription opioid, and unregulated opioid use were predictors of crystal meth initiation or re-initiation. Transition of different polysubstance use patterns to guide treatment requires further examination.



Learn More

Harm Reduction: Not Dirty Words Any More

Psychiatric Clinics of North America

This article provides an overview of harm reduction and its application to alcohol, tobacco, and drug use. Harm reduction refers to a collection of principles, practices, and policies that aim to minimize the negative health, social, and legal impacts associated with drug use. Harm reduction practices have been shown to significantly reduce negative consequences of substance use, such as infectious diseases and overdoses. Its principles and practices should be integrated with all traditional medical, psychiatric, and addiction treatment programs.


Perceptions and Experiences With Evidence-based Treatments Among People Who Use Opioids

Journal of Addiction Medicine

While medications for opioid use disorder (MOUD) have well-established evidence for improved outcomes for patients with opioid use disorder (OUD), many persons with OUD do not access care. In this study, the authors interviewed persons with active opioid use to assess their knowledge, interests, and experience with MOUD. Most persons had prior experience with treatment, primarily residential or MOUD. Overall, persons interviewed believed methadone and buprenorphine work better than other options. In terms of barriers, major themes were lack of readiness for abstinence, insurance barriers, methadone regulatory barriers, and burdensome intake processes. Participants also noted that low-barrier treatment, including mobile units providing methadone and buprenorphine, would be beneficial. 


Can a new formulation of opiate agonist treatment alter stigma?: Place, time and things in the experience of extended-release buprenorphine depot 🔓

International Journal of Drug Policy

This study conducted semi-structured interviews with 36 participants receiving monthly injections of extended-release buprenorphine (BUP-XR). Researchers noted that treatment with methadone or sublingual buprenorphine reinforced stigma by providing a daily reminder of their status. Contacts with health professionals were often tainted by perceived judgment or lack of respect and BUP-XR decreased the frequency of these episodes. Less frequent visits also facilitated arranging time away from family and work obligations and keeping the nature of these visits private. The authors also noted that with BUP-XR there was no need to conceal prescription bottles or take-home dose vials from family, friends, or employers. The authors conclude that BUP-XR has the potential to reduce stigma. This study was supported by Invidior, the manufacturer of Sublocade.